Trends of critical care management of obstetric patients in a tertiary hospital in sub-Saharan Africa

Background: The maternal mortality rate in sub-Saharan Africa is high compared to other regions of the world. Management of critically ill obstetric patients is very challenging. We therefore evaluate the trends, clinical characteristics and outcome of the obstetric patients admitted into the intensive care unit of a tertiary hospital in sub Saharan Africa.Methods: This was a 9- year retrospective study carried out at the multidisciplinary Intensive Care Unit (ICU) of a University Teaching Hospital which serves as a referral centre for the south east region of the country. Data were collected from the patients’ record, ICU admission and discharge register. Also collected was data concerning labor ward admission and deliveries. Data was analyzed using SPSS Version 17 (SPSS Inc., Chicago, IL, USA).Results: The total admission into the ICU during the study period was 1243 patients of which 73 (5.87%) were obstetric patients. They were between the ages of 17 and 54 years with mean of 32.05±5.96 years. The total number of deliveries within the period was 11224 (1247 per year). The commonest obstetric cases admitted into the ICU were (pre) eclampsia 28.8% followed by obstetric hemorrhage 24.7%. The overall mortality rate in this study was 39.7%. The commonest intervention carried out in the ICU was mechanical ventilation.Conclusions: The two leading indications for ICU admission and maternal mortality are (pre)eclampsia and obstetric hemorrhage

A comparative study of glycopyrrolate and dexamethasone in the control of postoperative nausea and vomiting after intrathecal fentanyl and bupivacaine for caesarean section

Background: Postoperative nausea and vomiting (PONV) is an undesirable outcome that parturient who undergo caesarean section experience. We compare the efficacies of IV glycopyrrolate and IV dexamethasone as prophyaxis against PONV in these paturient.Methods: This was a prospective, randomized, double blind placebo-controlled study of seventy six (76) ASA II patients aged 18-40 years who underwent elective caesarean section under spinal anaesthesia. Patients were randomly allocated to three groups, group G (glycopyrrolate): n=26, group D (dexamethasone): n=25 and group C (control; normal saline): n=25. Data collection was with the aid of a proforma which included the biophysical profile, Belville scoring scale for PONV, Likert scale was used for patient satisfaction and side effects were also documented. The data were analyzed using SPSS version 17 and presented in tables and figures.Results: The demographic characteristics and mallampati scores of patients in all 3 groups were similar. The results showed that the incidence of PONV in group D was 8%, in group G 19.2% and in group C 32% (p= 0.048, OR= 0.185, 95% C.I for OR= 0.035 – 0.983). All patients expressed satisfaction in the care they received as assessed using the Likert scale and only patients who received IV glycopyrrolate experienced side effects in the form of dryness of the mouth. There were no side effects reported in patients who received IV dexamethasone.Conclusions: The study demonstrated that IV dexamethasone 8mg was more effective in controlling PONV after intrathecal fentanyl and bupivacaine for caesarean section when compared to 0.2 mg IV glycopyrrolate

Complications following nasotracheal intubation using cuffed polyvinyl chloride tube: a prospective cross sectional study

Background: To examine the complications following nasotracheal intubation by documenting the nasal traumas observed with the use of untreated cuffed polyvinyl chloride tube in unprepared nostrils.Methods: Patients who had maxillofacial surgeries under general anesthesia, muscle relaxation and nasotracheal intubation were included in the study. Nasotracheal intubation was carried out after induction of anesthesia was effected with intravenous propofol and suxamethonium by an Anesthetist using well lubricated cuffed polyvinyl chloride tube. Sizes 6.0, 6.5 and 7.0mm were inserted in females while sizes 7.0 and 7.5mm were inserted in males. Occasionally, the natural curve of the tube guides it through the cords without the aid of Magill forceps. Anterior rhinoscopy was performed by otolaryngologist 24 hours after surgery. Results were subjected to statistical analysis.Results: Sixty four patients were included in the study. They were between the ages of 21 and 63 years (mean 33.2 ± 14.1 years); they were 39 males and 25 females. The most frequently used nasotracheal tube (NT) was size 7.0mm internal diameter. Epistaxis was noticed in 52 (81.2%) patients. There were no statistically significant differences in the incidence of epistaxis observed in males and females, and also between right and left nostrils. A total of 46.8% of nasal trauma were inferior turbinate trauma involving the inferior medial aspect.Conclusion: The use of untreated cuffed polyvinyl chloride tube for nasotracheal intubation in unprepared nostrils is associated with a high incidence of epistaxis and nasal trauma.Keywords: nasotracheal intubation, epistaxis, nasal traum

