The Nigerian Society of Anaesthesists is an organization with the mandate to promote excellence and quality service among Anaesthesists practicing in Nigeria. It enhances the much needed interaction and communication among Physician anaesthetists through various educational activities and research. The Society was formally launched in 1979 and registered officially in 2000. It has been a member of the World Federation of Societies of Anaesthesiologists (WFSA) as far back as 1966 and has over 1000 members both within Nigeria and in the diaspora. Title-Level DOI: https://doi.org/10.82223/ISSN.1595-9147
Clinical Profile of Children Admitted in a General ICU and Outcome at The University of Port Harcourt Teaching Hospital, Nigeria
Background: Admission of children for intensive care results from different causes and has varying outcomes. Objectives: The pattern of admissions and outcomes in children admitted between January 2021 - October 2022, at the intensive care unit (ICU) of UPTH was assessed in a retrospective study. Methods: Data on demography, clinical characteristics and outcomes of admission of children between one month – 17years old, admitted in the ICU during the study period were collected, using records from patient’s folders and intensive care registers. SPSS v.25 was used for analysis and results presented as frequencies and percentages. Results: From a total of 430 patients admitted, children were 47(11.0%) with mean age 7.0 ± 5.5yrs, and M:F ratio 1.9:1. Admissions were for postoperative care [(21/45.0%)], neurological diseases [11(23.0%)], respiratory distress and TBI [(6(13.0% each)] and neuromuscular diseases [3(6.0%)]. Admitting specialties were paediatric respiratory 6(12.8%), neurology 12(25.5%) and neurosurgical teams for nonoperative care 8(17.0%), and surgical specialties for critical postoperative care 21(44.7%). Postoperative patients were admitted following general paediatric 14(29.8%), cardiac and oral maxillofacial surgeries 2(4.3%) each and others 3(6.3%) for postoperative care 21(44.7%), low GCS 15(31.9%) and cardiorespiratory support 11(23.4%). Complications were severe brain injuries 17(36.2%), severe haemorrhage 9(19.1%), respiratory failure 8(17.0%), sepsis 7(14.8%) and electrolyte imbalance 2(4.3%). Mean duration of stay was 5.6 ± 6.3 days, 22(46.8%) were discharged and mortality rate was 25(53.2%), majority being CNS/neuromuscular diseases (17/68.0%). Conclusion: Critical postoperative care was commonest indication for ICU admission in children, but mortality was highest in CNS/Neuromuscular pathologies.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-sa/4.0
Society of Obstetric Anaesthetists of Nigeria 2025 Conference Abstract Proceedings
Abstracts of the 12th Annual Scientific Conference of the Society of Obstetric Anaesthetists of Nigeria Date – 3rd- 5th September, 2025 Venue – Landmarks Hotels Ltd. Port Harcourt, Rivers State, Nigeria
Copyright (c) 2025 Society of Obstetric Anaesthetists of Nigeria (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Paediatric Anaesthesia Society of Nigeria 2025 Conference Abstract Proceedings
Abstracts presented at the 3rd Annual Scientific Conference of Paediatric Anaesthesia Society of Nigeria held virtually on 17th and 18th September 2025. Conference Theme - Paediatric Anaesthesia in Nigeria; Planning for the future. Keynote speaker - Prof Ibironke Desalu Sub-themes - (1)Improving the Quality of Care in Paediatric Anaesthesia ( Prof Mark Newton) (2)Safety Checklists and Protocols (Dr Maryrose Osazuwa) (3)Advanced Paediatric Airway Management (Prof Patrick Olomu) (4) AI in Paediatric Anaesthesia (Dr Vikas O'Reily-Shah)
Copyright (c) 2025 Paediatric Anaesthesia Society of Nigeria (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Graded Epidural Anaesthesia for Abdominal Hysterectomy in an Adult with Congenital Heart Disease: A Case Report
Background: Congenital heart anomalies pose challenges during anaesthesia with its associated morbidities; Cor-triatriatum dexter may be associated with other heart anomalies which subject the patient to increased risks. Case Presentation: We here-in report the case of a 30 yr old woman that had cor-triatriatum dexter with associated multiple atrial septal defects, rheumatic valvular heart disease, pulmonary hypertension and associated ventricular dysfunction that had total abdominal hysterectomy under graded epidural anaesthesia. Conclusion: High risk patients with multiple congenital anomalies may undergo anaesthesia with careful choice of anaesthesia technique
Copyright (c) 2025 Mamuda Atiku, Dalhat Salahu, Abdullahi Mustapha Miko, Datti Mohammed Alhassan, Zynat Alhassan, Aminu Auwalu Bala (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Burnout among Anaesthesia Providers in Sub-Saharan Africa: A Scoping Review
Background: Anaesthesia providers are a unique population of healthcare workers because of the specialised nature of their work in the perioperative period. Sub-Saharan Africa (SSA) with its large proportion of Low-and Middle-Income Countries (LMICs) has limited manpower and resources. This scoping review was aimed at investigating the prevalence of burnout amongst Anaesthesia providers in SSA from previous research, to identify factors related to burnout, consequences of burnout, and possible interventions to mitigate burnout among SSA anaesthesia providers. Methodology: This is a scoping review of research in the last ten years on burnout amongst SSA anaesthesia providers. Peer-reviewed studies published between the years 2013 to 2023 were included in this study. Google Scholar, Research gate, National Library of Medicine and Web of science databases were searched for eligible studies. Eleven were identified. Results: The synthesized prevalence of burnout was 38.05%. The subscales of high Emotional Exhaustion (EE) of 50.37%, high depersonalisation (DP) 44.05%, and moderately low Personal Accomplishment (PA) of 35.7% were found. Several factors were identified as impacting Anaesthesia providers in SSA such as their years of experience, age of the Anaesthesia provider, and their work environment. Data was limited on the outcomes of burnout, and no studies on the interventions aimed at ameliorating burnout amongst SSA Anaesthesia providers. Conclusion: Findings highlight the need for more research on burnout among SSA anaesthesia providers, and an urgent need for the implementation of interventions to mitigate burnout in SSA anaesthesia providers.
