Anaesthesia for ambulatory paediatric surgery: common techniques and complications.

BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as benchmark. METHODS: This was a cross-sectional study of children who were presented for ambulatory surgical care in the University of Benin Teaching Hospital. A standardized questionnaire was employed to record the age, gender, indication for surgery, type of anaesthesia, timelines for the surgery and associated complications. RESULTS: A total of 93 patients had surgical procedures on ambulatory basis. The mean age of the patients was 4.1(4.0) yr and duration of surgical procedure 31.3(12.1) min. The male to female ratio was 3:1, and herniotomy was the most frequent procedure on ambulatory paediatric surgical care 60 (64.5%). The common anaesthetic techniques employed in the paediatric ambulatory setting were spontaneous respiration with face mask 40 (43%), Inhalation technique with tracheal intubations 31 (33.3%), general anaesthesia with relaxant technique five (5.4%), local infiltration with or without sedation eight (8.6%), GA plus caudal block eight(8.6%), and subarachnoid block one(1.1%). The indicators of quality care were unanticipated admission (5.4%), repeat hospital visit (4.3%), readmission (2.2%) and delayed discharge (21.5%). CONCLUSION: The practices of paediatric surgery on ambulatory services are feasible in our setting. The observable complications are within acceptable limits. The timelines in the scheduling and discharge appear not to be optimal for an effective ambulatory service.

Factors affecting the management and outcome of neonatal surgery in Benin City, Nigeria.

INTRODUCTION: Neonatal surgery poses a major challenge, particularly in developing countries. The objective of this study was to determine the pattern and various factors that may affect the outcome of surgical management of neonates in a developing country like Nigeria. METHODS: A retrospective study was carried out of all neonates who underwent surgery over an 8-year period at the University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: There were 83 males and 35 females with a male/female ratio of 3.4:1. The age of the patients was from 12 hours to 28 days (mean 8+/-5.1 days) and they weighed from 1.8 to 3.9 kg (mean 2.7+/-0.5 kg) on presentation. A large proportion of the babies, 103 (87.3%), were delivered by poor women living in rural areas without supervised antenatal care and delivery. Mortality did not differ significantly between those babies delivered in hospital and those delivered at home (p=0.2127). However, unhygienic care of neonates, which allowed overwhelming resistant sepsis to set in, the delay in presentation and hazardous transportation without stabilisation led to high morbidity and mortality rates. The difference in mortality was significant when the mortality of patients operated on an emergency basis was compared with those operated electively (p=0.0483). Nine (75%) patients with tracheo-oesophageal pathologies, 24 (35%) patients with gastrointestinal anomalies, 1 (17%) with a cranio-spinal defect, 1 (13%) with a head/neck defect and 1 (5%) with a genitourinary anomaly died, with no death in the musculoskeletal group. Overall, a total of 56 (47.4%) morbidities and 36 (30.5%) mortalities were recorded. CONCLUSION: The morbidity and mortality following surgical management of neonates is still very high in this hospital. Financial constraints, emergency surgery, delivery outside the hospital and tracheo-oesophageal/gastrointestinal anomalies were significant and contributory factors.