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Minor salivary glands are widely distributed in the mucosal surface of the lips, palate, nasal cavity, pharynx, and larynx, thus can arise from any of these primary sites. Intra-oral minor salivary gland tumors (IMSGTs), while considered rare in the general population are relatively more common when compared to all the other extra-oral sites. Pleomorphic adenoma, as seen in the index patient, is the most commonly diagnosed benign IMSGT. Intra-oral minor salivary gland tumors are not uncommon and depending on their size, nature, and location can be associated with severe limitation of the Patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality. In addition to these deleterious effects, they present a major surgical challenge to the surgeon, who has to determine the safest, most feasible access to ensure complete, or near-complete excision, as well as to the anesthetist, who needs to secure a definitive airway through the nose or mouth, both of which could be significantly restricted by the presence of the tumor. The aim is to present our successful management of one of the largest intra-oral minor salivary gland tumors documented in the literature, highlighting the specific measures we undertook to tackle the peculiar surgical and anesthetic challenges we faced. It had been two years since surgery and the patient is thriving with a markedly improved quality of life and no features of recurrence. The patient is a 50-year-old male with a slowly growing painless, left palatal mass in the roof of the mouth of 10 years duration with recurrent spontaneous bloody discharge effluent and snoring. There was an associated history of dysphagia to solid with associated choking spells, a left-sided facial asymmetry with no cheek swelling, odynophagia, sore throat, or difficulty with breathing. There was ipsilateral loss of upper incisors and dental anarchy about two years before presentation. No other nasal, otologic, or ophthalmic symptoms were present. No neck swelling, stiffness, cough, or chest symptoms. The oropharyngeal physical examination was highly restricted due to the intra-oral size of the mass. Figure 1. There was facial asymmetry with a bulge of the left maxilla, left-sided levels 1b and 2 non-tender lymph node enlargements, freely mobile, not adhered to the skin. A craniofacial CT scan revealed extensive isodense heterogeneously enhancing intra-oral soft tissue mass occupying the entire palate/oral cavity and encroaching laterally on the masticator and the parapharyngeal space with erosion of the left maxillary floor and hyoid bone Figure 2. The patient had an excision biopsy of the palatal mass with a free margin. No frozen section at the time of surgery. Histology revealed Pleomorphic adenoma and was followed up for 2 years with no evidence of recurrence. Prognosticators are delay in presentation leading to an increase in size of the mass and severe limitation of the patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality, the surgeon not being overwhelmed, the skillful Anaesthesist that could maneuver the nasal cavity without us doing tracheostomy and the successful outcome of the surgery., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Background: Pain relief is a basic aspect of anesthesia care. Optimal post-cesarean section analgesia should minimize postoperative complications, facilitate infant care, and prevent postoperative morbidity. Bilateral ilioinguinal-iliohypogastric (IIIH) nerve block has been considered as a part of the multimodal approach. This study was designed to explore the efficacy of adding magnesium sulfate as an adjunct to bupivacaine to provide analgesia following cesarean delivery, using bilateral IIIH nerve block., Materials and Methods: Seventy-two parturients who were scheduled for elective cesarean section were randomized into two groups of 36 patients each. Group MB patients were given bilateral IIIH nerve block with 250 mg of magnesium sulfate and 95 mg of 0.25% plain bupivacaine. Group B patients were given bilateral IIIH nerve block with 0.9% normal saline and 95 mg of 0.25% plain bupivacaine. Postoperative visual analog scale (VAS) pain scores at post-anesthesia care unit (PACU), 2, 4, 6, 12, and 24 h, both at rest and with activity were measured. Rescue doses of opioid (intravenous [IV] tramadol 50 mg) at each time point of assessment, total tramadol consumption, time to patients' first request for rescue analgesic agent, and patients' satisfaction score were recorded., Results: The demographic and social parameters of patients in both the groups were comparable. The mean postoperative VAS pain score in group MB was significantly lesser both at rest and with movement than in group B at 12 and 24 h after surgery ( P < 0.05). Total postoperative tramadol consumed over 24 h was significantly lesser in the magnesium group than in the control group (125.55 ± 20.76 vs. 160.24 ± 25.82 mg), with a P value of 0.026. The time to patient's first analgesic request was significantly prolonged in group MB compared to group B (505.2 ± 41.4 vs. 372.6 ± 88.8 min, respectively), with a P value of 0.040. However, patients in both groups expressed good satisfaction scores., Conclusion: Magnesium sulfate as an adjunct to bupivacaine in bilateral IIIH nerve block reduced VAS pain scores, total tramadol consumption, and prolonged post-cesarean section analgesia., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Saudi Journal of Anesthesia.)