Copyright (c) 2025 Alhassan Zynat, Atiku Mamuda, Salahu Dalhat, Abdullahi Mustapha Miko M, Alhassan Datti Mohammad (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Recent Advances in Cardiothoracic Anaesthesia: A Scoping Review of Innovations, Outcomes, and Future Directions
Background: Cardiothoracic anaesthesia has rapidly evolved owing to advances in monitoring, pharmacology, and perioperative care. Increasingly complex surgical techniques have positioned anaesthetists as key contributors to optimising outcomes, minimising complications, and supporting enhanced recovery. Despite these developments, the evidence base remains fragmented, emphasising the need for a comprehensive synthesis of recent progress. Objectives: This scoping review summarises recent innovations in cardiothoracic anaesthesia, assesses their effects on perioperative and long-term outcomes, and highlights priorities for future research and practice. Methods: The review followed Arksey and O'Malley's framework and PRISMA-ScR guidelines. Major databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched for articles published from 2010 to 2025. Eligible studies reported empirical research on innovations in monitoring, pharmacology, intraoperative techniques, or perioperative care in cardiothoracic anaesthesia. Data were thematically organised under innovations, outcomes, and future directions. Results: Key innovations included advanced transesophageal echocardiography, near-infrared spectroscopy, AI-assisted monitoring, short-acting pharmacological agents, multimodal analgesia, and fast-track anaesthesia protocols. These advances were associated with improved patient outcomes, such as reduced morbidity, earlier extubation, shorter ICU stays, and enhanced recovery. Healthcare systems benefited from decreased costs and resource utilisation. Future directions focus on precision medicine, AI-driven decision support, tele-anaesthesia, and global implementation of scalable innovations. Conclusion: Cardiothoracic anaesthesia is entering a transformative era characterised by precision, digital integration, and inclusivity. Although perioperative care and outcomes have improved, gaps remain in long-term evidence, paediatric populations, and global applicability.
Copyright (c) 2025 Mangai Ngeh, Yohanna Usman, Precious Kpalap, Husseina Aliyu, Kefas Malau, Rimamkanati Shaki, Aliyu Abdullahi, Jude Agbo, Samuel nuhu, Henry Embu, Erdoo Isamade (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Effects of Intravenous Magnesium-Sulphate on Postoperative Analgesia following Myomectomies and Hysterectomies
Background: Opioids are the mainstay of postoperative analgesic, but with many side effects. We explored the analgesic effects of magnesium preloading in abdominal surgeries. Methodology: Eighty patients, 18 – 65 years, ASA I-III, were randomised into groups M and N. Prior to induction of general anaesthesia, group M received IV magnesium 50mg/kg preloading while group N received placebo, both in 100mls 0.9% saline over 15 mins. All patients had paracetamol 1gm, pethidine 0.5mg/kg and wound infiltration. The time to first request for rescue IV pentazocine, total rescue opioid use, postoperative VAS pain scores over 24-hours, side effects profile and satisfaction score were compared. Results: Demographic parameters were comparable, p-value ˃ 0.05. The mean time to first request for rescue analgesia was prolonged in group M (219.25 ± 148.88 mins) compared to group N (82.25 ± 46.51 mins). The mean postoperative VAS pain scores were lower in group M versus group N over 24-hours (p ˂ 0.05). The mean 24-hours rescue opioid use was lower in group M (49.23 ± 20.05mg) versus group N (87.00 ± 15.27mg), p-value 0.001. PONV was lower in group M versus N, p-value 0.001. Group M had better satisfaction score versus N, p-value 0.001. Conclusion: Magnesium 50mg/kg preloading provided effective postoperative analgesia, and lower rescue opioid use and PONV incidence following gynaecological surgeries.
