Global pediatric anesthesia-Anglophone West Africa perspective.

BACKGROUND: This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services. FINDINGS: Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non-physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith-based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric-specific operating theaters, and inadequate critical care services. SOLUTIONS: The lack of opportunities for sub-specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non-governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed.

A clinical prediction of skin to subarachnoid space depth in parturients undergoing caesarean delivery in a Nigerian population.

Few studies on the prediction of skin to subarachnoid space depth (SSD) in African parturients undergoing caesarean delivery are available. We undertook a prospective observational study of 402 parturients scheduled for elective caesarean delivery to determine simple and clinically applicable formulae for predicting skin to SSD. Additionally, the impact of patient characteristics and variables such as age, height, weight, body mass index (BMI), and body surface area on SSD was studied. We employed a Stepwise Multiple Linear Regression Model to predict SSD in normal weight, overweight, and obese parturients using previously described formulae and compared our derived SSDs to these previous formulae for concordance. (Craig, Abe, Stocker, Chong's modified, Prakash, Ma, Hazarika, Taman and Celik). Mean SSD was 6.62 ± 1.07 cm in the overall population. SSD in normal weight patients was (6.19 ± 0.92 cm), overweight (6.44 ± 0.92 cm) and obese (6.97 ± 1.17 cm). There was a correlation between SSD and BMI (p = 0.001). Formulae for predicting SSD in the overall population, normal weight, overweight and obese parturients were 4.34 + weight × 0.03, 4.43 + weight × 0.03, 4.54 + weight × 0.03 and 3.56 + weight × 0.03, respectively. We also found the Prakash formula to correlate best with our observed SSD. We concluded that SSD correlated well with weight in the overall parturient population and that Prakash's formula was the most accurate of the other previously described formulae in predicting SSD in this subset of African parturients.

What is already known on this subject? Various formulae exist for predicting skin to subarachnoid space depth in adult patients and parturients.What the results of this study add? New formulae for predicting skin to subarachnoid space in a subset of African parturients are described and only one of the previously described formulae was found to reliably predict depth of the subarachnoid space in this cohort.What the implications are of these findings for clinical practice and/or further research? Formulae for the determination of skin to subarachnoid space depth using weight alone can be predictive for normal, overweight and obese parturients. Knowledge of the predicted depth can help guide appropriate needle selection and minimise wastage, especially in resource poor countries.

Anesthetic challenges in oro-facial cleft repair in Ile-Ife, Nigeria.

BACKGROUND AND METHODS: A retrospective review of all patients with oro-facial lip defects operated at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria over an 18 month period was undertaken with a view to determine: the pattern of presentation; associated clinical problems and congenital anomalies; perioperative complications; anaesthetic techniques used and outcomes; and the determinants of outcome. RESULTS: Of the 80 patients treated, 74 were managed under general anaesthesia but the case records of only 60 (81%) of these patients were available for review. The ages ranged between 3 months and 59 years. The male to female ratio was 1:1. Eighty percent of all cases studied were cleft lip (CL) +/- cleft palate (CP). Of these, 65% were left sided CL, 23% were right sided while 12% were bilateral. All patients had ASA score 1 or 2 at the time of surgery. Halothane in O2 induction was employed in 60% of the patients while 40% had IV induction. Intubation was facilitated with muscle relaxant in 63.3% of these patients. Naso-tracheal intubation was performed in 82% of all cleft palate repairs. Preoperative complications were encountered in 18% of the patients. Associated congenital anomalies were noted in 5% of the cases. One case each of difficult intubation and failed intubation were encountered. Intra-operative dysrrhythmia was noted in 5% of cases; no life-threatening complication was encountered peri-operatively. CONCLUSIONS: There is a dramatic increase in the number of patients presenting for care due to improved awareness of the population. Peri-operative attention to detail is essential in handling the challenges posed by the condition.

Post-operative symptoms at home in children following day case surgery.

BACKGROUND: This prospective questionnaire-based study examined the post-operative symptoms encountered by children who had day case surgery at a dedicated day case surgery unit. The study evaluated the postoperative symptoms at home. The parents also evaluated the instructions given in the hospital for care at home. METHODS: All children aged 1 day - 14 years operated over a one year period were prospectively followed up following elective day case surgery. The incidence and duration of symptoms were evaluated using a structured questionnaire completed by the parents. Also, the instructions given in hospital for care at home were evaluated by the parents using another questionnaire. RESULTS: A total of 100 children were operated during the period. Pain (72%), emetic symptoms (16%) and difficulty with walking (7%) were the commonest symptoms occurring on the way home. There were no unplanned admissions. Two thirds of the parents did not know enough of the treatment of the wound and of the overall recovery of the child. CONCLUSION: Post operative symptoms following elective day case surgery are amenable to treatment and prevention with a wider use of available drugs for peri-operative analgesia.