Milk production among the smallholder dairy farmers in Zambia is reported to be low despite improvements in milk collection infrastructure and unmet demand by the populace. This study was conducted to characterize cattle breeds and the breeding strategies of the smallholder dairy production system in the Southern province of Zambia. The study was conducted using questionnaires to obtain responses from identified respondents in six districts considered the main dairy cattle producing areas. One hundred and twenty questionnaires were administered and available for descriptive statistical analysis. The cattle genetic groups included local (Tonga and Angoni) breeds and their crosses (40.0%); beef (Boran and Brahman) breeds and their crosses (23.3%); Friesian breed and its crosses (28.8%); Jersey breed and its crosses (4.9%); and Fleckvieh breed (3.0%). Calving rate was found to be to be between 36% and 50% for the dairy herds. Compared to the other genetic groups, it was noted that Friesian and its crosses had higher milk production (3.55 L vs. 1.4 L). The low milk yield reported could be attributed to the period of study, which coincided with the long dry season between April and October. The Friesian and its crosses recorded earlier age at first calving (2.65 vs. 2.8 years), shorter longevity (10.5 vs. 12.25 years), and shorter lactation length (7.5 vs. 9.25 months). Jersey and its crosses, on the other hand, had an above average performance for all indices of economic importance such as milk production, lactation length, age at first calving, longevity, and number of calves produced. The results indicated natural mating was practised by 85% of the farmers. Farmer-preferred traits include size and conformation (23%); performance and colour (16% and 15%, respectively) in the choice of a bull. Selection by farmers were thus based on simple observation without pedigree or performance-based genetic evaluation. It was apparent that the smallholder dairy production system is in a shifting trend to transform the mainly local and beef breed animals into dairy herds through crossing with exotic dairy breeds. The production system is, however, faced with the challenges of water and feed supply to meet nutritional requirements, and high disease burden. Jersey breed was found to be a logical choice for the resource poor smallholder dairy farmers. The development and management of the smallholder dairy breeding schemes should be all-inclusive and directed at the prevalent production systems with the aim of also improving the feeding and management practices., (© 2022 John Wiley & Sons Ltd.)

This study was an attempt at the analysis of the Zambia cattle population, its production systems and management practices using data collected during the 2017/2018 livestock and aquaculture census. The Public User Microdata Sample dataset provided by the Central Statistics Organization were analyzed using both qualitative and quantitative methods. Traditional system and free range grazing were found to be the main production system and feeding practices (97.2%). Despite large expanse of arable land, crop and fodder production, there was poor integration with cattle production system thus predisposing the animal to poor productivity due to inadequate nutrition. The management practices were found to be limiting and a hindrance to improved performance. The study revealed diverse cattle genetic resources comprising of local and exotic breeds, and their crosses at different genetic proportions. The local breed crosses were mainly directed at exotic beef breeds (and evidence of crosses with exotic dairy breeds) as smallholder farmers tend to improve on the production performances and productivity. Disease prevalence was high and had been an impediment to the growth of the cattle industry. It was clear that cattle production development must be anchored on a value chain system approach. Efforts aimed at capacity building should be targeted at the smallholder farmers with the bulk (93.5%) of the cattle population. This should include impacting farmers with husbandry skills through provision of elaborate livestock extension services aimed at integrating crops and fodder production in feeding practices, communal grazing management and adequate access to veterinary services to control disease prevalence. Value addition and market development would be helpful in unlocking the potential of the beef meat and milk products industry., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

A term baby was delivered by cesarean and found to have an unexpected large teratoma attached to its mouth. Surgical excision was planned within 24 hours. Anesthesia concern of airway control required multidisciplinary team consultation, airway and patient preparation, and anticipation for failure. Challenging airway cases in low-resource countries can be successfully managed with deliberate attention to detail, preparation, and experience.

