Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility.

BACKGROUND: Trauma remains a leading cause of morbidity and mortality in resource challenged economies I. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually from road traffic accidents and are managed at the accident and emergency unit while the severe ones are admitted into the intensive care unit. METHODOLOGY: All trauma admissions to the intensive care unit (ICU) of LAUTECHTeaching Hospital Osogbo over a 5 year period (2008-2012) after ethical approval from the ethical unit of the hospital were reviewed. RESULTS: During the study period, 112 trauma patients were admitted to the ICU, representing 68% of total ICU admissions. The male:female ratio of ICU trauma cases was 3:1. Out of the trauma admissions 83 (74.1%) of the cases came as emergency from the accident and emergency unit while 2.4% and 1.6% respectively came from operating theatre-- and the general ward respectively. 83 (74.1%) of trauma cases admitted were road traffic accidents, while 20 (17.9%) were burns not related to RTA and the remaining 8(9%) were due to falls, fight/ssault. Most of the road traffic accidents related trauma patients admitted to the intensive care unit had head injuries (66.3%) while 7% and 12% had multiple fractures and chest injuries respectively. The mean patient age 35 years and the mean duration of ICU stay was 6.3 ± 8.4 days. Survivors had a longer ICU stay CONCLUSION: Trauma is a major cause of hospitalization and intensive care utilization. It also consumes a significant amount of the health care budget.In most instances it is preventtable.Trauma prevention, the most effective management strategy should include increased public education, improved security, better implementation of legislative measures to ensure safety for all road users, control of firearms, and minimizing domestic and intentional violence. Appropriate, aggressive intensive care in combination with efficient communications,rapid medical evacuation, and an organized emergency multidisciplinary trauma care team will further improve outcome in trauma patients.

Evolving pattern of spinal anaesthesia in stable eclamptic patients undergoing caesarean section at University of Benin Teaching Hospital, Benin, Nigeria.

BACKGROUND: Eclampsia is still associated with high maternal and perinatal and perinatal morbidity and mortality, especially in resource poor countries with limited access to perinatal and critical care facilities. The ideal method of anaesthesia for caesarean section in eclamptics is not generally agreed upon. METHODS: Review of the patients' case notes as well as records of the institution's Labour Ward Theatre, Intensive Care Unit and Postnatal Ward was carried out between January 2011 and December 2012. Patients' clinical and demographic data, anaesthetic management methods, maternal and perinatal outcome measures were evaluated and analysed. RESULTS: Ninety-nine cases of eclampsia were reviewed, of which 87 had Caesarean section. After excluding five patients who had intercurrent medical ailments, 82 patients were finally analyzed. Of these, 65 (79.3%) had spinal anaesthesia while 17 (20.7%) had general anaesthesia. Out of the 19 (23.2%) who were transferred to the intensive care unit, 12 (70.6%) had general anaesthesia while 7 (10.8%) had spinal anaesthesia. Of the 17 patients who had general anaesthesia, 10 (58.8%) were ventilated post operatively versus only 2 (3.1%) in spinal anaesthesia. Nine of the 17 general anaesthesia patients (52.9%) versus only 1 of 65 spinal anaesthesia (1.5%) died in ICU. Apgar was two fold better in the spinal anaesthesia group at 5 minutes.There was a higher risk ratio for stillbirths in the general anaesthesia patients. CONCLUSION: maternal and perinatal survival and well being are better in eclamptics who had spinal anaesthesia for caesarean section compared to those who had general anaesthesia.

Carbon monoxide poisoning in a Nigerian home: case reports.

AIMS AND OBJECTIVES: Casualties following inhalation of carbon monoxide in fumes produced/rom incomplete oxidation of hydrocarbon in gasoline-powered engines such as generator is common especially in developing countries. These are two case reports managed at University of Benin Teaching Hospital (UBTH)and their outcomes. CASE SUMMARY: The first patient was a 17 year old female with 12 hour history of breathlessness, restlessness and unconsciousness following inhalation of fumes produced by an electric generator that was put in a confined area. She also presented with convulsion, sphincteric incontinence and foaming in the mouth.Pulse oximetery showed desaturation. She was placed on mechanical ventilation,mannitol, phenytoin infusion and intravenous vitamin C. She was weaned off the ventilator on the fourth day in the Intensive Care Unit (ICU) and discharged from ICU on the 6th day.The second patient was a 78 year old man with 18 hour history of unconsciousness and breathlessness following carbon monoxide poisoning. Pulse oximetry showed desaturation. He was placed on mechanical ventilation but died one hour and 30 minutes later probably due to advanced age and delayed presentation at the hospital. CONCLUSION: The cases reported highlight the risk of prolonged exposure to carbon monoxide and protracted delay in instituting oxygen therapy. Early referral of victims of carbon monoxide poisoning to a hospital with adequate intensive care facilities may improve survival. There should be regular public education on safe use of electric generating sets.

Intrathecal tramadol versus intrathecal fentanyl for visceral pain control during bupivacaine subarachnoid block for open appendicectomy.