Copyright (c) 2025 Nnaemeka Chiagoziem Nwigwe, Abayomi Kolawole Ojo, Simeon Olugbade Olateju, Anthony Taiwo Adenekan, Folayemi Aramide Faponle (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Postoperative Recovery Profile Following Posterior Lumbar Laminectomy: A Comparative Study Of General Anaesthesia And Spinal Anaesthesia
Background: Elective lumbar laminectomy can be done under both general and spinal anaesthesia. Many authors have suggested that the choice of anaesthetic technique influences postoperative recovery outcomes. Existing literature provides inconsistent findings regarding which technique offers superior recovery profile. Furthermore, there is paucity of well- designed comparative studies evaluating the recovery profile of patients who had lumbar laminectomy under spinal anaesthesia with those under general anaesthesia. This lack of conclusive evidence underscores need for further research to determine the optimal anaesthetic approach that enhances recovery profile. Subjects and Methods: Fifty eligible patients were recruited and randomized into two groups (25 each) using block technique. Each group received either general anaesthesia or spinal anaesthesia. The discharge time from post anaesthetic care unit (PACU), pain scores at 4, 8, and 24hrs from the end of surgery, time at first ambulation and time of discharge from the hospital were assessed and recorded. The data were analyzed using Statistical Package for Social Sciences (SPSS) 26 for windows. Results: The mean duration of PACU stay was comparable (GA.=74.44±3.94 mins, SA=73.56±14.44 mins, p = 0.770). The spinal anaesthesia group had a significantly (p=0.003) lower mean pain scores (3.323.32±0.9) than the general anaesthesia group (4.08±0.81) at 4hr from the end of the surgery, thereafter the pain scores became comparable. The time to first ambulation after surgery (GA=67.92±13.14hrs, SA=62.70±12.60hrs), and the time to hospital discharge (GA=7.56±1.53days, SA=7.16±1.41days) in both groups were comparable with P=0.158, P = 0.340 respectively. Conclusion: Spinal anaesthesia offered a better early postoperative recovery profile than general anaesthesia, as evidenced by a lower pain score at 4hrs postoperative time.
Copyright (c) 2025 Ozor Chijioke, Anokwute Iheanyi, Odiakosa Martina, Ajuzieogu Obinna V, Emmanuel Iyidiobi, Okeke Ikechukwu B. (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Assessment of Regional Anaesthesia Exposure and Utilisation by Anaesthetists in Nigeria
Background: Although regional anaesthesia (RA) is a vital component of modern anaesthesia, it is underutilised and RA exposure appears to be limited in Nigeria. Aim: This study explored the exposure and use of RA among anaesthesia residents in Nigeria. Material: This was a prospective, cross-sectional study. A simple, convenience-based sampling was employed. Participants were contacted via Google forms using a self-administered structured questionnaire. The self-reported levels of access, exposure, competence, practice, and mentorship were assessed. Descriptive statistics were used to summarise results. Results: From 180 questionnaires, 129 were returned, i.e., 71.6% response rate. Of the responder’s centers, 92 (71.3%) were fully accredited, while 35 (27.1%) had partial accreditation. Daily exposure to SA and EA was 64 (49.6%) and 11 (8.5%), respectively, with 120 (93.0%) and 36 (27.9%) reporting competence. Daily or weekly exposure to PNBs was ≤ 5% in all categories. Four (3.1%) had competence in LLNB. Spinal and epidural kits were accessible to 126 (97.7%) and 85 (65.9%), respectively, while 6 (4.6%) had nerve stimulators and 11 (8.5%) had ultrasound. Mentorship was universal i.e., 129 (100%) for neuraxial techniques, but 9 (6.9%) for PNBs. Conclusion: The study highlights gaps in regional anaesthesia practice in Nigeria. Despite universal access to neuraxial blocks, limited exposure to PNBs reduces proficiency. Improving RA services requires access to equipment, mentorship, simulation, and curriculum reforms aligning with global standards.
Copyright (c) 2025 Temtope Akindele Owoniya, Abayomi Kolawole Ojo, Philip Shete, Oluwatobi Adewuyi (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Moving with the Current Tide in Anaesthesia Education
Haemodynamic Variability in Obstetric Patients Receiving Spinal Anaesthesia for Caesarean Section: A Comparative Analysis of the Effect of Prophylactic Administration of Ondansetron and Placebo.