Background: The injection of mixture of plain bupivacaine and triamcinolone acetonide into the sacroiliac joint (SIJ) to relieve chronic low back pain is uncommon in the West African sub-region. The objective of this study was to demonstrate the efficacy or otherwise of fluoroscopic-guided SI joint injection in the management of chronic axial low back pain in Nigeria., Design: This was a prospective observational interventional study., Setting: The study was carried out at a tertiary hospital in Nigeria., Participants: Twenty-six patients with SI joint pain, based on IASP diagnostic criteria, who presented to our unit over 36 months from March 2012 to March 2015 and., Interventions: Fluoroscopic-guided injections of 5mls mixture of bupivacaine and triamcinolone acetonide into the sacro-iliac (SI) joints of 26 patients with SI joint pain out of 116 patients who were offered different interventions for chronic low back pain. The patients were followed up for year and pain intensity and functional status were assessed at 3-, 6- and 12 months post-intervention., Main Outcome Measures: Pain relief and functional improvement were the main outcome measures., Results: The mean numeric rating score (NRS) and Oswestry Disability index (ODI) score in 14 (53.9%) patients at 12 months post-interventions were significantly lower compared with baseline values; 3.19 ± 1.10 vs 8.54 ±1.14 p=0.000 and 25.35 ± 5.40 vs 37.54 ±8.41, p=0.000 respectively., Conclusion: Fluoroscopic-guided steroid injection into the SI joint resulted into reduction in pain intensity and improved physical function in the majority of patients with SI joint pain., Funding: Not declared., Competing Interests: Conflict of interest: None declared

Objective: Although opioid analgesics are effective in the treatment of moderate to severe acute, cancer and chronic non-malignant pains, they are under-prescribed in Nigeria. The objective of this study was to assess the prescription pattern of opioids among physicians in a north central State, Nigeria.., Design: This was a descriptive cross sectional study., Setting: The study was conducted at the International Association for the Study of Pain (IASP)-sponsored workshops on pain and palliative care at the University of Ilorin Teaching Hospital, Ilorin, Nigeria., Participants: These were physicians at the monthly workshops organized by the Pain and Palliative Care Unit of the hospital between August 2011 and July, 2012., Interventions: Pre-tested semi-structured questionnaires were used to obtain responses to questions on pain management including opioids utilization in the various hospitals of the 114 participants., Main Outcome Measures: The main outcome measure was opioid prescription by the participants., Results: Out of the 114 questionnaires distributed, 113 were returned with complete information giving a response rate of 99.1%. The mean age of the respondents was 42.0±10.8 years. Although 97.3% of the respondents reported that pain was a frequent complaint in their practice, 69.5% of those who reported seeing patients with moderate to severe pain on a daily basis rarely or never prescribed opioid analgesics. The reasons given for poor opioid prescription were fear of respiratory depression (86.8%), fear of addiction (85.1%) and non-availability (28.9%)., Conclusion: Opioid prescription rate for patients with moderate-severe pain is low possibly due to myths and misconceptions about their adverse effects., Funding: International Association for the Study of Pain (IASP) Initiative for Improving Pain Education Grant awarded to Dr. K.W. Wahab in 2011., Competing Interests: Conflicts of Interest: None declared

