UNIVERSITY OF ILORIN, ILORIN, NIGERIA
COURSEWARE DEVELOPMENT
MODULE: ANAESTHESIA
Courseware developed by DR. B.O. BOLAJI
DURATION: 500L THEATRE SESSIONS, 600L (LECTURES, CLINICAL ANAESTHESIA,
THEATRE SESSIONS). Lectures are given throughout the period of the special surgical
postings at the end of the 500 level in conjunction with other surgically related specialties of
ophthalmology, radiology and ENT while each group of students spend 2 weeks in the
Department for theatre sessions, tutorials, demonstration of instruments and equipment, pre and
postoperative rounds.
LECTURERS: 1. BOLAJI, B.O.
FMCA (National Postgraduate Med College of Nigeria), FWACS (West
African College of Surgeons) D.A (Calabar), MBBS (Ibadan)
Department of Anaesthesia,
Faculty of Clinical Sciences
College of Health Sciences
University of Ilorin, Ilorin, Nigeria
E-mail: olubolajidr@yahoo.com
olubolajidr@unilorin.edu.ng
Office Location: Department of Anaesthesia,
Faculty of Clinical Sciences,
University of Ilorin, Ilorin, Nigeria
Consultation Hours: 8am- 11am (Tuesdays, Thursdays, Fridays)
2. KOLAWOLE, I.K.
FWACS (West African College of Surgeons), Diploma in Palliative Medicine
(UCT)D.A. (Zaria), MBBS (Ilorin)
Department of Anaesthesia,
Faculty of Clinical Sciences
College of Health Sciences
University of Ilorin, Ilorin, Nigeria
E-mail: ikkolawole@yahoo.com
kolawole.ik@unilorin.edu.ng
Office Location: Department of Anaesthesia,
Faculty of Clinical Sciences,
University of Ilorin, Ilorin, Nigeria
Consultation Hours: 8-11am (Mondays, Wednesdays, Fridays)
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3. OYEDEPO, O.O.
FMCA (National Postgraduate Med College of Nigeria), MBBS (Ilorin), B.Sc
(Ilorin)
Department of Anaesthesia,
Faculty of Clinical Sciences
College of Health Sciences
University of Ilorin, Ilorin, Nigeria
E-mail: droyedepo@yahoo.com
oyedepo.oo@unilorin.edu.ng
Office Location: Department of Anaesthesia,
Faculty of Clinical Sciences,
University of Ilorin, Ilorin, Nigeria
Consultation Hours: 8-11am (Mondays, Wednesdays and Fridays)
4. SULEIMAN, Z.A.
FWACS (West African College of Surgeons), MBBS (Zaria)
Department of Anaesthesia,
Faculty of Clinical Sciences,
College of Health Sciences
University of Ilorin, Ilorin, Nigeria
E-mail: suleiman.za@unilorin.edu.ng
suzack71@yahoo.com
Office Location: Department of Anaesthesia,
Faculty of Clinical Sciences,
University of Ilorin, Ilorin, Nigeria
Consultation Hours: 8-11am (Mondays, Tuesdays and Fridays)
5. IGE, O.A.
FWACS (West African College of Surgeons), MBBS (Benin)
Department of Anaesthesia,
Faculty of Clinical Sciences,
College of Health Sciences
University of Ilorin, Ilorin, Nigeria
E-mail: ige.oa@unilorin.edu.ng
femiigedoc@yahoo.com
Office Location: Department of Anaesthesia,
Faculty of Clinical Sciences,
University of Ilorin, Ilorin, Nigeria
Consultation Hours: 8-11am (Mondays, Wednesdays and Fridays)
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Course Content- Didactic lectures
Introduction to anaesthesia. History of Anaesthesia, Pre-operative assessment, premedication and
premedicant drugs, Intravenous anaesthetic agents- thiopental, methohexital, etomidate,
ketamine, propofol, midazolam. Inhalational anaesthetic agents- uptake & distribution. nitrous
oxide, ether, halothane and other halogenated hydrocarbons. Physiology of neuromuscular
transmission. Types of neuromuscular block. Neuromuscular blocking agents- suxamethonium,
tubocurarine, pancuronium, atracurium, vecuronium etc, factors affecting neuromuscular block,
reversal of neuromuscular paralysis. Practical conduct of anaesthesia. Routes of induction of
anaesthesia. Airway management- endotracheal intubation. Intraoperative monitoring.
