Masters Degrees (DS) Medicine

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Browsing Masters Degrees (DS) Medicine by Title

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    A comparison of intrathecal morphine or fentanyl on the duration of postoperative analgesia at Namibian teaching hospitals in Windhoek
    (University of Namibia, 2022) Murakwani, Mandiudza Maria
    Background: Pain management is a cornerstone in the management of femoral fractures. Poorly controlled perioperative pain is associated with detrimental short-term and long-term effects. Addition of intrathecal opioids has been shown to produce a dense block and enhance analgesic effect. The objective of the study was to compare the duration of postoperative analgesia of intrathecal morphine or fentanyl for femur fracture surgery at Namibian Teaching Hospitals in Windhoek. Methodology: This was a prospective randomised double blinded control study which was done in February – July 2021; in which 60 patients above 18 years scheduled for femur fracture surgeries received standard spinal anaesthesia with 0.5% heavy bupivacaine 12.5 mg plus 100 mcg morphine (ITM group) or 25 mcg fentanyl (ITF group). Data was collected using a form designed for the study and analysed with the statistical package for social sciences (SPSS for windows 26.0, SPSS Inc., Chicago, IL, USA). Results: Participants in the ITM group had a significantly longer time to first request for analgesic (14.5 ±8.03 hours) versus the ITF group (7.07 ± 3.07 hours), p =0.0001 and reduced total opioid consumption in 24 hours. The postoperative pain scores (verbal numerical rating scale) at rest and with movement were significantly lower in 2nd, 4th and 6th hour in the ITM group compared to the ITF group (p <0.05). No significant difference was observed between the two groups in terms of pruritus, nausea and vomiting. Respiratory depression was not observed in any participant in the two groups. Patient satisfaction with analgesia was superior in the ITM group (p =0.0001). No significant association was confirmed between type of femur fracture and the total opioid consumption in 24 hours. Conclusion: Use of intrathecal morphine significantly increased the duration of postoperative analgesia and reduced the total opioid consumption.
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    Evaluation of the effect of 2.5 IU vs 5 IU oxytocin on uterine tone during elective caesarean section at Windhoek hospital complex: A double-blind randomized controlled clinical study
    (University of Namibia, 2022) Nembale, Fredrika Nembale
    Introduction: Oxytocin is routinely administered during caesarean delivery to initiate and maintain uterine tone (UT) after delivery of the baby. It reduces blood loss thus preventing postpartum haemorrhage (PPH). However higher doses of oxytocin are associated with unwanted side effects namely; cardiovascular effects, headache as well as nausea and vomiting. However, the optimal dose of oxytocin at caesarean delivery remains ambiguous among various official bodies. This study compared the effect of two doses of oxytocin 2.5 IU vs 5 IU on uterine tone, haemodynamic changes, blood loss and side effects. Methodology: A double-blinded, randomized controlled clinical study was conducted at Windhoek Teaching Hospitals Complex. Eighty (80) parturients undergoing elective caesarean section under spinal anaesthesia received an intravenous bolus of either 2.5 IU (n=40) or 5 IU (n=40) of oxytocin after delivery followed by an infusion of 5 IU/hr. Uterine tone, haemodynamic changes, side effects and blood loss were compared between the two groups. The two groups were statistically compared using a two-sided, independent samples t-test with a P-value set at 0.05 (5%) critical level of significance using the per-protocol analysis. Results: The two groups were comparable in terms of demographic characteristics. Parturients in both study groups had adequate uterine tone at 3 minutes with a median (SD) score of 3.28(0.51) for the 2.5 IU group and 3.20(0.56) for the 5 IU group. A rapid increase in heart rate (HR) was seen in the 5 IU group with a mean increase of 17(17) and 12(16) beats/min at 1 min and 2 min with a p-value of 0.000 and 0.005 respectively. Higher incidence of nausea, headache and chest pain (40%, 25%, 15%) were noted in the ii 5 IU group compared to (15%, 2.5%, 0%) in the 2.5 group. Blood loss did not differ among the two groups. Conclusion: 2.5 IU of oxytocin bolus was compared and non-inferior to 5 IU oxytocin bolus in initiating and maintaining adequate uterine tone and it was associated with fewer haemodynamic changes and other adverse effects.