Background: Ondansetron suppresses the Bezold Jarisch reflex and has been postulated to be a therapeutic strategy for spinal-induced hypotension in obstetric patients for Caesarean section. The study is aimed at evaluating the effect of prophylactic ondansetron on spinal-induced hypotension in pregnant women scheduled for Caesarean section. Methodology: Eligible patients were randomized to receive 4mg Ondansetron diluted to 5ml (Group O, n=39) and 5ml of normal saline (Group C, (n=39) 5mins before spinal anaesthesia respectively. The arterial blood pressure, intraoperative vasopressor consumed, incidence of spinal-induced hypotension, bradycardia, side effects like nausea, vomiting, shivering were assessed and recorded. Data was collected and analysed using SPSS 25 for Windows. Numerical data was analysed using an unpaired student t-test, while Categorical data was analysed using the chi-squared test. A p-value < 0.05 was considered significant. Results: There was a significant decrease in mean HR between group O (99.8±14.7) and group C (91.0±14.5) within 5 minutes of SAB. The reduction in mean MAP was significant (p=0.04) at the 20th minute between the groups. Total ephedrine and glycopyrrolate consumed were significantly lower in group O (0.8±3.6; 0.07±0.1)mg than in group C (12.6±10.2; 0.14±0.1)mg, respectively. The incidence of nausea, vomiting, and shivering was significantly lower in group O (15.8%; 2.6%; 10.5%) than in group C (41.0%; 20.5%; 51.3%) respectively. Conclusion: Prophylactic ondansetron significantly reduced haemodynamic depression, incidence of nausea, vomiting, and shivering as well as total vasopressor consumption in obstetric patients undergoing Caesarean section under SAB.
Different Faces of Ambulatory Anaesthesia - A Reality Check of Practices
Ambulatory anaesthesia (AA) remains an alternative to the concerns of various stakeholders about the set backs with in-patient anaesthesia and surgery. It will continue to be so especially with continued technological advancements of the present era, improved anaesthesia drugs and techniques that enhance faster recovery, faster pace of life that makes patients seek early re-union with family and return to work, as well as overall reduction in costs. Cost reduction especially is a major concern to patients, hospitals and National Health Services. In the light of these reasons and more, there are already different settings where ambulatory anaesthesia is practised wholly, or as part of its processesin patient care. This brief communication seeks to highlight those real clinical scenarios which are already with us in our different settings (faces), where AA is being practised or will be on the rise as advances in surgical and anaesthesia care with the principles of enhanced recovery increase.
Spinal Anaesthesia for Posterior Spinal Decompression in a Patient with Intracoronary Stent: A Case Report
Background: Anaesthesia for posterior spinal decompression poses significant challenge for the anaesthetist because of awkward patient prone position, and this challenge becomes complex when the patient has a pre-existing cardiac dysfunction. This report shows the complexity of managing a middle aged man with intracoronary stent for posterior spinal decompression under spinal anaesthesia. Case Presentation: A 52year old businessman with intracoronary stent who was managed for L5 region spinal canal mass with chronic cauda equina syndrome on the background of L3/L4 disc disease. Multidisciplinary Pre–operative assessment and preparation was done with a clear plan for the management of double anti-platelet therapy. He had posterior spinal decompression with uneventful intraoperative and postoperative period. Conclusion: Multidisciplinary preoperative preparation, intraoperative precautions and monitoring as well as adequate postoperative management is needed to navigate the complexity of anaesthesia for intracoronary stent for posterior spinal decompression.
Copyright (c) 2025 Iheanyi Ihunanaya Anokwute, Chijioke Chibuzor Ozor, Babatunde Olusegun Ojus, Martina Chioma Odiakosa (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
NSA 2024 Conference Abstract Proceedings
Abstracts of the 32nd Annual Scientific Conference of the Nigerian Society of Anaesthetists (NSA) held in Collaboration with the World Federation of Societies of Anaesthesiologists (WFSA) Date – 11th - 15th November, 2024 Venue – National Orthopaedic Hospital/Amadeo Event Centre, Enugu, Nigeria
Submandibular Intubation in Severe Maxillofacial Trauma using C-MAC Videolaryngoscope: A Case Report
Introduction: Anatomical distortion, intra-oral bleeding, and the requirement for unhindered surgical access make managing the airway in patients with severe maxillofacial trauma extremely difficult. When midface fractures or involvement of the skull base are present, orotracheal and nasotracheal intubation may not be safe nor practical. Although tracheostomy is a common substitute, there are risks associated with it, including bleeding, subcutaneous emphysema and chronic issues like loss of airway, recurrent laryngeal nerve damage etc. Case Presentation: We describe the successful submandibular intubation of a patient with panfacial fractures using the C-MAC videolaryngoscope for maxillofacial reconstruction surgery. This method avoided the problems associated with tracheostomy while allowing unhindered surgical access. Conclusion: By enhancing glottic visualization and minimizing airway trauma, the C-MAC videolaryngoscope has further improved the technique's ease and safety during the procedure.
