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Talabi, A, Sowande O, Mosaku K, Owojuyigbe A, Amosu L, Adejuyigbe O.  2021.  Effect of parental presence on anxiety during induction of anaesthesia in children undergoing elective day case surgery, 2021/12/01. 17 Abstract

BackgroundSurgical operation and anaesthesia induction are fearful events which may interfere with the smooth conduct of anaesthesia and postoperative recovery in children. Indeed, the fear of needles, syringes and unknown hospital environment often compound their anxiety. Various modalities such as use of clowns, music, low intensity light in the induction room, pharmacological agents and parental presence during induction of anaesthesia have been utilized with the aim of gaining the cooperation of the children during induction. However, their use has yielded conflicting results. This prospective study was conducted among children whose ages were between 2 and 15 years. They were randomized into parental presence and parental absence (un-accompanied) or control groups. The anxiety levels of children and parents in both groups were compared at baseline, separation and during induction of anaesthesia.
The ages of the children ranged between 2 and 15 years with a mean age of 6.78 ± 2.50 years. The mean age of patients in the parental presence at induction (PPIA) was 7.14 ± 3.68 years while in the control group was 6.42 ± 3.31 years. The difference was not statistically significant, p < 0.05. The mean anxiety score of patients in the PPIA at reception, separation and induction of anaesthesia were 26.6 ± 9.2, 38.4 ± 18.3 and 54.1 ± 22.8 compared to 27.3 ± 8.04, 41.4 ± 21.7 and 58.6 ± 23.1 in the control group respectively, p < 0.05. The mean anxiety score of parents in the PPIA at reception, separation and induction of anaesthesia were 52.2 ± 6.7, 51.7 ± 7.8 and 51.9 ± 7.9 compared to 53.0 ± 6.5, 52.4 ± 6.2 and 52.9 ± 7.9 in the control group respectively, p < 0.05. Among the cohort of preschool age group, children in the control group were more anxious at induction compared to the PPIA group, p = 0.01. As the age increases, the anxiety state of the children decreases, t = − 0.398, p < 0.001. The mean score of parental satisfaction in the PPIA and the control groups were comparable, 8.1 ± 7.1 vs 7.3 ± 1.1 respectively, p = 0.395.
The presence of parents during induction of anaesthesia did not influence the anxiety states of children in our study. Anxiety at induction tends to reduce as the age of patients increases.

Ojo, T, Owojuyigbe A.  2021.  NICAFE 2021. 2507 REV-1, 2021/08/15. Abstract
Owojuyigbe, A, Adenekan A, Kawamae K, Suzuki H, Aaron O, Owojuyigbe T.  2021.  Cerebral oximetry in healthy adults: A comparison of three commercial Near-Infrared Spectrophotometers, 2021/02/01. 28:37-44. Abstract

Background: Cerebral oximetry is increasingly becoming a desirable form of monitoring inanaesthesia and critical care. Familiarity with normal values for each device is therefore important. We compared NIRO 300 and INVOS 5100 with the novel MASIMO O3 cerebral oximeter.
Methods: Regional cerebral oxygen saturations (rScO2) of nine healthy volunteers were
measured using NIRO 300, INVOS 5100, and MASIMO O3 under various conditions of hyperoxia, hypocapnia, and change in head position. Changes in vital signs and rScO2 were compared. Reliability analyses of the NIRS devices were performed using Intraclass Correlation Coefficients (ICC) estimates at 95% confidence interval based on 2-way mixed-effects model, multiple rater, and absolute-agreement and consistency selections. P <0.05 was considered statistically significant for this study.
Results: The mean (SD) baseline values from NIRO 300 and INVOS 5100 were comparable
[73.8% (4.2%) vs 73.4% (5.6%) respectively, (p = 0.84)]. The baseline from MASIMO O3 [66.8% (3.9%)] was significantly lower compared to NIRO 300 (p = 0.002), and INVOS 5100 (p = 0.011). Changes in head position were not associated with statistically significant changes in NIRS values (p > 0.05). Significant increases were recorded for each of the NIRS devices at FiO2 = 0.45 and FiO2 = 1 (p = 0.0001) and during supine hyperventilation (p = 0.0001). The Intraclass Correlation Coefficients (ICC) estimates based on 2-way mixed-effects model suggested poor absoluteagreement (0.63; 95% CI = 0.16 - 0.81), but good consistency (0.81; 95% CI = 0.77 - 0.85). Absolute-agreement and consistency tests for NIRO 300 and INVOS 5100 pairs were moderate (0.74; 95% CI = 0.68 - 0.79).
Conclusion: Findings of this study affirm that different NIRS devices give different estimates but similar trends during various interventions. Values from the novel MASIMO O3 were generally lower than NIRO 300 and INVOS 5100.

