Anesthetic Techniques for Gynecological Surgeries in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria

Background: Gynecological surgery refers to surgery on the female reproductive system usually performed by gynecologists. It includes procedures for benign conditions, cancer, infertility and incontinence.  Gynecological conditions are seen in the non-pregnant and early pregnant state up to 20 weeks gestation. . Just like every other surgery, they require anesthesia for the elimination of surgical pain and the surgical methods to a great extent, determine the choice of anesthesia employed. Anesthesia is usually in the form of regional, especially the neuroaxial type, or general anesthesia. This study was conducted to ascertain the anesthetic techniques employed for gynecological surgeries in the Benue State University Hospital (BSUTH), Makurdi, Nigeria and complications arising there from. Methodology: A retrospective and descriptive study of case files of patients that underwent gynecological surgeries between January 2016 and December 2018 in BSUH, Makurdi was carried out. A total of 156 case files of eligible patients were retrieved from the records department of BSUTH after approval from relevant authorities. Relevant information were extracted from the patients’ folders and transferred into a prepared proforma. The data collected were analyzed using SPSS version 25 using simple statistics. Result: A total of 156 cases were evaluated. The age bracket with the most number is that between 21 and 30 years which recorded 54 (34.6%). This was followed by the age group between 31 and 40 years which were 51, making up 32.7% of the study population. Uterine fibroid was the most recorded diagnosis with 36 cases accounting for 23.1% of the study population. This was followed by ruptured ectopic gestation which was observed to 23, representing 14.7% of the study group. Cancer (Ca) of the cervix recorded 22, amounting to 14.1% of the study group. Exploratory laparotomy was carried out 44 times accounting for 28.2% of the procedures. This was followed by myomectomy and examination under anesthesia (EUA) with 26, representing 14.7% of the variables each.  Of the 156 anesthetic procedures undertaken, 56 (35.9%) were sub-arachnoid block (SAB). This was followed closely by general anesthesia with endotracheal intubation (GA/ETT) with 55 (35.3%). General anesthesia with face mask (GA/FM) came third with 35 (22.4%). Twenty-four episodes of complications were observed out of which pain occurred 10 times accounting for 41.7% of the variables. Hypotension occurred 8 times representing 33.3% of the variables. Accordingly, 24 modalities were employed for the management of complications of anesthetic techniques of which IV administration of ephedrine was done 8 times representing 33.3% of the variables. This was followed by IV administration of pentazocine that was done 5 times accounting for 20.9% of the variables. Conclusion: As a result of the vast array of gynecological diseases observed in this study, GA with tracheal intubation and GA with face mask together make up the anesthetic technique of choice for gynecological surgeries. The prominence of SAB as an anesthetic technique is not unexpected because many gynecological lesions are sub-umbilical in location, thus making them amenable to the technique which also possesses a lot of advantages. In addition, complications observed were few and included mainly pain and hypotension, none of which was life-threatening.