Perioperative fluid therapy (crystalloids, colloids) and blood transfusion, massive blood
transfusion. Complications of blood transfusion. Postoperative care. Complications in the Postanaesthetic Care Unit. Postoperative pain and management. Anaesthesia for emergency surgerychallenges and preparation. Mendelson’s syndrome- predisposing causes, prevention, diagnosis
and management. Pain, acute and chronic. Pathophysiology, assessment and management .
Oxygen transport. Respiratory failure- aetiology, diagnosis and management. Oxygen therapydevices and complications of oxygen therapy. Cardiac arrest. CPR. Neonatal resuscitation.
Obstetric analgesia and anaesthesia. Paediatric anaesthesia. Anaesthesia in the presence of some
surgical and medical conditions- hypertension, diabetes mellitus, thyrotoxicosis,
haemoglobinopathy, asthma, typhoid perforation, intestinal obstruction. Pharmacology of local
anaesthetic agents- esters and amides. Local anaesthetic techniques- nerve blocks, brachial
plexus block, Bier’s technique, subarachnoid, epidural, caudal. The Intensive Care Unitorganization and management. Care of the unconscious patient. Invasive monitoring- CVP, intraarterial monitoring, arterial blood-gas analysis. Nutrition in the critically ill- enteral feeding, total
parenteral nutrition (indications, techniques and complications).
Course Content- Clinical
Anaesthesia for patients in general surgery, ENT, obstetrics and gynaecology, paediatric surgery,
plastic surgery, cardiothoracic surgery, orthopaedic surgery, neurosurgery, urological surgery
and ophthalmology. Pre-operative ward rounds (history taking, physical examination, relevant
investigations) and premedication. Intra-operative management of patients (general anaesthesia,
regional techniques, plexus and nerve blocks). Airway management and ventilation. Recovery
room care. Postoperative care- monitoring, pain management etc. Management of critically ill
and other patients in the Intensive Care Unit.
Course Justification
Good surgical outcome depends on sound scientific knowledge of anaesthesia which includes
physiology, anatomy, pharmacology and clinical medicine related to the specialty. Pain is the
most common presenting symptom of patients and this is a specialized area in anaesthesia in
which the student must have basic knowledge. Critical care involves airway management,
support of the respiration and circulation for which the student must also have a sound
knowledge in order to be able to manage such patients upon graduation.
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Course Objectives in Anaesthesia
At the end of period in anaesthesia posting, the student should:
a) have sound knowledge of and be able to perform life support procedures; viz: respiratory
resuscitation, cardiopulmonary resuscitation, care of the unconscious patient, other
resuscitative measures.
b) have a sound knowledge of and be able to enumerate the general principles of operative
anaesthesia
c) be able to provide peri-operative care
d) be able to perform some regional anaesthetic techniques
e) be able to give a general anaesthetic for minor surgical procedures
f) recognize high risk surgical patients
g) demonstrate basic skills in the management of common complications of anaesthesia
h) be able to assess and manage acute and chronic pain
i) demonstrate basic knowledge for provision of labour analgesia
WEEK 1: INTRODUCTION TO ANAESTHESIA.
LECTURER: DR B.O. BOLAJI
Overview of historical landmarks in Anaesthesia.
Types of Anaesthesia
Stages of Anaesthesia
Triad of Anaesthesia
PREOPERATIVE ASSESSMENT.
LECTURER: DR B.O. BOLAJI
objectives
History, physical examination, investigations, risk assessment.
