Do Abnormal Findings on Hystero-Salphingographic Examination Correlate with Intensity of Procedure Associated Pain?

The aim of this study is to determine if the intensity and nature of pain during Hystero-Salphingography could give a clue to the presence of abnormal finding/s. Eighty-two patients were recruited over a six-month period. Procedural pain was assessed using the numeric rating scale. Mean age was 33.2 ± 4.9 years. The median pain score in patients with normal findings was 6.0 but7.0, 8.0, and 8.5 in those with right tubal blockade, uterine fibroids and left tubal blockade respectively. No statistical difference in the absolute pain score between patients with normal and abnormal findings. Pain scores in patients with 1 and 2 abnormalities were 7.0 and 7.5, and the number of abnormalities did not affect pain score (P = 0.3). The presence or absence of pain during HSG may not be a suitable way of determining the presence or absence of abnormal HSG finding/s. .Afr J Reprod Health 2014; 18[2]: 147-151).Keywords: Hystero-salphingography; abnormal findings; Pain. Le but de cette étude est de déterminer si l'intensité et la nature de la douleur pendant l’hystérosalpingographie pourraient donner une indication de la présence des constatation(s) anormale(s). Quatre-vingt deux patients ont été recrutés au cours d’une période de six mois. La douleur de la procédure a été évaluée en utilisant l'échelle d'évaluation numérique. L'âge moyen était de 33,2 ± 4,9 ans. Le score de douleur médiane chez les patients qui présentaient des résultats normaux était de 6,0 but7.0, 8,0, et 8,5 chez ceux qui présentaient des blocages des trompes droites, les fibromes utérins et des blocages des trompes gauches respectivement. Il n’y avait aucune différence statistique du score de douleur absolue entre les patients avec des résultats normaux et anormaux. Les scores de douleur chez les patients avec 1 et 2 anomalies étaient de 7,0 et 7,5, respectivement et le nombre d'anomalies n'ont pas de conséquence sur le score de douleur (p = 0,3). La présence ou l'absence de douleur pendant la HSG peut ne pas être un moyen approprié de déterminer la présence ou l'absence des constatations anormales de la HSG. Afr J Reprod Health 2014; 18[2]: 147-151).Mots-clés : hystérosalpingographie, résultats anormaux, douleur

Intensive Care Management of Organophosphate Poisoned Patient: A Test of Critical Care Services in Nigeria

The management of organophosphate poisoning is challenging, more so in the setting of poor critical care facilities. The management requires the administration of atropine, an antidote (oxime) and supportive care often provided in the ICU. We report a 35year old male who presented with a history of ingestion of an organophosphate insecticide and features of cholinergic and central nervous system affectation. The patient was managed with intravenous atropine, pralidoxime, ventilator support and other supportive care. This paper highlights those challenges associated with the management of organophosphate poisoning in our environment.Keywords: Poisoning; organophosphate; ICU; Developing countries

Perception of Nigerian anaesthetists on intra-operative death

Background: Intra-operative death is an unusual devastating occurrence in anaesthetic practice, and it is of serious concern when it happens.Objectives: To assess the causes, the effects and the perception of Nigerian anaesthetists to intra-operative death.Design: A cross-sectional and questionnaire-based studySetting: Five University Teaching Hospitals in South-Western Nigeria.Subjects: Nurse anaesthetists, resident doctors in anaesthesia and consultant anaesthetistsResults: One hundred and five anaesthetists participated in the study (72.9% response rate). Seventy seven (73.3%) of the respondents had experienced an intra-operative death with most of them having five or more years of experience (p = 0.0001). Majority 53 (68.8%) of the respondents felt that the deaths were avoidable, and most deaths occurred mainly during emergency surgery (96.1%). Forty three (55.8%) of them were psychologically disturbed, fifty six (53.3%) respondents were of the opinion that it is reasonable for the anaesthetists involved not to take part in further surgery for that day. Sixty (57.1%) respondents considered discussion at mortality meeting as appropriate after an intra-operative death.Conclusion: This study showed that most anaesthetists would want those involved in the intra-operative death not to take part in further surgery for that day. Adequate preventive measures should be put in place with departmental or institutional policies on what to do after such events

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Conducting Sedation/Analgesia for Procedures Outside The Operating Theatre

The demand for sedation and/or analgesia for diagnostic and therapeutic procedures is on the increase and this puts high pressure on anaesthetists. Unfortunately in many developing countries, anaesthetists are concentrated in the tertiary health care centres, therefore guidelines for non-anaesthetist doctors who requires sedation of patients on a high-quality level and in a safe way are mandatory. This review will update the knowledge of practitioners interested in this area of medicine. However, close cooperation with anaesthetists seems mandatory to achieve and sustain a high-quality standard for our patients undergoing medical or surgical procedures under sedation.Key words: Sedation; Analgesia; Outpatient

ICU Utilization by Cardio-Thoracic Patients in a Nigerian Teaching Hospital: Any Role for HDU?

