It has been said that the development of surgery has been in tandem with the evolution of anaesthesia. This should hold true all over the world, but in some areas a lack of resources has hindered the growth of both specialities. Most of the work on the economics of anaesthesia in the developing world, especially in Africa, has been by carried out by Western authors. As commendable and factual as they are, little work has been done in the West African sub-region which consists of about sixteen countries, including the most populous nation in Africa, Nigeria.This review looks at the economics of anaesthetic practice in a major country in the region and how improvisation has helped limit the number of expensive drugs needed for the delivery of safe anaesthesia, whilst maintaining cost effectiveness. The cost of anaesthesia in Nigeria as a percentage of the total hospital cost is higher than that in most parts of the developed world, while the converse is true of total hospital costs in the developed world, which are much higher.