Anaesthetic Considerations for Interventional Neuroradiology in a Child with Moyamoya Disease - A Case Report
Introduction: The Moyamoya disease is a chronic condition involving cerebrovascular system characterized by progressive stenosis and occlusion or narrowing of the terminal internal carotid arteries. Case Presentation: Patient with severe cerebrovascular impairment with consequent cerebral ischemia and haemorrhage poses significant challenge due to compromised cerebral blood flow. The role of an anesthesiologist is particularly challenging in interventional neurological procedures such as revascularization as well as in digital subtraction angiography. These procedures require meticulous management of cerebral perfusion, hemodynamic stability and oxygenation to prevent ischemic complications or further deterioration in patients with pre-existing cerebral perfusion impairment. Conclusion: We report a case of 11year male child with Moyamoya disease with right sided paresis who presented to us for digital subtraction angiography (DSA) under general anaesthesia.
Difficult airway management in a neonate with giant sublingual cyst: A Case Report.
Introduction: Congenital ranula cysts are rare epithelial retention cysts originating from major sublingual or submandibular salivary glands, with an incidence of 0.74%. Early presentation often involves severe symptoms, including airway compromise and feeding difficulties. Management options include needle aspiration, surgical excision, marsupialization, sclerotherapy, laser excision, and cryotherapy. Significant airway compromises due to these congenital ranulas often occur inneonates; however, limited studies address their airway management. Case Presentation: We present the management of a 2-week-old neonate with a huge congenital ranula with sublingual swelling, poor feeding, sneezing, inability to cry post-delivery, and had surgery done following initial resuscitation and nasogastric tube insertion. Intubation using avideo laryngo scope with lidocaine and adrenaline instillation was successfully carried out to maintain th eairway. The cyst was then successfully removed and marsupialization performed under general anaesthesia. Subsequently, the neonate was extubated 24 hours postoperatively without complications and discharged home after an uneventful recovery. Conclusion: Giant congenital ranulas pose significant challenges for airway management. First intention use of a video laryngoscope with lidocaine and adrenaline instillation can be an effective technique to manage an anticipated difficult neonatal airway when performed meticulously.
An Audit of Intraoperative Cardiac Arrests in a Tertiary Hospital in South East Nigeria
Background: Intraoperative cardiac arrest (IOCA) is a complication of surgery associated with a great risk of mortality. This study evaluated the incidence, risk factors, causes and outcomes of IOCA at a tertiary hospital in South East Nigeria. Aim: It was a retrospective evaluation of the incidence, risk factors, causes and outcomes of intraoperative cardiac arrests at a tertiary hospital in South East Nigeria. Patients and Method: A retrospective study of intraoperative cardiac arrests occurring over a 5-year period was conducted. Data on patient demographics, surgery, and complications were retrieved from patients’ medical records and analyzed using the Statistical Package and Service Solutions (SPSS) version 25. Chi-square test analysis was used to determine relationship between risk factors and outcome. P-value of less than 0.05 was considered significant. Results: The incidence of IOCA was 2.96 per 1000 with a mortality of 1.1 per 1000. There were 8 males were 5 females Majority of the cardiac arrests occurred during emergency surgery (69.2%) and within the first 120 minutes of surgery. Blood loss (53.9%) and hypertension (30.8%) were the commonest causes of IOCA. Majority of the patients (61.5%) had successful resuscitation and patients aged 21 – 40 years had better survival (50%) compared to other age groups. Conclusion: The incidence of IOCA in this study is comparable with reports from other studies. Blood loss and intraoperative hypertension were the most common causes of IOCA. There was no significant relationship between risk factors and outcome of the intraoperative cardiac arrest.
