Diazepam: its use in anaesthesia and intensive care therapy at the Kenyatta National Hospital, Nairobi, from january, 1980 to December, 1984.

Abstract

A retrospective study was carried out at the Kenyatta National Hospital on 1369 patients who received diazepam for anaesthesia and for intens ive therapy in the period between January, 1980 and December 1984. About 1274 of these cases approximately (93.1 %) received diazepam for anaesthesia and 95 cases about (6.9%) for intensive care therapy.

Patient age distribution of the 1274 cases studied in anaesthesia ranged from 9 months to 67 years; 1121, about, (88%)of them were females and 153, about (12%) were males. In the Intensive Care Unit, of the 95 cases studied, 49, about (51.6%) were males and 46 I about (48.6%) were females with an age distribution of between three weeks and 70 years (Figure 2 and Table 1).

Bas ing on the American Society of Anaesthesiologists I class ifica­

tion I which categorises the fitness of a patient for anaesthesia I

1027 cases, about (75%) of all the patients studied were of grades

III and IV and were admitted to either the Intensive Care Unit or to other wards at the Kenyatta National Hospital (Table 2). These patients underwent various procedures and or operations in theatre or in the Intensive Care Unit. About 342 patients I about (25%) were of the 2nd grade by the ASA classification but they formed a special group because they came for day case surgery and were discharged home the same day after undergoing various surgical procedures and operations (Table 3).

Indications for the administration of diazepam in anaesthesia included: i) Premedication I

ii) Induction of anaesthesia I

iii) An an adjuvant to both general anaesthesia and local analges ia I and iv) Modifying the emergence phenomena after ketamine anaesthesia (Table 4).

In the Intensive Care Unit I indications for the administration of anaesthesia included: i) Sedation of patients during mechanical ventilatory support of the lungs I ii) Relief of muscle rigidity and spasms in tetanus cases I

iii) As a tranquilizer during intensive monitoring. and

Iv) As an anticonvulsant.

The most common clinical situations that necessitated the administration of diazepam in the Intensive Care Unit were:- i) Tetanus I

ii) Postmeasles laryngotracheobronchitis iii) Meningitis iv) Post operation status I and

v) Status asthmaticus .se vere trauma, status epilepticus and severe eclamps ia.

The routes of administration of diazepam were parenteral, as an intravenous bolus dose, as the case was in anaesthesia or as intravenous divided bolus doses or through a drip as the case was in the

Intensive Care Unit. The oral route of administration was used in the

Int ensive Care Unit only (Table 5,6).

The mean duration of administration of diazepam in anaesthesia was one day whereas in the Intens ive Care Unit was about 18.3 days. The average daily dose in anaesthesia per patient was about 10.3 mg while in the Intensive Care Unit it was about 116 mg.

Predetermined doses of diazepam were usually preferred in anaesthes ia and bolus single or divided doses of 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 35 mg and 40 mg were administered (Figure 3).

Complications and side effects arising from the use of diazepam in both anaesthesia and intensive care were difficult to detect since diazepam was administered along with many other drugs. To determine the specific complications and side effects, a different study will be necessary. However, pain at inj ection site in anaesthesia and thrombophlebitis in the Intens ive Care Unit was recorded in our study.