This World Anaesthesia Day, Memfys Hospital’s Anaesthesia Unit highlights the many roles of anaesthesiologists before, during and beyond surgery, and calls for greater investment in safe anaesthesia.
Every year on 16 October, the world marks World Anaesthesia Day. The date commemorates the first public demonstration of ether anaesthesia in 1846, a moment that made modern surgery possible.
This year’s theme is “Before, During and Beyond Surgery”. It reminds us that the anaesthesiologist is not only the doctor who puts patients to sleep. The anaesthesiologist is a perioperative physician who is with the patient at every stage of the care pathway.
Safe anaesthesia begins long before the operating theatre. The anaesthesiologist:
Once surgery begins, the anaesthesiologist is the patient’s constant guardian. This includes keeping the patient unconscious and pain-free, monitoring breathing, heart rate, blood pressure and oxygen levels, managing fluids and blood, and responding immediately to any emergency.
Airway management shows this vigilance best. Dr. Ufoegbunam Maduabuchi Paul, Head of the Anaesthesia Unit at Memfys Hospital, describes how a planned surgical airway is created for a patient who is already intubated but needs longer-term breathing support:
1. Preparation comes first. The patient lies flat with a pillow under the shoulders to extend the neck. The skin is cleaned and left to dry, and a sterile fenestrated drape is placed over the site. Before the first incision, the nursing team has all equipment ready.
2. Landmarks guide every step. The team identifies the cricothyroid membrane, then the first or second tracheal ring and the midline. Local anaesthetic is given, and the landmarks are checked again once it has taken effect.
3. Precision, not force. A small incision of about 1 to 1.5 cm is made and the tissue is gently opened to limit bleeding. A cannula enters the airway, its position is confirmed by drawing back air, and a guidewire is passed through it.
4. Gradual dilation. Dilators of increasing size are passed over the guidewire, each one well lubricated. The opening widens a little at a time until the airway tube can be placed.
5. Securing the airway. The cuff is inflated, the guide is removed, and the breathing circuit is connected to the new airway.
None of this is improvised. It relies on training, a ready team and the right equipment.
The anaesthesiologist’s work does not end when the last stitch is placed. Beyond surgery, anaesthesiologists:
In neurosurgery, these roles matter even more. Neuroanaesthesia requires careful control of brain pressure, blood flow and oxygen delivery, from the first assessment through to recovery.
Safe anaesthesia across the whole pathway depends on:
Memfys Hospital has trained postgraduate doctors across several specialties, including neuroanaesthesia. We believe that building skilled anaesthesiologists is one of the most direct ways to make surgery safer.
This World Anaesthesia Day, Memfys Hospital calls on hospital managers, policymakers and partners to:
Safe anaesthesia is a right, not a privilege. Before, during and beyond surgery, the anaesthesiologist is there.
Every August, the global neurosurgery community pauses to mark Neurosurgery Awareness Month, an observance led each year by the American Association of Neurological Surgeons (AANS), the field's premier scientific and educational body, representing over 12,000 neurosurgeons worldwide since its founding in 1931. For more than a decade, AANS has used the month to educate the public, advocate for the specialty, and celebrate the surgeons, residents, researchers, and hospital teams who move the field forward, this year under the global theme "Precision That Changes Lives."
At Memfys Hospital in Enugu, that global conversation found its own local voice. The hospital marked the month with a series of short talks under the theme "Showing the Science and Precision Behind Neurosurgery", a theme that, fittingly, echoes AANS's own 2026 framing almost word for word. Four voices from across the hospital; two residents, the Head of the Neurosurgery Unit, and the Theatre Manager, each took a different point in a patient's journey and, without quite planning it, told the same story from four angles: nothing about neurosurgery starts in the operating room.
It starts with seeing clearly.
Dr. Oti Ogbonnia Hilary, a neurosurgery resident, opened with the image, literally. Every operation, he explained, begins long before anyone picks up an instrument, with an MRI or CT scan that maps the terrain: where the tumor sits, what blood vessels or nerves surround it, whether there is bleeding, whether the ventricles are dangerously dilated. That scan does more than confirm a diagnosis, he noted, it decides the tempo of care itself, distinguishing a case that can wait from one that needs the theatre within the hour. His closing line captured the theme better than any tagline could: without imaging, surgery becomes a blind procedure, slow, and potentially catastrophic. Precision, in his telling, is simply the discipline of never operating on what you haven't first seen.
