Human Immunodeficiency Virus needlestick injury: knowledge and management in a population of Nigerian anaesthetists

Objective: To determine the knowledge of HIV transmission and of post exposure management, following an HIVinfected needlestick injury, in a population of Nigerian anaesthetists. Subjects and Method: A cross-sectional, prospective assessment was conducted voluntarily in anaesthetists at an annual healthcare provider's forum, and at a major general hospital, using a structured questionnaire. Results: 63 Anaesthetists participated in the study. One anaesthetist knew the percentage of infected HIV needlestick injury that would result in HIV infection. ALL the high risk body fluids were correctly identified by 7 (11.1%) respondents. Twelve (19.0%) knew the correct immediate management when injured by a HIV-infected needlestick. Fifty eight (92.1%) were aware of post exposure prophylaxis (PEP), 25 (39.7%) had a PEP policy in their institutions and 57 (90%) knew when to commence PEP.Conclusion: Nigerian anaesthetists, though acutely aware of post exposure prophylaxis, are not aware of the fluids at risk and have not demonstrated adequate knowledge in the management, when injured by a HIV-infected needlestick. Keywords: HIV, needle-stick injury, anaesthetist, knowledge, management South African Psychiatry Review Vol. 11(4) 2005: 131-13

Pattern of post-anaesthetic shivering at the Lagos University Teaching Hospital, Idi-Araba, Lagos

Background: Post-anaesthetic shivering (PAS) is a common complication following anaesthesia and one of the leading causes of discomfort in patients. Aim: To determine the incidence and associated factors relating to post anaesthetic shivering. Methods:  This was a prospective study of patients who received anaesthesia over a period of 8 months at the Lagos University Teaching Hospital. Analysis of data from demographic and anaesthetic record including ambient theatre temperature (ATT), pre and post shivering temperature, shivering characteristics and management offered was made.Results: Four hundred consecutive patients aged 16-79 years, with a male to female ratio of 1:3.3 were studied. Mean ATT and mean body temperature at onset of shivering were 28±1.8°C and 36.26±0.6oC respectively.  Shivering occurred in 79 (19.8%) cases and was significantly associated with female gender [65(82.3%)], obstetric surgery  [46(58.2%)], regional anaesthesia (RA) [55(69.6%)], grade 2 shivering [42(53.2%)]  but not with duration of anaesthesia or degree of blood loss. Perioperative thermal care was not routine; 27(77.1%) received oxygen therapy and 84.8% described it as unbearable (p<0.05). Conclusion: PAS was associated with the female gender, obstetric surgery and RA. Hypothermia recorded in shivering patients was not statistically significant. A high mean ATT contributed to the moderately low incidence and grade of shivering. Shivering was unbearable in most  of the affected patients.Keywords: Post-anaesthetic shivering, Hypothermia, Obstetrics, Regional anaesthesia, Unbearabl

Enhanced recovery in perioperative care of rectal carcinoma in the elderly

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Anaesthetic Challenges in a High Risk Parturient with Myasthenia Gravis Undergoing Caesarean Section Under Spinal Anaesthesia

The prevalence of myasthenia gravis is low. The management implications of this disease in pregnant women are very challenging for anaesthetists. The objective is to highlight some of the challenges, the management and the lessons learnt during the management of this patient. This is a case report of a 31-year old parturient with diagnosed myasthenia gravis co-existing with hepatitis B infection that presented for caesarean section. Surgery was carried out under a single-shot spinal anaesthesia with bupivacaine. Intraoperative myasthenia crisis was managed with  neostigmine infusion. She was managed in the Intensive Care Unit for a few days and discharged. Under spinal anaesthesia, she became very breathless and developed wide-spread musculo-skeletal weakness while having a stable haemodynamics intra-operatively. Surgery was carried out successfully. Both mother and child were discharged on the 7th day  post-operative after baby was confirmed sero-negative of hepatitis B surface antigen. A better understanding of the pathophysiology and complications that accompany myasthenia gravis is needed to manage these patients under anaesthesia

Tetanus - A Case Report with Severe Autonomic Instability and A Review of the Literature

BACKGROUND: Tetanus is an infection that can be associated with a high mortality especially in developing countries. Critical care which may include artificial control of respiration is crucial in survival, but cardiovascular complications from autonomic instability remains an important cause of death. The objective of this report is to highlight this important cause of mortality despite artificial control of ventilation to prevent respiratory arrest.METHOD: The medical record of the patient and relevant literature were reviewed.RESULT: A 29-year old male following a wound on the lower limb presented with clinical features suggestive of tetanus. Incubation period was short and immunization history was uncertain. Basic treatment directed at removing source of infection and neutralisation of unbound toxin was however commenced. Following signs of imminent respiratory failure due to severe uncontrollable spasms, controlled mechanical ventilation was instituted in the critical care unit(CCU). However, the patient succumbed to cardiac arrest as a result of severe autonomic instability, despite aggressive cardiopulmonary resuscitation.CONCLUSION: Cardiovascular arrest from severe autonomic instability remains an important cause of mortality in tetanus despite artificial ventilation. Early management with appropriate therapy is advisable to prevent its occurrence. KEY WORDS: Tetanus, Artificial ventilation, Autonomic instability

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa