Department of Anesthesia

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    Pregnancy in non-palliated functionally single ventricle: challenges of management in resource-poor settings
    (Pan African Medical Journal, 2020-01-09) Aniteye, E.; Delsol-Gyan, D.; Oppong, S.; Ofosu-Appiah, E.; Edwin, F.
    Women with complex functionally univentricular hearts rarely survive into adulthood without corrective or palliative surgery. Reports of pregnancy outcome in this group of patients in resource-poor settings are sparse. We report a case of unrepaired pulmonary atresia ventricular septal defect (VSD) with major aorto-pulmonary collateral arteries (MAPCA) who survived into adulthood and was able to complete a successful pregnancy in a resource-poor country
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    The Anaesthetic Management of a Case of Phaechromocytoma
    (Ghana Medical Journal, 1995) Henderson, K.; Baddoo, H.
    The anaesthetic management of a case of phaeochromocytoma is presented. It is pointed out that the number of cases in our environment may be higher than we think and that a high index of suspicion is necessary to pick out cases of phaeochromocytoma from the population of hypertensive patients. In our setting it is often difficult getting the necessary drugs to manage cases of phaeochromocytoma. Limited monitoring equipment may also be a handicap. It is however pointed out that with attention to care and detail, cases of phaeochromocytoma can be successfully managed in our environment
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    Anaesthesia manpower recruitment at Korle-Bu Teaching Hospital -A survey of house officers
    (Ghana Medical Journal, 2000-03) Baddoo, H.K.
    A survey was conducted among housemen at the Korle-Bu Teaching Hospital to find out young doc· tors ' al1itude towards the speciality of Anaesthesia. Out of 83 housemen contacted, there were 56 respondents. Out of the 56 respondents, 15 would consider specializing in anaesthesia and 29 would consider doing a rotation in anaesthesia. Reasons that were thought important in deterring doctors from anaesthesia were the heavy workload and stress in anaesthesia. Factors that were thought would increase interest in anaesthesia were facilities for intensive care and pain clinics and also the possibility of going abroad for part of the anaesthesia training. It is suggested that increased efforts are made to attract young doctors into the speciality of anaesthesia
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    Use of midazolam for conscious sedation in upper gastrointestinal endoscopy
    (Ghana Medical Journal, 2004-12) Aniteye, E.; Aduful, H.; Adu-Aryee, N.; Kotei, D.; Adu-Gyamfi, Y.
    The effectiveness, dosage regimen and amnesic properties of midazolam were studied in 77 Patients who presented for upper gastrointestinal endoscopy at the Korle-Bu Teaching Hospital. Patients were given an initial dose of 0.02- 0.04mg/kg of midazolam and top up doses 0.007SO. OISmg/kg. The total doses of midazolam given for adequate sedation were 2.5mg, 3.5mg, 4.5mg, in 19%, 35% nnd 45% of patients respectively. The average dose of midazolam used was 0.067 ± O.Ollmg/Kg. Ninety percent (90%) of the patients were awake but drowsy during the procedure, 6% were awake and anxious and 4% were asleep but responsive. Ninety-four percent (94%) of the patients had Ramsey sedation scale levels 2 to 4. Ninety.five percent (95%) of the patients had complelte or pantial anmesia of the procedure. Endoscopy conditions was fair to excellent in 88.3% and poor in 11 .7% of the patients. Oxygen saturation during the procedure was maintained at normal limits (>92%) without oxygen supplementation.
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    Failed Fibreoptic Intubation in a Patient with a Large Mandibular Fibreosseous Lesion
    (Ghana Medical Journal, 2008-12) Baddoo, H.K.; Parkins, G.E.
    A case is presented of a 25 year old patient with a 15 year history of a lesion in the oral cavity, the histology of which showed it to be fibrous dysplasia. Conventional laryngoscopy and intubation were not possible as the lesion filled the entire oral cavity. Attempted awake fibreoptic intubation failed as the lesion extended into the nasopharynx and oropharynx, making it impossible to pass the fibreoptic scope beyond the nasopharynx. A tracheostomy was performed under local anaesthesia and surgery proceeded uneventfully. Although fibreoptic intubation has proved to be extremely useful in difficult intubations, there are a number of situations where fibreoptic intubation is not possible
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    A Preliminary Report on the Use of Peripheral Nerve Blocks for Lower Limb Amputations
    (Ghana Medical Journal, 2009-03) Baddoo, H.K.
