Routine hemoglobin electrophoresis for pediatric surgery day case in at-risk populations: Suggested algorithm for screening using clinical risk factors.

BACKGROUND: Hemoglobin electrophoresis (HBE) is a part of the preoperative routine requested by anesthetists. However, the prevalence of hemoglobinopathy in the population is low. This study aims to determine the clinical risk factors for hemoglobinopathies and propose clinical guidelines for preoperative screening of patients for pediatric day care surgery. PATIENTS AND METHODS: A prospective study carried out over 12 months. Consecutive patients aged 6 months and older who had day case surgery were recruited to the study. Biodata and relevant clinical data were collated and documented in a proforma and analyzed using a statistical package for social sciences version 17. RESULTS: There were 124 patients106 boys and 18 girls. The median age was 3 years. Scrotal lesions were the most common conditions managed (71.7%). Seventy-eight percent of patients had HbAA, 15.3% had HbAS, and 4.8% had HbAC while 0.8% each had both HbSC and HbSS. At least one parent of 78.2% knew their Hb phenotype, of which, 79% were HbAA. A history of jaundice (P = 0.0001), hand and foot syndrome (P = 0.0001), frontal bossing (P = 0.0001), and low packed cell volume at surgery (P = 0.001) were found significant in predicting hemoglobinopathies. There was no mortality. CONCLUSION: Risk factors for hemoglobinopathies from this study included a positive history of jaundice, hand and foot syndrome, frontal bossing, and anemia. Proposed guidelines for HBE screening include the presence of hemoglobinopathy in one parent if one parent has sickle cell trait, and the other parent's genotype is unknown or if any of the risk factors is present.

Tracheal Intubation in the Emergency Department of a Sub-Saharan Teaching Hospital:A One-Year Survey at Lagos University Teaching Hospital, Nigeria.

OBJECTIVES: To identify the indications for tracheal intubation in the emergency department of the Lagos University Teaching Hospital and problems encountered with the view to improve patient outcome. METHODS: A one-year prospective observational study of endotracheal intubation in the emergency room (ER) of the Lagos University Teaching Hospital. Data collected included indications, methods, success rates, use of drugs and complications of intubation. RESULTS: Ninety-four patients underwent endotracheal intubation. Indications included severe traumatic brain injury (58.5%) and traumatic brain injury with associated multiple injuries (10.6%). Anaesthetist registrars performed 73.9% of the intubations. Seventy seven patients (81.9%) were successfully intubated at the first attempt. No patient required a surgical airway due to failed intubation. The mean time from a decision to intubate to successful tracheal intubation was 129.90 ± 23.43 mins. 63.8% of the patients were intubated between 4 pm-8 am. Causes of delay in endotracheal intubation were non availability of skilled personnel (47.9%), non-availability of drugs (27%) and lack of oxygen (25%). Eighty-eight patients (93.6%) had complications at intubation: hypotension (42.5%), desaturation (34%), oesophageal intubation (2.1%), bronchial intubation (5.3%), cardiac arrest (2.1%). Post intubation complications included: blocked tube in 3 patients, accidental extubation in 4 patients and kinking of tube in 1 patient. Nine patients (9.6%) improved and were extubated. CONCLUSION: In this institution, the majority of Emergency department intubations were performed by anaesthetists after working hours with a very high success rate and a low rate of post-intubation serious complications. The delay in intubation should urgently be addressed to improve patient outcome.

Has the middle-level anaesthesia manpower training program of the West African College of Surgeons fulfilled its objectives?

An audit of the West African College of Surgeons' middle-level Diploma in Anaesthesia program was carried out to determine the current status of the diplomates. Using the West African College of Surgeons' database, social media and personal communications, the current status of Diploma in Anaesthesia graduates spanning 20 years was determined. A total of 303 (97%) out of 311 of graduates were traced. Eighty percent were still practising anaesthesia, while 5% were now in other disciplines. Two hundred and four (67.3%) still resided in West Africa (183 in Nigeria, 50 in Ghana, one in Sierra Leone), while 69 (22.7%) were abroad: 35 (11.5%) in the United Kingdom, 21 (6.9%) in the United States of America and four (1.3%) in Canada. More Ghanaian than Nigerian graduates had emigrated (41 vs 14%, respectively). Only 9% of diplomates remained in rural communities (as originally envisaged), while 31% were now consultants (as fellows) and 30% were registrars in fellowship training. These findings indicate that most diplomates moved on to acquire further qualifications and a significant proportion migrated. The program did not appear to have achieved the objectives of meeting rural middle-level manpower needs in anaesthesia as envisaged. It has, however, boosted the recruitment drive for residency training in anaesthesia. Perhaps a less migrant cadre such as nurses may better serve this function if recruited into a suitably designed training program in countries desiring to use middle-level manpower in anaesthesia.

