Anaesthesiologists at University of Benin Teaching Hospital (UBTH) offer outstanding anaesthetic care for patients. Anaesthesiologists care for more than 100,000 patients each year. More than 30 staff doctors practice at the UBTH. They are assisted by numerous residents. Among the specialized services provided by the Anaesthesiology Department are:
• Administration of anaesthesia in all subspecialties
• Preoperative medical evaluation
• Preoperative pain management
• Intraoperative transesophageal echocardiography
• Critical care
• Management of acute and chronic pain syndromes
• Injections and nerve blocks
• Spinal-cord stimulation
• Spinal-infusion systems
• Obstetric analgesia and anaesthesia.
The department was involved in the preoperative care of all patients for surgery. In routine cases, this involved visiting the patient before surgery. Clinical examination was usually carried out to determine the fitness of the patient for the intended surgery and to ensure that relevant investigation had been performed. In major cases, the anaesthetist may be called in much earlier in consultation. In all cases, minimum investigations must be performed both to optimize clinical care and for medico-legal reason. It may be necessary to set up an anaesthesia out-patient clinic for preparing elective surgical patients before admission. This helps to reduce the use of hospital beds.
The anaesthetist prepares the patient for surgery and looks after him/her during surgery. He makes sure that at all times during anaesthesia and surgery the patient is in a good condition and has every prospect of good recovery with no morbidity. A good interaction between the surgeon and the anaesthesiologist is essential for the best result. Monitoring vital signs throughout the period helps to ensure that everything is under control and this calls for monitors for all the vital organ systems.
Immediate post-operative care is given in the recovery room manned by trained anaesthetic nurses. The patient remains here until full recovery of consciousness and all protective reflexes are once more active. Minimal but essential monitoring continues here until patient is transferred either to the ward or to an intensive care unit as the case may be. Discharge from the unit must be by the anaesthetist.
Resuscitation or Reanimation
The department must be prepared to play a leading role in cases of sudden and unexpected cardiac arrest occurring anywhere in the hospital. The anaesthetist must be a member of a standing resuscitation team. For this purpose, there must be resuscitation trolleys or carts, one in each ward, in the main theatre and one in the out-patient complex. The department must be prepared to give regular lectures on current resuscitation techniques. All new hospital staff must attend one of these lectures to ensure that they are aware of available local facilities and the plan for dealing with these emergencies.
Intensive Care Units
There must be a general intensive care unit run by the department. This highly specialized and equipped unit is for dealing with very ill patients particularly those who need mechanical support of one kind or the other. These patients may be admitted straight from the medical or surgical emergency unit, from the wards or from post-operative cases. Admission into the unit must be made by a consultant anaesthetist.
Management of Pain
The department may run a unit for the management of chronic pains either arising from surgical procedures, post traumatic sources or from degenerative changes. There may be need for in-service training for additional specialization in this and other areas of anaesthesiology.
OBJECTIVES AND GOALS
1. To give anaesthestic services to the University of Benin Teaching Hospital or any other approved institutions as may be required for the training of students.
2. To run an organized programme of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competences in the specialty.
3 To train and graduate competent, highly proficient, knowledgeable anaesthetists capable of functioning independently and compete with anaesthetists from all over the world.
by running suitable postgraduate courses such as:
1. A) Fellowship Diploma Programme of the National and West African Postgraduate Medical College
b) One year Postgraduate Diploma in Anaesthesiology programme of the University of Benin.
c) Training of anaesthetic technicians.
2. To provide undergraduate medical students with basic knowledge and skills in the field of anaesthesiology, necessary to enable them become good doctors.
3. To teach general principles of Anaesthesia and basic life support to student nurses, midwifery students, post basic nursing students, as well as doctors on rotation from other departments.
4. To carry out research in anaesthesiology and related fields aimed at promoting knowledge.
The department of Anaesthesia is engaged in many activities that are training, research, and service oriented.
a) Anaesthetic service is provided for all surgical specialties and wide varieties of anaesthetic techniques are practiced. Such as General Surgery, Obstetrics and Gynaecology, Paediatric, Ophthalmology, E.N.T., Orthopaedic, Dental, Urology, Cardiothoracic, Plastic Surgery and Accident & Emergency. Our anaesthetic services also extend to the radiotherapy department.
b) The department also coordinates and provides specialist cover in the management of patients in the Intensive Care Unit and responds to resuscitation calls from other areas of the hospital.
There are six consultant and 38 resident doctors.
The residents are at various stages of the postgraduate diploma and fellowship training programme in anaesthesia. In addition several doctors from other institutions and other departments rotate through the department for clinical exposure. It is gratifying to note that our department has trained a sizeable number of anaesthetists (111 diplomats) in the West African sub region and some of the Alumni have attained pinnacles of their career.