Evaluating the Efficacy of Intravenous Atropine in Preventing Spinal Anaesthesia-Induced Hypotension in Lower Abdominal Surgery: A Controlled Study
Background: Spinal anesthesia-induced hypotension is a frequent complication that can lead to significant morbidity and even mortality if not promptly detected and addressed. This study evaluated the effect of intravenous atropine on the incidence of spinal anesthesia-induced hypotension in patients undergoing lower abdominal surgery. Methods: This prospective, randomized, double-blinded study recruited 130 adults with American Society of Anesthesiologists physical status I or II who underwent elective lower abdominal surgeries under spinal anesthesia at the Federal Teaching Hospital (formerly Federal Medical Centre) Lokoja in Kogi State, Nigeria. Participants were randomly assigned to receive either a placebo of 1ml of 0.9% saline or 1ml of 0.6mg intravenous atropine, 1 minute post induction of spinal anesthesia. Haemodynamic parameters including blood pressure, mean arterial pressure (MAP), and oxygen saturation were measured and recorded throughout the study. Statistical analysis was done using SPSS version 22. Student t-test was used to compare the change in mean arterial pressure between the two groups and chi square for categorical data. Probability value less than 0.05 was considered as statistically significant. Results: The incidence of hypotension was significantly lower in the atropine group (6.8%) compared to the normal saline group (19.6%; p = 0.041). Although fewer patients in the atropine group required multiple doses of ephedrine, this difference was not statistically significant (p = 0.152). Tachycardia occured more frequently in the atropine group (54.2% vs.14.3%, p < 0.001), and all cases of dry mucous membrane occurred in the atropine group (p = 0.004). Conclusion: Intravenous atropine (0.6mg) administered 1 minute after spinal anesthesia induction significantly reduces the incidence of spinal anesthesia-induced hypotension in patients undergoing lower abdominal surgery, but comparatively the severity was not clinically relevant.
Effect of Three Different Prophylactic Bolus Doses of Phenylephrine on Hypotension Following Caesarean Section Under Combined Spinal-Epidural Anaesthesia
Background: Maternal hypotension is a frequent and potentially serious complication of spinal anaesthesia during Caesarean section. Phenylephrine is a commonly used vasopressor for prevention, but optimal dosing remains uncertain. Objective: To evaluate the effectiveness of three prophylactic bolus doses of phenylephrine in preventing spinal-induced maternal hypotension during elective Caesarean section under combined spinal–epidural anaesthesia. Methodology: A prospective comparative study at the University of Port Harcourt Teaching Hospital included 136 parturients scheduled for elective Caesarean section. All received an admixture of intrathecal 10 mg of 0.5% hyperbaric bupivacaine and 25 µg fentanyl. Participants were randomly assigned to four groups: a control group receiving normal saline and three intervention groups receiving 50 µg, 60 µg, or 80 µg of phenylephrine. Haemodynamic parameters were monitored every five minutes. Total phenylephrine used and neonatal Apgar scores were recorded. Results: Demographic characteristics were comparable across groups. The incidence of hypotension was highest in the saline group (85.5%) and lowest in the 80µg group (10.0%). Differences in hypotension rates were statistically significant between the 80 µg and saline group (p < 0.0001), and between other dose comparisons. Bradycardia was more frequent in the 80µg group (20.6%) (p = 0.030). Apgar scores were similar across groups, though umbilical cord venous pH was significantly lower in the saline group (p < 0.0001). Conclusion: Prophylactic bolus doses of phenylephrine, particularly 80 µg, are effective in preventing spinal-induced maternal hypotension but with a relatively higher incidence of bradycardia during Caesarean section without adverse neonatal outcomes.
Comparative Assessment of anxiety relief and ease of Parental Separation in Children undergoing Herniotomy with Oral Ketamine, Midazolam, or Combined Ketamine-Midazolam Premedication before General Anaesthesia: A Randomized Controlled Study
Introduction: Premedication is important to allay anxiety, produce sedation, and facilitate the smooth induction of anaesthesia, especially in children undergoing procedures or surgeries under general anaesthesia. However, there remains debate over the optimal drug or drug combination. This study aimed to compare the effectiveness of oral ketamine or oral midazolam alone versus combination oral ketamine and oral midazolam as paediatric premedication in children undergoing herniotomy under general anaesthesia in our tertiary centre. Methods: The study was a prospective, randomised study involving 129 consented paediatric patients aged 1 to 8 years scheduled for day surgery. Subjects were divided into three groups: group M received 0.5mg/kg of midazolam, group K received 5mg/kg of ketamine, while group K+M received a mixture of 0.3mg/kg midazolam and 3mg/kg ketamine. Sedation and ease of separation scores were measured with a 4-point sedation score and ease of separation score, respectively. Results: The level of sedation varied significantly across the groups at all time intervals (p <0.001). More subjects in the K+M group had statistically significantly better sedation and satisfactory ease of parental separation scores compared to the other groups. Conclusion: Our study revealed that combinations of oral ketamine and oral midazolam provided a more satisfactory level of pre-operative sedation and ease of parental separation than oral midazolam or oral ketamine alone in paediatric patients undergoing herniotomy under general anaesthesia. Unavailability of the bispectral index, which hindered the proper monitoring of the depth of sedation, was a limitation in our study.