Comparison between rocuronium and suxamethonium muscle relaxants in ocular trauma surgery.

BACKGROUND: Suxamethonium causes a rise in intraocular pressure (IOP). Its use for intraocular surgical procedures especially management of the penetrating eye injury is controversial because of the risk of extrusion of vitreous contents. This risk can be avoided by substituting it with rocuronium. The aim of this study was to compare the IOP changes and intubating conditions following the use of both muscle relaxants. AIM AND OBJECTIVES: To compare the intraocular pressure changes and intubating conditions following the use of both suxamethonium and rocuronium. DESIGN OF STUDY: Prospective, randomized, double-blind study. STUDY SETTING: The operating theatres of the Lagos University Teaching Hospital Patients and Methods: A prospective, randomized study in which 70 patients received suxamethonium 1.5mg/kg or rocuronium 0.9mg/kg after induction with thiopentone 5mg/kg. Laryngoscopy was performed after 60 seconds. Measurements of IOP were taken before induction, 1 minute after administration of either muscle relaxant and at 1, 3 and 5 minutes after intubation. Intubating conditions were evaluated using a simple scoring system. RESULTS: Suxamethonium caused a significant rise in intraocular pressure throughout the study period (p < 0.005), maximal 1 minute after intubation (p < 0.001). Rocuronium caused a significant fall in intraocular pressure 1 minute after administration (p < 0.001) and this remained less than the baseline value in the post intubation period. Intubating conditions in both groups were similar. CONCLUSION: Rocuronium is preferred as muscle relaxant for tracheal intubation when a rise in intraocular pressure is undesirable.

Multiple venous thrombosis complicating central venous cannulation in a non cancer patient - a case report.

Central venous catheterization is a common procedure for critically ill patients. Like all procedures, it has its complications, one of which is thrombosis. Reports of thrombosis are commoner among cancer patients. We present a 37 year old non cancer patient who developed thrombi in both right and left internal jugular veins, 10 and 13 days respectively after insertion of central venous catheter. This was detected by ultrasound scans of the neck while attempting re-cannulation for parenteral feeding. She also had left lower limb deep venous thrombosis, confirmed by doppler scan, which was managed with low molecular weight heparin and warfarin. The patient was subsequently treated with streptokinase. A repeat scan of the internal jugular veins 4 days after thrombolysis revealed a reduction in size of the thrombi. Symptoms of deep venous thrombosis improved and she was transferred to the wards where she made remarkable improvement. This case illustrates the potential usefulness of ultrasound guided-central line insertion in patients who have had central venous lines inserted previously in order to detect thrombi.

Routine haemoglobin electrophoresis screening in day case herniotomy in Nigerian children: Is it evidence-based?

BACKGROUND: To determine the prevalence of haemoglobinopathies in children who require day case herniotomy in our centre and ascertain if routine screening is necessary in all patients who require herniotomy. MATERIALS AND METHODS: A 12-month retrospective analysis of patients requiring herniotomy in our centre. Data including age, sex, diagnosis, haemoglobin electrophoresis status, surgical outcome and hospital stay were analysed. RESULTS: Ninety-five patients had complete records. There were 84 boys and 11 girls. M:F ratio: 7.6:1. The mean age was 3.2 ± 0.6 years. Fifty-five point eight per cent of the patients had right inguinal hernias while 35.8% had left inguinal hernias. Eight patients (8.4%) had bilateral inguinal hernias. Twenty-six patients (27.4%) had haemoglobinopathies while 69 patients (72.6%) had homozygous Haemoglobin A. The Sickle Cell trait (HbAS) was found in 22 patients (23.2%) while the HbAC was found in three patients (3.2%). One patient (1.1%) had Sickle Cell disease (Haemoglobin SS). He had had blood transfusion and previous history of jaundice. All patients survived and all patients were discharged on the day of surgery (mean hospital stay: 4hrs (range: 2.5 hrs-12 hrs)) except the patient with Sickle Cell disease who was admitted a day before surgery and discharged a day after the operation. CONCLUSION: One in four children coming for day case herniotomy in our centre had the Sickle Cell trait while only 1% had the Sickle Cell disease. These findings are in keeping with the prevalence in the Nigerian population. Routine screening may not be necessary for all patients coming for herniotomy in our centre. Clear indication(s) should be outlined for screening.

