Department of Anesthesia

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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
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
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.
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
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.
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.
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.
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”.
Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana
(BMC Anesthesiology, 2015-10) Djagbletey, R.; Boni, F.; Phillips, B.; Adu-Gyamfi, Y.; Adu-Gyamfi, E.; Owoo, C.; Owusu-Darkwa, E.; Yawson, A.E.
Background: Magnesium is the second most abundant intracellular cation and a co-factor in several reactions involved in the formation and usage of adenosine triphosphate and nucleic acid synthesis. Magnesium deficiency may be as high as 65 % in patients admitted to a medical Intensive Care Unit (ICU). Significant and potentially fatal conditions have been attributed to hypomagnesaemia and it has also been associated with poor prognosis and increased mortality in the critically ill. The study aimed to determine the prevalence and identify the predictive factors of preoperative hypomagnesaemia in adult surgical patients who require an emergency laparotomy. Methods: This was a hospital based prospective study conducted at the Korle-Bu teaching hospital. General surgical patients between the ages of eighteen and seventy years with a preoperative diagnosis which required emergency laparotomy for management were consecutively enrolled into the study. A total of 102 patients were enrolled in the study. Preoperative total serum magnesium and serum potassium were determined. Data was summarised utilising simple descriptive statistics (i.e., proportions, ratios and percentages). The Chi-square test was used to determine significant differences or associations between categorical variables, Pearson's correlation coefficient was used to determine the relationship between continuous variables and predictive factors were determined by multiple regression. Analysis was done in SPSS version 16. Results: The mean serum total magnesium and potassium were 0.66 ± 0.20 mmol/L and 3.79 ± 0.65 mmol/L respectively. The prevalence of preoperative hypomagnesaemia was found to be 68.0 %. Multiple logistic regression found only hypokalaemia to be a predictive factor (p-value of 0.001, odd's ratio of 9.21 and a confidence interval of 2.42-35.09). Conclusion: The prevalence of preoperative hypomagnesaemia was high (68.0 %) with hypokalaemia the only predictive factor. Hypokalaemic patients requiring emergency laparotomy are nine times more likely to develop hypomagnesaemia as compared to patients who were not hypokalaemic. (PDF) Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana. Available from: https://www.researchgate.net/publication/282659460_Prevalence_and_predictive_factors_of_preoperative_hypomagnesaemia_among_adult_surgical_patients_in_a_large_tertiary_hospital_in_Ghana [accessed Sep 14 2018].
Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: A systematic review
(The Lancet Global Health, 2016-04) Olowu, W.A.; Niang, A.; Osafo, C.; Ashuntantang, G.; Arogundade, F.A.; Porter, J.; Naicker, S.; Luyckx, V.A.
Background: Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. Methods: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. Findings: We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Interpretation: Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. © 2016 Olowu et al. Open Access article distributed under the terms of CC BY.
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.
Serum magnesium and calcium in preeclampsia: A comparative study at the Korle-Bu Teaching Hospital, Ghana
(Integrated Blood Pressure Control, 2017-08) Darkwa, E.O.; Antwi-Boasiako, C.; Djagbletey, R.; Owoo, C.; Obed, S.; Sottis, D.
Background: A large percentage (16% of maternal mortality in developed countries, compared to 9% in developing countries), is due to hypertensive disorders in pregnancy. The etiology of preeclampsia remains unknown, with poorly understood pathophysiology. Magnesium and calcium play an important role in vascular smooth muscle function and therefore a possible role in the development of preeclampsia. Aim: We aimed to compare serum magnesium and total calcium levels of preeclamptic and normal pregnant women at the Korle-Bu Teaching Hospital in Ghana. Patients and methods: A comparative cross-sectional study involving 30 normal pregnant and 30 preeclamptic women with >30 weeks gestation and aged 18-35 years, was conducted at the Korle-Bu Teaching Hospital. Magnesium and calcium were determined using a flame atomic absorption spectrometer. Results: Mean serum magnesium and total calcium levels in preeclamptic women were 0.70±0.15 and 2.13±0.30 mmol/L, respectively. Mean serum magnesium and total calcium levels in normal pregnant women were 0.76±0.14 and 2.13±0.35 mmol/L, respectively. There was a statistically nonsignificant difference in serum magnesium and total calcium in preeclamptic women compared to normal pregnant women, with p-values of 0.092 and 0.972, respectively. Conclusion: Serum magnesium and total calcium, therefore, seem not to differ in preeclamptic women compared to normal pregnant women in Ghana. © 2017 Owusu Darkwa et al.
