BRACHIAL PLEXUS BLOCK FOR UPPER LIMB PROCEDURES: EXPERIENCE AT THE UNIVERSITY OF UYO TEACHING HOSPITAL, UYO, AKWA IBOM STATE, NIGERIA.

BACKGROUND: Brachial plexus block (BPB) has many benefits over general anaesthesia in upper limb procedures. However, its utilization in Nigeria is not as high as expected. AIM: To evaluate BPB in upper limb surgeries, its utilization, outcome and complication profile. MATERIALS AND METHODS: Approval for the study was obtained from the institution's research ethical committee. This was a retrospective study of all patients who underwent upper limb surgeries from May 2011 to December 2014. Those who had BPB were further analysed. Data was obtained from the anaesthesia register and records, as well as the patients' folders. Information obtained included: age, gender, ASA class, type of BPB and nerve localization technique. The primary outcome was the adequacy of the block for surgery and complications. Data analysis was done using SPSS, version 16. RESULTS: Ninety two patients underwent upper limb surgeries, out of which 42(45.65%) were performed under BPB, the rest were done under GA-45(48.91%), local infiltration-4(4.35%) or wrist block-1(1.09%). Combined interscalene and axillary blocks were performed in 35(83.3%) patients, interscalene block only-5(11.9%), combined interscalene and supraclavicular blocks, and axillary block only in 1(2.4%) patient each. Paraesthesia technique-40(95.2%) was the dominant nerve localization technique, while nerve stimulator was used in 2(4.8%) patients only. BPB was adequate in 37(88.1%) patients, while it failed in only 5(11.9%) patients, and were converted to GA. No major complication was observed except dysthesia reported in 1(2.4%) patient postoperatively. CONCLUSION: The use of brachial plexus block for upper limb procedure in our centre is rising. Paraesthesia technique is predominant, and it is associated with a high success rate and low complications.

Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients- a survey.

In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.

Total Intravenous Anaesthesia in a Developing Environment

Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become widely popular in the developed world with the availability of computerized infusion devices and appropriate drugs making its use easy and safe for the practitioner; and acceptable; tolerable and cost-effective for the patient. Such infusion devices and new drugs are not readily available in the developing world; although in Nigeria today; infusion devices may be obtained through medical equipment companies now established in the country; and opioids are available through the National Agency for Food; Drug; Administration and Control (NAFDAC).Aim: This paper aims to discuss TIVA giving insights into its practice in a developing economy without the use of sophisticated equipment and drugs; in order to encourage practitioners to use the technique. Method : At the 1st South-South regional anaesthesia conference in Calabar in July 2004; a symposium on TIVA in a developing economy was held as part of the conference. This review utilized literature from relevant texts and that obtained through Medline search. Results: This paper discusses TIVA highlighting aspects of its use in the developed world; and presenting its rather peculiar practice in our environment without the use of sophisticated equipment and opioid analgesics. Conclusion: TIVA is a unique technique of anaesthesia which is easy to master. It is cost-effective and safe. Hence; it is possible to use what is available in the developing environment to obtain what is necessary

Total intravenous anaesthesia in a developing environment

Background: Total intravenous anaesthesia (TIVA) is a technique of anaesthesia which has become widely popular in the developed world with the availability of computerized infusion devices and appropriate drugs making its use easy and safe for the practitioner; and acceptable; tolerable and cost-effective for the patient. Such infusion devices and new drugs are not readily available in the developing world; although in Nigeria today; infusion devices may be obtained through medical equipment companies now established in the country; and opioids are available through the National Agency for Food; Drug; Administration and Control (NAFDAC).Aim: This paper aims to discuss TIVA giving insights into its practice in a developing economy without the use of sophisticated equipment and drugs; in order to encourage practitioners to use the technique.Method: At the 1st South-South regional anaesthesia conference in Calabar in July 2004; a symposium on TIVA in a developing economy was held as part of the conference. This review utilized literature from relevant texts and that obtained through Medline search.Results: This paper discusses TIVA highlighting aspects of its use in the developed world; and presenting its rather peculiar practice in our environment without the use of sophisticated equipment and opioid analgesics.Conclusion: TIVA is a unique technique of anaesthesia which is easy to master. It is cost-effective and safe. Hence; it is possible to use what is available in the developing environment to obtain what is necessary

Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients: a survey.

In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.

Subglottic stenosis in a child: a complication of prolonged endotracheal intubation.

A 1 1/2 year old Nigerian child sustained traumatic rupture of the diaphragm which was repaired under endotracheal anaesthesia. A red rubber endotracheal tube was used for the surgery and a nasotracheal tube was let in situ for 4 days. A post intubation subglottic stenosis which developed was managed with a tracheostomy and a series of 8 tracheal dilatations under hatothane within a period of 5 months. Appropriate choice of tubes and attention to details of humidification may have prevented this serious complication.

Recognition of the difficult airway in normal Nigerian adults (a prospective study).

Difficulty with laryngoscopy and intubation is known to be the most frequent cause of anaesthetic related deaths. Awareness of the possibility of difficulty would enable the anaesthetist to be adequately prepared. 57 "normal" adult patients were examined pre-operatively and at laryngoscopy using the Mallampatti (1985) and the Cormack (1984) classification respectively. The result showed that none of the patients was in the IV Mallampatti nor IV Cormack groups. Four patients with class III Mallampatti features were seen, two of which were classified Cormack III at laryngoscopy. Intubation failed in these two patients. The majority of patients were classified as Mallampatti class I (68.42%) and Cormack grade I (63.16%). This in effect demonstrates that in most "normal" patients laryngoscopy and intubation should be fairly easy.

The non-physician anaesthetist in a teaching hospital.

There is an overall shortage of physician anaesthetists in the West African Subregion. The non-physician anaesthetist (nurse anaesthetist) is used to provide adequate clinical service. However, in a teaching hospital setting it usually lead to the frustration of the efforts of resident physician anaesthetists. The Society of Anaesthetists of West Africa has therefore recommended that where possible nurses should not be involved in the administration of anaesthetics in the Teaching Hospitals. They should be placed out into intensive therapy units and recovery rooms.