Background: Oral premedication for paediatric age group is an uncommon practice amongst anaesthetists in Nigeria. Both parents and the child suffer some form of emotional or psychological distress., Aim: To determine the efficacy and safety of oral formulated ketamine for premedication in children scheduled for ambulatory surgeries., Methods: Seventy three children aged 1 - 6 years with American Society of Anesthesiologists (ASA) physical status I-II were prospectively studied. They were assigned randomly to receive either 5 mg/kg (Group A), 10 mg/kg (Group B), or no ketamine (Group C).The children were observed for acceptance of premedication, sedation and anxiolysis at 10, 20 and 30 minutes after drug administration. Behavior/response of each child at the time of separation from parents, intravenous access, and acceptance of facemask for induction, postanaesthetic arousal state and complications were also recorded., Results: There were 73 children in this study with a mean age of 37.4±18.0 months. The groups were comparable in age. The studied agent was tolerated by both groups that received premedication with no significant difference (P 0.73). Adequate sedation and anxiolysis were observed in groups A and B, (52%, 84%) and (68%, 88%) respectively. However, more children in group B (82.6%) had satisfactory behaviour at separation from parents and a better acceptance of anaesthetic face mask (64%) at induction than those in groups A and C (33.3%, 21.7%, respectively). No side effect was recorded in either of the premedication groups or the control group., Conclusion: Oral ketamine is acceptable and safe premedication for children. It provided good sedation, relieved anxiety and had no side effect in the children at the studied doses., Competing Interests: Competing Interests: The authors have declared that no competing interests exist.

Shoulder pain complaints are common in our environment. The disorder can occur among the young active age group or in the older patients as a result of degenerative changes with its attendant limitations of the function of the affected upper limb, hindrance of the performance of activities of daily living, and reduced quality of life. The traditional oral analgesics, physiotherapy, and intra-articular corticosteroid injections are seldom ineffective at providing the desired pain relief and functional improvement at the shoulder joint. We investigated the role of fluoroscopic-guided supra-scapular nerve blocks (SSNBs) in patients with shoulder pain who failed to respond to the routine conservative management. With the patient lying prone and the C-arm fluoroscope placed in anterior-posterior position, the scapula notch was visualized and a 22G spinal needle was directed toward the nerve. The mixture of local anesthetic agent and steroid was injected as close to the nerve as possible after negative aspiration. Fluoroscopic-guided SSNB can produce substantial pain relief and improved range of movement in patients with painful shoulders. The procedure is safe, well tolerated, and can be done on a day-case basis.

Background: Electroconvulsive therapy provokes abrupt changes in systemic haemodynamics. We compared the effects of propofol and thiopentone on haemodynamic responses of patients scheduled for ECT between September 2008 and March 2009 in two Nigerian tertiary hospitals., Methods: In a prospective, randomized study, 40 patients scheduled for ECT were allocated into 2 groups of 20 each. Anaesthesia was induced with either 1mg/kg propofol (PG) or 5 mg/kg thiopentone (TG) and 0.5mg/kg suxamethonium prior to ECT. Heart rate (HR), blood pressure- systolic (SBP), mean arterial (MAP) and diastolic (DBP) were taken before ECT and at 1 and 5 minutes postictal. The means of the increases in haemodynamic parameters were compared., Results: There were significant increases in mean HR in both groups at 1 and 5 min and the increases were comparable between the 2 groups (p = 0.784). The increases in SBP were not significant in both groups and were comparable (p = 0.988). The increases in mean DBP were not significant in both groups but it was significantly greater in TG (p = 0.012). Increase in MAP was significantly greater in the TG at 1 min (p = 0.028)., Conclusion: Propofol at 1 mg/kg and thiopentone at 5 mg/kg used for modified ECT in this study resulted in significant increases in heart rates. However, a significant increase in mean arterial pressure with thiopentone and a significantly greater increase in diastolic blood pressure when the two agents are compared confer some superiority on propofol over thiopentone in attenuating haemodynamic responses to ECT.

Background: Pain management has traditionally been provided by opioid analgesics. However, the reluctance of some health personnel to prescribe or administer opioids because of the fear of side effects has hindered their use. Local anaesthetic wound infiltration has been shown to improve postoperative pain management., Aims and Objectives: To determine the efficacy of combined subfascial and subcutaneous infiltration of bupivacaine in providing an opioid- sparing effect following abdominal surgery., Design of the Study: It was a prospective, randomized, double blind, placebo-controlled study., Setting: The study was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria., Patients and Methods: The study group received subcutaneous and subfascial infiltration with 40ml of 0.25% bupivacaine while the control group received 40ml of 0.9% saline administered by the surgeon after the closure of the peritoneum. Postoperative analgesia was provided with intramuscular morphine 0.1mg/kg 4hourly on demand and the time to first analgesic request was noted. Intravenous paracetamol was used as rescue analgesia. Postoperative pain was assessed using the verbal rating scale (VRS) at 6, 12 and 24 hours postoperatively at rest and during coughing., Results: The mean time to first analgesic request was significantly prolonged (p <0.05) in the study group (174 ± 117.6 min) than in the control group (102 ± 84 min). The patients in the control group received more morphine which was not statistically significant (p > 0.05). Request for rescue analgesia and the patients' impression of the analgesia were not significant (Fishers exact test two tailed p-value = 0.7164 and 0.4506 respectively)., Conclusion: Bupicacaine wound infiltration improved pain scores at rest within the first 6 hours and pain scores on coughing within the first 24 hours postoperatively. Although the technique increases the options available for postoperative pain relief after lower abdominal surgery, it cannot be used alone in this type of surgery.

