Unsedated flexible upper gastrointestinal endoscopy: need for routine oxygen monitoring?

BACKGROUND: To determine the incidence of oxygen desaturation and whether routine oxygen monitoring is necessary during unsedated diagnostic flexible upper gastrointestinalendoscopy. METHODS: A prospective study involving 54 consecutive in and out patients who had diagnostic upper gastrointestinal endoscopy at the endoscopy suit of the Jos University Teaching Hospital, Jos, Nigeria between March 2007 and October 2007. The patients were reviewed before the procedure and classified according to the American Society of Anesthesiologists' (ASA) classification into classes I, II, III and IV Endoscopy was carried out after topical pharyngeal anaesthesia using 10% lidocaine spray and oxygen saturation was monitored throughout the procedure. RESULTS: There were 30 males and 24 females, with a male, female ratio of 1.25:1. The mean age was 46.7 with a range of 17 to 81 years. Mild to moderate desaturation occurred in 10 (18.5%) of the patients while severe desaturation occurred in 7 (12.9%) of the patients. All cases of severe desaturation lasted less than 30 seconds and no supplementary oxygen was needed. There were no significant statistical correlations between desaturation and gender, age, duration of procedure or ASA status of the patients. CONCLUSION: Routine oxygen monitoring may not be necessary in patients undergoing unsedated diagnostic upper gastrointestinal endoscopy and who do not have respiratory disease.

Thyroidectomy under local anaesthesia: how safe?

BACKGROUND: In order to compliment the inadequate health facilities in the rural areas in Nigeria, nongovernmental organisations provide adhoc outreach health camps that offer treatment in various medical specialties including surgery. SETTING: Rural outreach health camps. OBJECTIVE: To evaluate the safety of thyroidectomy under local anaesthesia at rural outreach setting with inadequate facilities for general anaesthesia. PATIENTS AND METHODS: This was a prospective descriptive study of 33 consecutive cases of thyroidectomy performed using field block with 1% lignocaine and adrenaline 1: 200,000 dilution during two free medical outreaches that held at Jos, Nigeria in March and October 2005 respectively, lasting two weeks each. RESULTS: A total of 33 primary thyroid operations were performed consisting of 30 subtotal thyroidectomies (91%), 2 lobectomies (6%) and one total thyroidectomy (3%), The patients were aged between 23 and 62 years with a mean age of 45.8 years. There were 3 males and 30 females with a male: female ratio of 1:10. There was no mortality but morbidity was 2/33 (6%) Two complications were recorded in 2 patients and were superficial surgical site infection (3%) and reactionary haemorrhage (3%). CONCLUSION: We conclude that thyroidectomy under local anaesthesia is a safe procedure in experienced hands at rural settings with inadequate facilities for general anaesthesia.

Acute appendicitis in inguinal hernia: report of two cases.

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy. Posterior wall was repaired using nylon darn in both cases. Acute appendicitis should be considered in the differential diagnosis of obstructed right inguinal hernia.