The Intensive Care Unit of the University Teaching Hospital, Ilorin, Nigeria: a ten year review (1991 - 2001)

A retrospective study was conducted on all patients admitted to the Intensive Care Unit (ICU) of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over a 10 - year period (October 1991 - Sept. 2001). This period marks the first decade of the establishment of our ICU. The purpose of this study is to describe the pattern of admission of patients into the ICU, highlighting the variety of cases, indications for admission, outcome and causes of death, and the problems of medical and administrative management of the unit. No similar study has previously been carried out in this institution. A total of 295 patients, consisting of 185 males (62.7%) and 110 females (37.3%) were admitted to the ICU during the study period. The commonest indication for ICU admission was for postoperative high care (54.9%), with postlaparotomy patients accounting for 59.9% of these cases. Medical indications for admission accounted for 21.3%, with respiratory failure and asthma being the commonest and each accounting for 11.5%. One hundred and ten patients (37.3%) died during their ICU admission, giving an ICU survival rate of 62.7%. Late presentation of cases and inadequate staffing and equipment were important factors which may have contributed to mortality in these patients. Improved funding, training of additional staff and acquisition of advanced monitoring and life support equipment would improve the efficiency of our intensive care unit and patient survival. South African Psychiatry Review Vol. 11(4) 2005: 146-15

Post-anaesthetic Respiratory Complaints Following Endotracheal Anaesthesia In Lower Abdominal Obstetric And Gynaecology Surgery

Background: Postanaesthetic respiratory complications represent a significant negative aspect of surgical care. Objective: To assess the incidence and possible associated risk factors for postanaesthestic respiratory complaints following endotracheal anaesthesia in lower abdominal surgery in obstetric and gynecology patients in our hospital. Setting: A Teaching Hospital in Nigeria. Design: Prospective study Methodology: All consenting adult patients, aged 16-45years, undergoing caesarean section and major gynaecological abdominal operations, under general anaesthesia with endotracheal intubation, over a period of 8months, were studied. Postoperative respiratory symptoms, (sorethroat, hoarseness and cough), were assessed in the ward, by direct questioning method, daily for 5days. Those presenting with cough had their chest examined, and fever (T0 > 370C), was noted. Patients with positive chest signs had radiological examinations of the chest done for confirmation. Results: A total of 202 patients were studied. Out of these, 152(75.2%) patients had various forms of postoperative respiratory complaints. Overall, it was observed that caesarean section patients were more likely, than gynaecology patients, to report these respiratory complications in the postoperative period (88.4% vs. 58.9%). This difference was statistically significant (p < 0.05). The incidence of sorethroat directly correlated with the size of the endotracheal tube used (r = 0.936). There was a statistically significant difference in the incidence of sorethroat between the caesarean section patients and gynaecology patients (p< 0.00), particularly with endotracheal tube sizes larger than 7.5mm ID (p< 0.03). Duration of intubation, which was slightly longer in gynaecology patients (mean =72.48±30.62), and number of intubation attempts, did not have statistically significant effect on the incidence of respiratory complaints. Conclusion: The use of small endotracheal tube sizes

Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia

Introduction: The duration of action of sub-arachnoid block is short, and one of the ways to overcome this is the use of oral clonidine. Methods: 108 patients of ASA I and II, aged 18 to 65 years undergoing lower abdominal surgeries under spinal anaesthesia were randomized into three groups.. Control group A (n=36) no oral clonidine pre-medication, Group B (n=36) and group C (n=36) received 100 \u3bcg and 200 \u3bcg of oral clonidine pre-medication respectively, 1hr before spinal anaesthesia. Haemodynamic parameters were recorded. Sensory block, degree of motor blockage, and sedation were assessed. Results: Clonidine prolonged the mean duration of motor block by 189.98\ub126.93 min (100\u3bcg) and 191.89\ub128.13 min (200\u3bcg) compared to 117.92\ub125.13 min in the control group p&lt;0.05. The mean duration of analgesia was 188.19\ub135 min (100\u3bcg) and194\ub124.58 min (200\u3bcg) in the clonidine groups compared to 115.89\ub126.66 min in control group p&lt;0.05. All the patients were awake in the control group while 71.43% and 100% were drowsy in groups B and C respectively. Conclusion: Oral clonidine produces better clinical effects on the onset and duration of Bupivacaine spinal anaesthesia

Pediatric day case surgery: Experience from a tertiary health institution in Nigeria