PREMEDICATION AND DRUGS USED FOR PREMEDICATION
LECTURER: DR. B.O. BOLAJI
Objectives
Classification of premedicant drugs
Drugs used for premedication- pharmacology, clinical uses
Week 1 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 1 Study Questions
1. What is the triad of anaesthesia? List two agents that can be used to achieve each
component of the triad
2. What are the objectives of preoperative assessment?
3. What is premedication? What are the objectives of premedication?
4. What is the ASA classification?
5. List the anticholinergic agents used in anaesthesia. In a tabular form list their actions on
the central nervous and the cardiovascular system.
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WEEK 2 INTRAVENOUS ANAESTHETIC AGENTS.
LECTURER: DR Z. A. SULEIMAN
Pharmacokinetics
Ideal iv anaesthetic agents
Classification
Pharmacology-Thiopental, methohexital, etomidate, ketamine, propofol,
midazolam
WEEK 2: INHALATIONAL ANAESTHETIC AGENTS.
LECTURER: DR. O.O. OYEDEPO
Uptake and distribution
Physical characteristics- MAC, solubility coefficients
Ideal inhalational anaesthetic agents
Pharmacology, uses- N2O, ether, halothane and other halogenated hydrocarbons
Classification of inhalational anaesthetic agents
Administration, vapourizers
Week 2 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 2 Study Questions
1. Define an intravenous anaesthetic agent
2. List 10 characteristics of an ideal intravenous anaesthetic agent
3. Write short notes on halothane and isoflurane
4. In a tabular form list 5 differences between ketamine and thiopentone
5. What is minimum alveolar concentration?
6. Enumerate factors that determine uptake and distribution of inhalational anaesthetics
WEEK 3: NEUROMUSCULAR BLOCKADE IN ANAESTHESIA .
LECTURER: DR O.A. IGE
Physiology of neuromuscular transmission.
Types of block.
Neuromuscular blocking agents- suxamethonium, tubocurarine, pancuronium,
atracurium, vecuronium etc.
Monitoring of neuromuscular blockade
Reversal of neuromuscular blockade- anticholinesterases
Factors affecting blockade and reversal
Week 3 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 3 Study Questions
1. In a tabular form, list the differences between depolarizing and non-depolarizing block
2. List FIVE complications of suxamethonium administration
3. List three clinical assessments used to ascertain adequacy of reversal of neuromuscular block
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WEEK 4: PRACTICAL CONDUCT OF ANAESTHESIA.
LECTURER: DR. I.K. KOLAWOLE
Routes of induction of anaesthesia.
Airway management.
Endotracheal tubes and intubation- indications, complications.
Postoperative care
Complications in the post-anaesthetic care unit
Week 4 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 4 Study Questions
1. What are the routes of induction of anaesthesia. Give 2 examples for each route
2 What are the indications for endotraecheal intubation?
3 List five (5) early complications of endotracheal intubation.
4 List FIVE complications that can occur in the immediate postoperative period
5. List THREE supraglottic and TWO infraglottic airway devices
6. List FIVE signs of inadequate analgesia under general anaesthesia
WEEK 5:
LOCAL ANAESTHETIC AGENTS.
LECTURER: DR. Z. SULEIMAN
History
Mechanisms of action
Classification- esters and amides
Pharmacology- cocaine, chloroprocaine, amethocaine, etidocaine, lidocaine,
bupivacaine ropivacaine
Clinical applications
WEEK 5. LOCAL ANAESTHETIC TECHNIQUES.
LECTURER: DR. Z SULEIMAN
Nerve blocks, digital block
Field block e.g. for inguinal herniorrhaphy
Brachial plexus block
Bier’s block
Week 5 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 5 Study questions
1. What are the mechanisms of local anaesthetic agents?
2. List 4 differences between amides and esters.
3. What are the physical characteristics of LAs that affect onset, potency and duration
4. List the toxic effects of local anaesthetic agents
5. List the complications associated with interscalene block
6. What nerves are blocked during field block for inguinal herniorrhaphy
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WEEK 6. CENTRAL NEURAL AXIAL BLOCKADE.
