Bisola Onajin-Obembe
University of Port Harcourt, Anaesthesiology, Faculty Member
- Dr. Bisola Onajin-Obembe works as a Consultant Anaesthesiologist at University of Port Harcourt Teaching Hospital (UP... moreDr. Bisola Onajin-Obembe works as a Consultant Anaesthesiologist at University of Port Harcourt Teaching Hospital (UPTH), Nigeria. She was a Visiting Professor of Change Management at the International School of Management, Paris and taught final year MBA students at the Institut Supérieur de Gestion (ISG) Paris. Dr Onajin-Obembe has an interesting combination of qualifications. She believes that medicine and anaesthesiology, leadership and management are power fields that must be leveraged for an effective surgical and anaesthesia healthcare system. Her latest work is on human resources for anaesthesiology. She is a pragmatic scientific scholar, an action researcher, and a well-known international speaker. She was President of the Nigerian Society of Anaesthetists from 2014 to 2018. She served as Council Member, World Federation of Societies of Anaesthesiologists (2016 – March, 2024). She is Permanent Council (PC) Member, Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (G4 Alliance) and PC President 2022 - 2024.edit
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Background: Children with congenital heart disease (CHD) may present for non-cardiac surgery. Their anaesthetic management depends on their pre-morbid pathology. Aim: To report the anaesthetic management of a patient with congenital heart... more
Background: Children with congenital heart disease (CHD) may present for non-cardiac surgery. Their anaesthetic management depends on their pre-morbid pathology. Aim: To report the anaesthetic management of a patient with congenital heart disease for a non-cardiac surgery. Case report: Craniotomy for evacuation of an intracerebral abscess was performed on a 4-year-old female child with severe congenital ventricular septal defect (VSD). Induction was with halothane, nitrous oxide and oxygen using a Mapleson F breathing circuit. Endotracheal intubation was performed after a second dose of suxamethonium was administered. Muscle relaxant was maintained using atracurium. Spontaneous ventilation was resumed at the end of operation, after a repeat reversal of muscle paralysis. Lesson: The pathophysiology of CHD alters cardiovascular dynamics and therefore the uptake and distribution of anaesthetic agents Keywords : Congenital heart disease, Anaesthesia, Pulmonary vascular pressure Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 126-129
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908 www.anesthesia-analgesia.org March 2016 • Volume 122 • Number 3 Copyright © 2016 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000001104 More than 2 billion of the world’s population reside in lowand middle-income... more
908 www.anesthesia-analgesia.org March 2016 • Volume 122 • Number 3 Copyright © 2016 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000001104 More than 2 billion of the world’s population reside in lowand middle-income countries. In these countries, provision of emergency, essential surgical care, and anesthesia that have been shown to decrease mortality and disability is limited.1,2 One of the reasons could be that providing anesthesia in these countries can be challenging because of inadequate infrastructure and equipment. In addition, these countries have a shortage of trained anesthesiologists, and thus, nonphysician anesthesia providers generally provide anesthesia services in the rural and underserved hospitals.3–5 In such circumstances, it is necessary to use anesthetic drugs and techniques with safe profiles.
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Laparoscopy for gynaecological procedures is minimally invasive and is mostly performed as a daycase. The advancement of laparoscopy and minimal access surgery has greatly influenced the evolution of anaesthetic techniques. Preoperative... more
Laparoscopy for gynaecological procedures is minimally invasive and is mostly performed as a daycase. The advancement of laparoscopy and minimal access surgery has greatly influenced the evolution of anaesthetic techniques. Preoperative assessment can be simplified by the use of questionnaires in pre-assessment clinics. Intraoperative intravenous fluid administration improves patient well being while airway management can be by the age-old, tried and trusted orotracheal tube or by the newer laryngeal mask airways. The use of propofol as an induction agent, a short acting non-depolarizing muscle relaxant e.g. mivacurium, an inhalational anaesthetic agent with a fast wake up time e.g. sevoflurane or desflurane, and short acting opioids e.g. fentanyl guarantees quick recovery of patients. The trend towards a multimodal approach to postoperative pain and prevention of postoperative nausea and vomiting (PONV) improves postoperative profile of day case gynaecological patients. Expertise in providing a pneumoperitoneum with carbon dioxide is desirable even as other options for lifting the abdominal wall are being investigated.
