Journal of the West African College of Surgeons
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J West Afr Coll Surg · Apr 2014
VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.
The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa where there are obvious systemic and management-related challenges associated with trial of scar. However, there is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated. ⋯ . There is a significantly high vaginal birth after caesarian section (VBAC) success rate among carefully selected women undergoing trial of scar in Ghana although a decreasing trend towards trial of labor after caesarian section (TOLAC) and a rising CS rate were determined. TOLAC remains a viable option for child birth in low resource settings like West Africa even though there are specific clinical and management related challenges to overcome. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remains the cornerstone to achieving high VBAC success rate with minimal adverse outcomes in such settings.
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J West Afr Coll Surg · Jul 2013
Effectiveness of heat moisture exchangers (hmes) in preventing perioperative hypothermia among adult patients undergoing abdominal surgery under general endotracheal anaesthesia.
Heat Moisture Exchangers (HMEs) conserve heat and moisture during expiration and make this available to inspired gases during subsequent inspiration. We sought to evaluate the effectiveness of HMEs in the prevention of perioperative hypothermia in patients scheduled for abdominal surgery under general anaesthesia relaxant technique with endotrachael intubation (GART.) ⋯ Heat Moisture Exchangers, General endotracheal anaesthesia, Hypothermia, abdominal surgery.
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J West Afr Coll Surg · Apr 2013
Experience with Sonogram-guided hydrostatic reduction of Intussusception in Children in South-West Nigeria.
Intussusception is a common cause of intestinal obstruction in young children. The diagnosis and treatment of intussusception has evolved over the years with ultrasound being the first choice imaging technique and a major player in the non-operative reduction of intussusception owing to its advantage of reduced morbidity and non-exposure to ionizing radiation when compared to other modalities of treatment. Aim & Objectives: The aim of this study was to evaluate the efficiency of ultrasound guided hydrostatic reduction in the management of intussusception in children and assess the predictors of reducibility. ⋯ Hydrostatic reduction of intussusception under ultrasound guidance is an effective and useful conservative method of management in carefully selected children with intussusception. Overall, this modality of treatment is cost effective and could readily be used for patients in resource poor environment. It also monitors the reduction process and visualizes the components of the intussusception including the lead points.
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J West Afr Coll Surg · Jan 2013
Non-intubated Ambulatory Anaesthesia for Diagnostic gynaecological laparoscopy.
General endotracheal relaxant anaesthetic technique is favoured for laparoscopic gynaecological procedures, in order to prevent inadequate ventilation, regurgitation and aspiration resulting from pneumoperitoneum and steep trendelenburg position during the procedure. However, simple brief laparoscopic procedures have been performed safely over the years in adult population using alternative airway devices. We report our experience over a fifteen-year period, of using general anaesthesia by face mask ventilation for short diagnostic laparoscopy in gynaecologic practice. ⋯ General anaesthesia by facemask ventilation is a safe alternative to endotracheal intubation for short diagnostic gynaecological laparoscopy when fasting guidelines are observed.
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J West Afr Coll Surg · Jan 2013
Comparison between rocuronium and suxamethonium muscle relaxants in ocular trauma surgery.
Suxamethonium causes a rise in intraocular pressure (IOP). Its use for intraocular surgical procedures especially management of the penetrating eye injury is controversial because of the risk of extrusion of vitreous contents. This risk can be avoided by substituting it with rocuronium. The aim of this study was to compare the IOP changes and intubating conditions following the use of both muscle relaxants. ⋯ Rocuronium is preferred as muscle relaxant for tracheal intubation when a rise in intraocular pressure is undesirable.