Background: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern., Methods: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice., Results: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4%) of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6%) discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2%) respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important., Conclusion: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.

Despite being the second most common cause of road traffic injuries (RTIs) in Nigeria, no study had examined the peculiarities of motorcycle crash site characteristics in Nigeria. We examined and interviewed 363 motorcycle RTI patients in three tertiary hospitals in southwest Nigeria. All the motorcycles are small with capacities between 80 and 125cm3. 68.9% of the patients sustained their injuries while working or going to work and 23.4% on their way to school. 176 (48.5%) of the crashes were with moving vehicles and in 83 (22.3%) cases, either the motorcycle or the other vehicle is moving against the traffic. 37.8% of all crashes occurred at junctions with no roundabout versus 5% at junctions with roundabout. Some risky practices of the patient included carrying more than 2 persons (15.02%), travelling without headlight at night (31.7%) and not wearing helmets (96.5%). This study showed that risky behavior among motorcycle riders, chaotic traffic and road design faults accounted for most of the motorcycle crashes. The implications for the prevention and control of motorcycle injuries were discussed.

Local or regional anaesthesia has long been recognised as a useful anaesthetic option for thyroidectomy. A few authors have reported the successful use of local infiltration anaesthesia for thyroidectomy in our environment. The technique is said to be particularly suitable for simple giant goitres. Cervical plexus block has also been found useful for this operation in other parts of the world. However, we are unaware of any report on the use of cervical plexus block for thyroidectomy in our environment. We used bilateral superficial cervical plexus block for thyroidectomy in a 20-year old girl with a simple multinodular goitre. Surgery was performed with the patient in the classical thyroidectomy position. Though the patient was lightly sedated during the operation, the anaesthetist maintained communication with her throughout the procedure. Anaesthesia was generally effective, except for minor complaints of pressure symptoms during mobilization of the gland and postural aches. These, the patient described as tolerable. Surgery, which lasted 2 hours 45 minutes, was uneventful. The patient was allowed oral fluid intake within 2 hours postoperatively. Superficial cervical plexus block is simple, safe, effective and cheap for thyroidectomy for Simple Giant Goitre.

In this prospective, randomized, double-blind study, we evaluated the perioperative analgesic efficacy of caudal ketamine with or without bupivacaine in 62 American Society of Anesthesiologists I-II children undergoing lower abdominal surgery. Patients were randomized into three groups, and all blocks were placed under general anesthesia. Group 1 (n=20) had caudal injection of plain 0.125% bupivacaine 1 mlkg(-1). Group 2 (n=22) received caudal ketamine 0.5 mgkg(-1) diluted with 0.9% saline using the same weight-related volumes. Group 3 (n=20) received a similar dose of ketamine mixed with 0.125% bupivacaine 1 mlkg(-1). No supplementary intraoperative analgesic was required in any of the groups. Patients in group 3 had the longest duration of analgesia compared to the other two groups. There was no significant difference in the incidence of side effects among the three groups. We conclude that ketamine can safely be used as an adjuvant to prolong the duration of caudal analgesia in this group of West African children.

