Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital

BackgroundGeneral anaesthesia and regional anaesthesia have been used successfully for upper extremity orthopaedic procedures. Despite the advantages of regional anaesthesia, there is low utilisation in Nigeria. In this study, weassessed the types of anaesthesia employed for upper extremity surgeries in our centre.MethodsAfter obtaining approval from the institutional ethics committee, all the patients who had upper extremity surgeries from 1 January 2011 to 31 December 2012 were included in this review. Both prospective and retrospective data were gathered. The choice of anaesthesia was at the discretion of the attending anaesthetist.ResultsA total of 226 patients with a male-to-female ratio of 1.6:1 and median age of 35.0 (range 2 – 89) years, had orthopaedic upper extremity procedures during the study period. Sixty-three cases (27.9%) had general anaesthesia, 5 (2.2%) combined regional and general anaesthesia while 158 (69.9%) had regional blocks. The regional blocks comprised 145 (89%) different approaches to the brachial plexus and 18 (11%) local anaesthetic infiltrations. The arm was the site mostly operated upon; while supraclavicular and axillary brachial plexus blocks were performed in equal amounts. In 14 (6.2%) patients, brachial plexus blocks were performed with spinal anaesthesia because of concomitant iliac crest bone grafts. While the duration of surgery did not differ significantly, regional anaesthesia provided a significantly longer duration of anaesthesia than general anaesthesia (251 ± 70.8 min versus 141.3 ± 65.5 min; p = 0.0000001).ConclusionThere is a high use of regional anaesthesia for upper extremity orthopaedic surgeries in our centre, which is a positive development in a resource limited setting

Cardiac arrest during anesthesia at a University Hospital in Nigeria

Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably.Materials and Methods: After obtaining institutional ethics approval, we retrospectively reviewed patients’ hospital records such as anesthetic charts and register and ICU admission charts between 1st July 2005 and 30th June 2010. The cardiac arrests encountered during anesthesia was identified from anesthetic charts and followed‑up in the intensive care unit (ICU) for the first 24 h postoperatively. We consider that cardiac arrest occurred in any patient under anesthesia with asystole or ventricular fibrillation requiring cardiac compression or electrical defibrillation. We define recovery as an alive and non‑comatose patient 24‑h after the cardiac arrest.Results: During the study period, a total of 12,143 surgeries were done; the median age of all the patients was 30 years (range: 1 day-119 years). A total of 31 cardiac arrests identified (frequency 25.5:10,000; 95% confidence interval (CI) 17.7‑35.8) out of which 17 were nonfatal. Mortality related to anesthesia was 11.5:10,000 (95% CI 6.5‑18.9). The median age of patients with cardiac arrests was 39 years (range: 2 months–78 years). Overall, 80.7% cardiac arrests occurred in the American Society of Anesthesiologists’ (ASA) physical status 3-5. Cardiothoracic and neurosurgical operations accounted for 54.8% of the total cardiac arrests. The known risk factors identified among those who had cardiac arrest were, ASA physical status 3-5 (80.7%), procedures performed out‑of‑work hours (60%), and manually ventilating patients during general anesthesia (39%).Conclusion: Cardiac arrest during anesthesia is higher in poor risk patients (ASA 3-5) who are manually ventilated under general anesthesia and operated during out‑of‑work hours.Key words: Anesthesia, cardiac arrest, fatal, nonfatal, outcom

Clinical characteristics and outcome of patients with upper gastrointestinal bleeding at the emergency department of a tertiary hospital in Nigeria

