Ik Kolawole

Motorcycle crash characteristics in Nigeria: implication for control.

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.

The Intensive Care Unit of the University Teaching Hospital, Ilorin, Nigeria: A Ten Year Review (1991 - 2001)

ABSTRACT A retrospective study was conducted on all patients admitted to the Intensive Care Unit (ICU) of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over a 10—year period (October 1991—Sept. 2001). This period marks the first decade of the establishment of our ICU. The purpose of this study is to describe the pattern of admission of patients into the ICU, highlighting the variety of cases, indications for admission, outcome and causes of death, and the problems of medical and administrative management of the unit. No similar study has previously been carried out in this institution. A total of 295 patients, consisting of 185 males (62.7%) and 110 females (37.3%) were admitted to the ICU during the study period. The commonest indication for ICU admission was for postoperative high care (54.9%), with post-laparotomy patients accounting for 59.9% of these cases. Medical indications for admission accounted for 21.3%, with respiratory failure and asthma being the commonest and each accounting for 11.5%. One hundred and ten patients (37.3%) died during their ICU admission, giving an ICU survival rate of 62.7%. Late presentation of cases and inadequate staffing and equipment were important factors which may have contributed to mortality in these patients. Improved funding, training of additional staff and acquisition of advanced monitoring and life support equipment would improve the efficiency of our intensive care unit and patient survival.

Cervical plexus block for thyroidectomy

ABSTRACT Objective: Thyroidectomy is traditionally performed under general anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital. Design: This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999. Setting: The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution. Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. Outcome Measures/Results: The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20–80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. Conclusion: Bilateral superficial cervical plexus block is a useful anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.

Submucous dissection of the nasopharynx complicating nasotracheal intubation

SUMMARY We present the case of a 60-year old woman, who had an unusual complication of nasotracheal intubation, which was carried out to relieve post-thyroidectomy respiratory distress at the University of Ilorin Teaching Hospital (UITH). She presented with a huge malignant goitre complicated by severe respiratory distress due to pressure symptoms and left vocal cord palsy. An emergency near-total thyroidectomy was done under endotracheal general anaesthesia. Respiratory distress persisted after thyroidectomy and tracheal extubation. A nasotracheal tube was subsequently passed. On the fourth postoperative day, she developed another episode of severe respiratory distress due to endotracheal tube blockage. Her trachea was extubated but attempts to re-introduce the tube through the nasal route were unsuccessful but instead resulted in submucous dissection of the nasopharynx. An emergency tracheostomy was subsequently performed.