African Journal of Anaesthesia and Intensive Care

Editorial: Pre-anaesthesia clinic: A call coming from the cold!

Charles Imarengiaye — 2022-08-01

No Abstract.

Nasopharyngeal Temperature Probes: Is South Africa's Current Decontamination Process Adequate?

R.A. Davids — 2022-08-01

Background: The standard practice in many institutions incorporates nasopharyngeal probes for temperature monitoring in patients undergoing general anaesthesia. Current disinfection guidelines for these devices are not clear and they are poorly adhered to. In South Africa, these temperature probes are reused and subjected to unstandardized decontamination processes. This study sought to investigate the nasopharyngeal temperature probe as a possible source of cross-contamination and investigate the efficacy of current disinfection practices.
Method: This descriptive double-blind study viewed 48 nasopharyngeal temperature probe cultures across the 4 different cleaning protocols. These probes were randomized to a disinfection protocol. These protocols included water wash, alcohol based wash, dry wipe and (2.4% glutaraldehyde) Cidex® wash. After randomization, the probes were aseptically cultured and inoculated to blood agar plates. After 48hrs of aerobic culture, specimens were examined, and microorganisms identified. Logistic regression analysis assessed the efficacy of these decontamination processes. Results: Chi-Square analysis [p-value < 0,0001] established the nasopharyngeal temperature probe as a source of crosscontamination. Diverse pathogens were identified on nasopharyngeal temperature probes after exposure to a predetermined cleaning practice.Logistic regression of these cleaning methods [confidence interval of 95%] illustrates Hibitane® and CIDEX® methods as being more effective, yet only the CIDEX® group demonstrated decontamination success in excess of 90%. Commonly identified organisms include Staphylococcus aureus, Streptococcus epidermis; Pseudomonas aeruginosa and Acinetobacter baumanii.
Conclusion: The data shows that the nasopharyngeal temperature probe is indeed a source of cross-contamination. It goes on to highlight the issue of pathogenic spread due to inadequate decontamination of these temperature probes.

The Role of Pre-Aanaesthesia Clinic in Modern Anaesthesia Practice

Otu Etta — 2022-08-01

Background: Preanaesthetic Clinic (PAC) is a specialty clinic where patients are evaluated before surgery to establish a database upon which risk assessment and perioperative management decisions can be made.

Aims: To assess the opinion of Nigerian anaesthetists regarding preanaesthesia clinic and the possible challenges to its establishment.

Patients and methods: A three part questionnaire was filled by all anaesthetists who attended the annual Scientific Conference of the Nigerian Society of Anaesthetists in Owerri, Imo State, Nigeria 2015. Information obtained covered the demographic characteristics of the respondents and their opinions on benefits and challenges of preanaesthesia clinic. Data obtained were analysed using SPSS version 20.0.

Results: Seventy eight respondents completely filled the questionnaires. Forty two(53.8%) were resident doctors, 35(44.9%) consultants while only 1(1.3 %) was a nurse anaesthetist. Only 6(7.7%) respondents had PACs in their centre. Majority of the respondents (96.1%) agreed that every Teaching Hospital should have PAC. Also, majority agreed that PAC improves the perception of the anaesthetist (94.9%), reduces the morbidity of surgery (93.7%), surgical delays (87.2%) as well as case cancellations (89.7%). However, majority of respondents agreed that lack of adequate anaesthesia manpower was a major challenge to PAC (68%).

Conclusion: Preanaesthesia clinic improves the quality of anaesthesia services, however, adequate manpower is a major challenge.

Occupational Stress and Coping Strategies amongst Nigerian Physician Anaesthetists in Training

Olusola Kayode Idowu — 2022-08-01

Background: The environment of a healthcare setting can stimulate or impose stress on health personnel, and this can impact health delivery services. This study was carried out to assess the types of stress encountered by trainee anaesthetists and their effects on the trainees.
Methods: This is a descriptive cross-sectional survey amongst 76 trainee anaesthetists who attended an update course at the Department of Anaesthesia, University College Hospital, Ibadan, Nigeria in 2019. A self-administered questionnaire was used to obtain data which was analyzed using IBM SPSS (version 23.0®). Variables were presented using frequency tables, pie chart, and graph. Level of significance was set at 5%.
Results: Most (90.8%) of the participants were >30 years and predominantly (75%) males. Majority 71 (93.4%) were junior registrars, the rest were senior registrars 5(6.6%). Stress was reported in 73 (96.1%) respondents; 68 (93.2%) junior registrars and 5 (6.8%) senior registrars. The most reported stress type was physical stress by 45 (61.7%) trainees and the most common cause of stress was due to the vast syllabus 32 (43.8%). Statistical correlations were found between age and stress development (p=0.021), daily work duration and designation (p=0.018), and gender with accommodating demands of anaesthesia training (p=0.014). Forty-five (59.2%) respondents reported difficulty coping with the demands of anaesthesia training, 33 (73.3%) required psychosocial adjustments, 7 (15.6%) required counseling, while 5 (11.1%) went into depression of which, 3 (60.0%) required a psychiatrist's evaluation.
Conclusion: A high percentage of trainee anaesthetists reported experiencing occupational stress as a result of physical demands during training from the vast syllabus and daily work duration. Many trainees had difficulty coping with the demands of anaesthesia residency. Coping mechanisms employed include psychosocial adjustments and counseling, while a few required psychiatric evaluation.

A Comparative Study of the Analgesic Efficacy of Transversus Abdominis Plane Block Alone Versus Transversus Abdominis Plane Block and Diclofenac Suppository in the Management of Post Caesarean Section Pain

Joy O. Dayi — 2022-08-01

Background: Post caesarean delivery pain has both visceral and somatic components. Transversus abdominis plane (TAP) block which affects mainly the somatic component has been used to manage post caesarean section pain. The addition of diclofenac suppository which affects both visceral and somatic component could provide better analgesia.

Objective: To determine if a combination of TAP block and diclofenac suppository will improve the quality of post caesarean section analgesia.

Patients and Methods: Ninety pregnant women with American Society of Anaesthesiologist (ASA) physical status class I or II scheduled for elective caesarean section under subarachnoid block (SAB) were randomly assigned to 2 groups of 45 each, to receive either bilateral transversus abdominis plane block alone or bilateral transversus abdominis plane block and 200mg of diclofenac suppository postoperatively.

Results: The time to first request for analgesia was more than three times longer for the TAP block/rectal diclofenac group (332.71±96.70 min) when compared to the TAP block group (104.07±79.67 min, P = 0.001). The mean pethidine consumption was 215.56±56.23 mg in the TAP block/rectal diclofenac group and 319.51±55.77 mg (P=0.001) for TAP block group. The proportion of patients who strongly agree to a satisfactory pain management on Likert's scale was 60.0% in the TAP block/diclofenac suppository group compared to 11.1% (P=0.001) in the TAP block group.

Conclusion: Co-administration of diclofenac suppository and transversus abdominis plane block improved the quality of analgesia for post caesarean section pain.

Necrology

Nosa Philo Edomwonyi — 2022-08-01

No Abstract.

Book of Abstract

S.D. Amanor-Boadu — 2022-08-01

No Abstract.