Background: Previous studies on day case surgery in Nigeria have focused mainly on the immediate peri-operative care of the patients within the service hospital., Objective: To assess patients' satisfaction and postoperative complications within the first seven days following day case surgery., Methods: A post discharge patient's survey was conducted on the 7th Postoperative day in 102 consecutive patients who had undergone day care surgery. Patients were interviewed about their postoperative experiences, type of complications and treatment applied, and visits to hospitals or community health facilities/providers. They were also asked to comment on their satisfaction or otherwise of day case treatment., Results: There were 32 occasions of treatment provided to 24 patients (23.5%) after discharge. Seventy-two patients (70.6 %) reported one or more complications, with pain being present in all of them. Some patients received treatment more than once, and for more than one complaint. Pain was the most common reason for seeking treatment. There was no mortality. Eighty-six (84.3%) patients expressed satisfaction with day case treatment, while 10 (9.8%) patients (9.8%) expressed dissatisfaction and 6 (5.9%) patients were indifferent., Conclusion: Day surgery provided satisfactory outcome for the majority of our patients, with low complication rates.

Regional anesthesia is recognized as an alternative to general anesthesia for modern breast cancer surgery. Various techniques of block have been described. Each has its unique problems. Regional anesthesia was chosen for simple mastectomy in two patients with advanced breast malignancy, due to compromised pulmonary status resulting from widespread malignant infiltration of both lungs. We used intercostal nerves block. The block was supplemented with an infraclavicular infiltration to interrupt the branches of the superficial cervical plexus that provide sensation to the upper chest wall and subcutaneous infiltration in the midline to block the nerve supply from the contralateral side. Anesthesia was generally effective and the operations were uneventful. Both patients and surgeons expressed satisfaction. We conclude that where patients have significant comorbidities that make general anesthesia undesirable, the use of intercostal nerves block remains a safe and reliable anesthetic option that allows the patient access to surgery for simple mastectomy.

A case of severe airway obstruction caused by a giant malignant goiter is presented. The patient had emergency thyroidectomy under regional anesthesia (bilateral superficial cervical plexus block). The procedure was well tolerated and the intraoperative course was uneventful. The anesthetic challenges are discussed and a case is made for regional anesthesia as a safe and reliable anesthetic option for thyroidectomy in this situation.

Pre-hospital care in developing worlds has been found to be grossly deficient compared to high income countries. The pre-hospital care given to road accident victims attending the casualty departments of four tertiary level hospitals in South Western Nigeria was assessed using a one-page pro-forma. 1996 patients with injuries from road crashes were seen in the hospitals, only 172 had any form of pre-hospital care, just 160 were transported in ambulances and none had any form of organized pre-hospital care. The mean arrival time in the hospital after crashes was 93.6 minutes and there was a high rate (29.5%) of inter-hospital referral. For every Revised Trauma Score (RTS), the Probability of survival (Ps) of the patients was higher than the Ps of patients from high income countries.

Objective: To assess the common methods of analgesia used in our hospital following caesarean section, their effectiveness and patient satisfaction., Design: A prospective descriptive study., Settings: The study was conducted at the University of Ilorin Teaching Hospital (UITII), Ilorin, Nigeria over a period of 18 months (February 1999 - July 2000)., Methodology: We studied prospectively the methods used for postoperative analgesia in 88 consecutive patients who had elective caesarean section under general anaesthesia. Pain assessment was carried out by direct questioning method using a 4-point verbal rating scale of none, mild, moderate and severe, in the recovery room, and on the mornings of days 1 and 2 postoperatively. Patients' satisfaction of pain relief was assessed on day 2 on a 2-point scale of satisfactory or unsatisfactory. The postoperative drug sheets and medication charts were also reviewed and analysed., Results: Surgeon-prescribed, nurse-administered intermittent intramuscular administration of analgesics was the method used for postoperative pain control in all the patients. Pentazocine was prescribed in 86.4% of patient while the remaining 13.6% had Tramadol. Most of the patients (95%) experienced some degree of pain in the immediate postoperative period. The first 24 hours postoperatively was particularly painful for the patients with 79.6% and 54.6% reporting moderate to severe pain in the recovery room and on day 1 respectively. However, despite the high incidence of pain most of the patients (85.2%) still expressed satisfaction with the level of pain relief., Conclusion: Pain remains a significant problem following surgical operations in our environment.