The effect of anaesthesia and antenatal care on feto-maternal outcome after caesarean section in a developing country

Background: The feto-maternal outcome after delivery is precarious in developing country. The anaesthetic technique and antenatal care as it affect this outcome is assessed.Methods: This is a 5-year retrospective study carried out at the University of Nigeria Teaching Hospital Enugu. Obstetric theatre records of patients who had caesarean section between January 1st 2011 and December 31st 2015 were reviewed. Data extracted from the records using a proformer included socio-dermographic characteristics, indications for surgery, maternal and neonatal outcome, and anaesthetic technique. The data were analyzed using SPSS Version 17 [SPSS Inc., Chicago, IL, USA].Results: A total of 1574 patients had caesarean section within the study period and 1158 (73.6%) of the patients were booked, while 416 (26.4%) were unbooked. The total number of deliveries during this period was 6235 giving a caesarean section rate of 39.6%. More deaths on the operating table were recorded in the unbooked patients as compared to booked parturient (x2=20.013, p<0.001). More babies of the unbooked patients died perioperatively (17.3%) when compared to booked paturient (3.4%) p<0.001.Conclusions: The commonest anaesthesia administered was subarachnoid block. Maternal and neonatal mortality was significantly higher in paturient who did not attend antenatal care compared to those who attended

Amputation‑Related Phantom Limb Pain in Nigeria: A Prospective Cohort Study

Background: Phantom limb pain (PLP) is a common and distressing complication of limb amputations. Literature on PLP in Nigeria and indeedAfrica is scant despite the high rate of amputations in published works. We sought to highlight the burden of PLP among Nigerian amputeesin order to improve awareness and care by health‑care providers. Patients and Methods: In this prospective cohort study, consecutive limb amputees were recruited and relevant data were collected by in‑person interview at 1 week postamputation and subsequently by telephone survey at 6 months and 12 months. The sociodemographic and clinical&nbsp;&nbsp; information of the amputees were recorded, as well as presence of PLP and the treatment offered by the attending physician. The Chi‑square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by P &lt; 0.05. Results: One hundred and fourteen consecutive limb amputations were carried out in 113 patients over a 1‑year period. The period prevalence of PLP was 63.6%, and of these, only 8.6% had this documented in their medical record. No predictor of PLP was identified in the cohort. Conclusion:&nbsp; PLP is highly prevalent among limb amputees in our cohort. We call for improved awareness and practice relating to PLP among&nbsp; health‑care providers and partners, considering the vast population of amputees in the region. Keywords: Africa, American Society of Anesthesiologists physical status grade, amputees, phantom limb pai

Zika virus and birth defects: an obstetric issue

Zika virus is an emerging mosquito-borne virus that is relatively unknown, unstudied and under-diagnosed, but has potentials to spread to new geographical areas that favour survival of Aedes mosquitoes. It is associated with an alarming rise in babies with microcephaly that require much care and support with a lot of financial assistance. This is a review article on Zika virus and birth defects; a worrisome issue in today’s obstetric and medical practices. Since Zika’s discovery in Uganda, the virus was known to occur within a narrow equatorial belt from Africa to Asia with no or mild symptoms. It has emerged as a global public health threat over the last decade with accelerated geographic spread of the virus in the last nine years. The risk of Zika virus to the fetus is poorly understood, difficult to quantify and problematic. The causal link between Zika virus and microcephaly was initially speculative, strongly suspected and scientifically unproven. However, on 13th April, 2016, it was concluded that Zika virus is the cause of microcephaly and other severe fetal brain defects. The Center for Disease Control and Prevention (CDC) authors reviewed and weighed evidences using established scientific criteria to conclude after a careful review of the report published in the New England Journal of Medicine. There is no prophylaxis, treatment or vaccine to protect against Zika virus infection. However, preventive personal measures are highly recommended to avoid mosquito bites