Background: Upper gastrointestinal bleeding is a potentially life threatening condition with multiple causes. There is scarcity of health data depicting the clinical characteristics of the condition in African countries. This study was designed to describe the demographic, clinical characteristics and outcome of the patients who presented to our Emergency Department.Methods: The records of cohort of all patients admitted with upper gastrointestinal tract bleeding from 1 January 2011 to 31 December 2012 were retrospectively reviewed from admission to discharge or death.Results: There were 169 patients with median age of 44.0 years (range 13-89); 25 (15.0%) of them were known peptic ulcer disease patients. Most (69.2%) of the patients were males. The most common presenting symptom was haematemesis (34.9%) followed by melaena (16.6%). There was a history of NSAIDs use in 16.8% and alcohol ingestion in 12%. Upper Gastrointestinal Endoscopy was performed in 6.8% cases. Twenty-three (13.6%) patients died. There was association between mortality and diastolic blood pressure; more deaths (1/7; 14.3%) occurred in those with diastolic blood pressure > 90mmHg compared with <90mmHg (5/70; 7.1%) (P = 0.002). There were more deaths among patients who did not receive blood transfusion (4/40; 10.0%) compared with those who had blood transfusion (2/37; 5.4%) (P=0.008).Conclusions: The common presentations were haematemesis and melaena, mainly in middle aged men with mortality in one out of seven patients. The high mortality may be due to co-morbidities and poor support services.Keywords: Upper gastrointestinal bleeding, Emergency department, Characteristics, Outcom

Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

Background: In this pilot study, we evaluated the postoperative analgesic effect of the new lamina thoracic paravertebral block using a single-shot technique for major breast cancer surgery.Methods: A retrospective observational design was used to compare data involving 16 consecutive ASA 1 and 2 female patients who had unilateral modified radical mastectomy with axillary clearance under general anaesthesia with paravertebral block and 15 others without block between 13/03/2014 to 12/05/2015. We compared the time to the first request for analgesic, total analgesic (opioid and non-opioid) consumption (in mg) and postoperative pain scores over 72 h between the two groups.Results: One patient was excluded from the cohort due to block failure. The median time to first request for analgesic was 43 h (25.2-73.0 h) in the block group versus 2 h (1.0-2.5 h), p=0001. The pain scores was significantly lower at all measurement points among the block patients compared with the no-block group until 24 h postoperatively. No patient in the block group required analgesic within 24 h after surgery. The total consumption of pentazocine was nil (block group) vs. 154.0±74.2 (range 90-300) mg, p=0.0000001.Conclusions: Single-shot lamina paravertebral block provided prolonged postoperative analgesia and reduced opioid and non-opioid consumption

Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian Hospital

Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our centre even for hand surgeries.Objective: To evaluate the use and outcome of brachial plexus blocks for upper extremity surgeries.Design: A retrospective review of patients’ records and prospective observation of patients with upper extremity surgeries.Setting: The University College Hospital, Ibadan, situated in Southwestern Nigeria with over 875 beds.Subjects: Patients who had surgeries of the shoulder, humerus, elbow, forearm, wrist and hand were studied.Results: In 2006 and 2007, only general anaesthetic accounted for the 220 upper extremity surgeries. However, in 2008, 2009 and 2010, brachial plexus blocks accounted for 6.9, 27.9 and 48.6% respectively. From a success rate of 60.0% in the first year of practicing brachial plexus anaesthesia using 40% paraesthesia technique, the second and third years were 78.9 and 96.5% respectively due to better localisation techniques (nerve stimulation alone or in combination with echo-guidance).Conclusion: Our study shows an increasing successful use of brachial plexus block techniques for upper extremity procedures

Epidemiology of road traffic crashes among long distance drivers in Ibadan, Nigeria

Background: Road Traffic Crashes (RTCs) are major causes of morbidity and mortality in Nigeria. Few studies in Ibadan have focused on the distribution and determinants of RTC among long distance drivers.Objective: To describe the distribution of crashes by place, times of occurrence, characteristics of persons involved and identify associated factors.Methods: A cross-sectional study was carried out among consenting long distance drivers within selected parks in Ibadan.Results: Respondents (592) were males, with median age of 42.0 years (range 22.0-73.0 years). Secondary education was the highest level of education attained by 38.0%. About 34.0% reported current use of alcohol. The life-time prevalence of crashes was 35.3% (95% CI= 31.5-39.2%) and 15.9% (95% CI=13.1-19.0%) reported having had at least one episode of crash in the last one year preceding the study. The crash occurred mainly on narrow roads [32/94 (34.0%,)] and bad portions of tarred roads [35/94 (37.2%,)] with peak of occurrence on Saturdays 18/94 (19.1%,). Significantly higher proportions of drivers aged ≤39years (23.4%) versus >39years (11.7%), those with no education (29.9%) versus the educated (13.8%) and those who reported alcohol use (21.9%) versus non users (12.8%) were involved in crashes in the year preceding the study. Significant predictor of the last episode of crashes in the last one year were age (OR=2.2, 95% CI=1.4-3.5), education (OR=2.7, 95% CI=1.5-4.6) and alcohol use (OR=1.8, 95% CI=1.2-3.0).Conclusion: Road traffic crashes occurred commonly on bad roads, in the afternoon and during weekends, among young and uneducated long-distance drivers studied. Reconstruction of bad roads and implementation of road safety education programmes aimed at discouraging the use of alcohol and targeting the identified groups at risk are recommended.Keywords: Road traffic crashes, long distance drivers, mortalit

