Background: Maintenance of optimal Endotracheal Tube cuff Pressure (ETTcP) in anaesthetic practice reduces cuff pressure complications. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH). It also evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient's age, weight and height on this volume. Methods: Eighty-one patients who underwent general anaesthesia were recruited. ETTcP was measured using an aneroid manometer via a three-way tap. After full cuff deflation, the cuff was refilled with air until an ETTcP of 20 cm H2O was obtained. Independent t-test was used to measure the statistical variations in the ETTcP using estimation techniques in relation to recommended levels as well as the significant difference of mean VAR to obtain a cuff pressure of 20 cm H 2 O. Grouped t-test was used to determine significant differences in ETTcP between anaesthesia providers using estimation techniques. Results: Mean ETTcP obtained from estimation techniques was (61.87, 73.79) cm H 2 O. The mean ETTcP measured for Physician and Nurse Anaesthetists were 65.36 cm H 2 0 and 69.52 cm H 2 O respectively. The mean VAR to achieve an ETTcP of 20 cm H 2 O for endotracheal tube sizes 7. 0 mm and 8.0 mm were 3.90 ± 1.13 mls and 4.55 ± 0.95 mls respectively. Age and E. O. Darkwa et al. 234 weight significantly influenced the VAR to achieve a cuff pressure of 20 cm H 2 O, however, height did not. Conclusions: This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers. However, in the absence of an aneroid manometer, ETTcP of tube sizes 7.0 mm and 8.0 mm can be safely approximated to the recommended levels with predetermined inflation volumes.

SUMMARYIntroduction: Potassium and magnesium are the two most abundant intra-cellular cations. They play pivotal roles in many essential biological processes. Deficiencies of these electrolytes are of clinical importance in hospitalised patients. Aim: To determine the relationship between serum total magnesium and potassium levels in adult patients requiring an emergency intra-abdominal surgery and the clinical utility of this relationship in the care of patients. Methods: A cross sectional study was conducted over a five month period at the Korle-Bu Teaching Hospital. All 101 adult patients admitted for emergency intra-abdominal surgery, who met the inclusion criteria and gave informed consent, were consecutively recruited and enrolled into the study. Patients' characteristics preoperative total serum magnesium, serum potassium and albumin levels were determined. Regression analysis and correlation coefficients were used to determine the relation between serum magnesium and potassium. Analysis was done using SPSS version 20. Results: Mean serum total magnesium and serum potassium were 0.66±0.20mmol/L and 3.79±0.65mmol/L respectively. There was a significant but weak positive correlation between serum hypokalaemia and serum magnesium levels. Pearson's correlation coefficient (2 tailed) was 0.21, R 2 = 0.04, p = value 0.038. Analysis generated a regression model: [Mg] = 0.06[K] + 0.42mmol/L, with a p-value = 0.038. Conclusion: A mathematical relationship was found between serum total magnesium and serum potassium among adult patients who require emergency intra-abdominal surgery. However, it had limited clinical utility.

Background: Specialisation is perceived as essential for success, and affects the availability and distribution of medical personnel and the quality of service the health system is able to deliver. In Ghana, some areas of medical specialties have a relatively good number of practitioners and are constantly attracting prospective doctors into these fields. Anaesthesia, which is an essential and integral part of the health care system, is one field with an inadequate workforce and has been attracting few doctors into the specialty. Method: A cross-sectional study was conducted among 183 undergraduate final-year students of the University of Ghana School of Medicine and Dentistry. A total of 183 self-reporting questionnaires were distributed among the students during tutorials for their final exams. Of these, 146 questionnaires were completed and returned. Results: General surgery was the most desirable specialty 26 (17.8%), paediatrics was the second most desirable specialty 24 (16.4%), whilst anaesthesia 2 (1.4%) ranked seventh. Conclusions:The results of this survey suggest that duration of exposure during clinical clerkship influences career decision among undergraduate medical students. Most of the students prioritise their choice of specialty based on interest and exposure during rotation through the specialty.

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BackgroundMagnesium is the second most abundant intracellular cation and a co-factor in several reactions involved in the formation and usage of adenosine triphosphate and nucleic acid synthesis. Magnesium deficiency may be as high as 65 % in patients admitted to a medical Intensive Care Unit (ICU). Significant and potentially fatal conditions have been attributed to hypomagnesaemia and it has also been associated with poor prognosis and increased mortality in the critically ill. The study aimed to determine the prevalence and identify the predictive factors of preoperative hypomagnesaemia in adult surgical patients who require an emergency laparotomy.MethodsThis was a hospital based prospective study conducted at the Korle-Bu teaching hospital. General surgical patients between the ages of eighteen and seventy years with a preoperative diagnosis which required emergency laparotomy for management were consecutively enrolled into the study. A total of 102 patients were enrolled in the study. Preoperative total serum magnesium and serum potassium were determined.Data was summarised utilising simple descriptive statistics (i.e., proportions, ratios and percentages). The Chi-square test was used to determine significant differences or associations between categorical variables, Pearson’s correlation coefficient was used to determine the relationship between continuous variables and predictive factors were determined by multiple regression. Analysis was done in SPSS version 16.ResultsThe mean serum total magnesium and potassium were 0.66 ± 0.20 mmol/L and 3.79 ± 0.65 mmol/L respectively. The prevalence of preoperative hypomagnesaemia was found to be 68.0 %. Multiple logistic regression found only hypokalaemia to be a predictive factor (p-value of 0.001, odd’s ratio of 9.21 and a confidence interval of 2.42–35.09).ConclusionThe prevalence of preoperative hypomagnesaemia was high (68.0 %) with hypokalaemia the only predictive factor. Hypokalaemic patients requiring emergency laparotomy are nine times more likely to develop hypomagnesaemia as compared to patients who were not hypokalaemic.

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