The effect of nail polish and acrylic nails on pulse oximetry reading using the Lifebox oximeter in Nigeria.

AIMS AND OBJECTIVES - Pulse oximetry is mandatory during anaesthesia, sedation and transfer of critically ill patients. The effect of nail polish and acrylic nails on the accuracy of saturation reading is inconsistent. The Lifebox pulse oximeter is reliable and recommended for low and middle income countries. We investigated its accuracy in the presence of 4 nail colours and acrylic nails SUBJECTS AND METHODS Fifty non-smoking volunteers had their fingers numbered from right to left (little finger of right hand =1 and little finger of left hand =10). Alternate fingers were nails painted with clear, red, brown and black nail polish and the 5th finger had acrylic nail applied. The corresponding finger on the other hand acted as control. The oxygen saturation was determined using the Lifebox pulse oximeter. Results All fingers (100%) with clear nail polish, red nail polish and acrylic nails recorded a saturation value. Each of the mean saturation value for clear nail polish, red nail polish and acrylic nails was not significantly different from the control mean (p= 0.378, 0.427 and 0.921). Only 12% and 64% of nails polished black and brown respectively recorded a saturation value. The mean SpO- for black and brown polish were significantly different from their control mean (p<0.001). CONCLUSION Black and brown polish resulted in a significant decrease in SpO with the Lifebox oximeter. Dark coloured nail polish should be removed prior to SpO2 determination to ensure that accurate readings can be obtained.

Low-dose intravenous ketamine improves postoperative analgesia after caesarean delivery with spinal bupivacaine in African parturients.

BACKGROUND: In the absence of neuraxial opiates, postoperative analgesia after caesarean delivery is limited by the duration of action of bupivacaine. This could be prolonged by the co-administration of adjuvants such as ketamine. METHODS: Spinal anaesthesia was performed in 60 parturients using hyperbaric bupivacaine 15 mg. Patients were randomly allocated to receive a 2-mL intravenous injection of either ketamine 0.15 mg/kg (Group BK) or 0.9% saline (Group B) immediately after institution of spinal anaesthesia. Postoperative pain was assessed using a visual analogue scale and the time of first postoperative analgesic administration was noted. Postoperative analgesia was provided with intramuscular pentazocine and diclofenac, the total doses of which were recorded over 48 h. RESULTS: The mean (SEM) time of first postoperative analgesic administration was significantly longer in Group BK (209±14.7 min) than in Group B (164±14.1 min) (P<0.001). Pain scores were significantly lower in Group BK than in Group B for 120 min after surgery (P=0.022). Patients in Group BK required significantly less diclofenac (P<0.001) and pentazocine (P<0.001) on day one after surgery. There was no difference in diclofenac (P=0.302) and pentazocine (P=0.092) consumption between the groups on the second postoperative day. The incidence of adverse effects was not different between the groups. CONCLUSION: The use of intravenous low-dose ketamine as an adjuvant to bupivacaine for spinal anaesthesia for caesarean delivery was associated with longer postoperative analgesia and lower early postoperative analgesia consumption than bupivacaine alone.

Propofol versus halothane in paediatric daycase surgery: a comparison of the duration of induction and haemodynamic profile.