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Background: Acquiring experience and surgical skills in maxillofacial surgery and anaesthesia depend on an optimal case volume and case mix. The more opportunities available for hands-on participation in various surgical operations, the... more
Background: Acquiring experience and surgical skills in maxillofacial surgery and anaesthesia depend on an optimal case volume and case mix. The more opportunities available for hands-on participation in various surgical operations, the better for the maxillofacial surgical team. Building and equipping operating rooms (ORs) are high-cost intensive projects. The aim of this study was to find if the current operative case mix and volume justifies capital investment in maxillofacial surgery-specific ORs. Methods: This is a descriptive, nonexperimental quantitative research. We reviewed the maxillofacial OR records from November 2008 to December 2013. Data collected from the maxillofacial theatre records were incorporated into an SPSS v 22 spreadsheet and analysed. The OR utilisation time was computed. The analysis was performed to guide managerial and investment decisions. Results: A total of 175 maxillofacial operative cases reviewed from a period of 62 months gave a rate of 2.8 cases per month. More males 90 (51.4%) than females 85 (48.6%) were operated on. Of the 236 operating days, 129 days (54.7%) were utilised. Major and major/smile-train operations formed 73.7% of all operations performed. All operations started after 10 am. Conclusion: The maxillofacial case volume and output do not justify the need for capital investment into building surgery-specific ORs. However, there is a need to improve OR management and put in place strategies that will optimise the present facility.
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Se presenta la experiencia médica recopilada principalmente de países del África Sud-Saharina en relación a la pandemia del COVID-19, donde la mayoría de los contenidos descritos provienen de publicaciones científicas aparecidas durante... more
Se presenta la experiencia médica recopilada principalmente de países del África Sud-Saharina en relación a la pandemia del COVID-19, donde la mayoría de los contenidos descritos provienen de publicaciones científicas aparecidas durante el transcurso de la epidemia (algunos antes de la revisión por pares), incluyendo artículos de medios de comunicación independientes, junto a frecuentes intercambios de información entre los autores, así como, testimonios personales que ellos mismos han recibido. No se hará referencia a las consecuencias socio-económicas posibles de esta crisis, aunque se podrá suponer que estas serán importantes, aunque diferentes a aquellas consecuencias que afectarán a los países técnicamente avanzados. Las conclusiones expuestas pertenecen exclusivamente a los autores y no comprometen, de ninguna forma, a las instituciones en las cuales ellos forman parte.
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The World Health Organization (WHO) has launched campaigns to boost immunization rates to 70 percent globally by the middle of 2022. However, despite the global success of about 64% COVID-19 vaccination coverage, there is a big gap in... more
The World Health Organization (WHO) has launched campaigns to boost immunization rates to 70 percent globally by the middle of 2022. However, despite the global success of about 64% COVID-19 vaccination coverage, there is a big gap in Nigeria. To date, only 13.8% of the population has received the recommended dose. This demonstrates a significant disparity between the vaccinated and the unvaccinated. Amidst the wide gap in vaccination, COVID-19 vaccine wastage still occurs in Nigeria. At the end of 2021, it was estimated that over a million doses of the COVID-19 vaccine had been wasted. It is anticipated that there will be more COVID-19 vaccine wastage in Nigeria, because of the combined factors that threaten vaccination uptake including vaccine hesitancy, lack of appropriate storage facilities, poor electricity supply, insecurity challenges, and inadequate health promotion. This results in concomitant financial and opportunity losses. In this paper, we discuss COVID-19 vaccine wast...