Experts at UBTH offer services for the management of acute and chronic pain through special Pain Clinics. These services are designed to restore function and increase the quality of life for patients who experience pain syndromes.
A BRIEF HISTORY OF THE DEPARTMENT OF ANAESTHESIOLOGY.
Prof M.O.Obiaya returned from his post-graduate training in Anaesthesiology in May 1969. He had trained partly in Toronto, Canada and partly in Cambridge, England. As he was partly sponsored by the then Mid-West Bendel State Government, he joined the Mid-West Government Civil Service. He worked as a consultant anaesthetist in charge of anaesthetic service throughout the state.
Towards the end of the year 1972, the University of Benin Teaching Hospital under construction was completed. It was to be opened the following year. Prof M.O.Obiaya was appointed senior lecturer in the department of anaesthesia.
He joined the department at the beginning of the year and as the only university medical member staff, he was in charge of the department. While, Prof. Bello-Osagie who was then in charge of the Medical School and the teaching hospital as the Dean. Named it “The department of anaesthesiology”. In Britain, the departments are called Departments of anaesthesia and the practitioners are anaesthetists. In America, the department is called “The Department of Anaesthesiology” and the medical practitioners are called “anaesthesiologists”. Nurses who are trained to practice anaesthesia in America are called anaesthetists. “Anaesthesiology” was a combination of the British and American terms and at the time seemed the trend of international usage. Our department was then called “The department of anaesthesiology”.
Four offices were assigned to the department in the new college Building. This building on hospital premises was meant to house the new clinical departments of the medical school of the University of Benin. Our four offices were on the ground floor and we used them as follows:
1. Office for head of department and secretary
2. Two offices for consultant staff
3. Office for resident doctors. This also doubled as hall for clinical meetings.
1. Dr. M.O. Obiaya- Senior lecturer, Head of Department
2. Dr. Osaigbovo- Senior registrar in anesthesiology
3. Secretary I- Mrs. C.A. Alile
4. Secretary II-
5. Messenger- Theopilus
6. Technicians and theatre orderlies
4 theatres in the main theatre suites
2 theatres in the Obstetric Unit
2 theatres in the out-patient department
The work load on the department dependeded on the number of surgical staff and the consequent number of patients. At the onset, there were eight surgeons as follows:
1 urologist and general surgeon
3 general surgeons
1 cardiothoracic surgeon
2 obstetricians and gynaecologists
As indicated above, there were only two anaesthetists. If the surgeons were to work to their full capacity and all the theatres put into use, more anaesthetists were needed and that urgently immediate steps were taken as a temporary solution.
1. Available anaesthetists in town were hired on part time basis.
2. Resident doctors in training in relevant specialties were made to rotate through anaesthesiology for periods of 3-6 months. They were given quick training in the administration of routine general anaesthesia. This later became a requirement for resident doctors in surgical disciplines.
3. A trip was planned for the recruitment of anaesthetists and other specialists (pathologists) from outside the country.
Sometime in 1973, Prof. T. Bello-Osagie and few others travelled out of the country for the recruitment of anaesthetists, pathologists and others. We travelled to Britain and India together, but after India, He travelled alone to Egypt for the same purpose. India was our most successful point. Our host the Professor of anaesthesiology (Velore, CMC India) had made preliminary arrangements for us. We were able to interview a number of young anaesthetists who had completed a four year training period. We were quite impressed and offered tentative appointment to three of the candidates:
Dr. Raju C.
Dr. Sudaman Devasirvada
The visit to Britain and Egypt was not as successful. We had promises of likely candidates in anaesthesiology, all branches of pathology, who would send in their application later. Nothing came out of the promises.
By the end of the year, our staff situation had improved. In addition to the foreign recruits, we were able to recruit new residents for training in anaesthesiology. Among the first batch were:
These were sponsored for training in Britain but only Dr. Iyasere obtained the British fellowship in anaesthesia.
Dr. Okechukwu returned from Germany in 1973. He was employed as lecturer in the department after a successful interview.
The staff situation at the end of the year was as follows.
Dr. M.O. Obiaya
Sub-specialization in Anaesthesia:
a)Obstetric anaesthesia-Prof.C.O.Imarengiaye and Dr (Mrs)N.P.Edomwonyi
b)Paediatric anaesthesia-Dr O.P.Adudu/Dr(Mrs)N,P.Edomwonyi
d)Intensive Care Unit/ Dr F.E.Amadasun/-Dr.S.O.Tudjegbe
Chronic Pain Management-Dr F.E.Amadasun
e)Neuroanaesthesia-Dr.S.O.Tudjegbe /Dr I.T.Ekwere
f) Ambulatory anaesthesia-Prof.C.O.Imarengiaye.
G) Resuscitation-Dr (Mrs) N.P.Edomwonyi
h)Trauma and Orthopaedics-Dr I.J.Isa/Dr I.T.Ekwere