Video-assisted thoracic surgery in a Nigerian teaching hospital: Experience and challenges.

BACKGROUND: Video-assisted thoracic surgery (VATS) is well established. Its application in Nigeria has however been limited and not been reported. The aim of this study was to describe our institutional experience and challenges with VATS. MATERIALS AND METHODS: This was a retrospective cross-sectional study of all patients that underwent VATS in our institution between March 2008 and June 2013. Data were extracted from a prospectively maintained database. RESULTS: Two hundred and sixty-one patients were assessed as potential VATS cases. VATS was initiated in 26 patients, but completed in 25 patients (9.6%) as there was one case of conversion of a planned VATS bullectomy due to the failure of one lung ventilation. There were 12 males and 13 females. Mean age was 40.7 ± 13.9 years. The indication was interstitial lung disease in 9 patients (36%), malignant pleural effusion in 6 patients (24%), spontaneous pneumothorax in 5 patients (20%), indeterminate pulmonary nodule in 2 patients (8%), pleural endometriosis in 2 patients (8%) and bronchogenic cyst in one patient (4%). Procedures performed were lung biopsy in 13 patients (52%), pleural biopsy and pleurodesis in 6 patients (24%), bullectomy and pleurodesis in 5 patients (20%) and excision of bronchogenic cyst in one patient (4%). Mean hospital stay was 4 ± 0.7 days. There were no complications and no mortalities. CONCLUSION: VATS is being performed in our institution with successful outcomes. The use of VATS in Nigeria is encouraged. The relatively high cost of VATS is, however, a major limitation to more widespread use.

One lung ventilation using double-lumen tubes: Initial experience from Lagos, Nigeria.

BACKGROUND: One lung ventilation (OLV) is a technique routinely used in thoracic anesthesia to facilitate thoracic surgery. Double-lumen tubes (DLT) remain the most popular and reliable choice for one lung ventilation especially in adult patients though use in Nigeria is limited. This study aimed to describe the experience in our institution with the use of double-lumen tubes for one lung ventilation. MATERIALS AND METHODS: This was a retrospective cross-sectional study conducted on all patients who had double-lumen tube intubations for one lung ventilation between March 2008 and Feb 2013. RESULTS: A total of 55 patients (27 males and 28 females, with a mean age of 39.6 ± 15.7 years) had left double-lumen tube intubations during the period. There were 30 left-sided (54.5%) and 25 right-sided (45.5%) surgical procedures performed. Tube position was verified by flexible bronchoscopy in 50 patients (91.9%) and by chest auscultation in 5 patients (9.1%) with satisfactory collapse in all but one of the procedures. The major surgical indications for one lung ventilation were Video-assisted Thoracic Surgery (VATS) in 22 patients (40%) and Heller's cardiomyotomy in 17 (30.9%). There were no mortalities and all patients had a complete recovery with no sequelae attributable to double-lumen tube use or one lung ventilation. CONCLUSIONS: One lung ventilation is an integral component of modern anesthetic practice. It can be safely practiced in Nigeria with appropriate equipment and expertise. The use of DLT for OLV to enhance thoracic anesthetic practice should be encouraged in other Nigerian institutions.

Nicorandil-induced peripheral vasodilatation during cardiopulmonary bypass.

Nicorandil is an antianginal agent with actions at epicardial coronary arteries and arterioles, systemic arterioles, and veins. We report our experience with 7 patients taking oral Nicorandil who had severe vasodilation and hypotension requiring significant vasoconstrictor support after cardiopulmonary bypass. Although the mechanism for this phenomenon remains unknown Nicorandil might be interacting with other factors present during cardiopulmonary bypass, as it has relatively mild hemodynamic effects outside this situation.