Anaesthetic outcomes in neonatal surgical care in a tertiary health facility in Nigeria

ABSTRACT: There is always a concern about the survival of new-borns undergoing corrective surgical procedure early in life. Perioperative care, especially in sick babies, is challenging, and this makes ascribing outcomes to care given difficult. This study was aimed at determining and evaluating factors associated with poor outcomes in new-borns undergoing surgery and anaesthesia. This was a retrospective case notes review of 37 neonates who received general anaesthesia during surgical care over a three-year period. After ethical approval for the study, the demographic data, indications for surgery, American Society of Anesthesiologists' (ASA) classifications, preoperative, intraoperative and postoperative challenges present in these neonates as well as their outcome were extracted. A total of 48 neonates were operated over a three-year period, and only 37(77.1%) case files were available for review. Male: Female ratio was about 2:1, the two most common procedures performed were bowel resection and anastomosis in 7(18.9%) and colostomy 7(18.9%). Overall mortality was 29.7%. Neonatal mortality was significantly higher in patients with postoperative sepsis (p=0.006) and respiratory challenge (p=0.035). The median time to death was 9 days. Only one (9.1%) patient died within 24hours postoperative. Mortality in neonates undergoing surgical procedure early in life is very high in this study. However, it is difficult to implicate anaesthesia in our study as the cause of mortality as most occurred very late after many days of surgery. Availability of postoperative elective ventilation for selected patients may improve outcome

Completeness of manual anaesthesia records in a tertiary facility in Nigeria

Introduction: The human brain, as efficient as it is, cannot remember everything.It is legally required by law that healthcare providers maintain a record for each of their patients. In anaesthesia, every aspect of the anaesthetic care from preoperative to postoperative care needs to be documented. It is, therefore, essential to review the efficiency of manual record keeping and explore possible ways of improving it. Materials and Methods: This was a retrospective study of all patients of obstetrics undergoing caesarean section between 1st July, 2013 and 30th June, 2014. Study participants were identified from Institutional Anaesthesia record books and clinical record (case notes). With the aid of a questionnaire, relevant information concerning patients' biodata, names of health personnel involved in the surgery and clinical information about vital signs and drug administration were documented from the records. Results: The chart completion rate was 63.88%. Emergency procedures had an average chart completion rate of 51.68% while the charts in elective procedures had a completion rate of 73.4%. The patients' name was the most frequently recorded item. The Apgar score was not recorded in any of the charts reviewed. Critical incidents were poorly charted with a chart completion rate of 36.59%. Conclusion: Manual recording of anaesthesia information is unreliable and results in incomplete anaesthesia records. It is poorer in emergency surgeries as compared to elective ones. A comprehensive approach that would include structured teaching on the importance of chart completion and the use of automated information systems in recording may correct this anomaly

Clomiphene resistant polycystic ovarian syndrome: Analysis of outcomes following laparoscopic ovarian drilling in infertile women in Ilorin, North-central, Nigeria

Background: Laparoscopic ovarian drilling (LOD) is one-off treatment modality for clomiphene citrate (CC)-resistant polycystic ovarian syndrome (PCOS) avoiding the need of medical therapy and its attendant complications. Aims and Objectives: This study aimed at determining the efficacy of LOD in women with anovulatory infertility secondary to CC-resistant PCOS and factors influencing reproductive outcomes. Materials and Methods: A cross-sectional study of infertile women who underwent LOD on account of CC-resistant PCOS between January 2012 and December 2015 at a tertiary institution. Results: Patients aged 24­38 years (29.7 ± 3.6 years) and their body mass index (BMI) ranges from 20 to 35 (26.3 ± 4.3). The majority (90.5%) were nulliparous. Most (61.3%) had primary infertility. Their duration of infertility ranges from 1 to 13 years (4.3 ± 2.7) and ovarian volume ranges from 10 to 24 cm3 (mean, right ovary = 15.2 ± 3.2; left ovary = 16.3 ± 3.2). The number of drills per ovary ranged from 4 to 14 (mean, right ovary = 7.4 ± 2.1; left ovary = 7.3 ± 2.1) and the luteinizing hormone/follicle stimulating hormone (LH)/FSH ratio ranges from 2 to 6 (3.2 ± 1.4). All achieved spontaneous resumption of menses and ovulation with mean durations of 4.0 ± 1.8 days and 5.3 ± 3.2 weeks, respectively. Eighty-three (60.6%) clinical pregnancies were recorded, of which 68 (49.6%) resulted to live births (61 singletons and 7 twin births) and 14 (10.2%) early first trimester miscarriages. The mean time interval from LOD to pregnancy was 4.4 ± 1.1 months. There was a significant association between BMI, duration of infertility, FSH/LH ratio, and pregnancy outcomes (P < 0.05). Conclusion: LOD is the most preferred treatment modality for CC-resistant PCOS as it resulted in higher pregnancy rate