The psychological impact of intensive care unit admission on relatives of critically ill patients

Introduction: It is recognized that ICU patients are exposed to massive stresses both from their life-threatening illness and the necessary intensive medical procedures they are subjected to. These stresses may lead to psychological problems like depression, anxiety and post-traumatic stress disorder. However, the psychological demands and impact of the ICU on the relatives of these patients are often not appreciated. We aimed to determine the prevalence of anxiety and depression and the influence of ICU specific interventions on the development of psychological symptoms in relatives of ICU patients. Methods: This prospective, descriptive, questionnaire-based study was conducted on all consenting primary caregivers of patients on admission in the intensive care unit during the study period. The Hospital Anxiety and Depression Scale and the General Health Questionnaire were used to determine the presence of psychological disorders during this study.Result: In this study, GHQ demonstrated a 72.5% prevalence of psychological illness in relatives of ICU patients. The prevalence of psychological illness using Hospital Anxiety and Depression Scale (HADS) was 56.3% on the anxiety scale and 55% on the depression scale.Conclusion: Critical care can result in the development of psychological disorders among primary caregivers of ICU patients. Intensive care physicians need to pay more attention to their care's impact on the psychological health of their patients’ relatives

Outcome of intensive care management of acute chest syndrome in a Nigerian Teaching Hospital: A preliminary report

Objectives: Acute chest syndrome (ACS) is a common complication of vaso-occlusive crisis in sickle cell disease patients. It causes respiratory failure which may require mechanical ventilation in the intensive care unit, but outcome of such intervention has been sparingly reported in our environment. This study highlights the intensive care management and outcomes of acute chest syndrome in our centre. Design: This was a retrospective descriptive study Setting: This study was carried out at the intensive care unit of a tertiary hospital in Nigeria Subjects or participants: These were 27 sickle cell disease patients with acute chest syndrome managed in our intensive care unit from January 2013 to December 2017. Methods: We reviewed the medical records of all the 27 sickle cell disease patients managed in our intensive care unit on account of acute chest syndrome in the last 5 years. Relevant information on supplemental oxygen administration, modes of ventilation, transfusion, length of stay in the ICU and mortality rate was also extracted.Main outcome measure: The main outcome measure was the number of patients who survived and discharged from the intensive care unit.Results: Nine (50%) out of the 18 patients with acute chest syndrome, complicated by severe respiratory insufficiency, ventilated mechanically survived. The median length of ICU stay was 6 (12) days.Conclusion: Mechanical ventilation of patients and adequate pain control can help reduce the mortality and enhance the quality of life of sickle cell disease patients with acute chest syndrome

Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study

Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria.Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months.Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively.Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.Keywords: herniated intervertebral disc, lumbosacral radicular pain, Nigeria, pain relief, transforaminal epidural steroid injectio

Reasons For Cancellation of Elective Paediatric Surgery Cases

Many factors have contributed to incessant cancellation of elective cases in paediatric surgery. The objective of this study was to review the reasons for cancellation of such cases in our centre and to suggest solutions to these problems. Prospective collation of information on all cancelled elective paediatric surgical cases was done. The bio-data on; clinical diagnosis and reasons for cancellation were documented. The study period was 18 months (March 2006- August 2007). Causes of cancellation were grouped into patients' factors (group A), parental factors (group B), and institutional factors (group C) There were 437 elective paediatric surgery cases within this period of which 298 (68.2%) were day cases and 139 (31.8%) were in-patients. Sixty-one patients (14%) were cancelled [36 (8.2%) day cases and 25 (5.8%) in-patients] of which 49 (80.3%) were males, 10 (16.4%) were females and 2 (3.3%) cases of ambiguous genitalia. The age ranged between 30 days and 11 years with a mean of 33.4 months ± SD of 34.4 months. The commonest reason for cancellation were in group A (22, 36.1%), followed by groups B and C (17or 27.9% each). The commonest reason in group A was Upper respiratory tract infection (59.1%), for group B was parents' refusal to present wards on the day of surgery (88.2%) and for group C was impromptu public holidays (58.8%). Elective paediatric surgery cases are usually cancelled in our centre due to Upper Respiratory Tract Infection (URTI) in children and parents' refusal to present their wards on surgery day. There is a need to properly review children with runny nostrils before cancellation because some children's nostrils are chronically wet and it may be delicate to postpone their operation. Adequate counseling of parents will reduce default.Keywords:  cancellation, elective, day-case, paediatric surger

Evaluation of Unanticipated Admissions Following Paediatric Day-Case Surgery in the University of Ilorin Teaching Hospital

Paediatric patients scheduled for ambulatory surgery in our environment has been on the increase. These patients would undergo different surgical procedures with the intent of going home after the surgery with little or no complications. This study was a retrospective evaluation of unanticipated admission following paediatric day-case surgery.  A retrospective data of ambulatory paediatric surgeries done between 2015 and 2016 was collected; unanticipated hospital admission and the reason for admission were analysed.  A total of 69 (7.40%) patients out of the total number of 932 paediatric general surgery cases had day-case surgery within the period under study, 13 (18.90%) of the patients were less than 1 year, while 56 (81.10%) of the patients were above one-year-old. Herniotomy was the most common surgical procedure in 57 (82.60%) of the day case procedures, 43 (62.30%) of the cases were completed in less than one hour while 26 (37.70%) of the surgical procedures were completed between one and three hours. None of the patients had a post anaesthesia discharge score (PADS) below 8. General anaesthesia with a facemask or laryngeal mask airway with or without caudal block was the most common anaesthetic technique in 58 (79.60%) of cases, while general anaesthesia with relaxant technique with or without caudal block was the anaesthetic technique in 8 (11.50%) of cases. There were no recorded cases of unanticipated postoperative admission. In conclusion, there was no incidence of unanticipated hospital admission following day-case surgery in our centre because of proper patient selection, team cooperation, safe anaesthetic and surgical practice with proper discharge criteria. Keywords: ambulatory surgery, complications, admission

Medication errors during anaesthesia in a tertiary health institution in Nigeria: a case series

Polypharmacy is a routine practice in anaesthesia, hence occurrence of medication errors is not uncommon. A medication error is an error in the prescription, dispensing, or administration of medication which results in failure of patients to receive correct drug or appropriate dose. Such errors usually occur due to human and drugs packaging factors and consequences may range from no harm to morbidity or mortality. This case series highlighted some of the common medication errors that occurred in our center, their causes, interventions and outcomes.Medication error is a common occurrence in anaesthesia. Similar looking vials, ampoules and syringes and inexperience of the anaesthesia care provider are associated risk factors. Anaesthesia care providers should be vigilant and protected from undue fatigue and overwork because human errors were responsible for all the cases highlighted and discussed.Keywords: Medication error, Anaesthesia, tertiary health institution, Nigeri