WOMEN ANAESTHETISTS IN WEST AFRICA - CHALLENGES AND ACHIEVEMENTS.

The entry of women into medicine was late compared to men. The number of women entering medical schools has increased worldwide in recent years. This increase in female medical graduates has led to a gradual increase in the number of women specialising in various fields. Anaesthesia as a specialty has not been popular with medical graduates, a situation which seems to be changing all over the world. Women in anaesthesia in West Africa have broken through the "glass ceiling." This paper will show how they have progressed through academia, and gained entry into "local politics" by occupying various positions in administration. Their involvement and achievements in the various Postgraduate Medical Colleges is highlighted. Their interest in various societies and associations, their roles and achievements are also highlighted in the paper. The results of a questionnaire administered to some female anaesthetists of the Department of Anaesthesia, Korle Bu Teaching Hospital, concludes this paper.

Bony Injuries in Trauma Patients Diagnosed by Radiological Examination.

OBJECTIVE: This study was carried out to determine the incidence of bony injuries in trauma patients who had plain radiographs done at the Central Regional Hospital in Cape Coast. DESIGN: This is a retrospective study based on plain radiographs taken by trauma patients who reported to the Central Regional Hospital. METHOD: The case notes of all patients with a discharge diagnosis of Road Traffic Accident or trauma of all aetiologies that presented to the hospital between January 2005 and December 2011 were retrieved, and those patients that had skeletal radiographic examinations were included in this study. RESULTS: The total number of cases seen was 1,133. The ages of the patients ranged between 1 and 72 years. Sixty-nine (6.1%) of the patients were between 1 and 4 years old, with the majority between 20 and 49 years old, constituting 52.3%, with patients 60 years and above at 9.2%. There was statistically significant difference between male and female patients (p=0.001). A total of 912 (80.5%) patients had radiographic examination done out of which only 324 (35.5%) radiographs could be retrieved. There were 106 (32.7%) radiographs with various bony injuries which was statistically significant (p=0.001). Rib fractures represented 19/106 (17.9%) of which 62.5% had multiple rib fractures. Fifty-eight (54.7%) had long bone fractures. Other anatomical sites included the pelvis and the skull. CONCLUSION: Trauma is a major public health problem in the country, involving mainly the productive age group. Unnecessary exposure to X-rays is common. Inadequate management of trauma patients negatively impacts on the outcome of trauma patients. Trauma prevention is the best way forward.

NEONATAL HYPOGLYCAEMIA AT CAPE COAST TEACHING HOSPITAL.

BACKGROUND: Hypoglycaemia is an important metabolic condition in the neonate although there is no common consensus with regards to diagnosis, management and follow-up. It is common in preterm, small and large for gestational age and in birth asphyxia. Although the incidence of these predisposing factors is common among neonates in Ghana, the prevalence of neonatal hypoglycaemia (NH) has not been studied in this environment. AIM AND OBJECTIVES: To determine the prevalence of neonatal hypoglycaemia at the Cape Coast Teaching Hospital, Ghana. DESIGN: Cross sectional. SETTING: Cape Coast Teaching Hospital, Ghana. PATIENTS AND METHODS: Neonates between 3-24 hours of age delivered at the Cape Coast Teaching Hospital were included in the study. The blood glucose concentration was measured using Onetouch® Select TM Blood Glucose Monitoring System for 434 consecutively delivered neonates within 3-24 hours of birth. In addition the birth and delivery characteristics of the neonates were recorded. RESULTS: The overall prevalence of neonatal hypoglycaemia (NH) was 16 per 1000 births. The prevalence in appropriate weight for gestational age was 21 per 1000 births but none in small and large for gestational age group. The prevalence of NH in preterm, term and post-term neonates were 0, 18 and 15 per 1000 births respectively. CONCLUSION: The study showed that neonatal hypoglycaemia is common in Ghana although the expected result of high neonatal hypoglycaemia in preterm, small and large for gestational age groups was not recorded in this study.

Laparoscopic cholecystectomy at the Korle Bu Teaching Hospital, Accra, Ghana: an initial report.