A survey of critical incidents in anaesthesia

Aims: To document the frequency of critical incidents during general anaesthesia, identify the causes of incidents and develop preventive strategies to prevent recurrence of such incidents. Methods: This was a retrospective review of all anaesthetic misadventures in a University Teaching Hospital during a one year period. Results: During the study period, general anaesthetics were administered on 2190 occasions out of which 54 critical incidents were reported. Human error was more frequently responsible than equipment failure. Conclusion: Critical incident reporting was effective in revealing latent errors and in clarifying the role of human error in the generation of incidents. Keywords: anaesthesia, critical incident Orient Journal of Medicine Vol. 17(3&4) 2005: 7-1

Carotid Body Tumour Excision: A Case Report of Anaesthetic Challenges in A Regional Hospital in South-East Nigeria

Carotid body tumour is an uncommon tumour with potential to cause marked haemodynamic instability intraoperatively and turbulent post-operative recovery. A carefully planned anaesthesia is very important for a successful peri-operative management.We report a case of a 44-year-old male that had carotid tumour excision under general anaesthesia. Nitroglycerin was used for hypotensive anaesthesia. Patient was electively ventilated post operatively in the Intensive Care Unit (ICU). Anaesthetic challenges encountered were discussed Key words: Neck, Paraganglioma, Resection, General anaesthesi

The influence of cigarette smoking on the cardiovascular response to direct laryngoscopy and endotracheal intubation

Aim: To determin if cigarette smoking influences the cardiovascular response to direct laryngoscopy and endotracheal intubation under general anaesthesia. Method: This was a prospective study of haemodynamic changes in response to tracheal intubation in 50 ASA 1 (ASA = American Society of Anesthesiologists) men undergoing elective general or urological surgery under general anaesthesia with endotracheal intubation. Twenty-five of the men were smokers of more than 10 cigarettes a day, while the other 25 were non-smokers. Anaesthesia was induced with thiopental and endotracheal intubation facilitated with atracurium. Measurements of systolic, diastolic and mean arterial pressures, heart rate and oxygen saturation were recorded at intubation, 45 seconds after intubation and at 30-second intervals thereafter for a period of 4 minutes. Results: Immediately after intubation, heart rate of smokers [mean: 105.0 (SD17) beats/min] was significantly greater (

The practice of spinal anaesthesia in two tertiary hospitals in South-East Nigeria - review of 100 cases

Background: Spinal anaesthesia is very important as it avoids the numerous complications that could arise from general anaesthesia including airway problems. It is cost effective and can be used for surgeries of up to two hours duration.Objectives: To evaluate the practice of spinal anaesthesia in South-East Nigeria and document the intraoperative complications as was observed in our centre.Methodology: The study is a prospective multi-centre study carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu and the National Orthopaedic Hospital Enugu (NOHE). Patients who were scheduled for surgery under spinal anaesthesia were recruited into the study. Demographic data, type of operation done, American Society of Anesthesiologists (ASA) physical status classification and intra-operative complications were recorded using a proforma. Also, recorded were the size and type of spinal needle and site of injection of local anaesthetics.Results: A total of 100 patients who met the inclusion criteria were simultaneously recruited into the study. They were between the ages of 18 and 75years with a mean age of 40.2 ± 14.5years. They were 50 males and 50 females. The mean weight was 76.0 ± 13kg and the height was 168 ±11.7cm. The mean duration of surgery was 83.3 ± 26.3minutes. Most of the operations done were orthopaedic surgery 46%. The most common intra-operative complication was hypotension with an incidence of 28%, followed by shivering 21%. Other intra-operative complications included pain 9%, nausea 3%, respiratory difficulty 2%, bradycardia 1% and failed spinal anaesthesia 1%. The hypotension observed during caesarean section was significantly higher than in orthopaedic patients (X2=4.060, p = 0.044).Conclusion: In this series no mortality or permanent morbidity was recorded. The practice of spinal anaesthesia is safe.Keywords: Caesarian section, hypotension, intra-operative complication, orthopaedic surgery, safe anaesthesi