LECTURER: DR. I.K. KOLAWOLE
Anatomy- vertebrae, epidural space, sacral hiatus
Contraindications to central neural axial blockade
Subarachnoid block
Epidural block
Caudal block
Local anaesthetic agents used for central neural axial blockade
Complications of central neural axial blockade
WEEK 6:
MONITORING IN ANAESTHESIA.
LECTURER: DR. O.A. IGE
Monitors- types
Monitoring of patients under anaesthesia
Monitoring of ICU patients- invasive and non-invasive
Arterial blood gas analyses
Week 6 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 6 Study Questions
1. What is caudal anaesthesia? List five (5) indications of caudal anaesthesia
2. What is spinal anaesthesia? List ten (10) contraindications to spinal anaesthesia.
3. List four parameters which can be monitored in the cardiovascular system
4. List four indications for arterial canulation
5. In a tabular form, list FIVE differences between epidural and subarachnoid blocks
WEEK 7. PERIOPERATIVE FLUID THERAPY.
LECTURER: DR. O.O. OYEDEPO
Crystalloids and colloids
Fluid deficit, intraoperative maintenance and ongoing losses
Intaoperative blood loss, assessment
Intraoperative blood transfusion, massive blood transfusion and complications of
blood transfusion.
WEEK 7: PAIN I: ACUTE PAIN.
LECTURER: DR I.K. KOLAWOLE
Introduction to pain, anatomy
Pathophysiology of acute pain
Assessment of acute pain and management
Postoperative pain- incidence, factors affecting, management
Consequences of unrelieved pain
Barriers to pain control- opioids and non-opioid analgesics
Adjuvant in pain management
Week 7 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
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Week 7 Study Questions
1. What is pain? What are the consequences of unrelieved postoperative pain.
2. Describe the WHO Analgesic ladder
3. List FIVE methods of postoperative pain relief
4.In a tabular form, list the differences between crystalloids and colloids
5. What is massive blood transfusion? List the complications.
WEEK 8: ANAESTHESIA FOR EMERGENCY SURGERY.
LECTURER: DR O.O. OYEDEPO
Challenges and preparation
Acid aspiration prophylaxis
Techniques of anaesthesia- Regional, General (rapid sequence induction)
Mendelson’s syndrome- predisposing conditions, prevention, diagnosis and
management
WEEK 8. PAIN II- CHRONIC PAIN.
LECTURER: DR Z.A. Suleiman
Pathophysiology
Factors predisposing
Assessment and diagnosis of chronic pain
Management of chronic pain
Week 8 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 8 Study Questions
1. What is Mendelson’s syndrome. List FIVE features of the syndrome
2. List FIVE methods that can be used to prevent acid aspiration preoperatively
3. Outline management of a 65 year old woman with chronic back pain.
WEEK 9. OXYGEN THERAPY.
LECTURER: DR. O.A. IGE
Oxygen transport, oxygen flux, oxy-haemoglobin dissociation curve
Respiratory failure- aetiology, diagnosis and management.
Oxygen therapy.
Devices used for oxygen therapy- variable and fixed performance
Complications of oxygen therapy.
WEEK 9: CARDIOPULMONARY RESUSCITATION.
LECTURER: DR. B.O. BOLAJI
Cardiac arrest- definition
Causes of cardiac arrest
Chain of Survival
Basic life support- definition, practice with manikins
Advance life support
Defibrillation
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Week 9 theatre sessions/instruments/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 9 Study Questions
1. List five aetiological factors in respiratory failure
2. What are the complications of oxygen therapy?
3 Define cardiac arrest
4 List the features of cardiac arrest
5 What are the components of Basic Life Support
6. List FIVE contents of the resuscitation trolley
WEEK 10. OBSTETRICS ANALGESIA AND ANAESTHESIA.
LECTURER: DR. I.K. KOLAWOLE
Physiology of pregnancy- implications for anaesthesia
Non-pharmacological methods of labour analgesia
Systemic analgesia in labour
Regional analgesia in labour
Anaesthesia for obstetrics- general, subarachnoid block, epidural
WEEK 10. PAEDIATRIC ANAESTHESIA.
