Browsing by Author "Ocen, Davidson"

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    Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections
    (BMC pregnancy and childbirth, 2015) Dlamini, Lomangisi D.; Sekikubo, Musa; Tumukunde, Janat; Kojjo, Charles; Ocen, Davidson; Wabule, Agnes; Kwizera, Arthur
    Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. Methods: We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis. Results: The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62–0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39–0.99; P value 0.036). Conclusions: Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis.
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    Effects of propofol versus thiopental on Apgar scores in newborns and peri-operative outcomes of women undergoing emergency cesarean section: a randomized clinical trial
    (BMC anesthesiology, 2015) Tumukunde, Janat; Dlamini, Diana L.; Ocen, Davidson; Kintu, Andrew; Ejoku, Joseph; Kwizera, Arthur
    General and regional anesthesia are the two main techniques used in cesarean section. Regional anesthesia is preferred, but under certain circumstances, such as by patient request and in patients with back deformities, general anesthesia is the only option. Commonly used induction agents include thiopental, ketamine, and propofol, depending on availability and the maternal clinical condition. The objective of this study was to investigate the effects of thiopental and propofol on the neonatal Apgar score and maternal recovery time following emergency cesarean section in order to determine the superior agent for mothers and neonates. Methods: This single-blinded randomized clinical trial included 150 ASA I and II patients block-randomized equally between the two study arms. Pregnant women at term scheduled to undergo cesarean section and their neonates were enrolled. The primary outcomes were the Apgar scores through 10-min postpartum, resuscitation requirement, and admission to the neonatal intensive care unit. The secondary outcome was the maternal recovery times. Results: At 0 min (umbilical cord clamp time), 43 (57.3%) neonates in the propofol group had an Apgar score < 7 compared with 31 (41.3%) neonates in the thiopental group (p = 0.05). The maternal recovery time was shorter in the propofol group than in the thiopental group (25 min vs. 31 min, respectively, p = 0.003). Conclusion: Apgar scores do not differ significantly whether thiopental or propofol is used for anesthetic induction in women undergoing general anesthesia for an emergency cesarean section. Trial registration: Pan-African Clinical Trial Registry (#PACTR201306000536344) http://www.pactr.org/ATMWeb/ appmanager/atm/atmregistry?_nfpb=true&_pageLabel=atm_portal_page_mytrials
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    Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study
    (BMC Emergency Medicine, 2015) Ocen, Davidson; Kalungi, Sam; Ejoku, Joseph; Luggya, Tonny; Wabule, Agnes; Tumukunde, Janat; Kwizera, Arthur
    Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country. Methods: Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05. Results: There was a cardiac arrest in 2.3 % (190) of 8,131 hospital admissions; 34.5 % occurred in the intensive care unit, 4.4 % in emergency operating theaters, and 3.0 % in emergency wards. A majority (63.2 %) was unwitnessed, and only 35 patients (18.4 %) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4 %) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6 % of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity. Conclusion: Our hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.