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    Prophylactic phenylephrine bolus versus infusion for prevention of maternal hypotension during spinal anaesthesia for caesarean section at Windhoek-based teaching hospitals, Namibia
    (University of Namibia, 2022) Shaanika, Ebba Panduleni
    Background: Maternal hypotension is a common complication of spinal anaesthesia during caesarean delivery. Injection of vasopressors with non-pharmacological measures have been investigated for prevention of martenal hypotension as well as the foeto-maternal effects of treatment. Aim: The primary aim of the study was to compare prophylactic 50 mcg phenylephrine bolus (PB) with a fixed continuous 25 mcg/min phenylephrine infusion (PI). The secondary aim was to assess the side effects and neonatal outcomes of the two treatments. Settings and design: A prospective, randomised, controlled double-blinded study was conducted in the maternity theatres of Windhoek Central Hospital and Katutura Intermediate Hospital. Methods and Materials: Ninety-two eligible parturients, ASA I and II, scheduled for elective caesarean section under spinal anaesthesia were recruited and randomised into two groups. PB group received a prophylactic 50 mcg phenylephrine (PE) bolus immediately after spinal anaesthesia whereas PI group received prophylactic 25 mcg/min PE infusion. Maternal blood pressure, heart rate and side effects were recorded every minute for the first 20 minutes while neonatal outcome was assessed with Apgar score at the 1st and 5th minute. Statistical Analysis: Categorical variables were presented in numbers and percentages. Normally distributed continuous variables were presented as mean standard deviation (±SD) and compared using t-test. Non normally distributed continuous variables were compared with Mann-Whitney test. A p-value of p< 0.05 was considered significant. Results: Parturients in the PI group had a significantly lower incidence of hypotension than PB group (32% vs 71% p = 0.0001). Nausea and vomiting was lower in PI group than PB group (13% vs 31% p = 0.033). Reflex bradycardia was comparable between groups (p= 0.489). No parturient in the PB group had reactive hypertension whereas 11% of participants in PI group did (p=0.024). Participants in the PI group received about 36% more phenylephrine than the PB group (p=0. 0277). Apgar scores between the two groups showed good neonatal outcomes. Conclusion: There was better control of blood pressure in the PI group than PB group. Both groups had similar incidence of reflex bradycardia as well as good neonatal outcomes. Intraoperative nausea and vomiting (IONV) was higher in the PB group than PI group, whereas no reactive hypertension experienced in PB group.
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    A survey on end of life care practices in intensive care units of three government teaching hospitals in Namibia
    (University of Namibia, 2022) Shivolo, Loini Talishi
    Background: End of life (EOL) care may be described as care provided for patients in the final hours or days of their life. More broadly it’s defined as care for all patients with a terminal illness that is deemed progressive and incurable. It implies a focus on pain and symptom management which is distinct from the aggressive pursuit of investigation and therapies focused on cure. End of life care in the ICU however involves a substantial degree of emotional and psychological stress both for health care providers as well as the family members. Significance of the study: The study aimed to evaluate the current practices of EOL care in a lifesaving department like the intensive care unit. It also intended to evaluate the knowledge of EOL care practices among ICU health professions and to identify gaps that would require improvement. Methodology: This was a mixed study that used the sequential explanatory design. It had a quantitative study phase 1 and a qualitative study phase 2. The quantitative method looked at the experience of health care workers on EOL care as the dependent variable with relation to age, training background, gender, and years of employment and facility of employment. The qualitative method approach was used to assess the knowledge and attitudes of family members and health care providers on EOL care. This methodology was achieved through cross-sectional surveys and a series of questionnaire-based interviews. Findings: About 59.7% of the respondents had never heard the term EOL care. In addition, less than half of them reported that the decision to offer EOL care to patients rested with the attending physicians. Furthermore, 50% of the study participants believed that family members do not take part in the decision to offer their patients EOL care. Conclusion: EOL is an essential part of patient management. Not only for the patient but also focuses on family members and health care workers as it has an effect on their emotional, mental health, as well as physical health. Recommendations: Improve communication between health care workers and family members and continuous medical education to be offered to health care workers on EOL care.