Efficacy of Airway Ultrasound in the Confirmation of Endotracheal Tube Placement in Children is Comparable to Capnograph and better than Auscultation
Background: Confirmation of correct placement of endotracheal tube is mostly done by capnography (the gold standard) and auscultation, but both methods have their limitations. Airway ultrasonography is a non-invasive diagnostic imaging technique that has been shown to correctly delineate the airway structures and confirm correct placement of endotracheal tube during general anaesthesia. This study aimed at comparing the accuracy of airway ultrasound with auscultation using capnograph as the gold standard.. Patients and Method: This prospective randomized controlled clinical trial involved 106 American Society of Anesthesiologists I and II patients aged 1-10 years who presented for elective surgery and required general anaesthesia. After intubation, the endotracheal tube placement was confirmed with airway ultrasonography and five-point auscultation and compared with capnography in all the patients. The time of intubation and confirmation of correct placement of endotracheal tube by the three methods: airway ultrasound, auscultation and time to five waveforms on the capnograph were recorded. Results: When compared with capnography, airway ultrasonography showed accuracy, sensitivity and specificity of 100% while auscultation showed accuracy, sensitivity and specificity of 94.3%, 97.0% and 57.1% respectively. The time required for confirmation of endotracheal tube position was observed to be significantly lower with airway ultrasonography (average time of 6.68 ± 2.1s) than both capnography (25.81 ± 6.9s) and auscultation (29.29 ± 9.0s) respectively with a p value of <0.001. Conclusion: Data from this study show that airway ultrasonography confirmed correct placement more accurately than auscultation when compared with capnography. Ultrasound is a simple, accurate, non-invasive and fast method for confirming paediatric endotracheal tube placement.
Correlative Value of Airway Assessment by the Modified Mallampati Classification and Cormack and Lehane grading in Patients with Goitre Scheduled for Thyroidectomy Under General Anaesthesia
Background: Patients with goitres may present with difficult airway. The Modified Mallampati test (MMP) assists the anaesthetist in planning airway management. Aim of the study was to determine the correlative value of the MMP and Cormack and Lehane (CL) in goiter patients scheduled for thyroidectomy. Methodology: Patients recruited were 250. MMP was assessed preoperatively and CL grading at laryngoscopy. MMP and CL 1 and 2 were rated easy intubations while MMP and CL 3 and 4 were rated difficult intubations. Data collected: number of patients in MMP and CL, true positive (TP), false positive (FP), true negative (TN) and false negative (FN). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and correlation were derived. Results: Highest percentage of patients in MMP were in class II, 45.6% and the lowest were in class IV, 4.8%. Highest percentage of patients in CL were in grade 1, 42.8% while the lowest were in grade 4, 13.2%. There were 37, 36, 131 and 46 patients that had TP, FP, TN and FN respectively. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were 50.68%, 74.01%, 49.22%, 75.12% and 66.27% respectively. Pearson’s correlation coefficient was 0.192, p = 0.002. Three patients had failed intubation. Conclusion: MMP had low sensitivity of 50.68% and low positive predictive value of 49.22% in goitre patients scheduled for thyroidectomy under general anaesthesia. Though there was positive correlation between MP and CL, it was negligible Addition of other tests may improve predictive accuracy when there is a high index of suspicion.
Implementation of the WHO surgical safety checklist in a tertiary hospital in South-South Nigeria and commonly encountered barriers
Background: The WHO Surgical Safety Checklist (SSC) was established to improve the standard of care of surgical patients and thereby improve perioperative outcome. Objective: This is an overview of the implementation of the WHO-SSC and commonly encountered barriers at the University of Port Harcourt Teaching Hospital, Port Harcourt –Nigeria. Methodology: Following institutional Research Ethics Committee approval, the processes leading to the commencement of SSC in the institution were identified. The period of study was over a one-year period in the various operating theatres and a documentation of the total number of procedures performed, total number of administered surgical safety checklists (SSC’s) and types of problems encountered were made. Data were analysed with the SPSS software v.20 and presented as frequencies and percentages of total responses. Results: An Anaesthetist and a Perioperative Nurse from the institution were part of a national training on SSC and subsequently, meetings were held with the theatre users committee. Out of a total of 4,844 procedures over a wide range of specialties, Anaesthetists led the team in 100% of SSC’s conducted in 3,126(64.5%) and 2,018(64.6%) were general surgical patients. Attributed problems in those not conducted 1718(35.5%) were errors of omission-930(54.1%), lack of time-580(33.8%), lack of documentation sheets-200 (11.6%) and others-8(0.46%). Conclusion: The Anaesthetists remain the lead and most enthusiastic in the conduct of the WHO-SSC. There is need for improved team approach for conduct of this crucial step aimed at surgical safety.
