Anesthetic and surgical experience in a tertiary hospital in a setting of fossil-fuel explosion resulting in mass casualty burn injury

Abstract

A mass casualty flame burn injury involving seventeen patients occurred in Benue State, Nigeria in 2019 when a petrol tanker fell, and exploded as villagers at Ahumbe were scooping the petrol. An unidentified number of people were burned to death at the scene of the incident. The study was conducted to highlight the anesthetic and surgical experience gained in the management of these cases in a temporary emergency burn unit in Benue State University Hospital (BSUTH), Makurdi. Seventeen case files of eligible patients were retrieved from the Records Department. Relevant information were extracted from the patients’ files and entered into a prepared proforma. The data collected were analyzed using SPSS version 25. A total of 17 patients’ files were evaluated. There were 13 male patient’s representing 76.5% and 4 females making up 23.5% of the study population, with male to female ratio of 3.3:1. The age bracket mostly affected was 21 to 30 years with 9 constituting 53.0% of the study population.  Patients with mixed thickness burn were 12 accounting for 70.6% of the study population, full thickness and superficial burn were 3 and 2 making up 17.6% and 11.7% respectively. The least percentage total body surface area (TBSA) of burn was 8 and the highest was 91, with mean of 40.1 ±15.9.  Seven patients came to our facility by way of referral from Federal Medical Centre (FMC) Makurdi, accounting for 41.2% of the study population. Most of the patients belonged to ASA II with 13 in number making up 76.5% of the study group. All the patients had meshed split thickness skin graft (SSG). A total of 19 anesthetic techniques were employed. Of these, the highest was general anesthesia (GA) with tracheal intubation and mechanical ventilation with 13 accounting for 68.4% of the study population. Of other therapies instituted, physiotherapy was done 16 times accounting for 64% of the variables. Sixteen (94.1%) patients   had 100% grafts take while one (5.9%) had 97% graft take. Unfortunate as the incident of mass casualty burn injuries following the fossil-fuel explosion was, it brought about an indelible experience in the anesthetic and surgical management of these patients. The intervention by Médecins Sans Frontières (MSF) resulted in the availability of both anesthetic and surgical choices of procedures with most patients undergoing GA with tracheal intubation and mechanical ventilation and all the patients having meshed split thickness skin graft with good outcome.