An Overview on the Use of the Laryngeal Mask Airway amongst Anaesthesia Practitioners in a Developing Country

BACKGROUND: The aim of this study is to provide an overview on the use of the Laryngeal Mask Airway (LMA) amongst anaesthesia practitioners in NigeriaMATERIALS AND METHODS: This is a multicentre questionnaire based study involving eight tertiary health care institutions in Nigeria. The questionnaires were administered to anaesthetists. They were standardised open- and close-ended questions which were completed in person. The questionnaire was subdivided into a set of questionswhich include: status of the anaesthetist; the routine use of LMA in general anaesthesia and as a device for airway management in difficult airway. Statistical analyses were done by simple percentages.RESULTS: The numbers of respondents were seventy; 38 were junior residents, 20 were senior residents and 12 were consultants. Sixty (85.7%) respondent had personally used LMA, while 10 had never used it andthey were all junior residents. Classic LMA was most commonly used (88%), followed by intubating LMA (7.5%), and proseal LMA (4.5%).Most of the respondents (67.1%) have used LMA in difficult airway management while 10% of respondents had used it in airway management during cardiopulmonary resuscitation (CPR). The reason for not using LMA routinely for general anaesthesia was due to unavailability in 15.7% ofrespondents, inexperience in 8.6% and habitual in 30%. CONCLUSION: Airway management is a vital discipline in the specialty of anaesthesia. The use of LMA as an airway device in the practice of anaesthesia in our setting is inadequate. Training, re-training andcontinuous medical education of anaesthetists' very necessary to improve our practice. KEY WORDS: laryngeal mask airway, anaesthetist, airway management

Right colon interposition in corrosive esophageal long segment stricture: Our local experience

Background: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive  esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance.Materials and Methods: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained.Result: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow.up.Conclusion: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore  swallowing among patients with long segment esophageal stricture. Key words: Colon interposition, corrosive esophageal stricture, nutrition, vascular pedicl

Pattern of Admission and Outcome of Patients Admitted into the Intensive Care Unit of University of Nigeria Teaching Hospital Enugu: A 5‑Year Review

Objective: The objective was to determine the pattern of admission and outcome of patients in the Intensive Care Unit (ICU) of University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.Materials and Methods: A retrospective review of all patients admitted into the general ICU at UNTH from 2008 to 2012. Data were collected from the ICU admission and discharge registers, and data analysis was done using Microsoft Excel 2007.Results: A total of 766 patients were admitted during the period, consisting of 501 (65.4%) males and 265 (34.6%) females. Ages ranged from 1‑day to 89 years with a mean age of 38.2 ± 18.2 years. The most common cases admitted were neurosurgical patients of which there were 316 (41.2%). Patients admitted as a result of critical incidents in anesthesia formed the lowest number of cases admitted 10 (1.3%). Of the 316 neurosurgical cases, 224 (70.9%) were due to severe traumatic brain injury (TBI). An overall admission of 92.4% (207) was for severe TBI due to motor‑vehicular accident (MVA). The average length of stay was <24 h to 72 days with a mean of 4.9 ± 3.2 days. A total of 16.7% (128) patients received invasive mechanical ventilation during their stay in ICU. Only 15% (34 patients) of all the cases of severe TBI patients received invasive mechanical ventilation. Mortality rate was 34.6% in this study.Conclusion: The highest number of admissions into the ICU was for severe TBI following MVA. Developing a viable trauma team and separately equipped neurosurgical ICU with adequately trained and motivated staff will help improve the outcome of patients.Keywords: Admission, Intensive Care Unit, Outcom

Emergency airway management with laryngeal mask airway

No Abstract

Bronchoscopy for foreign body removal in children: anaesthetic challenges in a tertiary health Centre.

Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment; to review the anaesthetic practice in our centre, and compare them with universally accepted standards.Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body aspiration was diagnosed clinically and radiologically. Data concerning demography, clinical characteristics, anaesthetics and complications were obtained from the hospital records.Result: A total of 45 patients were studied. They were between the ages of 6 months and 11 years, 29 males and 16 females. A total of 64 procedures were carried out, of which 38 (59.4%) were bronchoscopy. Bronchoscopy was done with Stortz ventilating bronchoscope under general anaesthesia. Repeated doses of suxamethonium were used as muscle relaxant in 92.1% of cases.Conclussion: Rigid bronchoscopy for aspirated foreign body is a safe, effective and often life saving procedure in the hands of experienced anaesthetist and bronchoscopist. A close rapour between the two teams is necessary for a desired outcome.Key words: Foreign body aspiration, Bronchoscopy, Anaesthesia

Anaesthesia manpower need in Nigeria

Aims: To compare the anaesthesia and surgical manpower in four tertiary hospitals in Nigeria and assess the anaesthesia work load in those institutions; to determine the per capita anaesthetist manpower in Nigeria (anaesthesia providers per 100,000 population) and compare with what obtains in other regions of the world.Materials and Methods: This is a multicentre study carried out in four tertiary hospitals in Nigeria between June 2011 and June 2012. The hospitals were University of Nigeria Teaching Hospital (UNTH) Enugu, National Orthopaedic Hospital Enugu (NOHE), University of Benin Teaching Hospital (UBTH) Benin and Jos University Teaching Hospital (JUTH) Jos. Data were collected from the records of the various hospital operative rooms and intensive care units (ICU).Results: Our study revealed that the ratio of consultant anaesthetist to consultant surgeon was 1:6.6 in UBTH Benin, 1:7.9 in UNTH Enugu, 1:11.7 in JUTH Jos, and 1:9.5 in NOH Enugu. The ratio of resident doctors in training in anaesthesia to those of surgery was 1: 7.3 in UBTH, 1: 5.3 in UNTH: and 1:10.6 in JUTH. On the whole, there were a total of 100 anaesthetists to 767 surgeons (consultant plus resident doctors) in these four hospitals. The physician anaesthesia provider per 100,000 people in Nigeria was 0.113.Conclusion: The per capita anaesthetist manpower in Nigeria is extremely low when compared to developed countries. Training institutions must ensure sufficient funding and recruitment into the training programme in order to develop the specialty and improve expertise.Keywords: Hospital, physician, specialist, surgeons, tertiary, trainin

Postoperative vomiting and fever following tonsillectomy in Enugu, Nigeria

OBJECTIVE: To determine the incidence of postoperative vomiting and fever in patients that had tonsillectomy in our centre over a five year period.METHODS: The hospital records (case files) of patients that had tonsillectomy with or without adenoidectomy under general anaesthesia at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria from January 2004 to December 2008 were retrieved and analyzed. Patients that had an adenoidectomy only were excluded. The patients were of the American Society of Anesthesiologists (ASA) 1 to III status. RESULTS: There were fifty two (52) patients that had tonsillectomy and adenotonsillectomy under general anaesthesia during the period under review. Forty one (41) patients were between the ages of 1-13 years (78%) and eleven (11) patients between the ages of 18 - 62 years (12%). There were 32 males and 20 females. The average age for all the patients was 9.03 years. There were seven (7) patients with post operative vomiting (13.4%). These included four (4) patients in the paediatric population (9.75%) and three (3) in the adult population (27.2%). Twenty one (21) patients (40.3%) developed postoperative fever. There were no deaths. The other significant morbidity was postoperative pain.CONCLUSION: The number of patients that had tonsillectomy in our center was small compared to other studies. The incidence of postoperative vomiting in this study is lower than that reported from Western World, showing possible racial variations, a trend that has been reported in some earlier studies in Black populations.KEYWORDS: Tonsillectomy, postoperative vomiting and fever, Afric