Copyright (c) 2024 Nigerian Journal of Anaesthesia https://creativecommons.org/licenses/by-nc-sa/4.0
Physiology Of Pregnancy And Anaesthetic Implications
Series of physiological and anatomical adaptations occur in pregnancy, largely due to the actions of oestrogen and progesterone, to support fetal growth. These adaptations present unique challenges for anaesthetic management, especially during labor and delivery. This article reviews key physiological adaptations in cardiovascular, respiratory, gastrointestinal, and metabolic systems, and discusses their anaesthetic implications, focusing on optimized care for both mother and fetus.
Selected topics from NSA Educational Webinars I
Control of ICP and Perioperative Considerations in Neuroanaesthesia
Intracranial pressure (ICP) is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brain’s circulating blood volume.Is the pressure inside the lateral ventricles and lumbar subarachnoid space in supine position. it is constantly fluctuating in response to activities and measured in millimeters of mercury (mmHg).
A Synopsis Of Airway Assessment: Ease Of Intubation
Airway management is a critical aspect of anaesthesia practice, with significant implications for patient safety and outcomes. This synopsis synthesizes key concepts from recent presentations on airway assessment, predictors of difficult intubation, and management strategies. Emphasizing the importance of thorough preoperative evaluations, this article aims to provide a framework for anticipating and managing difficult airways effectively.
Improving the practice of airway management in Nigeria by education, training and communities of practice
Introduction: There is a significant variation in resources and skills of healthcare providers in airway management in healthcare institutions in Nigeria. The aim was to bridge the gap in access to training and airway management devices to improve the practice of airway management in Nigeria. Methodology: Surveys revealed challenges to the training and practice of airway management in Nigeria. An airway society was established to coordinate activities to address these challenges. Results: Several webinars and workshops were held across the country and collaborations with other societies to deliver airway management training to over 2000 healthcare professionals. Over 40 Simulation centres have been established in collaboration with the Airway Development Incorporated and coordinated by airway leads responsible for training and research in their centres and research. Templates have been designed to ensure standardized training at these centres. Healthcare providers now have more skills, confidence, and access to more advanced airway management equipment. Conclusion: The birth of the airway society enabled the engagement of all stakeholders in airway management in the country leading to better access to training, enhanced skills and confidence of healthcare professionals, provision of equipment, and collaborations for improvement in the practice of airway management in Nigeria.
Overview of Critical Care - LMICs in Perspective
Introduction: Critical Care Medicine is an evolving specialty in our environment. Intensive Care Unit is a specially staffed and equipped hospital ward dedicated to the management of critically ill patients with reversible organ dysfunction, life threatening illness, injuries or complications who will benefit from care not available on the general ward. The Care is INTENSIVE! Case Scenario: A 62year old known hypertensive, diabetic and asthmatic, a victim of RTA rushed to ER. GCS 5/15, PR 125bpm, BP 80/55mmHg, RR 48cpm, Sat 85% on NRM @15L/min, dyspnoiec. Bleeding from orofacial orifices, # ribs, blunt abdominal injury with guarding, tenderness++, #long bones Hb 7.2g/dl, WBC 32,000, PLT 80,000 Lactate 8. What is the diagnosis? What is the next line of management? Who is a critically ill patient? A critically ill patient describes a patient with a clinical state that may arise from various medical conditions e.g. acute coronary syndrome, stroke, infection, trauma etc or following major surgery leading to one or more organ dysfunction (consciousness, circulation, spiration, renal, endocrine or metabolic etc).
Analgesic use in the intensive care unit of a tertiary teaching hospital
Background: Moderate to severe pain is common in the intensive care unit (ICU). There are various sources of pain in the ICU ranging from trauma-related pain, acute post-operative pain, ICU procedure-related pains and pain from disease processes. We aim to determine the pattern of analgesic use and the extent of use of potent opioids in our ICU. Methodology: This was a retrospective audit of all ICU admissions during 12 months in a tertiary hospital in Northern Nigeria after an ethical waiver. Data on age, sex, indication for admission (medical/surgical) and types of analgesics were retrieved and analyzed using SPSS version 21. Continuous data were summarized as mean±standard deviations while qualitative data were summarized as proportions. Fisher’s Exact Test (FET) was computed. The level of significance was set at p≤0.05. Results: There were 98 admissions out of whom 94(95.9%) received analgesics. Females that were administered analgesics constituted 42(44.7%) of admitted patients. The mean age was 35.4±18.4years. Most of the admissions were surgical 86(91.5%). Paracetamol, diclofenac, pentazocine and tramadol were used in 20(21.3%), 15(16%), 54(57.4%), and 2(2.1%) patients while pethidine and morphine were administered in 1(1.1%) and 2(2.1%) patients respectively. There was no statistically significant relationship between the types of analgesics used and indication for admission (medical/surgical) p=0.422 (FET). Conclusion: Most of those treated during the period under review were postoperative surgical patients. Pentazocine was the most commonly used analgesic at that time and there was low utilization of potent opioids such as fentanyl and morphine.