Department of Anaesthetics
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Item The role of journals and journal editors in advancing global health research equity https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15638(Anaesthesia, 2022) Jumbam, D.T.; Touray, S.; Totimeh, T.Item A simple tissue model for practicing ultrasound guided vascular cannulation(Ghana Medical Journal, 2014-03) Baddoo, H.; Djagbletey, R.; Owoo, C.Introduction: The use of ultrasound in anaesthetic practice continues to be more established and the use of ultrasound guidance in establishing vascular access is recommended by various groups. We have developed a tissue model for the practice and skills development in ultrasound vascular access. Method: The tissue model consist of a piece of “pork belly”, a longitudinal shaped balloon inserted between two muscle layers at a chosen depth of the tissue model (mimics a blood vessel), a bag of intravenous fluid (e.g. Ringer’s Lactate) together with a giving set and a short piece of extension tubing connected to a threeway tap used to expel air from the system. One end of the balloon is tied to the giving set with the intravenous fluid. The other end is tied to the short tubing with the three-way tap Results: Ultrasound images of the fluid filled balloon mimic a blood vessel. It is possible under ultrasound guidance to puncture the balloon several times (>10times) and still be able to distend the balloon with fluid. Interpretation: Ultrasound guided techniques require practice to improve hand-eye coordination. The “pork belly” tissue model allows multiple needle puncture without losing its functional integrity. Conclusion: We believe the “pork belly” tissue model adds to the range of models that can be used to practice ultrasound guided vascular access. The components required for this model are readily available locally and affordable.Item Preoperative Haematological Investigation in Paediatric Patients for Elective Surgery.(Ghana Medical Journal, 1995) Amponsah, G.Haemalologica1 investigations for 225 paediatric patients aged between zero to 15 years who presented for elective surgery were studied retrospectively over a five-month period. In addition to the Haemoglobin (Hb), the Sickling test and the haemoglobin electrophoresis where applicable were done. Thirty per cent (30%) of the patients bad Hb of 10g/d) and below. The lower Hb was found more commonly in the age group zero to 5 years. Eleven (4.9%) patients did not have the Sickling test done. Twenty-three (23) out of 29 patients with Sickling positive had electrophoresis done. The results were 21 AS; 1 SS; and 1 SC. Blood film for malaria parasites yielded positive results in 33 out of 175 (18.9) patients. There were no immediate anaesthetic complications in any of the patients. The need for minimum test of Hb. Sickling and blood film for malaria parasites are discussed.Item Postoperative Nausea and Vomiting in Korle Bu Teaching Hospital(Ghana Medical Journal, 2007-12) Amponsah, G.Objective: Postoperative nausea and vomiting (PONV) is one of the most distressing morbidities associated with surgery. Even though the incidence can be as high as 30% elsewhere no work has been done to assess the incidence in any health facility in Ghana. This study was carried out to find out the incidence, risk factors and the management of PONV in a tertiary healthcare facility. Design: This was a prospective study. Setting: The study was carried out in Korle Bu Teaching Hospital (KBTH). Subjects and Methods: All patients above the age of 18 years who had surgery including general surgery were included in the study. Information obtained using a questionnaire included demographic data, the type of anaesthesia, the incidence of PONV and its management. Results: Three hundred and six (306) completed forms out of 322 questionnaires were analyzed. One hundred and six patients (34%) had episodes of PONV of whom 82 (77.4%) had intra-operative opioids. Of the other factors only age was found to be a risk factor with patients in the 20-49 age group constituting 71.8% (p= 0.007). Eleven out of 93 patients who reported the episode to a health worker received medication for their PONV. Drugs used included promethazine and antimalaria. Conclusions: Thirty-four percent of patients in the study had PONV indicating that the problem is not uncommon among post-surgical patients in KBTH. Awareness of the problem should be highlighted and adequate management should be given to all patients. Patients at risk should be identified and appropriate management instituted.Item Porcine Anaesthesia for Advanced Trauma Operative Management (Atom)(Ghana Medical Journal, 2008-09) Baddoo, H.; Ahiaku, F.; Fordjuor, E; Wulff, I.; Akuoku, D.; Kwami, D.Anaesthesia has been provided for pigs for the Advanced Trauma Operative Management Course which was first held at the Korle Bu Teaching Hospital in February 2005. As of January 2006, 16 animals have been anaesthetized. Acepromazine (1mg/kg) and atropine (0.05mg/kg) were used for premedication. IM ketamine (30mg/kg) and isoflurane (in oxygen) were used for the anaesthesia and the animals were intubated and ventilated with positive pressure ventilation. No neuromuscular blocking agents were used. Morphine (average 3 doses of 10mg) was used for analgesia. Systolic blood pressure ranged between 80mmHg and 115mmHg and diastolic pressure ranged between 45mmHg and 80mmHg. Large amounts of IV fluids were given during the procedure. At the end of surgery, the animals were euthanized by increasing the concentration of isoflurane and administering potassium chloride. Out of the 14 cases reported on, 13 animals survived to the end of all the surgical procedures. 