Then it becomes a process of confirmation and preparation.
Dr. Abeze Chukwu Francis picked up the thread from the clinic door. A patient rarely walks in with a diagnosis already in hand, they arrive with headaches, back pain, seizures, blurred vision. Getting from symptom to certainty, he explained, is its own exacting method: assessing mental state, memory, speech, reflexes, visual fields, each observation narrowing the possibilities before imaging is ever ordered. Only once a scan confirms what the examination already suggested does the real work of preparation begin, cardiology clearing the heart, endocrinology stabilizing blood sugar, anaesthesia assessing fitness, and always, before any of it, an informed conversation with the patient about what is being proposed and why. What struck a chord in his account was how much of "precision" is really about sequence, nothing skipped, nothing assumed.
And it depends on people well beyond the surgeon.
Prof. Chika Ndubuisi, Head of the Neurosurgery Unit, reframed the entire idea of the surgeon as sole author. He described a neurosurgery team the way one might describe a flight crew: the surgeon may be the one the patient sees, but cardiologists, endocrinologists, nephrologists, radiologists, anaesthetists, nurses across every subspecialty, physiotherapists, and even the biomedical engineers who service the microscopes are all quietly present in every outcome. At Memfys, he noted, that coordination is formalised, a round-table review where every angle of a case, clinical and psychological alike, is discussed before a patient ever reaches the theatre. His central claim was simple and, by the end of the month's talks, entirely earned: safe surgery is a team's discipline before it is a surgeon's skill.
And finally, it is enforced by protocol.
Mr. Ozulu Augustine, the hospital's Theatre Manager, closed the arc from the other side of the theatre doors. His talk detailed the unglamorous machinery of safety: identity checks against at least two identifiers, consent verification, allergy and fasting reviews, surgical-site marking, and the WHO surgical safety checklist completed in full before a single incision is made. His line, that for the patient, surgery begins when they enter the theatre, but for the team, it begins much earlier was, in effect, the thesis of the entire month.
The pattern beneath four different jobs
Taken together, the four talks trace one continuous line rather than four separate topics: precision begins with an image, is confirmed through examination, is safeguarded by a team, and is enforced by protocol, long before it ever becomes a scalpel meeting tissue. Where the public tends to picture neurosurgery as a single dramatic moment, the people who practise it at Memfys described it as something closer to a relay: each stage handing off to the next with almost no room for improvisation, because none is needed when the preparation has been this exact.
That, perhaps, is the real answer to the month's theme. The science of neurosurgery lives in the imaging, the anatomy, the physiology. The precision lives everywhere else, in the sequence, the handoffs, and the people who make sure nothing is left to chance before the first incision is ever made. It is a fitting local answer, too, to the question AANS poses to the wider neurosurgical world every August: that precision, wherever it is practised, is never the work of one person, it is a discipline a whole team commits to, together, long before a patient ever reaches the theatre.
By the Laboratory Department — Originally presented at Nurses Week Masterclass 2026
Infection prevention is the cornerstone of safe, high-quality healthcare. At Memfys Hospital, where we manage complex neurosurgical, neurological, and multi-specialty cases, the stakes are even higher. During our recent Nurses Week Masterclass, the Laboratory Department shared essential insights on infection prevention that every member of our clinical team, and every patient, should know.
This masterclass was developed and delivered by Miss Adanna Eze, Head of the Laboratory Unit at Memfys Hospital. With her extensive expertise in clinical microbiology and laboratory medicine, Miss Eze leads our efforts in diagnostic accuracy, pathogen surveillance, and infection prevention across all hospital departments. Her leadership ensures that Memfys Hospital maintains the highest standards of laboratory practice and patient safety.