BACKGROUND: Inhalational induction with Halothane is commonly used for anaesthesia in children. Its drawbacks include bradycardia and hypotension. Intravenous propofol has recently challenged this position. OBJECTIVE: This study sought to compare duration of and cardiovascular changes at induction of anaesthesia in children. METHODS: Sixty ASA I and II children aged 1- 7 years scheduled for elective daycase surgery were prospectively studied from January to July 2008. They were assigned to receive inhalational induction with halothane 3% or intravenous induction with 3.5mg/kg of propofol. Heart rate, systolic, diastolic and mean blood pressure as well as oxygen saturation were monitored throughout induction. The duration of induction as well as any complications were documented. RESULTS: Demographic data was comparable between the two groups. Duration of induction was significantly longer in the halothane group 8.23 +/- 2.34 minutes compared with 2.30 +/- 1.26 minutes in the propofol group (p < 0.001). Heart rate rose by 4.7 +/- 17.73 beats/minute in the propofol group and fell by 4.19 +/- 18.03 in the halothane group (p = 0.05). Systolic, diastolic and mean blood pressures fell in both groups with values being less in the halothane group. These differences were not significantly different (p = 0.189, p = 0.059, p = 0.058 respectively). Sixteen patients (33%) in the propofol group developed apnoea compared to 2 (6.6%) in the halothane group (p < 0.001). The duration of apnoea differed significantly between groups (p = 0.003). CONCLUSION: Halothane and propofol had similar changes to cardiovascular parameters during anaesthetic induction. The shorter duration of induction of propofol may be preferable for daycase surgeries.

Appropriate practice of anesthesia: A plea for better training.

BACKGROUND: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern. METHODS: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice. RESULTS: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4%) of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6%) discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2%) respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important. CONCLUSION: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.

Submental / transmylohyoid intubation in maxillofacial surgery: report of two cases.

The submental / transmylohyoid intubation technique, as an alternative technique of airway management in oral and maxillofacial surgery, and its modifications, have been widely reported in the literature since it was first described by Altemir in 1986. However, the technique is not yet popular in Nigeria and Africa in general. A report of two cases in which this technique was used in orofacial reconstruction is presented here. The surgical / anesthetic outcome was satisfactory. No complication was seen in the two cases, and healing of the submental wound was uneventful. Submental intubation is a reliable technique of alternative airway management in oral and maxillofacial surgery. The submental / transmylohyoid technique should be considered by both the anesthetist and the maxillofacial surgeon in challenging cases, where an alternative airway technique is required for maxillofacial surgery.

Airway and respiratory complications in children undergoing cleft lip and palate repair.

OBJECTIVES: Anatomical abnormalities associated with cleft lip and palate increase the risk of airway complications. The aim of this study was to determine the incidence of intra-operative airway and respiratory complications during cleft lip and palate repair and identify risk factors. DESIGN: Observational study in which fifty consecutive patients undergoing cleft lip or/ and palate repair (CL, CP, CLP) were prospectively studied in a teaching hospital in Nigeria. Anaesthesia was achieved by the inhalational or intravenous route. Tracheal intubation was performed under deep inhalational anaesthesia or muscle relaxation. All patients were ventilated. Demographic data, airway and respiratory complications were documented. RESULTS: The mean age of the patients was 26.62± 4.71(SEM) months (median 11.50). Nineteen airway complications occurred in 16 patients (incidence - 38%) as failed and difficult intubation (2% respectively) which only occurred in CP surgeries, Tube disconnection (6%), Tube compression (2%), Accidental extubation (2%) and Desaturation (14%). Laryngeal spasm (6%) and Bronchospasm (4%) occurred in surgeries for CP repair only. Some patients had more than one complication. Complications occurred in 38.4% of patients having CP repair, 15.8% having CL repair and 50% having CLP repair (p=0.185). This was not influenced by weight nor age group (p = 0.076 and 0.400 respectively). CONCLUSION: Cleft repair had a high incidence of airway/ respiratory complications. More complications occurred with CP surgery. There is a need to ensure adequately skilled personnel and appropriate monitoring to minimise morbidity.

Day case cleft lip surgery in Lagos, Nigeria.

BACKGROUND: The correction of cleft lip deformity has included overnight admission and postoperative ward admission from 5 to 7 days. In developing countries, increasing cost of treatment and medical insurance and shortage of bed space have led to a reduction in the length of hospitalization or its elimination for some cases of surgery. OBJECTIVE: To assess the feasibility and complications associated with day case cleft lip surgery in our center. METHODS: A prospective study of patients undergoing day case cleft lip repair at three hospitals from 1995 to 2005. RESULTS: A total of 43 patients were seen. Twenty seven (63.8%) were treated as day case, and 16 (37.2%) were operated as inpatients. The mean age for patients treated as day case was 1.32 +/- 1.45 years. Fifteen (55.6%) of these patients had severe associated nasal deformities, six (22.2%) had moderate nasal deformity, and four (14.83%) had mild nasal deformity. The only complication was a nasovestibular fistula that occurred in one of the day case patients. From 27 patients operated on as day cases, eight calls were received. Two (7.4%) mothers called to report febrile illness in their children on the first postoperative day. Two mothers (7.4%) reported excessive crying. The most frequent reason for postoperative consultation was obstruction of the modified nasal retainer, which occurred in four patients (14.8%). CONCLUSION: Day case surgery for cleft lip can be said to be safe, with a 2.3% rate of complications in selected patients. Day case surgery was a cheaper alternative to admission.