1 animal had a cardiac arrest during the last procedure (inflicting a laceration to the heart) and could not be resuscitated.Item Outcome of Thrombolysis for Massive Pulmonary Embolism(Ghana Medical Journal, 2009-03) Aniteye, E; Tettey, M.; Sereboe, L.; Edwin, F.; Kotei, D.; Doku, A.; Tamatey, M.; Enstuah- Mensah, K.; Delia, I.; Frimpong-Boateng, 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.Item Impalement Injuries of the Chest(Ghana Medical Journal, 2009-06) Edwin, F.; Tettey, M.; Sereboe, L.; Aniteye, E; Kotei, D.; Tamatey, M.; Entsuamensah, K.; Delia, I.; Frimpong-Boateng, K.Impalement injuries of the chest are uncommon in civilian practice with few reports in the literature. We report three cases of thoracic impalement seen over a 5 year period with unusual underlying mechanisms. In two of the cases, the impalement was obvious; in the third, the impalement was concealed having occurred 5 months earlier. In Case 1, the underlying mechanism was a high-speed road traffic accident. The patient was impaled by a metallic square pipe piled by the roadside. In Case 2, the gun-housing of a locally-made rifle gave way as it was fired and allowed a reverse ejection of the barrel during recoil that impaled the hunter’s chest. In Case 3, a domestic assault with an old umbrella caused an impalement injury as one of the umbrella spokes broke off, penetrated and lodged in the left chest going unnoticed for 5 months. Persistent chest pain and haemoptysis led to a request for chest radiographic examination upon which the foreign body was discovered. Massive haemoptysis brought the patient to emergency thoracotomy. All three patients underwent thoracotomy with a successful outcome.Item Predictors of Post Operative Bleeding and Blood Transfusion in Cardiac Surgery(Ghana Medical Journal, 2009-06) Tettey, M.; Aniteye, E; Sereboe, L.; Edwin, F.; Kotei, D.; Tamatey, M.; Entsuamensah, K.; Amuzu, V.; Frimpong-Boateng, K.Introduction: In spite of the recent advances in heart surgery, patients undergoing cardiac surgery with cardiopulmonary bypass are at risk of developing significant post-operative bleeding and substantial blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, international normalised ratio (INR), platelet count, and total bypass time. Eighty-seven consecutive patients who underwent heart surgery in the year 2004 were selected. Each patient had laboratory work up which included full blood count, clotting profile, kidney and liver function tests. The total blood loss within the first twenty-four hours and the total units of blood transfused before the patient was discharged were also recorded. Results: Pre-operative haemoglobin was significant in determining the total units of blood received by a patient. Increasing total bypass time caused a significant increase in the percentage reduction of the pre-operative platelet count (p <0.004). However even though there was an increasing trend of post-operative bleeding with increase in total bypass time, this was not significant from the analysis (p<0.069). The percentage reduction in platelet count and immediate postoperative platelet count were significant predictors of postoperative bleeding (p <0 .009) and (p <0.003) respectively. Conclusion: Pre-operative haemoglobin, percentage reduction in the platelet count after cardiopulmonary bypass and immediate postoperative platelet count are significant predictors of postoperative bleeding and blood requirements.Item Challenges of meeting surgical needs in the developing world(World Journal of Surgery, 2011-07) Gosselin, R.A.; Gyamfi, Y.A.; Contini, S.The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs. © 2010 The Author(s).Item Challenges of anaesthesia in the management of the surgical neonates in Africa(African Journal of Paediatric Surgery, 2010-09) Amponsah, G.Africa has one of the highest neonatal mortalities in the world, for which the commonest causes do not include surgical conditions such as some congenital anomalies that are amenable to surgery but are not often operated on because of a number of challenges. These challenges include cultural beliefs and practices, dearth of human resource capacity, inadequate laboratory and imaging support and lack of consumables and intensive or high dependency care facilities. Some of these challenges will be examined and highlighted using the acronym "ASKS" in this article.