Anaesthetic management of mentosternal contractures where resources are limited

Objective: Perioperative airway management in postburn mentosternal contractures often pose great challenges to the anaesthetist as well as the plastic surgeon. This is more so where resources are limited. Method: Patients with postburn mentosternal contracture who had surgery between January 2000 and December 2006 at the Jos University Teaching Hospital, Jos Nigeria were retrospectively reviewed. The information obtained from the anaesthetic chart as well as the patients' case notes included demographic data, type of anaesthetic induction and maintenance as well as the type of airway management. Results: There were 15 patients (12 males and 3 females), aged between 6 and 65 years. A total of 17 procedures were performed on the patients. Five of the patients were induced with ketamine and maintained with the same drug until adequate release was achieved. In five others the release were done under inhalational anaesthesia using a facemask after induction with ketamine. Six of the cases had laryngeal mask airway (LMA) inserted while one patient had a tracheostomy under local anaesthesia. After adequate release endotracheal tubes were inserted except in those who had LMA which were maintained to the end of the surgery. The rest of the procedure was then continued under general inhalational anaesthesia. Conclusion: Fixed flexion deformities in postburn mentosternal contractures could present serious airway challenges to the attending anaesthetist during contracture release and skin cover. This could be overcome by the use of ketamine, inhalational anaesthesia as well as the use of LMA before contracture release

Isolated bilateral macrostomia : case series and review of literature

Macrostomia is a rare congenital anomaly of the face; especially the isolated type. This report aims to document our experience inmanaging this rare pathology. All consecutive cases of children managed for isolated bilateral macrostomia at the Jos University Teaching Hospital were retrospectively reviewed. Five patients; aged between 10 weeks and 30 months were managed. They were all females and presented with bilateral symmetrical transverse lateral facial cleft (macrostomia). There were no associated anomalies; and no family history of facial clefts or any other congenital anomaly. All the patients had repair of the defect under a general anaesthesia with satisfactory outcome. Macrostomia can present as an isolated entity. The final outcome of the repair depends on the technique of repair; function of the orbicularis oris muscle and the quality of scar

Management of Conjoined Twins : a Report of Two Sets

Background: Conjoined twinning is a rare congenital anomaly. We present here; our experience in the management of two sets of conjoined twins at a Teaching Hospital in north central Nigeria. Method: Data of conjoined twins managed at the Jos University Teaching Hospital in 1987 and 2004 were retrospectively collated and analyzed. Result: Two sets of pyopagus tetrapus conjoined twins were managed within the period; one was a set of triplets. The conjoined pairs in both sets of twins were females. None of the twins was diagnosed prenatally. Both sets of conjoined twins were delivered spontaneously by vaginal route. Emergency surgical separation was undertaken in both sets be- cause of deteriorating anencephaly in one twin in the first set and anorectal malformation and intestinal obstruction in one twin in the second set. Both sets of twins died after separation. Conclusion: Our experience showed that separation of conjoined twins may be associated with high mortality. Sepsis and electrolyte imbalance appear to be the major causes of morbidity and mortality; particularly when the resultant skin defects are large

Typhoid intestinal perforation in North Central Nigeria

Background: Typhoid intestinal perforation is a surgical problem with severe morbidity and high mortality in North Central Nigeria.Patients and Methods: In order to determine the pattern and the prognostic indices; we studied 101 patients with typhoid intestinal perforation managed over a ten-year periodResults: Children constituted 49 of the cases and majority(78) of the patients were in the low socio-economic strata. The incidence peaked to 67 between November and March - the dry season in Nigeria. The male/female ratio was 1.9:1 with a mean age of 19 years and a mean hospitalization period of 18 days. There were 167 perforations; four involved the large bowel and appendix; and in 72.2 cases; the perforation was single. The mortality rate was 13.9; affected mostly children and significantly worsened by prolonged perforation-surgery interval 72 hours; jaundice; convulsion; ASA V; faecal peritonitis and re-exploration for early intra-peritoneal complications. Morbidity rate was 65.3 and significantly affected more children than adults and associated with perforation-surgery interval of between 24 and 72 hours; haematochezia and multiple perforations. Moribund patients fared better when operated upon under local anaesthesia with adequate analgesia. The least traumatic but effective surgical procedure that could seal the perforations and keep the peritoneum clean gave the best results. Children who survived up to 5 days and adults who survived up to 10 days after surgery had better chances of survival.Conclusion: The most significant prognostic factor is late presentation which prolongs perforation-surgery interval and the other complication and mortality indices are directly influenced by it