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Biomedical subjects

S D Amanor-Boadu

Publications and source records attributed to S D Amanor-Boadu.

At least 19 recordsLinked to original sources
PubMed2004

Surgical management of tuberculum sellae meningioma in a patient with a twin pregnancy: case report.

BACKGROUND: Meningioma in twin pregnancy is rare. The tumor has an accelerated growth during the pregnancy and may enlarge or become symptomatic during this period. This relationship makes management of patients with this tumor quite challenging. CASE DESCRIPTION: We describe a case of a rapidly deteriorating 35-year-old woman harboring an extensive tuberculum sellae meningioma who underwent craniotomy during the 24th week of pregnancy because of rapid deterioration. The surgical procedure and postoperative period were relatively uneventful. CONCLUSION: To the best of our knowledge, this is the first reported case of surgical management of a meningioma in a patient carrying a twin pregnancy (one missed abortus). When indicated, craniotomy is a safe and effective treatment option for huge frontobasal tumors during the second trimester of pregnancy.

Adult↗
PubMed2002

Acute isovolaemic haemodilution in two Jehovah's Witnesses presenting for major intracranial surgery.

The Jehovah's Witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000 ml) were collected from each patient resulting in post donation PCV of 40% and 33%. The intraoperative blood loss was 300 ml and 2000 ml, respectively, and the units and crystalloid fluids were transfused for replacement. Postoperative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral haematinics. The two cases are discussed in the light of the experience gained.

Adult↗
PubMed2001

Management of cancer pain--a survey of current practice in West Africa.

A comprehensive management plan for cancer pain is yet to be formulated in the West African sub region despite the priority that the World Health Organisation (WHO) has devoted to the problem over the past decade. As a prerequisite to our cancer pain management curriculum development a structured questionnaire on cancer pain management practice was administered to 80 Fellows attending the Annual Scientific Conference of the West African College of Surgeons in 1996. They were asked how often they treated cancer patients, the causes of cancer pain, their methods of assessment and therapeutic measures and complications of management techniques. Forty-four fellows from Nigeria, Ghana, Liberia and Sierra Leone, all consultants and trainers, responded to the questionnaire. About 80% of them treated cancer patients all the time. Specific anti-cancer therapy such as surgery, chemotherapy and hormone therapy were available in the four countries but radiotherapy was only available in two centers in Nigeria. The respondents estimated that 70-90% of their patients had severe pain at presentation. Pain was thought by 52% of respondents to be due to cancer and its treatment while 47% thought it was due to cancer and the fear of dying. Pain assessment was mostly by the verbal rating scale, only 20% included psychological measurement in their schedules. Oral preparations of strong opioids were not available in most countries andfor severe pain, the parenteral route was employed. Only 18% knew about the 'by the clock' dosing schedule. The study revealed that the standard of practice of the respondents falls below accepted practice. There is thus an urgent need for the formal education of personnel involved in the care of these patients.

Africa, Western↗
PubMed1998

Post operative nausea and vomiting in Nigerians.

A retrospective survey of postoperative nausea and vomiting (PONV) in the recovery room over a five year period was conducted, followed by a prospective study of 200 adult patients to estimate the incidence and predisposing factors to nausea and vomiting during the first 24 hours after anaesthesia and surgery in Nigerians. In the retrospective study only records of 61 patients (0.79%) out of the 7714 post anaesthetic recovery room charts reviewed revealed documentation of vomiting. These were 20 males (32.8%) and 41 females (67.2%). In the prospective study, the incidence of post operative nausea and vomiting within twenty four hours of surgery was 41.6% and 19.6%, respectively. But only two out of 39 patients (one per cent) vomited within the first three hours in postoperative period. The frequency of vomiting varied from one to 15 times and women had significantly more emetic symptoms than men (p < 0.05). Preoperative administration of pethidine and morphine was associated with postoperative nausea and vomiting. It is suggested that Nigerian women should be considered for prophylactic anti-emetic therapy, especially when narcotic analgesic are to be employed in their anaesthetic management.

Adult↗
PubMed1995

Anaesthesia and surgical aspects of thyroid swelling: the Ibadan experience.