Background: The underlying pathological conditions in cardiothoracicpatients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors thatdetermined outcome.Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patientdemographics, indications for admission, interventions offered in the ICU and the outcome.Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardiothoracic procedures, accounting for 7.9% of ICU admissionsand 46.6% of cardio-thoracic procedures done within the reviewperiod. The mean length of stay and ventilation were 5.71 ± 5.26and 1.30 ± 2.62 days. The most significant predictor of outcomewas endotracheal intubation (P = 0.001) and overall mortalitywas 15%.Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted.Keywords: Cardio-thoracic surgery, hospital, intensive care unit, Nigeria, teaching, utilizatio

Haemorrhagic pulmonary oedema following postoperative laryngospasm after ear reconstructive surgery: A case report

Introduction: After the initial report by Oswalt in 1977 some cases of postanaesthetic laryngospasm causing pulmonary oedema, have been reported in the anaesthesia and surgery literature. However none of these is from West Africa. We therefore report this uncommon entity in a Nigerian adult male following ear reconstructive surgery.Method and result: We present a 33 year old healthy adult male who developed haemorrhagic pulmonary oedema following post-extubation laryngaspasm to illustrate the management of this uncommon clinical condition.Conclusion: An exhaustive pre-operative history and a high index of suspicion are important for diagnosis, followed by prompt intervention. Keywords: upper airway obstruction, laryngospasm, pulmonary oedem

Clinical audit of knowledge and practice of epidural labour analgesia amongst obstetricians in South-West Nigeria

Epidural analgesia (EA) is the most ideal method for pain relief during labour. We sought to highlight the current knowledge and practice of the obstetricians regarding epidural labour analgesia (ELA). An audit was conducted amongst obstetricians in two teaching hospitals in the south west of Nigeria. Most of our respondents received lectures about ELA but about half of them rated the lectures as inadequate. Though 37.8 % and 53.3% of respondents are of the opinion that there is interference with labour and increased incidence of instrumentation following epidural analgesia in labour respectively, however 84.4% agreed that the technique is not associated with adverse neonatal or maternal outcome and 97.8% will prefer their patients having epidural labour analgesia. We are of the opinion that education regarding ELA, both during and after obstetric speciality training, be improved, and well-established interpersonal relationship between obstetricians and anaesthetists will be needed to achieve this

Intra‑Operative Airway Management in Patients with Maxillofacial Trauma having Reduction and Immobilization of Facial Fractures

Background: Despite advancements in airway management, treatment of fractures in the maxillofacial region under general anesthesia remains a unique anesthetic challenge. We reviewed the pattern of airway management in patients with maxillofacial fractures and assessed those challenges associated with the different airway management techniques employed. Materials and Methods: The anesthetic chart, theatre and maxillofacial operations records of patients who had reduction and immobilization of various maxillofacial fractures over a 2‑year period were reviewed. Information obtained included the patient demographics, mechanisms of injury, types of fractures and details about airway management. Statistical Package for Social Sciences, SPSS version 17.0 was utilized for all data analysis. Results: Fifty‑one patients were recruited during the 2‑year study period. Mask ventilation was easy in 80–90% of the patients, 80% had Mallampati three or four, while 4 (7.8%) had laryngoscopy grading of 4. There was no statistically significant difference between the fracture groups in terms of the laryngoscopy grading (P = 0.153) but there was statistical significant difference in the technique of airway management (P = 0.0001). Nasal intubation following direct laryngoscopy was employed in 64.7% of the patients, fiber‑optic guided nasal intubation was utilized in only 7.8%. None of the patients had tracheostomy either before or during operative management. Conclusion: Laryngoscopic grading and not adequacy of mouth opening predicted difficult intubation in this group of patients in the immediate preoperative period. Despite the distortions in the anatomy of the upper airway that may result from maxillofacial fractures, nasal intubation following direct laryngoscopy may be possible in many patients with maxillofacial fractures.Keywords: Airway management, maxillofacial trauma, reduction and immobilizatio

Predictors of difficult laryngoscopy in children presenting for cleft lip and palate surgery

Background: Endotracheal intubation is required to maintain a patent and clear airway as well as ensure good surgical access during cleft lip and palate repair in children. This study is aimed at identifying factors that would predict the risk of difficult intubation in patients presenting for cleft lip and palate surgery in order to focus on preventive measures andsave lives.Patients and Methods: Data on anaesthetic techniques and ease of intubation was prospectively documented in 88 consecutive patients scheduled for elective cleft lip (61.4%) or palate repair (38.6%) over a period of 24 months. Three variables: age, type of cleft and laryngoscopic assessment using Cormack and Lehane grading were analyzed usingunivariate analysis in order to determine risk factors for difficult laryngoscopy.Result: There were 88 paediatric patients aged two months to 12 years comprising 51 boys and 37 girls. Tracheal intubation was easy in 73 (83%) patients and difficult in 15 (17%) patients. Of the 15 patients with difficult laryngoscopy, 13 (86.7%) were children aged less than 24 months, 8 (53.3%) presented with complete cleft palate and difficulty occurred across all the four grades of laryngoscopic view. Age and Cormack and Lehane laryngoscopic view grading were found to be significantly associated with difficult laryngoscopy (