Background : The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. Method : A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2\ubd years). Results : Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient\u2032s fitness for surgery were statistically significant delay factors (P= 0.001). Conclusion : Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people. Conclusion: Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH.Arri\ue8re-plan: Le observation g\ue9n\ue9rale que les enfants atteindre convalescence mieux \ue0 la maison environnement prend en charge la n\ue9cessit\ue9 d\u2019adoption de la chirurgie affaire jour qui gagne plus d\u2019acceptations dans les pays en d\ue9veloppement. Service Chirurgie p\ue9diatrique est en grande demande aux pays en d\ue9veloppement et de lits de remboursement des soins et de fournitures chirurgicales sont insuffi santes. M\ue9thode: UN prospective collecte de donn\ue9es sur tous les enfants PDS par le p\ue9diatrique chirurgicale unit\ue9 de UITH, Ilorin a \ue9t\ue9 faite. Parents avaient pr\ue9op\ue9ratoire externe briefi ng et entrevues post op\ue9rationnels sur le deuxi\ue8me et le neuvi\ue8me jour pour post-operative les complications et les \ue9v\ue9nements \ue0 la maison. P\ue9riode d\u2019\ue9tude a \ue9t\ue9 entre avril 2005 et Septembre 2007 (2,5 ans). R\ue9sultats: De les 660 enfants (68.02 %) de 449 \ue9lectif cas ont \ue9t\ue9 recrut\ue9s comme cas de la journ\ue9e. UN m\ue2le \ue0 ratio f\ue9minin de 14,3: 1. \uc2ge varie entre 20 jours et 15 ans avec signifi e mois 37.6 et SD 34,4 mois. Cong\ue9nitales hernias/ hydroceles ont \ue9t\ue9 les indications plus \ue9lev\ue9es (71.2 %) suivies par forfaitaire/masses (12,9 %), undescended testes (8,7 %), ombilical hernias (4,8 %) et thyroglossal canaux kyste (2,5 %). Dans 98.9 % des cas les parents r\ue9sident dans le rayon de 20 km de l\u2019h\uf4pital et 91,5 % d\u2019entre eux pourrait atteindre l\u2019h\uf4pital dans 1 heure. Les p\ue8res et m\ue8res avaient au-dessus de l\u2019enseignement primaire dans % 80.1 et 77.1 % respectivement. Plus de la moiti\ue9 des p\ue8res (55 %) \ue9taient des civile fonctionnaires, alors que 30 % \ue9taient travailleurs autonomes. Les m\ue8res ont \ue9t\ue9 des fonctionnaires en 37,3 % cas et 34 % \ue9taient travailleurs autonomes. Moyenne clinique externe visites avant une intervention chirurgicale est 2-3times (41.2 %) avec intervalle moyenne \ue0 la chirurgie de 4-5 semaines (60,3 %). Logistique (enqu\ueates et la disponibilit\ue9 de liste de l\u2019op\ue9ration) et les patients de l\u2019ad\ue9quation \ue0 une intervention chirurgicale \ue9taient statistiquement facteurs de retard signifi catif (valeur p = 0.001). Parents a signal\ue9 14 enfants d\u2019\ueatre irritable chez eux en raison de douleur pendant les autres signal\ue9 exp\ue9rience affaire jour satisfaisante. Aucune admission non planifi \ue9e ou la mortalit\ue9 enregistr\ue9e et seulement 3 parents (0,8 %) ne recommanderaient pas une intervention chirurgicale jour affaire \ue0 autres personnes. Conclusion: P\ue9diatrie Chirurgie affaire jour est possible pour les cas bien s\ue9lectionn\ue9s et surveill\ue9s dans notre environnement. Neonates \ue0 terme, avec les parents inform\ue9s sont adapt\ue9es pour p\ue9diatrique Chirurgie affaire de jour. Il est n\ue9cessaire pour un centre d\u2019affaire de jour r\ue9duire la liste d\u2019attente

Pediatric day case surgery: Experience from a tertiary health institution in Nigeria

Background : The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. Method : A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2½ years). Results : Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient's fitness for surgery were statistically significant delay factors (P= 0.001). Conclusion : Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people. Conclusion: Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH

