Blood transfusion in critically ill patients in an Intensive Care Unit of a Tertiary Hospital in Nigeria

Objective: To evaluate the use of whole blood and blood products in our ICU to determine patterns and outcome after transfusion.Design: A retrospective, case-control study.Setting: The Intensive care unit (ICU) of the University of Benin Teaching Hospital, a seven-bed open unit for the management of surgical, medical and paediatric patients.Subjects: Patients who received blood transfusion in the ICU. Every patient who received blood transfusion was matched for a similar case without blood transfusion. Patients’ socio-demographic characteristics, number of units of blood transfused, length of stay and outcomes were determined.Result: Approximately 30% of all patients admitted during the study period were transfused with blood. Majority of these patients (83.2%) had one to three units of blood. Obstetrics and neuro-surgical patients had more blood transfused than others. Whole blood constituted >85% of blood transfused while packed cells and fresh frozen plasma constituted 11.8% and 2.8% respectively. Blood transfusion did not have any significant impact on patients’ length of stay and mortality. The number of units of blood transfused appears to be associated with poor outcome (P=0.006).Conclusion: Obstetric and neuro-surgical patients utilised blood and blood products in the ICU more than any other patients. The number of units of blood transfused was more predictive of mortality than the blood  transfusion per se. A judicious use of blood and blood products, giving patients what they need and the development of transfusion guideline in the ICU is expedient

Pain in osteoarthritis: A review of literature

There is a vast body of evidence to suggest that osteoarthritis is a heterogenous condition that involves not only the articular cartilage but also an adaptive response of the bone and the synovium to a variety of environmental, genetic and biomechanical stresses.5-11 There is also growing evidence pointing towards long term potentiation as the most likely mechanism for the transition of acute nociception to a chronic pain (CP) state.The complexity and plasticity of the nociceptive system not only serve survival needs but also provide research opportunities for pharmacologic modulation of human suffering resulting from osteoarthritis

The effects of dexamethasone and metoclopramide on early and late postoperative nausea and vomiting in women undergoing myomectomy under spinal anaesthesia

Background: Post.operative nausea and vomiting (PONV); early or late, has detrimental effects on surgical patients such as surgical wound disruption, esophageal tear and delayed discharge from the post  anesthetic care unit. This study evaluated the effects of  dexamethasone.metoclopramide (DM) in the prevention of early and late PONV in women undergoing myomectomy under subarachnoid block.Materials and Methods: Following approval from the Research and Ethics Committee of the Hospital, informed consent was obtained from each prospective patient. Patients were randomly allocated to either the DM group, metoclopramide only (MO) group or dexamethasones only (DO) group using the computer.generated random numbers in sealed envelopes. Immediately after the induction of spinal anesthesia, the DM group received intravenous (i.v.) dexamethasone 8 mg and  metoclopramide 10 mg, the MO group received metoclopramide 10 mg i.v and the DO group received dexamethasone 8 mg i.v. The incidence of early and late PONV formed the primary outcome.Results: A total of 90 patients, with aged range between 21.64 years were studied. Dexamethasone alone group had the highest incidence of 40% for early but no for late PONV (P = 0.003) Metoclopramide alone group had an incidence of 29.97% for early PONV and 26.6% for late PONV. There was reduced incidence of both early and late PONV in the DM group, but of lesser magnitude than DO or MO respectively.Conclusion: Dexamethasone protects against the incidence of late PONV with a minimal effect on early PONV. The combination of dexamethasone and metoclopramide had comparable effect on both and of better  magnitude than metoclopramide alone.Key words: Antiemetic, myomectomy, spinal anaesthesi

Anaesthetic Challenges Associated with Achondroplasia: A Case Report

We report the anaesthetic management of two achondroplastic patients who presented for emergency cesarean section. Regional anaesthesia could not be done in both cases as a result of technical difficulties and general anaesthesia was performed. Airway management was done with two different techniques following airway assessment. The perioperative periods were uneventful. We discuss the anaesthetic implications and problems associated with regional and general anaesthesia in achondroplastic parturients. The controversies in the anesthetic management of these patients are also highlighted (Afr. J. Reprod. Health 2010; 14[2]: 149-155).KEYWORDS: Emergency cesarean section, achondroplasia, difficult airway, subarachnoid block, General anesthesia

