Assessment of cross-cultural measurement invariance of the NIH toolbox fluid cognition measures between Jamaicans and African-Americans.

The NIH Toolbox Cognitive Battery (NIHTB-CB) was developed as a common-metric, computerized cognitive screener for research. Although extensively normed and validated in Americans of different ethnicities, there is little data on how generalizable such results would be when used outside of the United States. The objective of this study was to assess measurement invariance (MI) of the NIHTB-CB across Jamaican and African-American samples and determine appropriateness of comparisons across groups. Multi-group confirmatory factor analyses using a single-factor model were conducted using five tests of fluid cognitive abilities from the NIHTB-CB, which assess working memory, episodic memory, processing speed, and executive function. MI was tested sequentially for configural, metric and scalar invariance. 125 Jamaican and 154 American adults of African descent were included. The Jamaican mean age was 31.6 ± 8.6 years (57% males) compared to 43.5 ± 15.5 years (25% males) for the African-American group. The Jamaicans had on average 11.3 ± 2.7 years of education compared to 13.9 ± 2.6 years for the African-Americans. We found metric and configural invariance across both samples but not scalar invariance. These findings suggest that the single factor emerging from the NIHTB-CB measures the same construct, i.e. fluid cognitive ability, in both groups and hence the battery is appropriate for assessments within cultures. However, lack of scalar invariance indicates that direct cross-cultural comparisons of performance levels should be interpreted with caution, also suggesting that U.S. normative standards are not generalizable to the Jamaican population.

Liver fat in adult survivors of severe acute malnutrition.

The association between severe acute malnutrition (SAM) in early childhood and liver fat in adults is unknown. We hypothesized that exposure to SAM, especially severe wasting, is associated with fatty liver later in life. In this observational study, abdominal CT was used to quantify mean liver attenuation (MLA) and liver:spleen attenuation ratio (L/S). Birth weight (BW), serum lipids, insulin resistance (homeostatic model assessment), anthropometry and intrabdominal fat were collected. Mean differences between diagnostic groups were tested and hierarchical regression analysis determined the best predictors of liver fat. We studied 88 adult SAM survivors and 84 community participants (CPs); age 29.0 ± 8.4 years, BMI 23.5 ± 5.0 kg/m2 (mean ± SDs). SAM survivors had less liver fat than CPs (using L/S) (p = 0.025). Severe wasting survivors (SWs) had lower BW (-0.51 kg; p = 0.02), were younger, thinner and had smaller waist circumference than oedematous malnutrition survivors (OMs). In the final regression model adjusting for age, sex, birth weight and SAM phenotype (i.e., oedematous malnutrition or severe wasting), SWs had more liver fat than OMs (using MLA) (B = 2.6 ± 1.3; p = 0.04) but similar liver fat using L/S (p = 0.07) and lower BW infants had less liver fat (MLA) (B = -1.8 ± 0.8; p = 0.03). Greater liver fat in SWs than OMs, despite having less body fat, supports our hypothesis of greater cardiometabolic risk in SWs. Other postnatal factors might influence greater liver fat in survivors of severe wasting, suggesting the need to monitor infants exposed to SAM beyond the acute episode.

Nonalcoholic Fatty Liver Disease in Nonobese Subjects of African Origin Has Atypical Metabolic Characteristics.

BACKGROUND: Nonobese nonalcoholic fatty liver disease is reported in several populations. However, because persons of African origin display unique fat accumulation, insulin resistance, and lipid profiles, we investigated fatty liver in nonobese persons of African origin. METHOD: We recruited 78 urban Jamaican volunteers. CT was used to estimate liver and abdominal fat and dual-energy X-ray absorptiometry to measure body composition. Fasting blood was collected for lipids, alanine aminotransferase (ALT), adiponectin, and fetuin-A. Homeostatic model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), insulinogenic index (IGI), and oral disposition index (oDI) were calculated after a 75-g oral glucose tolerance test. RESULTS: Fifty-two percent of participants were male; mean (±SD) age was 28.5 ± 7.8 years, and body mass index was 22.4 ± 3.0 kg/m2. Mean liver attenuation (MLA) and liver/spleen (LS) ratio, both inversely correlated to liver fat, were 62.8 ± 4.3 HU and 1.2 ± 0.1, respectively; 3.8% of participants had liver fat >30% (LS ratio < 1). In age, sex, and BMI-adjusted correlations, MLA was negatively associated with weight (r = -0.30; P = 0.009) and height (r = -0.28; P = 0.017) and was associated with fasting glucose (r = 0.23; P = 0.05), fasting insulin (r = 0.42; P ≤ 0.001) and HOMA-IR (r = 0.35; P = 0.004). Serum lipids, ALT, adiponectin, fetuin-A, WBISI, IGI, and oDI were not associated with liver fat. CONCLUSIONS: In nonobese Afro-Caribbean participants, greater liver fat was associated with weight and height and lower fasting insulin and hyperinsulinemia appears to be influential in the reduction of NAFLD. These findings may be influenced by ethnicity, body size, and method of estimating liver fat.

