West African journal of medicine
-
Improving quality of health care delivery is a primary goal of all health care institutions. Health care systems face challenges in providing quality health care to the citizenry due to rising health care cost and clients demanding higher standards of care. ⋯ Overall quality of health care as measured by the indicators used were generally perceived to be high except with client waiting time for services, lack of directional signs in the hospital and an uncomfortable waiting area at the COPD. There were concerns about attitude of some staff and late starting times of outpatient clinics. These when addressed would further improve quality.
-
Perioperative antibiotic administration for prophylaxis of surgical site infections can increase the anaesthetists workload. However, timely administration is essential to reduce risks and improve patient outcome. ⋯ Antibiotic selection though exclusively by the surgeon, higher responsibility is placed on the anaesthetist for preoperative administration, confirmation before incision and intraoperative re-dosing during prolonged surgery. Knowledge in selection and administration of antibiotics is inadequate and should be incorporated during the training.
-
Examination of the airway is necessary in a wide variety of conditions. This study was carried out to determine the need for oxygen supplementation during the conduct of flexible fibreoptic bronchoscopy on the awake patient. ⋯ Routine oxygen supplementation is not mandatory for the safe conduct of flexible bronchoscopy. The baseline oxygen saturation value accurately predicts the need for oxygen administration.
-
Spinal anaesthesia is regarded safe for caesarean section. Serious complications resulting from spinal anaesthesia such as cardiac arrest are often times considered rare. This is a case of a 27-year old unbooked gravida1 who was scheduled for emergency caesarean section on account of cephalo-pelvic disproportion (CPD) with associated history of prolonged labour. ⋯ She was treated with an anti-epileptic drug and was also mechanically ventilated. She also developed features of puerperal psychosis and was managed with anti-psychotics. The patient was on admission in the intensive care unit for four days and she made quick recovery with no apparent residual damage.
-
Paediatricians are required to attend all Caesarian sections, yet most neonates so delivered do not require complex resuscitations necessitating a paediatrician's presence. ⋯ Unbooked status, foetal indication (foetal distress, prematurity, abnormal lie), emergency sections, and general anaesthesia may lead to poor Apgar scores and the need for active resuscitation. These settings justify the paediatrician's presence at Caesarean section.