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Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria’s national strategic health development plan 2018–2022 placed little emphasis on... more
Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria’s national strategic health development plan 2018–2022 placed little emphasis on surgical care. To address the gap, we worked with professional societies and other partners to develop the national surgical, obstetric, anaesthesia and nursing plan 2019–2023. The aim was to foster actions to prioritize surgical care for the achievement of universal health coverage. In addition to creating a costed strategy to strengthen surgical care, the plan included children’s surgery and nursing: two key aspects that have been neglected in other national surgical plans. Pilot implementation of the plan began in 2020, supported by a nongovernmental organization with experience in surgical care in the region. We have created specific entry points to facilitate the pilot implementation. In the pilot, an electronic surgery registry has been created; ...
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Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria’s national strategic health development plan 2018–2022 placed little emphasis on... more
Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria’s national strategic health development plan 2018–2022 placed little emphasis on surgical care. To address the gap, we worked with professional societies and other partners to develop the national surgical, obstetric, anaesthesia and nursing plan 2019–2023. The aim was to foster actions to prioritize surgical care for the achievement of universal health coverage. In addition to creating a costed strategy to strengthen surgical care, the plan included children’s surgery and nursing: two key aspects that have been neglected in other national surgical plans. Pilot implementation of the plan began in 2020, supported by a nongovernmental organization with experience in surgical care in the region. We have created specific entry points to facilitate the pilot implementation. In the pilot, an electronic surgery registry has been created; ...
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Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures... more
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery.Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3 ± (18.5) years. Isolated unilateral cleft lip had t...
Gunshot facial injury may be frightening and overwhelming. We present a case report of a male employee who was shot in the face during an armed robbery attack on a bank. He sustained severe injuries to the eyes, as well as fractures... more
Gunshot facial injury may be frightening and overwhelming. We present a case report of a male employee who was shot in the face during an armed robbery attack on a bank. He sustained severe injuries to the eyes, as well as fractures involving the orbital, maxillary and mandibular bones, with impending airway compromise. He bled profusely and was resuscitated and stabilized. Anaesthesia management included initial local anaesthesia for emergency tracheostomy and then a general anaesthetic for emergency ophthalmology and maxillofacial surgeries in a one-staged operation all on the same day lasting six hours.
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There is great improvement in the practice of anaesthesiology in the 21st century when compared with the past. Anaesthesiology can only be studied after obtaining a medical qualification. The knowledge and appropriated skills are acquired... more
There is great improvement in the practice of anaesthesiology in the 21st century when compared with the past. Anaesthesiology can only be studied after obtaining a medical qualification. The knowledge and appropriated skills are acquired during a specialist or fellowship training programme; while the duration of study may vary from country to country and is programme-specific. The innovations, high monitoring standard and technology available in modern times has made the delivery of anaesthesia to surgical patients very safe. Anaesthesiology remains a stressful medical profession but it provides diverse opportunities. It offers an exceptionally wide career prospect outside the operating room, as well as skills for team management and leadership positions.
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After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential... more
After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. T...
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Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria's national strategic health development plan 2018-2022 placed little emphasis on... more
Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria's national strategic health development plan 2018-2022 placed little emphasis on surgical care. To address the gap, we worked with professional societies and other partners to develop the national surgical, obstetric, anaesthesia and nursing plan 2019-2023. The aim was to foster actions to prioritize surgical care for the achievement of universal health coverage. In addition to creating a costed strategy to strengthen surgical care, the plan included children's surgery and nursing: two key aspects that have been neglected in other national surgical plans. Pilot implementation of the plan began in 2020, supported by a nongovernmental organization with experience in surgical care in the region. We have created specific entry points to facilitate the pilot implementation. In the pilot, an electronic surgery registry has been created; personnel are being trained in life support; nurses are being trained in safe perioperative care; biomedical technicians and sterile supplies nurses are being trained in surgical instrument repair and maintenance; and research capacity is being strengthened. In addition, the mainstream media are being mobilized to improve awareness about the plan among policy-makers and the general population. Another development partner is interested in providing support for paediatric surgery, and a children's hospital is being planned. As funding is a key challenge to full implementation, we need innovative domestic funding strategies to support and sustain implementation.