An infection occurs when pathogens successfully invade and multiply in body tissue, typically entering through "portals of entry" such as IV sites, surgical wounds, or mucosal surfaces. Cross-contamination, the unintentional transfer of germs between patients, staff, or equipment, is one of the most common ways infections spread in healthcare settings. Pathogens move primarily through contaminated hands or shared equipment.
Healthcare-Associated Infections (HAIs), also known as nosocomial infections, are infections acquired while receiving treatment for other conditions. An HAI is defined as an infection that:
Nurses and nursing assistants are the primary defense against HAIs.
At Memfys Hospital, where we care for critically ill patients in our ICU, HDU, and surgical units, we remain vigilant against four major categories of HAIs:
1. CLABSI (Central Line-Associated Bloodstream Infections)
These are highly preventable through sterile hub care and vigilant monitoring of dressing integrity. With our advanced vascular imaging and critical care capabilities, maintaining sterile technique during central line management is non-negotiable.
2. CAUTI (Catheter-Associated Urinary Tract Infections)
Mitigated by strictly closed drainage systems and daily clinical necessity reviews to ensure catheters are removed as early as possible.
3. VAP (Ventilator-Associated Pneumonia)
Pneumonia that develops in patients on mechanical ventilation is preventable through head elevation (30–45°) and rigorous oral hygiene protocols. This is especially critical in our 6-bed ICU, where ventilated neurosurgical and stroke patients require meticulous care.
4. SSI (Surgical Site Infections)
Infections at operative sites are prevented through aseptic maintenance, correct timing of antibiotic prophylaxis, and strict sterile field protocols in our modern operating theatre suites.
Pathogens in our clinical environment fall into three primary groups:
| Type | Characteristics | Examples |
|---|---|---|
| Bacteria | Fast-growing, can develop resistance | MRSA, E. coli |
| Viruses | Small but persistent | Influenza, Hepatitis |
| Fungi | Often target post-op or immunocompromised patients | Candida species |
Infection transmission follows a predictable chain with six links:
Break any link, and you stop the cycle of infection.
The consequences of inadequate infection prevention are severe:
At Memfys Hospital, we refuse to accept these statistics as inevitable. Our commitment to zero preventable infections drives every protocol we implement.
Mastering hand hygiene during critical moments and protecting sterile fields during all invasive care. This includes:
Professional standards that protect both staff and patients:
Accountability and teamwork:
Pathogens don't have wings; they have carriers. Cross-contamination moves through:
The WOW keyboard, mouse, and handles are major mobile reservoirs. They travel room-to-room carrying pathogens. Our shift habit: Wipe the WOW at the start of every shift and sanitize hands after every typing session.
Our hand hygiene protocol follows the World Health Organization's five critical moments:
To kill pathogens, a surface must remain visibly wet for the dwell time (typically 1–3 minutes) to allow for complete chemical kill.
S-Curve Motion: Wipe in a continuous "S" pattern with overlapping paths to ensure 100% coverage without re-dragging soil across clean surfaces.
| Process Level | Definition | Target Items at Memfys |
|---|---|---|
| Cleaning | Physical removal of organic soil and dirt | Floors, chairs, WOW bases |
| Disinfection | Chemical destruction of most pathogens | Bed rails, keyboards, monitors |
| Sterilization | Total kill of all life forms (including spores) | Surgical kits, invasive catheters |
| Antisepsis | Pathogen reduction on living skin | Hand rub, IV site prepping |
At Memfys Hospital, infection prevention is reinforced through:
Clinical leaders of aseptic stewardship. You supervise invasive site care, maintain sterile field integrity, and lead the shift-start safety huddle.
Frontline guardians of hygiene. You manage environmental decontamination and monitor skin integrity to prevent colonization at vulnerable sites.
At Memfys Hospital, infection prevention is not just a protocol, it is a culture of excellence. From our ICU to our operating theatres, from our radiology suites to our general wards, every member of our team plays a vital role in protecting our patients.
By mastering Asepsis, Body Hygiene, and a Caring Attitude, we honor the trust our patients place in us and uphold the standard of care that Memfys Hospital has delivered since 2002.
Memfys Hospital — Pioneering Neurosurgical and Multi-Specialty Care in Nigeria Since 2002
The pager goes off at 2:00 AM.