Reasons for cancellation of elective surgery in Ilorin

Background: The rising cost of health care and dwindling economic resources necessitate the need to encourage cost-effectiveness in patient care. Cancellation of cases on the scheduled day of surgery leads to inefficient utilization of theatre space, waste of valuable manpower and scarce resources for patients and hospital. Avoidance of unnecessary cancellations of cases may therefore be an important way of ensuring efficient utilization of resources. Methods: This is a prospective study. Record was taken of all patients whose names appeared on the routine elective surgical operation lists. The names of all those who could not have their surgery done were compiled. The age, sex, diagnosis, specialty of surgery, proposed surgery and reasons for cancellation were collated and analysed. Results: Out of the 1,175 patients scheduled for surgery during the study period, 272(23.15%) were cancelled for various reasons. The highest incidence of cancellation 130(11.06%) was recorded in orthopaedic specialty, even though it ranked second to General Surgery in the total number of cases booked. Cardiothoracic unit recorded the lowest incidence of cancellations (1.84%), but it also had the lowest number of cases scheduled for surgery. The commonest cause of cancellations was time constraints (22.59%). Patients absconded from surgery for personal reasons not communicated to the Surgeons in 13.60% of cases, while unanticipated logistic problems accounted for another 9.93%. Other causes of cancellations included industrial action embarked upon by members of the hospital community staff auditing exercise, uncontrolled medical illness and unresolved laboratory abnormalities. Conclusion: The incidence of cancellation of cases on the scheduled day of surgery is still high in our hospital. Most of the causes of the cancellations are preventable. In order to enhance cost-effectiveness, efforts should be made to prevent unnecessary cancellations through careful planning and closer interactions between surgeons and patients, and amongst members of the surgical team. Keywords: Elective surgery, Cancellation, Causes, Cost-effectiveness. Nig. J. of Surgical Research 4(1-2) 2002: 28-3

Cervical plexus block for thyroidectomy

Objective: Thyroidectomy is traditionally performed under general  anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our  environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital.Design: This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999.Setting: The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution.Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. Outcome Measures/Results: The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20-80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal  thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was  completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became  extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. Conclusion: Bilateral superficial cervical plexus block is a useful   anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.Key words: Cervical Plexus, Superficial, block, and thyroidectomy

Parental Experiences, Coping Strategies and Level of Satisfaction Following Paediatric Day - Case Surgery in a Tertiary Health Institution in Nigeria.

Background : Little is known about the home experience, coping strategies and level of satisfaction of parents following day-case surgery performed on their children in developing countries. Objective: To evaluate the experiences, coping strategies and level of satisfaction of parents following day case surgery performed on their children. Methodology: A 48 hour post-discharge survey of parents of 152 consecutive children who underwent day–case surgery over a period of 18 months was extracted from our routine database. Information obtained included, postoperative complications and treatment applied; parents’ coping strategies, use of primary care facilities following discharge; their level of satisfaction, or otherwise, of day case surgery performed on their children, postoperative pain control at home, their involvement in the postoperative care of their children, and how they found the nursing responsibility they had to bear. Results: There were142 (93.4%) males, and 10 (6.6%) females. The age ranged between 21days and 14years, with a mean age of 33.4 ± 34.4 months. The most common Surgical procedure was herniotomy, (132 or 86.8%), followed by orchidopexy (13or 8.6 %), and excision biopsy (7or 4.6 %). Eighty-eight parents (57.9%) reported one or more complications at home, with pain which occured in 69 (45.4%) children being the commonest. Although, this figure is statistically significant (p = 0.035), all the complications were minor; and majority of them were easily handled within the limit of the medical support services available within the community. None of the cases required hospital admission for management of complications. There was no mortality in our series. Although, a statistically significant number of parents (55 or 36.2%), p = 0.000, found the nursing responsibility they had to bear at home unacceptable, a higher proportion 89 (58.6%) found the responsibility acceptable or challenging, while 8 (5.8%) parents were indifferent. Virtually all, except one parent expressed satisfaction with their experiences of day–case treatment for their children, and 144 (94. 7%) of them would recommend similar treatment to others. Conclusion: Parental satisfaction with paediatric day-case surgery in our hospital is high. Although minor morbidities were experienced at home, they were not severe enough to overwhelm the coping abilities of the parents. Keywords: Day case, Parental experiences, coping strategies, satisfactio

Non-cardiac Surgery in a Child with Major Congenital Heart Disease: A Challenge to Safe Anaesthesia

Surgery in children with congenital heart disease poses an increased risk of morbidity and mortality. Ideally such children should be managed in specialist cardiac centres. However, it is not unusual in developing countries for the patients to present in non-specialist centres. This was the case with a 5 month old baby who presented at our hospital with a major and severe cyanotic congenital cardiovascular anomaly for the repair of a bilateral complete cleft lip. The parents declined referal to a specialist cardiac centre. The surgery was successfully done under general anaesthesia despite the limited facilities. It is important that all anaesthetists are familiar with the basic principles involved in the management of these patients. Appropriate cardiologist consultation and close collaboration between the surgical, anaesthetic and nursing teams, is also critical to a successful outcome. Keywords: Anaesthesia, non-cardiac surgery, congenital heart disease, non-specialist cardiac centre, limited facilities