LECTURER: DR. O.O. OYEDEPO
Anatomy and physiology in child- implications for anaesthesia
Equipment for paediatric anaesthesia- e.g. Jackson Rees’ modified Ayre’s T-piece
Intraoperative fluid therapy, drug dosages
Caudal block
Week 10 theatre sessions/instruments/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 10 Study Questions
1. List the consequences of unrelieved pain in labour.
2. List the pharmacological methods of pain relief in labour.
3 What is postoperative croup? Outline its management.
4 List FIVE differences between pediatric and adult airway
WEEK 11. ANAESTHESIA IN THE PRESENCE OF SOME MEDICAL AND
SURGICAL CONDITIONS.
LECTURER: DR. O.O. OYEDEPO
Hypertension
Diabetes mellitus
Thyrotoxicosis
Haemoglobinopathy
Asthma
Intestinal obstruction
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WEEK 11: INTRODUCTION TO INTENSIVE CARE.
LECTURER: DR. O.A. IGE
Organization of ICU
Indications for admission into ICU
Resuscitation of critically ill patients
Week 11 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 11 Study Questions
1. Outline the preanaesthetic preparation of a controlled hypertensive patient scheduled for
prostatectomy under general anaesthesia
2. What is thyroid storm? How can it be diagnosed under general anaesthesia?
3. List THREE features of an intensive care unit
4. What are the indications for ICU admission?
5. Outline the treatment of bronchospasm occurring under general anaesthesia in an asthmatic
patient
WEEK 12: INTRODUCTION TO ICU II.
LECTURER: DR. O.A. IGE
Organ support- mechanical ventilation
Nutrition in the critically ill- enteral, parenteral, complications
Care of the unconscious patient
Week 12 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
Week 12 Study Questions
1. List FIVE indications for parenteral nutrition
2. What are the complications of parenteral nutrition?
3. List FIVE methods of maintaining the airway of an unconscious patient
WEEK 13. PRACTICAL SESSIONS ON EXAMINATIONS. ALL LECTURERS
Demonstration of clinical pictures in anaesthesia
Training on Objective Structured Clinical Examination
Week 13 theatre sessions/tutorials/equipment 8am-1pm Mon-Fri: ALL LECTURERS
WEEK 14. REVISION. ALL LECTURERS
WEEK 15. END OF POSTING EXAMINATION
GENERAL READING LIST:
1. Aitkenhead1 AR, Smith G(1998). Textbook of Anaesthesia, 3rd ed. London, Harcourt Brace
and Company Ltd
2. Akpan2 SG, Eshiet AI, Ilori IU, Kalu Q (2008). Basic Principles of Anaesthesia for
Medical Students. Calabar, Optimist Press Nigerian Company.
3. Allman3 KG, Wilson IH. Oxford Handbook of Anaesthesia, 2nd edition. Oxford, Oxford
University Press
4. Churchill-Davidson4 HC (1984). Wylie and Churchill-Davidson’s A Practice of Anaesthesia,
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5th edition. Chicago, Year Book Medical Publishers Inc.
5. Elegbe5 EO (2007). Handbook of Anaethetics for Medical Students and General Medical
Practitioners, New Edition. Ibadan, HEBN Publishers.
6. Famewo6 CE (1994). Lecutres in Anaesthesia and Intensive Care for Medical Students and
Practitioners, 2nd edition. Ibadan, Les Shyraden (Nig) Ltd.
7. Morgan7 GE (JNR), Mikhail MS, Murray MJ (2006). Clinical Anaesthesiology, 4th Edition.
New York, Lange Medical Books/McGraw-Hill Medical Publishing Division
LEGEND
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- Available in College of Health Sciences Library
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- Available in Department Library
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- Available in Department Library
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- Available in College of Health Sciences Library
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- Available in Department Library
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- Personal collection
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- Personal collection
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