"Head trauma, GCS 8, intubated, coming from scene."
You have read the textbooks. You have watched the attendings. Now it's in your hands- your call, your patient. Neurosurgical emergencies don't wait for confidence to arrive; they demand it on arrival. Here's what you need to have already internalized before you pick up that phone.
Before any diagnosis, any CT, any call to the OR, remember the ABCs of resuscitation. Secure the airway. Avoid hyperventilation unless the patient is actively herniating. Maintain cerebral perfusion pressure like it's the only thing keeping them alive, because right now, it is.
Remember this and let it drive your urgency: millions of neurons die every minute of ongoing ischemia. Time is not a clinical variable here; it is the intervention.
When in doubt, scan. CT is fast, accessible, and in most neurosurgical emergencies, it will tell you exactly what you need to know. And call your attending/consultant early, at the first sign of deterioration, not after herniation has already begun. That distinction will define your reputation as a resident.
This is the classic trap. The patient talks to the paramedics. They arrive lucid. Then they don't. The "talk and die" syndrome exists because the lucid interval is deceptive, a temporary calm before the middle meningeal artery hemorrhage crosses a threshold that the brain can no longer compensate for. On CT, the lens-shaped hyperdensity is unmistakable.
If they are deteriorating and the epidural is significant, your next step is the OR. Not another scan. Not a phone consult. The OR. Speed here is the difference between a good outcome and a catastrophe.
The crescent-shaped collection tells half the story; the other half is the underlying brain injury, which is why mortality sits at 50–60%. Operate if the thickness exceeds 10mm, midline shift is greater than 5mm, or GCS drops more than 2 points. Anticoagulation must be reversed immediately; use prothrombin complex concentrate and move toward the OR. Do not wait for normalized values in an unstable patient. The brain cannot afford that delay.
They evolve. Serial CTs in the first 24 - 48 hours are not optional; contusions that looked manageable on initial imaging frequently expand. Watch them.
Saddle anesthesia. Urinary retention. Decreased rectal tone. If a patient presents with this triad, the MRI is an emergency, and the surgery is an emergency. Every hour of delay is a potential lifetime of bowel, bladder, and sexual dysfunction for your patient. This is one of the few scenarios in medicine where urgency and outcome are almost perfectly correlated.
Back pain with fever and a neurological deficit should immediately raise your suspicion. MRI with contrast confirms it. If neurological deficits are present, emergent decompression plus antibiotics is the standard. Don't let the infectious disease optics slow your surgical decision-making when the cord is at risk.
"Worst headache of my life." When a patient uses those words, take them seriously; they are describing a sentinel bleed until proven otherwise. CT within 6 hours is highly sensitive; CTA identifies the culprit aneurysm. Secure it within 24 -72 hours. Rebleeding carries a 70% mortality. Nimodipine runs for 21 days. Monitor vigilantly for vasospasm and hydrocephalus; they are predictable complications, and being ahead of them is what separates good management from reactive management.
Reverse anticoagulation immediately, without equivocation. For cerebellar hemorrhage greater than 3cm or with brainstem compression, surgery deserves serious consideration. The posterior fossa tolerates expansion poorly; what looks stable can deteriorate fast.
A young patient with a large MCA infarct can look deceptively stable and then herniate. Decompressive hemicraniectomy within 48 hours improves survival, even when the imaging looks devastating. This is one of the hardest calls in neurosurgery, operating on someone with catastrophic-appearing scans, but the data support it, and your attending will guide you through it the first time.
Know the signs of herniation before you see them for the first time: blown pupil (uncal herniation), decerebrate posturing, and respiratory pattern changes. When these appear, you are already behind; the goal is to recognize the trajectory before the endpoint.
Your stepwise response: Head of bed to 30°. Mannitol 1g/kg. Temporary hyperventilation to PaCO₂ 30–35 (a bridge, not a treatment). Sedation. CSF drainage if an EVD is in place. Decompressive craniectomy as a last resort.
One absolute: never perform a lumbar puncture in the presence of mass effect. It can precipitate the very herniation you are trying to prevent.