Nitric oxide and pre-eclampsia: A comparative study in Ghana
(Open Access Macedonian Journal of Medical Sciences, 2018-06) Darkwa, E.O.; Djagbletey, R.; Essuman, R.; Sottie, D.; Dankwah, G.B.; Aryee, G.
BACKGROUND: Preeclampsia is one of the commonest aetiologies of foetal and maternal mortality and morbidity. Though common, the aetiology of preeclampsia has remained unknown with several inconclusive theories surrounding the disease. Recent studies have implicated vascular endothelial dysfunction and possibly nitric oxide in preeclampsia. AIM: To compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in a large tertiary hospital in Ghana. METHODS: This was a case-control study conducted among pre-eclampsia and healthy pregnant women in Korle-Bu Teaching Hospital over a four-month period. Thirty (30) pre-eclamptic and 30 healthy pregnant women aged 18-35 years with over 30 weeks’ gestation were consecutively recruited into the study after obtaining informed consent. Plasma nitric oxide levels were determined using the Griess Reagent system. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and results were compared using the independent t-test. A P-value of ≤ 0.05 was considered statistically significant. RESULTS: The parity and body mass index (BMI) of the participants were similar. There was a significant difference in the blood pressure of the pre-eclamptic compared to healthy pregnant women. There was no statistically significant difference (P-value = 0.160) in the plasma levels of nitric oxide in pre-eclamptic (Mean = 1178.78; SD = 89.70 nM) compared to healthy pregnant women (Mean = 1365.43; SD = 95.46 nM). CONCLUSION: Plasma nitric oxide levels may not play a significant role in the aetiology of pre-eclampsia. © 2018 Ebenezer Owusu Darkwa, Robert Djagbletey, Raymond Essuman, Daniel Sottie, Gifty Boatemaa Dankwah, George Aryee.
Estimating the incidence of tuberculosis cases reported at a tertiary hospital in Ghana: a time series model approach
(BMC Public Health, 2018-11) Aryee, G.; Kwarteng, E.; Essuman, R.; Nkansa Agyei, A.; Kudzawu, S.; Djagbletey, R.; Owusu Darkwa, E.; Forson, A.
Background The incidence of Tuberculosis (TB) differs among countries and contributes to morbidity and mortality especially in the developing countries. Trends and seasonal changes in the number of patients presenting with TB have been studied worldwide including sub-Saharan Africa. However, these changes are unknown at the Korle-Bu Teaching Hospital (KBTH). The aim of this study was to obtain a time series model to estimate the incidence of TB cases at the chest clinic of the Korle-Bu Teaching hospital. Methods A time series analysis using a Box-Jenkins approach propounded as an autoregressive moving average (ARIMA) was conducted on the monthly TB cases reported at the KBTH from 2008 to 2017. Various models were stated and compared and the best was found to be based on the Akaike Information Criterion and Bayesian Information Criterion. Results There was no evidence of obvious increasing or decreasing trend in the TB data. The log-transformed of the data achieved stationarity with fairly stable variations around the mean of the series. ARIMA (1, 0, 1) or ARMA (1,1) was obtained as the best model. The monthly forecasted values of the best model ranged from 53 to 55 for the year 2018; however, the best model does not always produce the best results with respect to the mean absolute and mean square errors. Conclusions Irregular fluctuations were observed in the 10 -year data studied. The model equation to estimate the expected monthly TB cases at KBTH produced an AR coefficient of 0.971 plus an MA coefficient of − 0.826 with a constant value of 4.127. The result is important for developing a hypothesis to explain the dynamics of TB occurrence so as to outline prevention programmes, optimal use of resources and effective service delivery.
Serum Calcium and Magnesium Levels in Normal Ghanaian Pregnant Women: A Comparative Cross-Sectional Study
(Open Access Macedonian Journal of Medical Sciences, 2018-11) Djagbletey, R.; Darkwa, E.O.; Degraft-Johnson, P.K.; Sottie, D.A.Y.; Essuman, R.; Aryee, G.; Aniteye, E.