Intraocular pressure changes in a Nigerian population--effects of tracheal tube and laryngeal mask airway insertion and removal.

OBJECTIVES: Laryngoscopy and tracheal intubation lead to acute elevation in intraocular pressure (IOP); the ocular hypertensive response. The Laryngeal mask airway prevents sudden surges in IOP. We compared IOP changes to the insertion and removal of the Laryngeal mask airway (LMA) and the endotracheal tube (ETT). PATIENTS AND METHODS: Seventy ASA I and II patients aged 18 to 60 years at the Lagos University Teaching Hospital between January and December 2003 were randomly allocated to receive either an LMA or ETT for airway management. Anaesthesia was induced with propofol and atracurium. Intraocular pressure was measured by applanation tonometry post induction (baseline) and prior to removal (pre-extubation), after insertion or removal (0 minute), at 1,2,3,5 and 10 minutes after insertion or removal. RESULTS: Insertion of the airway device caused an immediate rise in IOP of 4.6% in the LMA group (from 13.1 +/- 2.4 to 13.7 +/- 2.4 mmHg) and 49.2 in the ETT group (from 12.0 +/- 2.5 to 17.9 +/- 4.0 mmHg) (p<0.001). Removal of the airway device caused an immediate rise in IOP of 14.6 in the LMA group (from 11.26 +/- 2.4 to 12.9 +/-2.4 mmHg) and 50.3 in the ETT group (from 11.37 +/- 2.0 to 17.1 +/- 3.3 mmHg) (p<0.001). IOP thereafter declined towards baseline in both groups. Cardiovascular responses accompanied IOP changes. The mean insertion time was 39.8 +/- 9.1 seconds (ETT) vs 31.5 +/- 4.4 seconds (LMA). (p<0.001) Cough (17.1) and mild laryngeal spasm (2.9) occurred in the ETT group only following removal. CONCLUSION: The LMA produced better IOP stability following its insertion and removal compared to the tracheal tube.

Appropriateness of intra-operative blood transfusion in children at the Lagos University Teaching Hospital--an initial survey.

BACKGROUND: The decision to transfuse intra-operatively is based on preoperative haemoglobin (Hb), estimated blood loss and physiological variables. The visual estimate of blood loss is notoriously unreliable especially with small volumes of blood losses in children. OBJECTIVES: We sought therefore to determine the appropriateness of intra-operative blood transfusion in a sample of children METHODS: All children requiring intra-operative blood transfusion between May and June 2008 were prospectively studied. Neonates and children already on blood transfusion at induction were excluded. Transfusion was prescribed at the discretion of the attending anaesthetist. The Estimated blood volume (EBV) and estimated blood loss (EBL)were determined. Appropriate transfusion was defined as blood transfusion at EBL > 15% of EBV, maximum allowable blood loss to PCV of 27% and pre-transfusion Hb < 8g/dl. RESULTS: Twenty-five patients were studied with a mean age of 4.16 +/- 3.59 years (Range 0.33-11 years). The mean preoperative PCV was 31.14 +/- 3.53% (range 25-34%). Twelve patients (48%) were appropriately transfused when MABL was calculated to PCV of 27%. Nine patients (36%) had appropriate blood transfusion at an EBL greater or equal to 15% of the EBV. Of the 12 patients that had pre-transfusion Hb measured, 2 (16.6%) were appropriately transfused at Hb < 8 g/dl. CONCLUSION: The use of near patient monitoring devices should be encouraged as this will give an accurate assessment of Hb and appropriate indication for transfusion. Equipment should be made available to perform gravimetric estimation of blood loss as the visual method is notoriously unreliable.

Transfusion trigger--how precise are we? Intraoperative blood transfusion practices in a tertiary centre in Nigeria.