Alatise, O, Owojuyigbe A, Omisore A, Ndububa D, Dua K, Asombang A.  2020.  Endoscopic management and clinical outcomes of obstructive jaundice, 2020/11/04. Abstract

Background:This study aimed at evaluating the endoscopic management and clinical outcomes in patients with obstructive jaundice undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) within a newly established apprenticeship teaching model at an academic centre in a resource-limited setting.
Materials and methods:
We employed an apprenticeship-style model of ERCP training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collected sociodemographic and clinicopathologic data on consecutive patients who underwent ERCP from March 2018 to February 2020.
A total of 177 patients were referred, of which 146 patients had an ERCP performed for obstructive jaundice and 31 excluded during the study period. The median age was 55 years, age range from 8 to 83 years. The most common referral diagnosis was pancreatic head cancer 56/146 (38.1%), followed by choledocholithiasis 29/146 (19.7%), cholangiocarcinoma 22/146 (15.0%) and gall bladder cancer 11/146 (7.5%). In all, 102 patients had a malignant indication for ERCP. The cannulation rate was 92%. The most common site for malignant biliary obstruction was proximal bile stricture in 31/102 (30.4%), followed by distal bile strictures in 30/102 (28.4%), periampullary cancer 20/102 (19.6%) and mid bile duct stricture in 9/102 (8.8%). The common benign obstructive etiology includes choledocholithiasis in 33/44 (75%) and mid duct obstruction from post-cholecystectomy bile duct injury in 3/44 (2.9%) while 2/44 (2.0%) patients had choledochal cyst. Overall complications were post-ERCP pancreatitis (8/146 patients), cholangitis (3/146 patients), stent migration and post-sphincterotomy bleeding (one patient each). Peri-procedural mortality was 5/146 (3.4%).
ERCP is an effective and safe method of treatment of patients with benign and malignant biliary obstruction. The low morbidity and mortality and its immediate therapeutic benefits, together with the short duration of hospitalization, indicate that this procedure is an important asset in the management of such patients.

S.O, L, Afonso E, Benbenishty J, B B, Owojuyigbe A, Adenekan A.  2020.  Prevalence,associated factors and outcomes of pressure injuries in adult intensive care unit patients:the decubICUs Study., 2020/10/09. Abstract

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients.Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis.
Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9-27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6-16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2-1.8), stage II (OR 1.6; 95% CI 1.4-1.9), and stage III or worse (OR 2.8; 95% CI 2.3-3.3).
Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.

Abimbola, J, Adenekan A, Owojuyigbe A, Orji E, Owojuyigbe T, Aaron O.  2020.  Opioid sparing effect of post induction intramuscular midazolam following myomectomy, 2020/10/01. 27:187-195. Abstract

Background: Adequate post-operative pain control is essential for smooth recovery after surgery. This study assessed the opioid-sparing effect of immediate post-induction intramuscular midazolam in patients who underwent myomectomy under general anesthesia.Methods: This is a randomized double-blinded controlled study of sixty ASA I and II female patients allocated into three groups. Group A received intramuscular midazolam 0.1mg/kg, group B received intramuscular diclofenac 75mg while group C had a placebo following induction of anesthesia. All patients had morphine 0.1mg/kg for intraoperative analgesia before skin incision. Pain scores were compared at recovery, then at 1st, 2nd, 4th and 8th post-operative hours. In addition, the total opioid consumption over the first 24 hours postoperatively was compared between the three groups.
Results: The pain scores at the end of surgery, 1st and 2nd hours were comparable in the 3 groups; however there was statistically significant difference at the 4th hour postoperatively (p = 0.0001), with lowest pain scores in the midazolam and diclofenac groups (3.70 ± 0.66 and 3.80 ± 1.01 respectively) compared to the placebo group (4.75 ± 0.79). The total additional opioid (pentazocine) consumption in first 24 hour after surgery was significantly reduced in the midazolam group (105.00 ± 15.39 mg) compared to diclofenac and placebo groups (112.50 ± 13.33 mg, and 121.50 ± 18.14 mg respectively, p = 0.007).
Conclusion: Post induction intramuscular Midazolam at 0.1mg/kg appears to have a better opioid sparing effect compared to intramuscular diclofenac 75mg in the early postoperative period
following myomectomy done under general anesthesia.

