Nigeria's policy towards southern Africa 1966-1979

SIGLEAvailable from British Library Document Supply Centre- DSC:DX95725 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Does the Addition of Neostigmine to Intrathecal Bupivacaine-Fentanyl provide Significant Haemodynamic Stability in Patients Undergoing Surgery under Spinal Anaesthesia?

Background: Hypotension is a common complication of spinal anaesthesia. Neostigmine, an anticholinesterase, when given intrathecally has been shown to counteract the hypotensive effects of local anesthetic thereby providing haemodynamic stability during spinal anaesthesia. The aim of this study was to test the hypothesis that neostigmine when added to intrathecal bupivacaine could counteract the hypotensive effect of the local anaesthetic agents and thereby maintaining the stability of blood pressure and heart rate.Patients and Methods: Sixty male adult patients,ASA 1-1 I requiring surgical procedures under subarachnoid block were randomly allocated into Neostigmine and Saline groups. Patients in Neostigmine group (NG) received 15mg of 0.5% hyperbaric bupivacaine, fentanyl 25mcg and preservative-free neostigmine 25mcg intrathecally while patients in the Saline group(SG) received same dose of heavy bupivacaine and fentanyl plus 0.5ml saline. Perioperatively, the haemodynamic (blood pressure and heart rate) changes after subarachnoid injection were recorded.Results: Four patients (13.8%) in the saline group and two patients (6.7%) in the neostigmine group fulfilled the criteria for hypotension. The incidence of hypotension and bradycardia in the two groups was not statistically significant, p = 0.424 (hypotension) and p = 1.000 (bradycardia). Three patients (I 0.3%) in the saline group developed bradycardia, mean hear rate (MHR) of 51 beats/min while three patients ( 1 0.0%) in the Neostigmine group also had bradycardia, MHR of 54. beats/min, p = 0.166.Conclusion: Neostigmine at a dose of 25mcg in combination with hyperbaric bupivacaine and fentanyl given intrathecally provided statistically insignificant haemodynamic stability in male patients that had surgical procedures under spinal anaesthesia.Key Words: Intrathecal Neostigmine, Bupivacaine-Fentanyl, Haemodynamic changes, Spinal anaesthesia

An Evaluation of Open Tracheostomy in Oral and Maxillofacial Surgery

This study was carried out to evaluate the indications, utilisation and the overall impact of tracheostomy on the practice of Oral and Maxillofacial Surgery at the University College Hospital, Ibadan, Nigeria. In a retrospective study of a total of 381 patients operated under general anaesthesia by the Department of Oral and Maxillofacial Surgery within the study period, 41 patients (10.8%) were tracheostomised. There were 26 males and 15 females with a ratio of 1.7:1 and the mean age was 28.9 years (SD = 12.25, range of 5 – 65 years). Indications for tracheostomy were orofacial tumours 70.7% (n=29), trauma 19.5% (n=8), temporomandibular joint (TMJ) ankylosis 7.3% (n=3) and post operative airway obstruction 2.4% (n=1). Orofacial tumours account for a major part of the indication for tracheostomy as a surgical airway intervention which is safe and with low morbidity. Keywords: Tracheostomy, Airway management, Orofacial tumoursNigerian Journal of Surgical Sciences Vol. 17 (2) 2007: pp. 96-10

The challenges of single-shot spinal anaesthesia for cesearean section in a morbidly obese patient: a case report

An unusual case of morbid obesity, severe hypertension and twin gestation at 36weeks in an unbooked multigravid patient was presented for cesarean section. She was referred from a private clinic to the obstetric emergency unit of the University College Hospital, Ibadan with history of hypertension in pregnancy. She was a known hypertensive for ten years and her blood pressure was poorly controlled due to non-compliance with medications and medical check-up. She had been having progressive visual loss over the ten year period and had lost three previous pregnancies. Following comprehensive clinical and radiological evaluation, she had a carefully planed single-shot spinal anaesthesia for cesarean delivery of a set of twin which was performed on a double operation table. She remained stable throughout the procedure and post operative period. Keywords: single-shot spinal anaesthesia, obesity, hypertension, cesarean sectionTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 202-20

Intensive care unit admissions during the puerperium in Ibadan

Context: Intensive care unit (ICU) admissions of parturients are rare and is about 0.2% of total number of maternities per year in the United Kingdom (UK) compared to 1.1% reported from a teaching hospital in Benin, Nigeria. Objective: This study sought the indications and outcome of critically ill obstetric patients admitted into the intensive care unit (ICU) of the University College Hospital (UCH), Ibadan, Nigeria in the year 2001. Study Design, setting and subjects: Descriptive study involving 21patients admitted into the ICU, University st st College Hospital, Ibadan, between 1 January to 31 December 2001. Data was prospectively collected from each obstetric patient admitted. Results: The total number of deliveries during the year was 1,132 and 21 patients required admission into the ICU (1.86%). The median age was 26 years with a range of 20 35years. Eighteen patients (81%) were admitted postemergency caesarean section or exploratory laparatomy. Eclampsia accounted for 47.6% (10/21) of the admissions, followed by severe haemorrhage from ruptured uterus 33.3% (7/21). Ten patients died giving a mortality rate of 47.6% in this series of obstetric patients admitted into the ICU. Conclusion: The admission rate of obstetrics patient into the ICU in Ibadan is 1.86%, this may be reduced by an improvement in the management of hypertensive disease of pregnancy and reducing the incidence of ruptured uterus through health education of parturient with high risk pregnancies on the need to have monitored ante-natal care and delivery. Keywords: obstetric, ICU admissions, indications, outcome Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 56-5