BACKGROUND: Pregnancy is described as a normal physiologic state associated with various biochemical changes. Magnesium and calcium are essential macronutrients required for foetal growth. Complications associated with their deficiency during normal pregnancy include; low neonatal birth weight, pre-eclampsia, eclampsia and preterm labour. Changes in serum levels of magnesium and calcium in normal pregnancy have not been extensively studied among Ghanaian women. AIM: To determine the variation in serum magnesium and calcium levels with gestational age in normal pregnancy in Ghanaian women. METHODS: A hospital-based comparative cross-sectional study was conducted among 32 normal non-pregnant women (Group A) and 100 normal pregnant women (Group B) attending the clinic at the Korle-Bu Teaching hospital. The group B pregnant women were further divided into Group B1 (n = 33), Group B2 (n = 37) and Group B3 (n = 30) based on their pregnancy gestation as first, second and third trimester respectively. Blood samples were obtained from the antecubital vein of subjects and total serum calcium, magnesium, protein and albumin were estimated. Data obtained were analysed using SPSS for windows version 20. Analysis of variance (ANOVA) was employed to determine the statistical differences between the groups. A p-value of ≤ 0.05 was considered significant. RESULTS: Mean serum total calcium and magnesium in first, second and third trimester normal pregnant women were 2.14 ± 0.16, 2.13 ± 0.44, 2.13 ± 0.35 mmol/L and 0.77 ± 0.11, 0.77 ± 0.16 and 0.76 ± 0.14 mmol/L respectively. Mean serum total calcium and magnesium levels in non-pregnant women were 2.20 ± 0.16 and 0.80 ± 0.10 mmol/L respectively. There was a statistically non-significant difference in serum total calcium and magnesium between non-pregnant and normal pregnant women, with p-values of 0.779 and 0.566 respectively. Mean total serum protein and albumin in first, second and third-trimester normal pregnant women were 68.42 ± 10.37, 70.46 ± 6.84, 66.70 ± 7.83 g/L and 39.92 ± 3.22, 40.75 ± 8.06, 38.26 ± 3.02 g/L respectively. Mean total serum protein and albumin in non-pregnant women were 73.13 ± 7.02 and 42.94 ± 3.03 g/L respectively. Mean total serum protein and albumin levels were lower in pregnant women as compared to non-pregnant women with the difference being significant in the third trimester (p-values of 0.012 and 0.002). CONCLUSION: Total serum calcium and magnesium levels in normal pregnancy were non-significantly lower compared to non-pregnant women in Ghana. There was a reduction in total serum protein, and albumin levels during pregnancy with a significant reduction noticed during the third trimester compared to the non-pregnant state.
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
Coping strategies of COVID-19 recovered patients at the Ghana Infectious Disease Centre
(PLOS ONE, 2025-01-08) Amedewonu, E.A.; Aryeetey, G.C.; Godi, A.; et al
Background The Coronavirus Disease (COVID-19) is a disease with diverse effects on multiple organ systems, leading to varying presentations and severe complications. As the pandemic progresses, the challenges faced by those who recovered from the disease evolved as various coping strategies were adopted post recovery. Aim This study investigated the coping strategies used by individuals recovering from COVID-19 to manage the physical, psychological, and social impacts of the disease. It further explored the factors influencing these strategies and their correlation with post-recovery quality of life. Methods This cross-sectional quantitative study involved 150 participants who attended the Ghana Infectious Disease Centre’s post-COVID 19 review clinic between January and June 2021. Coping mechanisms were evaluated using the Brief-COPE questionnaire, which covers 28 strategies across three styles: Problem-focused coping, emotional-focused coping, and avoidant coping. Participants rated their coping strategies on a 4-point Likert scale. Analysis of variance was used to determine differences in use of coping strategies. Quality of life was assessed with the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) and the EQ-VAS scale. Spearman correlation analyzed the relationship between coping strategies and quality of life. Results Majority of the study participants used problem-focused (2.71 ± 0.64 SD) type of coping strategy, followed by emotional-focused coping (2.32 ± 0.43 SD). The least strategy used was avoidant coping (1.57 ± 0.39 SD). Older participants, non-healthcare workers, and those with complications or persistent symptoms exhibited higher scores in avoidant and problem-focused coping. Those with persistent symptoms had higher emotional-focused coping scores. Better quality of life was associated with less reliance on all types of coping strategies.