Seventy-five cases of thyroid swelling operated on at the University College Hospital, Ibadan over a period of two years and three months (March 1990 - May 1993) were reviewed. The male-female ratio was 1:8.6, and the highest incidence was in the fourth decade (34.7%). Benign nodular and multinodular goitre constituted 80%, solitary adenoma constituted 6.7%, papillary carcinoma constituted 4% and toxic goitre 9.3%. Approximately 20% presented with a duration of over 5 years, and 22.7% of the glands removed weighed over 100 gms. Eighteen of the cases (24%) showed tracheal deviation, but this did not cause preoperative respiratory problems although there were difficulties in endotracheal incubation during anaesthesia. The non-toxic benign goitres were totally asymptomatic regardless of their size, and the indication for surgery was for cosmetic reasons. We did not routinely search for the recurrent laryngeal nerve and we did not routinely dissect out the inferior thyroid artery for ligation at its main trunk.

Adenoma↗
PubMed1994

Serum complement levels in asymptomatic Plasmodium falciparum parasitaemic children.

Twenty-eight (42%) of 67 afebrile children (mean age 6.3 +/- 3.6 years) undergoing various minor elective surgeries were slide positive for malaria parasitaemia. All infected subjects were given oral chloroquine therapy before and after blood samples were collected. Pre- and post-treatment complement (C4, C3, Bf and CH50 levels were evaluated in 15 of the subjects who had parasite densities > or = 500/microliter. These were compared with the levels in 15 age/sex-matched children who had acute malaria, as well as with the levels in 15 age/sex matched, non-infected controls. Significant consumption of C4 was observed in both the asymptomatic (p < 0.05) and symptomatic (p < 0.05) subjects. The mean serum levels of C4 were significantly higher in the asymptomatic, when compared with the symptomatic subjects (p < 0.01), and the healthy controls (p < 0.05). The distribution of classical pathway complement haemolytic titres in the groups studied was the same as that of the C4 levels. It is concluded that the forth component of the classical complement pathway may play a protective role in asymptomatic malaria.

Child↗
PubMed1992

Translaryngeal guided intubation in a patient with raised intracranial pressure.

A 60-year old man with intracranial space occupying lesion, presented with difficulty in intubation at induction of anaesthesia. Several attempts at direct tracheal intubation were made until the airway was finally secured. Though the brain was slack, the tumour could not be located at this operation. He presented for re-operation with worse signs of raised intracranial pressure which may accompany repeated attempts at intubation, a planned translaryngeal guided intubation was employed to secure the airway. Where fibreoptic laryngoscope is unavailable and difficult tracheal intubation is envisaged, translaryngeal guided intubation may save time and reduce morbidity of prolonged and repeated attempts at tracheal intubation.

Craniopharyngioma↗
PubMedDate not supplied

The diagnostic dilemma of intraoperative hyperpyrexia in a malaria endemic area.

Malignant hyperthermia (MH) is a serious and feared complication of general anaesthesia. The diagnosis of MH may pose a diagnostic dilemma, as its two most common signs tachycardia and hyperthermia are also common features of infections, transfusion and drug reactions. We report three cases of hyperthermia occurring during anaesthesia posing diagnostic dilemma in which two of the cases appear to be due to malaria. It is therefore suggested that all patients undergoing anaesthesia in a malaria endemic area should be investigated and treated for malaria if indicated preoperatively even when asymptomatic to prevent such diagnostic confusion.

Adolescent↗
PubMedDate not supplied

Goldenhar syndrome: a case report and literature review.

The case of a 24-year-old female Nigerian with features of Goldenhar syndrome is presented and the challenges of management especially with reference to reconstructive facial surgery and general anaesthesia are discussed.

Adult↗
PubMedDate not supplied

Pain assessment in Nigerians--Visual Analogue Scale and Verbal Rating Scale compared.

The usefulness of 2 methods of pain assessment was determined in a cohort of Nigerians who had pain as a symptom and were receiving physiotherapy for various indications. The English and Yoruba versions of two Pain Rating Scales, the Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) with 1 to 4 or 1 to 5 intensity scales (VRS-4 or VRS-5) were employed for the assessment of pain in 100 patients. The mean pain score on the 4-point VRS scale was 2.49 +/- 0.72, for the 5-point VRS 2.1 +/- 1.18 and for the VAS 4.93 +/- 2.5. Correlation analysis for corresponding groups of patients showed a significant positive relationship between the VAS and VRS-4 (r = 0.68 P < 0.001) VAS and VRS-5 (r = 0.64 P < 0.001) indicating that both VAS and VRS constitute useful tools for pain assessment in Nigerian patients.

Adolescent↗
PubMedDate not supplied

Ketamine anaesthesia for young children undergoing radiotherapy.