If your patient is getting worse after surgery, get a CT immediately. The differential is predictable; hematoma expansion is most common, followed by cerebral edema, seizure, hydrocephalus, electrolyte abnormalities, and infection. None of these wait until morning rounds. Neither should you.
Use SOAP, (Subjective, Objective, Assessment, Plan) every time you escalate cases to the senior colleagues. It is the framework that turns a panicked phone call into a structured handoff. Document everything: times, findings, who you called, what was decided, and what was done. In a specialty where minutes matter legally and clinically, your documentation is your record of having acted correctly.
Build checklists for your most common emergency scenarios before you need them. The time to think through an EDH protocol is not at 2 AM with a deteriorating patient; it's now, in the quiet of a Tuesday afternoon.
Anticipate deterioration. The best neurosurgeons in the room are rarely reacting; they are two steps ahead of a patient who hasn't gotten worse yet.
Debrief after every emergency, even the ones that went well. Especially the ones that went well, there is always something to refine.
And know your limits. Calling your attending early is not a weakness. It is good patient care, and the best residents understand that distinction intuitively.
There is a reason neurosurgery attracts a particular kind of physician. You are not just preserving life; you are preserving the architecture of who a person is. Their memory, their movement, their ability to recognize their children's faces.
Your pager will ring again tonight.
You will be ready.
Professor Ndubuisi Chika is the Head of the Neurosurgery Unit at Memfys Hospital, Enugu.
With decades of hands-on experience managing the full spectrum of neurosurgical emergencies, from trauma to complex vascular pathology, Professor Chika has trained generations of neurosurgeons within the walls of Memfys.
As a consultant and trainer, he has watched residents walk into their first 2 AM emergency call and walk out the other side as surgeons. He has seen what preparation does, and what its absence costs. This article is drawn directly from that experience, and the quiet conversations that happen after a difficult night.
"The best residents I have trained were not necessarily the most talented on day one. They were the ones who treated every emergency as a lesson, called for help without ego, and never stopped refining their instincts. Neurosurgery will demand everything from you. Give it that, and it will make you someone worth being."
Professor Ndubuisi Chika, Head of Neurosurgery, Memfys Hospital.
The often-general perception that a Specialist Health Facility like Memfys Hospital Enugu, is about life saving, precision, complex brain or spinal surgery hospital, tells only part of the accurate story. General Medicine plays a deep, integrated systems role behind every successful neurosurgical outcome. This evidence-based fact is ordinarily unappreciated.
Specialist care does not exist in isolation. WORLD HEALTH ORGANISATION (WHO), defined HEALTH, as “a complete state of physical, mental, and social well-being, rather than merely the absence of disease or infirmity.” Neurosurgical patients, therefore, are first and foremost, General Medicine patients. There is scarcely any patient who presents in a Specialist Hospital without co-morbidities that form underlying challenge(s) which missing them out or ignoring their symptoms/signs, amount to remarkable less outcomes in managing the patient(s). General Medicine skills reveal systemic challenges that extend beyond the Central & Peripheral Nervous systems' focus of Neurosurgeons & Neurologists.
A Neurological patient may have a background of an unstable family relationship that is projecting a background of Hypertension &/or Diabetes Mellitus. Infections, allergy, electrolyte imbalance, hormonal imbalance, other psychosocial challenges, do frequently intersect with neurological diseases.
General Medicine provides the foundation upon which neurosurgical excellence is built. From initial patient assessment to post-operative recovery, experienced General Medicine practitioners play one stop cost-cutting, skillful roles in ensuring that the patient’s body or health as a whole, is stable, thus optimizing the capacity of the patient and family/loved ones to withstand complex specialty interventions.
Before any neurosurgical procedure, a critical question must be answered: Is the patient physically, mentally, economically, spiritually & psychologically fit for surgery and post-surgery care? Is the patient a homosexual or heterosexual person? This question has become a dynamic inclusion in patients' holistic assessment.
General Medicine plays central & inter-specialists’ role in:
For example, uncontrolled blood pressure significantly increases the risk of intraoperative bleeding, while unidentified or poorly managed diabetes can impair wound healing and increase local or spread infection risks. Without proper medical optimization, even the most technically successful surgery can result in embarrassing poor cost expensive outcomes.
