Heat loss in Nigerian newborn infants in the delivery room.

Fifty-three vigorous infants were randomly assigned to six different groups (A-F). The babies in groups A and F were not dried and were either exposed wet to room air or warmed under the radiant heater. The other groups of infants were quickly dried and exposed to room air (group B), wrapped with one sterile sheet (group C), wrapped with two towels (group D) or placed under the radiant heater (group E). The infants exposed to room air lost twice the amount of heat when compared with those insulated with two towels. The amount of heat loss by evaporation could not be demonstrated. The role of high relative humidity as an important determinant of the degree of heat loss by evaporation is stressed.

A study of co-induction of anaesthesia U.B.T.H. experience.

Co-induction is the concurrent administration of two or more drugs that facilitate induction of anaesthesia. Some combinations have been shown to have pharmacological advantages. In addition to the safety and comfort of the patient, it is also important to find a cost effective combination in view of the rather stringent economy of the times. This project was undertaken to study the response of Nigerian patients to co-induction (midazolam and propofol) by comparison with the traditional thiopentone or propofol alone, and to study the cost implications. 45 patients who came in for various surgical procedures were randomly assigned to three different groups. The first group was induced with thiopentone alone. The second group had a combination of midazolam and propofol and the third group had propofol alone. In all other respects except for the surgery the patients had the same treatment. The induction was satisfactory in all groups. The cardiovascular and respiratory changes were within clinically acceptable limits but the emergence was best with propofol, followed by midazolam/propofol and thiopentone in that order. Although thiopentone was the cheapest in terms of absolute cost, the combination of midazolam and propofol was most cost-effective.

Anaesthesia related complications following caesarean delivery necessitating intensive care unit admissions in a tertiary centre.

To determine the anaesthesia-related complications after caesarean section in a tertiary hospital, the hospital records of parturients admitted to the Intensive Care Unit (ICU) after caesarean section were studied. In a ten-year period, 2,686 women were delivered by caesarean section at the University of Benin Teaching Hospital, Benin City. Two thousand one hundred and two (78.3%) had emergency caesarean section while 584 (21.7%) had elective caesarean section. Of these, 2597 (96.7%) had general anaesthesia (GA) and 89 (3.3%) regional anaesthesia (RA). Within this period, 30 paturients (1.1%) were admitted to the ICU; one was after elective caesarean and 29 (96.7%) were after emergency caesarean section. Fifteen patients were admitted for anaesthesia-related complications, of which all were after caesarean section done under GA. The incidence of a major anaesthetic complication resulting in ICU admission was 15 in 2597 GA while it was zero in 89 RA (p < 0.01). Total maternal deaths in the ICU admissions were 11(36.7%); anaesthesia being directly the cause of death in 3 (27.3%) while non-anaesthetic factors accounted for 8 (72.7%) deaths. Emergency caesarean section and GA, were risk factors for anaesthesia-related morbidities after caesarean section. Preventable deaths due to poor laboratory support services and inadequate anaesthetic materials accounted for the anaesthesia-related mortalities.

Cardiac response of Nigerian hypertensives to anaesthesia and surgery.

This study was undertaken to determine the cardiac response of Nigerian hypertensives to anaesthesia and surgery, using systolic time intervals as an indication of ventricular function. Nine hypertensive and eight normotensive patients who were admitted for various operations had carotidogram, phonocardiogram and electrocardiogram recorded simultaneously before induction of anaesthesia, after induction and during operation. The pre-ejection phase, (PEP) and the left ventricular ejection time (LVET) were measured from the tracings and the ratio PEP/LVET was calculated. The results showed that for both normotensive patients and hypertensive patients there was a mean increase of the PEP/LVET ratio under anaesthesia and surgery, indicating deterioration of ventricular function. Hypertensive patients showed a much greater deviation from normal, approaching heart failure values. It is concluded that hypertensive patients seemed to be at greater risk during anaesthesia and surgery. The implication is that hypertensive patients should be adequately treated before operation.

Magill circuit and controlled ventilation.

Nine patients under anaesthesia were controlled manually with the Magill attachment. Nine other patients using the same circuit under anaesthesia breathed spontaneously. Blood gases were studied throughout the period of operation to determine the adequacy of ventilation. The results show that the Magill attachment was adequate for controlled ventilation using normal flows (9 1/min) in young healthy patients.

Anaesthetic management of achondroplasia.

We report a patient with achondroplasia who presented for emergency Caesarean section. Endotracheal intubation was not difficult. The reaction of this patient to drugs such as thiopentone and tubocurarine, judged on body weight basis, was normal.