Outcome of emergency caesarean sections in Calabar, Nigeria: Impact of the seniority of the medical team.

We set out to assess the maternal outcome of emergency caesarean sections in University of Calabar Teaching Hospital (UCTH) in relationship to the seniority and experience of medical personnel involved in the operation. This was a review of 349 cases of emergency caesarean sections in UCTH over a 2-year period (January 2000-December 2001). The sociodemographic data, antenatal booking status and clinical condition of the patients as well as the seniority of the medical staff who participated in the operations were extracted from the case notes of the patients. A total of 280 (80.0%) booked patients and 69 (20.0%) unbooked mothers were delivered by emergency caesarean sections. The consultants performed only 16.4% of the emergency caesarean sections, while the residents performed 83.6%. Similarly consultant anaesthetists administered anaesthesia in 12.9% of the cases. A total of 12 maternal deaths occurred from emergency caesarean sections in which six (1.7%) were due to sepsis, three (0.8%) due to severe haemorrhage and three (0.8%) due to anaesthetic complications. None of the deaths occurred in operations in which consultant obstetricians and anaesthetists were involved. The intraoperative blood loss was more in operations performed by the residents than in those performed by the consultants. Similarly, morbidity was higher in patients operated upon by residents. The maternal morbidity and mortality associated with emergency caesarean sections in UCTH would be reduced significantly if consultant obstetricians and anaesthetists were more involved in these operative procedures.

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

Prediction formulae for lung function parameters in females of south eastern Nigeria.

This study was carried out to obtain normal lung function values for women in south eastern Nigeria with a view to establishing prediction equations for forced vital capacity (FVC), forced expiratory volume at the first second (FEV(1)) and peak expiratory flow rate (PEFR). Lung function values were measured in 600 apparently healthy Nigerian women aged between 18 and 57 years. FVC and FEV1 were significantly related to height [P < 0.001] and [P < 0.01] respectively) and body weight [P < 0.01], PEFR was also related to age [P < 0.01] and height [P < 0.001]. Prediction equations for the various lung function indices were as follows: FVC = 0.145 + (1.390Ht) - (0.0076age) + (0.0089wt); FEV1 = 0.240 + (1.045Ht) - (0.0055age) + (0.0064wt); PEFR = -38.80 + (210.83Ht) + (1.650age) + (0.252wt). Ht is height in meters, wt. is body weight in kilograms and age is age in years. The ventilatory function indices were directly proportional to weight, height and to age. All the observed or measured lung function indices were not significantly different from their predicted values using the above prediction equations. Therefore, we conclude that lung function indices are influenced by the anthropometric parameters viz: age, body weight and height, and the prediction equations stated for FVC, FEV1 and PEFR for Nigerian women between the ages 18 and 57 years are reliable.

Lung function, oxygen saturation and symptoms among street sweepers in calabar-Nigeria.

Chronic inhalation of dust impairs lung function and may cause respiratory symptoms. However, knowledge about the type of dust that can cause these problems is uncertain. Very little attention has been paid to the health of workers chronically exposed to dust raised by street sweeping without precautionary measures. Therefore, a study of lung function, oxygen saturation and symptoms among female street sweepers and their control groups in Calabar, Nigeria was carried out. Ventilatory function tests were done using 200 female street sweepers whose length of service was less than two years and 200 sex, age, weight, and height - matched external controls who were not exposed to any known air pollutant. The percentage of oxygen saturation (SPO((2)) of both the subjects and their control population was determined using a pulse oximeter. Respirable dust level in the test sites was 0.194 +/- 0.002 mu g/m3 and it was significantly higher (P < 0.001) than in control sites, which was 0.015 +/- 0.003 mu g/m3.There was no significant difference in the mean values of SPO((2))between the test and control subjects. However, there was also a significantly higher [P < 0.001] prevalence of back pain, cough, chest pain , catarrh and sneezing among the street sweepers compared to control. Lung function values, namely; FVC, FEV((1)), FEV((1)) % and PEFR were not significantly different in the two groups. Street sweeping; without precautionary measures may predispose to respiratory and non-respiratory symptoms.

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.