Ojo, O, Onakpoya U, Okeniyi J, Adenekan A, Owojuyigbe A, O.T A.  2019.  Atrial Septal Defect with Rheumatic Mitral Regurgitation:A rare Association in Nigerian Child, 2019/09/24. Abstract

Atrial septal defect (ASD) coexisting with mitral valve regurgitation has been described in literature with various aetiologies and pathophysiologic mechanisms. Mitral valve lesions coexisting with an ASD could either be congenital or acquired. The most prominent congenital mitral valve pathology is a cleft in the anterior leaflet of the mitral valve, as seen in patients with partial atrio-ventricular septal defects. Acquired mitral valve lesions include, hemodynamic induced annular dilatation resulting in significant mitral regurgitation, iatrogenic leaflet perforation and coexisting diseases such as infective endocarditis or rheumatic valve disease. However, the aetiology of the mitral valve regurgitation being due to rheumatic heart disease is uncommon. We report the case of a 12-year-old female who presented with easy fatigability, palpitation and a precordial bulge dating about 2 years. Examination revealed cardiac murmurs in the apex and pulmonary areas and transthoracic echocardiography confirmed the presence of an Ostium Secundum ASD and features of severe rheumatic mitral valve regurgitation. Child was initially placed on medications which included diuretics and an Angiotensin converting enzyme inhibitor ACEi, before she eventually had surgical closure of ASD and mitral valve replacement. The purpose of this case report is to highlight the symptomatology, diagnosis and treatment of this rare association, particularly in our environment.

Adetoye, A, Adenekan A, Faponle AF, OA S, Owojuyigbe A.  2017.  Caudal bupivacaine and midazolam versus bupivacaine alone for pain relief in paediatric ambulatory groin surgeries, 2017/10/01. Abstract
Adeyemo, A, Ameye S, YAB A, Eziyi J, Owojuyigbe A, SA B, Adenekan A.  2017.  Setting up office ENT Endoscopy in low resource setting in semi-urban Hospital: Adaptations and Modifications, 2017/10/01. Abstract
TO, O, Owojuyigbe A, Afolayan J, MO A.  2017.  Preloading or Coloading of Crysralloid for Prevention of Hypotension during Ceaserian Section under Spinal Anaesthesia, a Randomisd Control Trial, 2017/04/01. 16:140-142. Abstract

Background: Hypotension after spinal anesthesia for cesarean delivery is common. Previous studies have demonstrated that a crystalloid fluid " coload " (rapid administration of a fluid bolus starting at the time of intrathecal injection) is superior to the conventional crystalloid preload (fluid administered before the intrathecal injection) for preventing hypotension. However there is paucity of study on the effectiveness or otherwise of coloading as against the common practice of crystalloid preloading for ceaserian section under subarachnoid block. This study compared crystalloid preloading to coloading in preventing hypotension usually associated with subarachnoid block for ceaserian section Methods: In this double-blind study, 60 patients were randomly assigned to receive a preload of 1L of normal saline over a period of 15–20 min before initiation of spinal anesthesia or an identical fluid (bolus of normal saline) starting at the time of identification of cerebrospinal fluid. Vasopressors (ephedrine) were administered if systolic arterial blood pressure decreased less than 80% of the baseline pressure and <100 mm Hg. The primary outcome was the incidence of hypotension (defined as the administration of at least one dose of vasopressor). Other complications like nausea and vomiting were also sought for. Results: There was no significant difference in the two groups in the incidence of hypotension (p= 0.823), nausea and vomiting and vasopressor requirements. Conclusion: There is no difference in the incidence of hypotension whether patients were coloaded or preloaded.