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones, information was obtained on demography, duration of various stages of the operation, analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation, muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14 mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44%) and previous cholecystitis 15(29%). There were scars from previous abdominal surgery in 22 (42%), mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77%). Only one patient (1.9%) had the operation converted to open cholecystectomy. Most patients, 47/51 (92%), were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes), pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6%), infection of the umbilical wound 3(5.9%), right shoulder tip pain (3; 5.9%) and bile leak 1(2%). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra.

Laparoscopic Cholecystectomy at the Korle Bu Teaching Hospital; Accra; Ghana: an Initial Report

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones; information was obtained on demography; duration of various stages of the operation; analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation; muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44) and previous cholecystitis 15(29). There were scars from previous abdominal surgery in 22 (42); mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77). Only one patient (1.9) had the operation converted to open cholecystectomy. Most patients; 47/51 (92); were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes); pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6); infection of the umbilical wound 3(5.9); right shoulder tip pain (3; 5.9) and bile leak 1(2). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra

Postoperative Nausea and Vomiting in Korle Bu Teaching Hospital

Objective: Postoperative nausea and vomiting (PONV) is one of the most distressing morbidities associated with surgery. Even though the incidence can be as high as 30 elsewhere no work has been done to assess the incidence in any health facility in Ghana. This study was carried out to find out the incidence; risk factors and the management of PONV in a tertiary healthcare facility. Design: This was a prospective study. Setting: The study was carried out in Korle Bu Teaching Hospital (KBTH). Subjects and Methods: All patients above the age of 18 years who had surgery including general surgery were included in the study. Information obtained using a questionnaire included demographic data; the type of anaesthesia; the incidence of PONV and its management. Results: Three hundred and six (306) completed forms out of 322 questionnaires were analyzed. One hundred and six patients (34) had episodes of PONV of whom 82 (77.4) had intra-operative opioids. Of the other factors only age was found to be a risk factor with patients in the 20-49 age group constituting 71.8(p= 0.007). Eleven out of 93 patients who reported the episode to a health worker received medication for their PONV. Drugs used included promethazine and antimalaria. Conclusions: Thirty-four percent of patients in the study had PONV indicating that the problem is not uncommon among post-surgical patients in KBTH. Awareness of the problem should be highlighted and adequate management should be given to all patients. Patients at risk should be identified and appropriate management instituted

Blood sugar concentrations in children undergoing surgery under general anaesthesia.

One hundred children admitted for various operations were studied to determine their blood sugar levels at the time of induction of anaesthesia. The patients were divided into 4 groups according to their age. In Group 1 were patients below one year, Group 2, 1-5 years, Group 3, 6-10 years and Group 4, above 10 years. The highest percentage of patients developing hypoglycaemia was found in Group 1 (65%) i.e. babies aged below 1 year and the lowest in Group 4 (25%) children aged 10 years and above.

2% plain xylocaine for subarachnoid or spinal anaesthesia.

56 males and 14 females undergoing various lower abdominal and lower limb surgery were given Spinal Anaesthesia using 2% Plain Xylocaine. The different volumes used were 3.0ml, 3.5ml and 4.0ml. The levels of analgesia achieved were adequate for the surgery. There was no significant difference between the 3 volumes in the mean levels of analgesia obtained and the mean duration of sensory and motor blockade. This study has confirmed the usefulness of 2% Plain Xylocaine in Spinal Anaesthesia.

Pre-operative haematological investigation in paediatric patients for elective surgery

Haematological investigations for 225 paediatric patients aged between zero to 15 years who presented for elective surgery were studied retrospectively over a five-month period. In addition to the Haemoglobin (Hb); the Sickling test and the haemoglobin electrophoresis where applicable were done. Thirty per cent (30 per cent) of the patients had Hb of 10g/dl and below. The lower Hb was found more commonly in the age group zero to 5 years. Eleven (4.9 per cent) patients did not have the Sickling test done. Twenty-three (23) out of 29 patients with Sickling positive had electrophoresis done. The results were 21 AS; 1 SS; and 1 SC. Blood film for malaria parasites yielded positive results in 33 out of 175 (18.9 per cent) patients. There were no immediate anaesthetic complications in any of the patients. The need for minimum test of Hb; Sickling and blood film for malaria parasites are discussed