    Background: Deep vein thrombosis is increasingly being diagnosed in Ghana. The commonest complication that leads to death is pulmonary embolism. The mortality rate from massive pulmonary embolism is high even with intervention. Thrombolysis is recommended in massive embolism. Objective: To determine the outcome of thrombolysis in the management of massive pulmonary embolism in patients admitted to the Cardiothoracic Intensive Care unit. Method: A retrospective audit of the patients who were admitted to the Intensive care unit of the National Cardiothoracic centre with a diagnosis of massive pulmonary embolism between 1st January 2003 and 31st September 2007. Results: Seventeen patients were admitted with the diagnosis of massive pulmonary embolism of which 14 were thrombolysed. Commonest clinical presentations were dyspnoea in 17(100.0%) and hypotension in 12(70.3%) of the patients. Streptokinase was used in 13(92.9%) and urokinase in 1(7.1%) of the patients. The main complications of thrombolysis were bleeding in 12(85.7%), hypotension in 10(71.4%) and nausea and vomiting in 7(50.0%) of the patients. Postthrombolysis, the respiratory function deteriorated in 12 (85.7%) of the patients which required mechanical ventilation. The overall mortality rate was 35.3%. Three patients died before thrombolysis. Of the 14 (82.4%) who were thrombolysed 3(21.4%) died within 8 hours. Conclusion: The mortality rate of patients with massive pulmonary embolism is high even after thrombolysis. The commonest complication of thrombolysis was bleeding.
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    Permanent Complete Heart Block Following Surgical Correction of Congenital Heart Disease
    (Ghana Medical Journal, 2010-09) Edwin, F.; Aniteye, E.; Tettey, M.; Sereboe, L.; Kotei, D.; Tamatey, M.; Entsua-Mensah, K.; Frimpong-Boateng, K.
    Background: The risk of complete heart block (CHB) from congenital heart repairs in Ghana is unknown. This information is important for referring physicians and in pre-operative counselling of patients and facilitates the process of obtaining informed consent for such repairs. Objectives: This study was undertaken to determine the incidence of permanent post-operative CHB requiring pacemaker implantation; and the post-operative problems related to the pacemaker. Design: Retrospective study design. Setting: The National Cardiothoracic Centre (NCTC), Korle-Bu Teaching Hospital, Accra, Ghana. Method: Review of all patients who had intra-cardiac repair of congenital heart disease known to predispose to post-operative complete heart block from January 1993 to December 2008 was carried out with computation of the frequency of complete heart block according to the intra-operative diagnoses. Results: Six out of 242 patients (2.5%) developed permanent post-operative CHB. All underwent closure of a large perimembranous ventricular septal defect (VSD) either as an isolated defect (2 of 151 or 1.3%) or in the setting of conotruncal anomalies (4 of 73 or 5.5%). The dominant parental concern relating to the implanted device was the financial implications of future multiple surgeries to replace a depleted pulse generator. Conclusion: Permanent post-operative complete heart block occurred in 1.3% of patients undergoing VSD repair and 5.5% of those undergoing repair of conotruncal anomalies (Fallot’s tetralogy). The dominant anatomic risk factor was a large perimembranous VSD as an isolated defect or as part of a conotruncal anomaly. Permanent pacemaker implantation in this setting is attended by a low morbidity.
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    Cuff Inflation to Aid Nasotracheal Intubation Using the C-MAC Videolaryngoscope
    (Ghana medical journal, 2011-06) Baddoo, H.K.; Phillips, B.J.
    A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation.
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    Employment of Colour Flow Doppler to Identify the Tip of the Needle During Ultrasound Guided Nerve Blocks
    (Ghana medical journal, 2013-12) Baddoo, H.; Djagbletey, R.; Owoo, C.
    Identifying the needle tip during ultrasound guided procedures such as nerve blocks or vascular access can be a problem. “Visualising the needle tip on ultrasound requires that it be aligned with the ultrasound beam; however even when alignment is achieved, the physical characteristics of the needle and the limitations of ul-trasound technology may hinder visibility”.
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    Status and Challenges of Care in Africa for Adults With Congenital Heart Defects
    (World journal for pediatric & congenital heart surgery, 2017) Edwin, F.; Zühlke, L.; Farouk, H.; Mocumbi, A.O.; Entsua-Mensah, K.; Delsol-Gyan, D.; Bode-Thomas, F.; Brooks, A.; Cupido, B.; Tettey, M.; Aniteye, E.; Tamatey, M.M.; Gyan, K.B.
    The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa's population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.