Critical Care in Sub-Saharan Africa, Where Are We? A Review.

Critical care services in sub-Saharan Africa have not gained much grounds despite becoming part of modern clinical practice in the 1950s. Managing patients with potentially recoverable illnesses and injuries is still not at par with evidence-based practices in developed climes, and most die from many preventable causes. Many hospitals in Africa do not have an intensive care unit, leaving critically ill patients being treated mostly in the general wards. A survey from Zambia indicated that only 7% of hospitals in the country have an intensive care unit, whereas a cross-sectional survey in Nigeria revealed that there were 30 public and private intensive care units serving a population of over 200 million, spread around all the geo-political zones, with most in the teaching hospitals. The situation is not generally better in most parts of the continent. This review focuses on why critical care is at the level it is in sub-Saharan Africa and provides suggestions on what should be done to change the narrative.

Subcutaneous ketamine prolongs the analgesic effect of local infiltration of plain Bupivacaine in children undergoing inguinal herniotomy.

BACKGROUND: Inguinal herniotomy is one of the commonest paediatric surgical procedures at the University of Benin Teaching Hospital. Incisional infiltration with plain bupivacaine has been used to provide postoperative analgesia for this procedure but with a short duration of action, 4-6 hours. AIMS/OBJECTIVES: The aim of this study therefore was to evaluate the efficacy of subcutaneous ketamine on post-operative analgesia in children undergoing unilateral inguinal herniotomy. METHODS: Forty-six (46) ASA I or II patients aged three to seven years scheduled for unilateral inguinal herniotomy were recruited. The patients were randomized to receive surgical wound site infiltration with plain bupivacaine plus subcutaneous injection of ketamine for group I or surgical wound site infiltration plain bupivacaine plus 2ml of saline subcutaneously for group II at the end of surgery. Data obtained were analyzed using SPSS version 20. Continuous data were compared using student t-test while categorical data were compared using Chi-square or Fisher's exact test. P-value <0.05 was considered statistically significant. RESULTS: In group, I, the mean time to first analgesic request was 667.7 minutes (11.12 hours) and in group II, it was 371.3 minutes (6.2 hours) with p<0.001. The pain scores were better and more favourable in group I from the 8th hour and above of the assessment period. The mean post-operative analgesic consumption in 24 hours was less in group I (19.35±5.4mg) than in group II (27.32±5.8 mg) with p-value <0.001. CONCLUSION: The study showed that subcutaneous ketamine prolonged the analgesic effect of plain bupivacaine surgical wound site infiltration in children undergoing unilateral inguinal herniotomy.

Cardio-pulmonary resuscitation in the intensive care unit: An experience from a tertiary hospital in Sub-Saharan Africa.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is one the most commonly performed procedures in the intensive care unit (ICU). However, success rate of CPR vary widely from 3.1% to 16.5%. PATIENTS AND METHODS: We conducted a retrospective study of all cardiac arrests prompting CPR in our ICU for a period of 12 months. Data retrieved from ICU records included patients demographic characteristics, diagnosis at admission, length of ICU stay, time and day of cardiac arrest, cardiac rhythm, duration of CPR and outcome of CPR. RESULTS: A total of 156 CPRs were performed within the study period with 8.3% success rate. Male: female ratio was 1.2:1. Indications for ICU admission, length of stay in ICU, time and day of cardiac and duration of CPR were found to be determinants of outcome. CONCLUSIONS: There is an urgent need to constitute a cardiac arrest team (CAT) which will be available at all times for improved successful outcome after cardiac arrest in our ICU.