CONTEXT: Profound side-effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open appendicectomy uncommon. AIM: The aim of this study was to evaluate the effectiveness of intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy. SETTINGS AND DESIGN: A prospective randomized study was performed. MATERIALS AND METHODS: A total of 186 American Society of Anesthesiologists 1 or 11 patients scheduled for emergency open appendicectomy were analyzed. Group FB ( n = 62) received intrathecal fentanyl 25 µg plus 3 ml of 0.5% hyperbaric bupivacaine, Group SB ( n = 62) received 0.5 ml normal saline plus 3 ml of 0.5% hyperbaric bupivacaine and Group TB ( n = 62) received intrathecal tramadol 25 mg plus 3 ml of 0.5% hyperbaric bupivacaine. Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study. RESULTS: Effective intraoperative sensory block was achieved in 100% of patients in group FB and TB while 29 (46.8%) patients in group SB had ineffective sensory block ( P = 0.0001). The pain free period was significantly longer in patients in Group FB than Group SB and TB. Mean time for Group FB with regard to first analgesic request was 304.73 ± 67.91 min, Group SB was 146.59 ± 36.62 and Group TB was 238.39 ± 61.28 min. Incidence of complications were comparable among the three groups. CONCLUSION: This study showed that intrathecal tramadol (25 mg) can safely replace intrathecal fentanyl (25 µg) in the management of visceral pain and discomfort during subarachnoid block for appendicectomy.

Single dose of dexamethasone for prevention of nausea and vomiting after major gynaecological surgery.

BACKGROUND: Post-operative nausea and vomiting (PONV) is a common complications following general anaesthesia and is a leading cause of morbidity following surgery. The mainstay of management them is by the use of antiemetic. METHOD: It was a randomized double blind placebo controlled study. The sample size was calculated as 90 from previous study with 10% attrition to make the 100. They were randomly divided into two groups; group B received dexamethasone prophylactically at induction while group A received placebo also at induction. All patients had balanced general anaesthesia and were taken to the recovery room postoperatively where incidences of postoperative nausea and vomiting were recorded. Patients with incidences of nausea and vomiting were treated with 10 mg metoclopramide intravenously while postoperative complications that may be associated with dexametnasone prophylaxis were also noted. RESULTS: The groups were comparable with respect to demographic characteristics. More patients in group A (placebo group)) had incidence of nausea than group B (dexamethasone group) with p value of 0.01 and also more patients in group A had vomiting than group B with p value of 0.02; which was significant. The duration of stay in the recovery room for both groups A and B were however comparable with no statistical difference. CONCLUSION: Dexamethasone when given prophylactically at induction reduces incidence of postoperative nausea and vomiting after gynaecological surgeries.

Spinal anaesthesia for caesarean section in pregnant women with fetal distress: time for reappraisal.

Residents' competency-based training and multidisciplinary cooperation are needed for rapid sequence spinal anaesthesia for fetal distress. Multiple standard but 'crash' spinal anaesthesia for non-obstetric procedures is imperative for acquisition of experienced hands. The purpose of this review is to share our modest experiences in the use of rapid spinal anaesthesia for emergency Caesarean delivery in pregnant women complicated with fetal distress. Fetal distress diagnosis is made promtly, intravenous line put in place in labour ward. Pre-loading or not, one-touch, non-touch spinal technique prevents unnecessary delay and further fetal hypoxic injury. Spinal pack is on stand by in the operating room at all time. Preloading is possible during the waiting period for other care providers otherwise coloading is used. A single wipe of the back with chlorhexidine lotion is frequently used for scrubbing. Lidocaine infiltration or spay is essential and does not waste time but opioid as adjuvant to bupivacaine wastes a lot of time to constitute and measure. So, opioid should be avoided. Average of 2.5 ml of 0.5% hyperbaric bupivacaine is frequently used in our centres. Surgery starts almost immediately after cleaning and drapping of the patient by the obstetrician. Ephedrine is made handy and constituted in case there is hypotension which fluid alone cannot treat.

CARDIOPULMONARY RESUSCITATION - KNOWLEDGE, ATTITUDE & PRACTICES IN OSUN STATE, NIGERIA.

BACKGROUND: Cardiopulmonary arrest is not an uncommon event in the medical practice with the causes ranging from reversible to irreversible causes. Therefore the skill in the performance of effective cardiopulmonary resuscitation is an essential part of successful medical practice. In some developed countries the CPR Training programmes were mandatory for all health care givers and even for non medical workers. However in the setting of ours, the situation is not so as most heath workers go for CPR Training programmes by wish except in some few centres were it is mandatory. AIM & OBJECTIVES: To assess the knowledge, attitudes and practices of medical practitioners in relation to cardiopulmonary resuscitation and defibrillation. SETTING: The study was carried out among medical practitioners in Osun State, Southwest Nigeria. METHODS: The study was conducted through a survey of medical practitioners in Osun state during an annual general meeting using a self administered questionnaire. RESULTS: The response rate was 65% with 65 out of 100 physicians returning the completed questionnaire. Only 40% of respondents had attended a basic and an advanced life support training programme while 30% knew how to operate an automated external defribellator (AED), seventy percent knew the meaning of AED. Most of the respondents that had attended a basic and an advanced life support programme were residents (80%) while 16% were consultants and the remaining 4% were general practitioners. More males (67%) among the respondents that knew how to operate an AED and majority (56%) were in the age range of 30-40years. Eighty two percent of the respondents would prefer to do a chest compression only resuscitation of which 44% were. CONCLUSION: Most of the medical practitioners in Osun State were not knowledgeable about cardiopulmonary resuscitation and defibrillation . The few with the knowledge were from the tertiary institutions. There is therefore the need for the creation of more awareness among medical practitioners, especially among those outside tertiary health facilities.