SUMMARY: To determine how well anaesthetists in Nigeria determine the need for transfusion based solely on physiological variables and estimated blood loss. To determine the incidence of inappropriate blood transfusion. Anaesthetists in our hospital determine when to transfuse patients based solely on clinical acumen. This may result in inappropriate transfusion especially in this subregion where blood donors are scarce and risk of transmission of infection high. All surgical patients requiring blood transfusion were prospectively studied over 3 months. Transfusion was based solely on the discretion of the attending anaesthetist. Haemoglobin (Hb) concentration was measured prior to transfusion and 24 h postoperatively. Appropriate transfusion was defined as blood transfusion at Hb < 8 g dL(-1) or 10 g dL(-1) in the elderly and those with medical comorbidities. The trigger for transfusion was documented as well as estimated blood loss. Thirty-four patients were studied. The mean pretransfusion Hb was 8.09 +/- 2.45 g dL(-1) (range 4.6-14.2). Twenty-one patients (61.8%) had appropriate blood transfusion. The commonest transfusion triggers were clinical pallor (82.4%), excessive blood loss (76.4%), delayed capillary refill (55.9%) and severe hypotension (50%). The use of near patient monitoring devices might further improve blood transfusion practice in this setting where donor blood is scarce.

Pre-induction hypokalaemic phenomenon in Nigerian adult population.

BACKGROUND: Anaesthesia in the perioperative period is characterized by acute changes in plasma potassium (K+) which may be caused by anxiety. Anxiety leads to an intracellular shift of potassium which may lead to hypokalaemia. These fluctuations in plasma potassium may sometimes induce arrhythmias. This study was designed to determine the acute changes in plasma potassium levels in the immediate pre-induction period in a sample of Nigerian patients and to determine the incidence of arrhythmias correlating with these changes. METHODS: Sixty ASA I and II adults aged 14 to 70 years, both genders, undergoing elective surgery under general anaesthesia at the Lagos University Teaching Hospital were prospectively and consecutively recruited. Preoperative plasma potassium level was determined 1-3 days before surgery. Premedication was with oral diazepam 10-20 mg given nocte and on the morning of surgery. Pre-induction plasma potassium level was determined within 5 minutes before induction of anaesthesia. RESULTS: Mean preoperative K+ was 3.98 +/- 0.38 mEq.L(-1) (range of 3.5 - 4.9 mEqL(-1)). The mean pre-induction plasma K+ level was 3.01 +/- 0.35 mEq.L(-1) (range of 2.1 - 3.6). This represented a fall of 24% (0.97 +/- 0.39 mEq.L(-1)) which was significantly different (p < 0.001). More than 80% of the patients exhibited some fall in plasma K+. No arrhythmias were recorded during the study period. CONCLUSION: Pre-induction hypokalaemia occurred frequently despite the administration of anxiolysis with diazepam. There is a need to consider this phenomenon and measure K+ levels immediately pre-induction especially in patients with existing borderline normal K+ levels.

An audit of perioperative cardiac arrest at Lagos University Teaching Hospital.

OBJECTIVE: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. MATERIALS AND METHODS: All perioperative cardiac arrests in adults that occurred in a one year period(January 2003 to December 2003) at the Lagos University Teaching Hospital were prospectively studied. All patients less than 16 years and cardiac arrests occurring outside the direct supervision of the anaesthetists were excluded. Study variables included demographic data, ASA score, urgency of surgery, surgical procedure, aetiology, time and duration of arrest, cardiac arrest rhythm, management as well as immediate outcome and survival to hospital discharge. RESULTS: Thirteen cardiac arrests occurred in 2147 cases (incidence of 6 per 1000). The mean age of patients was 30.23 +/- 11.06 years. Ten patients had anASA score greater than 3. Hypovolaemia was responsible for arrests in 9 patients. Two arrests occurred at induction, 7 intraoperatively and 4 postoperatively. Seven patients had non-VF/VT rhythms. Cardiopulmonary resuscitation was instituted immediately. The mean duration of arrest was 25.66 +/- 13.34 minutes. Drug and defibrillator therapy were inadequate. Immediate survival occurred in 5 patients (38.46%). Factors associated with significant difference in recovery from a cardiac arrest were type of surgery (p=0.043) and duration of resuscitation (p=0.022) CONCLUSION: Majority of cardiac arrests were due to hypovolaemia from massive blood loss. There is a need for the provision of adequate banked blood as well as improvement in training in the management of in-hospital cardiac arrest to ensure a better outcome.

Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients- a survey.

In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.