Tracheal Intubation in the Emergency Department of a Sub-Saharan Teaching Hospital:A One-Year Survey at Lagos University Teaching Hospital, Nigeria.

OBJECTIVES: To identify the indications for tracheal intubation in the emergency department of the Lagos University Teaching Hospital and problems encountered with the view to improve patient outcome. METHODS: A one-year prospective observational study of endotracheal intubation in the emergency room (ER) of the Lagos University Teaching Hospital. Data collected included indications, methods, success rates, use of drugs and complications of intubation. RESULTS: Ninety-four patients underwent endotracheal intubation. Indications included severe traumatic brain injury (58.5%) and traumatic brain injury with associated multiple injuries (10.6%). Anaesthetist registrars performed 73.9% of the intubations. Seventy seven patients (81.9%) were successfully intubated at the first attempt. No patient required a surgical airway due to failed intubation. The mean time from a decision to intubate to successful tracheal intubation was 129.90 ± 23.43 mins. 63.8% of the patients were intubated between 4 pm-8 am. Causes of delay in endotracheal intubation were non availability of skilled personnel (47.9%), non-availability of drugs (27%) and lack of oxygen (25%). Eighty-eight patients (93.6%) had complications at intubation: hypotension (42.5%), desaturation (34%), oesophageal intubation (2.1%), bronchial intubation (5.3%), cardiac arrest (2.1%). Post intubation complications included: blocked tube in 3 patients, accidental extubation in 4 patients and kinking of tube in 1 patient. Nine patients (9.6%) improved and were extubated. CONCLUSION: In this institution, the majority of Emergency department intubations were performed by anaesthetists after working hours with a very high success rate and a low rate of post-intubation serious complications. The delay in intubation should urgently be addressed to improve patient outcome.

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital.

BACKGROUND: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients. OBJECTIVE: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients. METHODS: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000. RESULTS: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L. CONCLUSION: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.

The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

BACKGROUND: In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. OBJECTIVES: This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. SUBJECTS AND METHODS: Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. RESULTS: The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. CONCLUSION: This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

Low-dose intravenous ketamine improves postoperative analgesia after caesarean delivery with spinal bupivacaine in African parturients.

BACKGROUND: In the absence of neuraxial opiates, postoperative analgesia after caesarean delivery is limited by the duration of action of bupivacaine. This could be prolonged by the co-administration of adjuvants such as ketamine. METHODS: Spinal anaesthesia was performed in 60 parturients using hyperbaric bupivacaine 15 mg. Patients were randomly allocated to receive a 2-mL intravenous injection of either ketamine 0.15 mg/kg (Group BK) or 0.9% saline (Group B) immediately after institution of spinal anaesthesia. Postoperative pain was assessed using a visual analogue scale and the time of first postoperative analgesic administration was noted. Postoperative analgesia was provided with intramuscular pentazocine and diclofenac, the total doses of which were recorded over 48 h. RESULTS: The mean (SEM) time of first postoperative analgesic administration was significantly longer in Group BK (209±14.7 min) than in Group B (164±14.1 min) (P<0.001). Pain scores were significantly lower in Group BK than in Group B for 120 min after surgery (P=0.022). Patients in Group BK required significantly less diclofenac (P<0.001) and pentazocine (P<0.001) on day one after surgery. There was no difference in diclofenac (P=0.302) and pentazocine (P=0.092) consumption between the groups on the second postoperative day. The incidence of adverse effects was not different between the groups. CONCLUSION: The use of intravenous low-dose ketamine as an adjuvant to bupivacaine for spinal anaesthesia for caesarean delivery was associated with longer postoperative analgesia and lower early postoperative analgesia consumption than bupivacaine alone.