An assessment report on an immunization clinic located in a tertiary institution in Ibadan

Objectives: The aims of the assessment report were to appraise immunization system components and review vaccination coverage between January 2007 and December 2011 at the University College Hospital (UCH) immunization clinic.Methods: The immunization clinic has an annual target population of 997 (for children < one year of age) and 1246 (for pregnant women), which were used in this assessment. The data collection method used included; Key informant - interview, administration of a semi-structured  questionnaire, records review and observations during immunization sessions.Results: The UCH immunization clinic mainly offers fixed sessions and only provides outreach services when there is a need, such as during outbreaks. However, there are no records of vaccinepreventable diseases being  monitored. The coverage rate for nearly all of the vaccines was greater than 100% of the estimated target population for the hospital. Except for the coverage rate of Bacille Calmette Guerin (BCG) vaccine, which peaked in 2011, other vaccines’ coverage peaked in 2009, after which therewas a decline. The highest dropout rate was recorded in 2007, while the rates between 2009 and 2010 were <10%, but the BCG and measles drop out rates were >10% for the 5-year period. For the adult immunizations, yellow fever recorded the highest coverage rate, while the lowest rate was recorded for tetanus toxoid dose 5 (TT5). The vaccines that were most often in short supply included Diphtheria-pertusis-tetanus, Hepatitis B,yellow fever, oral polio, and cerebrospinal meningitis vaccines. Although good-quality supplies, equipment and consumables were observed, there was no inventory of these items. There were evident interpersonal communication and community mobilization as well as capacity building for staff.Conclusion: The assessment showed there was progress in the provision and administration of immunization based on available resources. There is, however, the need to improve documentation of clinic activities

Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana

Abstract Background There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana. Methods Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models. Results The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177–9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636–20.430) were significantly associated with polypharmacy after regression analysis. Conclusion Psychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana

Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

Ambrose Rukewe,1 Oludolapo O Afuwape,2 Austin Ugheoke,3 Akinola A Fatiregun4 1Department of Anaesthesia & Critical Care, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Surgery, College of Medicine, 3Department of Anaesthesia, University College Hospital, Ibadan, 4World Health Organisation, Akure, Ondo State, Nigeria Abstract: We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8 months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95 minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable. Keywords: anesthesia, breast surgery, lamina, paravertebral, low resourc

Interscalene block for shoulder surgery

Fracture dislocation of the shoulder is a common musculoskeletal injury following road traffic accident. Peripheral nerve block has become a recognized anesthetic technique due to the rapid onset of prolonged analgesia, sufficient for both pain and surgical management. However, interscalene block for shoulder surgery has not been reported as a primary anesthetic technique in our environment. We report its successful use in open reduction and internal fixation of left humeral surgical neck fracture dislocation. The interscalene brachial plexus were localized by a Polystim II nerve stimulator (te me na, Bondy, France) with sustained biceps motor response at 0.2 mA and 40 ml of local anesthetic, comprising 0.25% bupivacaine and 1.0% of lidocaine with 1 : 200 000 epinephrine in equal parts was administered to establish the block. Surgical anesthesia was achieved 18 minutes after instituting the block and surgery lasted 70 minutes without complications. This technique may obviate the use of general anesthesia with its risks.DOI: 10.4103/1596-3519.82063