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Ambulatory anaesthesia for paediatric surgery has n umerous benefits in appropriately selected patients. In rural surgical outreaches which consti tute unusual environments with peculiar challenges, a specialized anaesthesia practice can... more
Ambulatory anaesthesia for paediatric surgery has n umerous benefits in appropriately selected patients. In rural surgical outreaches which consti tute unusual environments with peculiar challenges, a specialized anaesthesia practice can improve outc ome. This report highlights the experience of a specialized anaesthesia team in a rural surgical ou treach for paediatric day case inguinoscrotal surgeries by the Lagos State Ministry of Health, Ni geria. Following logistic preparations and pre- surgical screening, resolutions of the anaesthetic outreach team were documented, while demographic, surgical and anaesthesia records of paediatric pati ents billed for inguinoscrotal surgery at various health centres between March 2007 and March 2009 we re reviewed. These included types of surgery and anaesthesia as well as perioperative sequelae. Findings were documented and analysed using the SPSS v.16 software, and results presented as freque ncies and means ± standard deviation. A total of ...
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Background: Vasopressors are often needed for prevention of spinal anaesthesia-induced hypotension despite intravenous fluid preload. Prophylactic intravenous ephedrine in doses of 5mg and above has been used successfully to prevent this... more
Background: Vasopressors are often needed for prevention of spinal anaesthesia-induced hypotension despite intravenous fluid preload. Prophylactic intravenous ephedrine in doses of 5mg and above has been used successfully to prevent this condition. However, there is limited data on the use of doses lower than 5mg as prophylaxis. This study compared the efficacy of prophylactic intravenous ephedrine 3mg with 6mg ephedrine in the prevention of spinal anaesthesia-induced hypotension in patients undergoing lower abdominal (general) surgeries.Patients and methods: Sixty nine ASAI and II patients scheduled for elective lower abdominal surgeries were randomly allocated into 3 groups (A, B and C). Spinal anaesthesia was induced in all the patients using 3.0mls of 0.5% plain bupivacaine after a preload with 10ml/kg of 0.9% Normal saline. Patients in group A received 2mls of Normal saline intravenously, while those in groups B and C received 3mg and 6mg intravenous ephedrine respectively, dil...
1. Massachusetts Eye and Ear Infirmary, Boston MA USA 2. Program in Global Surgery and Social Change, Harvard Medical School, Boston MA USA 3. Addis Ababa University, Addis Ababa Ethiopia 4. Dean, University of Global Health Equity,... more
1. Massachusetts Eye and Ear Infirmary, Boston MA USA 2. Program in Global Surgery and Social Change, Harvard Medical School, Boston MA USA 3. Addis Ababa University, Addis Ababa Ethiopia 4. Dean, University of Global Health Equity, Kigali Rwanda 5. Cabinet Office – Office of the President, Lusaka Zambia 6. University of the Witwatersrand, Faculty of Health Sciences, Johannesburg South Africa 7. Boston Children’s Hospital, Boston MA USA 8. Department of Anesthesiology, College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria 9. Nigerian Society of Anesthetists 10. New York, NY, USA 11. Ministry of Health, Dar Es Salaam, Tanzania
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Background: Acquiring experience and surgical skills in maxillofacial surgery and anaesthesia depend on an optimal case volume and case mix. The more opportunities available for hands-on participation in various surgical operations, the... more
Background: Acquiring experience and surgical skills in maxillofacial surgery and anaesthesia depend on an optimal case volume and case mix. The more opportunities available for hands-on participation in various surgical operations, the better for the maxillofacial surgical team. Building and equipping operating rooms (ORs) are high-cost intensive projects. The aim of this study was to find if the current operative case mix and volume justifies capital investment in maxillofacial surgery-specific ORs. Methods: This is a descriptive, nonexperimental quantitative research. We reviewed the maxillofacial OR records from November 2008 to December 2013. Data collected from the maxillofacial theatre records were incorporated into an SPSS v 22 spreadsheet and analysed. The OR utilisation time was computed. The analysis was performed to guide managerial and investment decisions. Results: A total of 175 maxillofacial operative cases reviewed from a period of 62 months gave a rate of 2.8 cases per month. More males 90 (51.4%) than females 85 (48.6%) were operated on. Of the 236 operating days, 129 days (54.7%) were utilised. Major and major/smile-train operations formed 73.7% of all operations performed. All operations started after 10 am. Conclusion: The maxillofacial case volume and output do not justify the need for capital investment into building surgery-specific ORs. However, there is a need to improve OR management and put in place strategies that will optimise the present facility.