The pain of labour: Perspectives of traditional birth attendants in Edo State, Nigeria

Objective: To determine the concept of labour pain and its relief in a cultural setting using the perspectives of Traditional Birth Attendants (TBAs).Design: Cross Sectional Comparative Study.Setting: An urban area (Benin City) and a semi-urban town (Auchi) in Edo State, Nigeria.Subjects: Traditional Birth Attendants in an urban area (Benin City) and a  semi-urban town (Auchi) were identified using  information from a local directory and a respondent driven sampling method.Results: A total of 58 TBAs (37 in Benin and 21 in Auchi) were interviewed. MostTBAs, 36 (97.3%) in Benin and 21 (100.0%) in Auchi, agreed that there is pain during labour. Almost all the TBAs, 34 (94.4%) in Benin and 21 (100,0%) in Auchi, reported that labour pain could be severe. Most of the TBAs, 31(83.8%) in Benin and 20 (95.2%) in Auchi reported that their clients request for pain relief in labour. Use of oral herbs was the most common method of pain relief in labour amongst the TBAs, 12(32.2%) in Benin and 20(100.0%) in Auchi. Most of the TBAs in Benin, 19(61.3%) offer nothing for labour pain, when pain relief is sought by their clients.Conclusion: Labour is considered painful in our culture and most women desire relief. TBAs in semi-urban setting used herbal remedies more readily than their urban counterparts. Efforts should be made at providing comfort to all women in labour irrespective of the location of delivery

Anaesthesia for Ophthalmic Procedures in a Teaching Hospital

Objectives: To study the pattern of anaesthesia for ophthalmic procedures in order to improve the scheduling of cases in the ophthalmic operating room. Methods: The surgical register of the operating room from August 01, 1999 to July 31, 2004 was examined, to document the types of procedure, timing of surgery (elective or emergency), methods of anaesthesia, and involvement of anaesthesia personnel. Results: A total of 970 patients (506 males, 464 females) had ophthalmic surgery in the five-year period under review. General anaesthesia was employed for 119 (12.3%) patients and regional anaesthesia for 851 (87.7%). 400 patients had their procedures on ambulatory basis (LA = 397, GA = 3). Local blocks were the favoured technique for both the outpatient and inpatient settings. Cataract extraction, repair of corneal/scleral/conjunctival/lid lacerations, excision biopsy, trabeculectomy and evisceration were the leading indications. General anaesthesia was the more commonly employed anaesthetic technique in younger patients and for emergency ophthalmic procedures. The general anaesthesia was administered by the registrar and senior registrar grades of anaesthetists. Conclusion: The study shows that the use of general anaesthesia appeared largely restricted to paediatric patients and emergency situations. However, evolving techniques – like sub-tenon block, total intravenous anaesthesia (TIVA), monitored anaesthesia care – should be encouraged. Keywords: ophthalmic anaesthesia, paediatric anaesthesia, regional blocks, outcomeNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 1-

Adaptation of the rubber bandage for safe use as tourniquet

The safety of the pneumatic tourniquet lies in the fact that the pressure generated beneath it can be determined and is reproducible unlike the rubber bandage tourniquet with subjective and irreproducible tissue pressure. Application of the rubber bandage over the cuff of an aneroid sphygmomanometer enabled direct determination of tourniquet pressure in sixty-four patients with associated low rate of tourniquet related complications. Seventy-eight limbs, in sixty-four patients, were operated using this composite tourniquet and evaluation after surgery as well as out-patients' clinic follow-up for tourniquet complications revealed complications in six out of eight patients in whom the tourniquet time exceeded 120minutes. In conclusion, the inclusion of an aneroid sphygmomanometer to record tourniquet pressure enhanced the safety of the rubber bandage tourniquet in our study and offers an alternative to the pneumatic type in the attainment of bloodless field where the latter is unavailable

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

<p>Abstract</p> <p>Background</p> <p>Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.</p> <p>Methods</p> <p>Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1^stOctober and 31^stDecember 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.</p> <p>Results</p> <p>There were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).</p> <p>Conclusion</p> <p>Even though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.</p