Background: The subject of postoperative complication and prevention has continued to generate interest in the last decade. Unfortunately, very few data are available locally to assess the extent of the problems and measures designed to address them., Objective: This prospective study was designed to identify the anaesthesia-related postoperative complications at the University of Ilorin Teaching Hospital, through a follow-up programme., Setting: The study was conducted at the University of Ilorin Teaching Hospital, Nigeria between August, 1999 and February, 2000., Method: A total of 172(67 male and 105 female) patients who underwent various types of surgical operations under general anaesthesia were followed up postoperatively for five days. Clinical progress including complications related to anaesthesia were recorded., Results: There were 105 female and 67 male patients with a mean age of 35.27 (range 10-70) years. Of the total number only 7(9.88%) had no complications of any kind. The remaining 155(90.12%) had complications ranging from transient episode of shivering in the recovery room to severe respiratory tract infection. The commonest postoperative complication observed was respiratory tract infection, which occurred in 29.65% of patients. This was followed by pyrexia (Temp > 37 degrees C) (27.91%), nausea/vomiting (23.36%) and sore throat (19.77%). Ocular complication and urinary retention ranked lowest in the list of complications, each occurring in one patient (0.58%)., Conclusion: This study has shown that despite recent advances in anaesthetic techniques and the introduction of newer anaesthetic drugs, the incidence of postanaesthetic complications has not changed significantly in our environment.

The acceptance of surgery as the best hope of survival in patients with typhoid perforation has greatly increased the role of the anaesthetist in the management of these patients. The purpose of this study was to review our anaesthetic experience in the management of patients with typhoid perforation over a period of 10 years (January 1988-December 1997). Ninety-five patients aged between 3 and 70 years were anaesthetized for surgery on account of typhoid perforation within the study period. More than three-quarter of them (78%) were in the ASA classification 3 and 4. All the patients had general anaesthesia with endotracheal intubation. Preoperative adverse events were recorded in 30 patients (31.6%) and mortality rate was 18.95%. Severe dehydration and ASA=4 were preoperative factors of statistical prognostic importance (P=0.03 and 0.00 respectively). We conclude that even though patients with typhoid perforation usually present in poor clinical state with high anaesthetic risk, a well conducted anaesthesia preceded by adequate resuscitation, still offers a good hope for fairly good surgical outcome. Anaesthetic management must ensure adequate oxygenation and perio-operative haemodynamic stability.

The use of subarachnoid block has become an established and reliable method of providing anaesthesia for lower abdominal and lower limb surgery. Unfortunately, it remains largely unappealing to a large number of our patients who sometimes associate it with paralysis. The aim of this study was to assess the efficiency and safety of subarachnoid block for lower abdominal and lower limb surgery in the University of Ilorin Teaching Hospital. This prospective study was carried out between January 1998 and August 2000 the University of Ilorin Teaching Hospital, Ilorin, Nigeria. One hundred and ten (110) consenting adult patients had subarachnoid block for lower abdominal and lower limb surgery over a period of two years and eight months Patients were assessed in the theatre as well as in the postanaesthetic recovery room and daily in the ward for five days. All complications related to anaesthesia were recorded and analysed. There were 75 (68%) male and 35 (32%) female patients. Ninety-six (87%) were elective and 14 (13%) were emergency cases. The specialty distribution of cases included 66 (60%) patients for Orthopaedic surgery, 16 (14.5%) for General Surgery and 13 (11.8%) for Urology. Intravenous ketamine and pentazocine were used to supplement anaesthesia in 12 (11%) of cases due to varying degrees of discomfort experienced by the patients. There was no case of total failure. Intra-operative complications included hypotension in 9(8.18%) patients which responded to saline infusion in 5 and vasoconstrictor in 4 cases, hypertension in 9 (8.18%) patients which responded to reassurance and midazolam sedation, and a brief episode of shivering in 9 (8.18%) patients treated by additional drape cover. The incidence of post-spinal headache was 2.7% in this study. Subarachnoid block still remains a very effective and safe anaesthetic technique for lower abdominal and lower limb surgery. The technique is cheap and effort should be made to increase patient awareness and its acceptability in the new millennium.