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BackgroundAbout 96.3 million children and adolescents aged 0–19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of... more
BackgroundAbout 96.3 million children and adolescents aged 0–19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population’s unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study’s aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level.MethodsThe Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed ...
Background: There are reports of the spread of the novel COVID-19 to Africa, Nigeria, and some cases in Rivers State. The aim of this study was to investigate the knowledge, attitude and effects of the coronavirus disease pandemic on... more
Background: There are reports of the spread of the novel COVID-19 to Africa, Nigeria, and some cases in Rivers State. The aim of this study was to investigate the knowledge, attitude and effects of the coronavirus disease pandemic on hospital staff in the month of May to June 2020. Methodology: The convenience sampling method was used to recruit 297 hospital staff in a cross-sectional descriptive study carried out using semi-structured questionnaires in a tertiary healthcare facility. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Two hundred and sixty-two respondents (88.2%) had prior knowledge of coronavirus, and 228 (76.8%) got their information from Television/Radio/Newspapers. Two hundred and fifty-one (84.5%) respondents described COVID-19 pandemic as a disease caused by an imported germ. Regardless of the fear/panic of the COVID-19 pandemic, 230 (77.4%) of the respondents indicated that they would continue to vis...
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IntroductionThe number of specialist anaesthetists in most low-income and middle-income countries is below what is needed to provide a safe quality anaesthesia service. There are no estimates of the optimal number; therefore, we estimated... more
IntroductionThe number of specialist anaesthetists in most low-income and middle-income countries is below what is needed to provide a safe quality anaesthesia service. There are no estimates of the optimal number; therefore, we estimated the minimum density of specialist anaesthetists to achieve a reasonable standard of healthcare as indicated by the maternal mortality ratio (MMR).MethodsUtilising existing country-level data of the number of physician anaesthesia providers (PAPs), MMR and Human Development Index (HDI), we developed best-fit curves to describe the relationship between MMR and PAPs, controlling for HDI. The aim was to use this relationship to estimate the number of PAPs associated with achieving the median MMR.ResultsWe estimated that, in order to achieve a reasonable standard of healthcare, as indicated by the global median MMR, countries should aim to have at least four PAPs per 100 000 population. Existing data show that currently 80 countries have fewer than this...
The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical... more
The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (1...
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Postoperative pain is a common complaint in day-case inguinal herniotomy, thus there is a need to provide effective analgesia. This study compared the postoperative analgesic effects of the combinations of caudal-bupivacaine and rectal... more
Postoperative pain is a common complaint in day-case inguinal herniotomy, thus there is a need to provide effective analgesia. This study compared the postoperative analgesic effects of the combinations of caudal-bupivacaine and rectal diclofenac with caudal-bupivacaine and rectal-paracetamol in children scheduled for daycase inguinal-herniotomy. Ninety children of ASA I scheduled for elective day-case inguinal-herniotomy were randomly assigned into Group A (1ml/kg of 0.25% caudal-bupivacaine and 1mg/kg rectal-diclofenac), Group B (1ml/kg of 0.25% caudal-bupivacaine and 30mg/kg rectal paracetamol) and Group C (1ml/kg of 0.25% caudal-bupivacaine). The duration of analgesia, pain scores, postoperative analgesic consumption and side effects were assessed and recorded. Data collected was analyzed with the statistical package for social sciences 17 for windows. Eighty-seven children completed the study, and it was found that the duration of analgesia was prolonged in Group A compared to Groups B and C (p<0.01). Caudal-bupivacaine and rectal-diclofenac combination provides a more prolonged postoperative analgesia, and lower pain score compared to caudal-bupivacaine and rectal-paracetamol combination or caudal-bupivacaine alone. Level 1 evidence treatment study. Randomized controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up >80%.