Young children with radiosensitive malignant tumours often require sedation or anaesthesia to provide immobility for radiotherapy sessions lasting several days. This paper describes the use of repeated intramuscular ketamine anaesthesia for radiotherapy in children age 1.5 to 5 years. Intramuscular ketamine 5-13mg/kg body weight was administered on 280 occasions to 15 children, the highest number of sessions per child being 30 and the least 9. The airway and cardiovascular parameters were well maintained. The time to complete recovery varied from 15 to 90 minutes (mean 52.5+/-31.7 S.D.). Involuntary movements of the tongue, mouth and limbs were observed in 8 patients (52.3%) during 63 sessions (22.5%) but only necessitated interruption of radiotherapy on 6 occasions (2.1%). Ketamine was found to be safe and effective for sedation of young children in the radiotherapy suite and minimal aneasthetic facilities were required.

Age Factors↗
PubMedDate not supplied

Pathological fracture complicating epidural local anaesthetic opioid infusion for cancer pain.

Two cases of severe bone pains from metastatic cancer, without clinical or radiological evidence of fractures on admission, are presented. Pain control and mobilization were achieved initially with local anaesthetic-opioid epidural infusion. Subsequent loss of analgesia prompted a re-examination, which revealed pathological fractures of the femur. Internal fixation of the fractures resulted in good control such that strong opioids were no longer required.

Aged↗
PubMedDate not supplied

Intra-operative cardiac arrests.

This is a review of patients who had cardiac arrest in the operating suites at the University College Hospital (UCH), Ibadan between January 1994 and December 1998. The main objectives of the study were to evaluate the incidence of intraoperative cardiac arrests, identify associated factors and, in particular, those factors that might be essential for better prognosis. The study was retrospective, descriptive and cross-sectional. The figures were retrieved from the theatre records, the intensive care records, case notes and pathology reports. During the study period, 6,356 operations were performed. There were 35 cardiac arrests giving an incidence of 55 per 10,000 operations. Of the 35 cases, 18(51.4%) were males while 17(48.6%) were females. The age range was 4 months to 84 years (mean 32.5 years) with wide distribution through the decades. Of the twenty-four patients (68.6%) that were done as emergency cases, four patients (17.1%) recovered fully. Of the 11(31.4%) elective cases, 5 (41.7%) made full recovery. Ten patients (28.6%) were ASA I & II, while 25 (71.4%) were graded ASA status III to V. The factors associated with cardiac arrest in this study included emergency operation and the ASA status.

Adult↗
PubMedDate not supplied

Case report: difficult spinal anaesthesia for caesarian section in two obese pregnant patients.

Two obese patients presented for Caesarean Section for poor progress in labour. Spinal anaesthesia was chosen because of obesity, gravidity and worry about possible related airway problems in both patients. In both cases the needle seemed to be short. In case 1, no cerebrospinal fluid (CSF) was obtained, and she was subsequently done under General Anaesthesia (GA); in case 2, CSF was obtained when the needle was pressed firmly into the patients back but flow stopped if the pressure was released. These case reports serve to illustrate that although spinal anaesthesia for obese pregnant patients may seem the safer alternative, mechanical difficulty may be considerable and eventually a GA may be considered in spite of possible risk of difficult intubation.

Adult↗
PubMedDate not supplied

The effect of parental presence at induction of anaesthesia on the behaviour of unsedated Nigerian children presenting for day-case anaesthesia.

The effect of parental presence at induction of anaesthesia on one hundred and eighteen children presenting for day-case inguinal operations and the behaviour of the attending parents at induction were studied. Of the 24 children aged 5 years and below whose parents at were present at induction, 25% were distressed, while 80% of 36 children of this age group whose parents were absent showed distress. Better behaviour was observed among the children who were above 5 years of age. When parents were present 7% of 28 children cried while 20% of 30 children cried when parents were absent. In both age groups induction heart rates were significantly higher in the children whose parents were absent. All parents except one who cried and another one who was too anxious, were helpful at induction and they would welcome the same opportunity to be present at the children's induction.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Assessment of minidose intrathecal morphine for analgesia after hemorroidectomy.

The efficacy of 0.5kg intrathecal morphine was tested on 10 patients who had hemorrhoidectomy performed at the University College Hospital (UCH), Ibadan. They were anesthetized with 3 mls of 0.5% intrathecal bupivacine to which 0.5mg of morphine was added. Another 14 patients had intrathecal 3 mls of 0.5% bupivacine with normal saline. Post-operative analgesia was prolonged in the opiate group compared to the saline group up to 8th post-operative hour. Narcotic analgesic requirement was much less in the opiate group. There were no serious complications in either group. In view of the excellent analgesia in the immediate post-operative period and absence of delayed respiratory depression usually associated with higher doses of spinal opiates it is recommended that use of the technique be encouraged in similar surgical patients for pain relief.

Adult↗