General Medicine is, therefore, not just supportive but serve essential coordinated preventive, protective, and rehabilitative roles.
In a specialist hospital setting, patients often present in critical conditions; stroke, acute malaria, typhoid fever, STIs, urinary tract infections, ongoing or threatened pregnancy, traumatic brain injury, or severe neurological compromise, including, at times, high-value individuals such as criminal suspects under active investigation. These are not purely surgical emergencies; they are complex consequential General medicine crises.
Dynamic General Medicine contributes by coaching & coordinating activities in Accident and Emergency (A&E) or Out patients Departments of a Specialist Hospital by:
At Memfys Hospital, Accident & Emergency as well as the Intensive Care Unit are clear examples of areas that demand synergized administrative & clinical multi-units manpower collaboration.
Critically ill patients often require ventilatory support, cardiovascular stabilization, and metabolic management, all are areas where experienced general medicine physicians and critical care specialists are indispensable.
Surgery may address the primary neurological problem, but recovery depends heavily on post-operative care. This is where General Medicine becomes even more visible in inter disciplinary bridge-building activities.
After neurosurgery, patients are vulnerable to:
For the sake of emphasis, the Multidisciplinary advantage of General Medicine in a Specialist Hospital setting can’t be overlooked, since that has become one of the defining strengths of a modern specialist hospital, where:
Neurosurgeons, Neurologists, Radiologists, Cardiologists, Endocrinologists, work in synergy with General Coordinating Physician & not in silos.
General Medicine acts as the remarkable coach of a sports team of players in different wings. He embodies knowledge-about-every-clinical-action bridge across specialties by:
This integration is particularly important in complex cases, where neurological disease overlaps with systemic illness. For instance, a stroke patient may require input from neurology, cardiology, and endocrinology, yet it is often the general medicine practitioner who ensures that these inputs are harmonized into a sustained dynamic, coherent care plan framework.
General Medicine is central to the evolution where over time, institutions like Memfys Hospital have evolved functionally, to expand beyond their original focus. While neurosurgery remains a core strength, the expansion of services to include cardiology, Paediatrics, endocrinology (& Obstetrics/Gynaecology), - reflects a broader vision to deliver comprehensive, high-quality secondary & tertiary care, under one roof.
It enables specialist hospitals like Memfys to:
In many ways, experienced General Medicine practice, function administratively, clinically & psychosocially behind the scenes. It is less visible than specialty surgery, yet remains the one stop discipline that ensures stability, continuity, and resilience, objective monitoring & evaluation in patients care. Neurosurgical procedure is not defined solely by what happens in the operating theatre. General Medicine defines every step of the patient’s journey, with all the associated psycho-social & economic factors, from OPD, admission to recovery, including out-of-pocket bill settlements or medical insurance issues.
Specialist hospitals are often judged by their ability to perform complex surgical procedures. However, their true strength lies in their ability to deliver complete care to achieve optimal state of physical, mental and social well-being. Neurosurgery may be the headline, but General Medicine is the behind-the-scenes objective coordinating backbone.
At institutions like Memfys Hospital, the clinical, administrative, and psycho-social integration of these disciplines, within properly organized referral frameworks, is what transforms clinical expertise into consistent excellent patient outcomes. In the end, treating the brain and spinal pathologies are important, but treating/managing the whole patients with their families and loved ones, remain what truly save lives.
The Nigerian Medical & Dental Council (MDCN) is urged to reactivate & intensify the training program for clinicians in Fellowship certification (FMCGP) in General Practice.
Dr. Hilary Okey Agbo - MB.BS (Nig.), FCAI, AIMR, is the Chief Medical Officer at Memfys Hospital, Enugu. With his extensive local & International exposure, administrative Primary Healthcare, as well as headship of & practice experience in many secondary healthcare facilities, while managing complex medical & general surgical conditions (within specialist settings), he is committed to advancing integrated, patient-centered care that bridges disciplines and improves clinical outcomes which would continue to project the Specialist Institution as a united one-stop center of International health standard.