Correction to: The knowledge, attitudes and practices of doctors regarding antibiotic resistance at a tertiary care institution in the Caribbean.

[This corrects the article DOI: 10.1186/s13756-018-0315-3.].

A national survey of the knowledge, attitudes and prescribing practices of doctors regarding antibiotic resistance in a Caribbean country.

Background: Antibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean. Methods: As part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire. Results: Of the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60-79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges. Conclusion: Physicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

INTRODUCTION: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. METHODOLOGY: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. RESULTS: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). CONCLUSION: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

[The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica]. / Incidência de delírio ao despertar e fatores de risco após o uso de sevoflurano em pacientes pediátricos para cirurgia ambulatorial, Kingston, Jamaica.

BACKGROUND AND OBJECTIVES: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. METHODS: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. RESULTS: 145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). CONCLUSION: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition.

Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls. We studied 116 adult SAM survivors, 54 after marasmus, 62 kwashiorkor, and 45 age/sex/body mass index-matched community controls who had standardized anthropometry, blood pressure, echocardiography, and arterial tonometry performed. Left ventricular indices and outflow tract diameter, carotid parameters, and pulse wave velocity were measured, with systemic vascular resistance calculated. All were expressed as SD scores. Mean (SD) age was 28.8±7.8 years (55% men). Adjusting for age, sex, height, and weight, SAM survivors had mean (SE) reductions for left ventricular outflow tract diameter of 0.67 (0.16; P<0.001), stroke volume 0.44 (0.17; P=0.009), cardiac output 0.5 (0.16; P=0.001), and pulse wave velocity 0.32 (0.15; P=0.03) compared with controls but higher diastolic blood pressures (by 4.3; 1.2-7.3 mm Hg; P=0.007). Systemic vascular resistance was higher in marasmus and kwashiorkor survivors (30.2 [1.2] and 30.8 [1.1], respectively) than controls 25.3 (0.8), overall difference 5.5 (95% confidence interval, 2.8-8.4 mm Hg min/L; P<0.0001). No evidence of large vessel or cardiac remodeling was found, except closer relationships between these indices in former marasmic survivors. Other parameters did not differ between SAM survivor groups. We conclude that adult SAM survivors had smaller outflow tracts and cardiac output when compared with controls, yet markedly elevated peripheral resistance. Malnutrition survivors are thus likely to develop excess hypertension in later life, especially when exposed to obesity.

Infection control practice in the operating room: staff adherence to existing policies in a developing country.

CONTEXT: Infection control interventions are important for containing surgery-related infections. For this reason, the modern operating room (OR) should have well-developed infection control policies. The efficacy of these policies depends on how well the OR staff adhere to them. There is a lack of available data documenting adherence to infection control policies. OBJECTIVE: To evaluate OR staff adherence to existing infection control policies in Jamaica. METHODS: We administered a questionnaire to all OR staff to assess their training, knowledge of local infection control protocols, and practice with regard to 8 randomly selected guidelines. Adherence to each guideline was rated with fixed-choice items on a 4-point Likert scale. The sum of points determined the adherence score. Two respondent groups were defined: adherent (score > 26) and nonadherent (score ≤ 26). We evaluated the relationship between respondent group and age, sex, occupational rank, and time since completion of basic medical training. We used χ(2) and Fisher exact tests to assess associations and t tests to compare means between variables of interest. RESULTS: The sample comprised 132 participants (90 physicians and 42 nurses) with a mean age of 36 (standard deviation ± 9.5) years. Overall, 40.1% were adherent to existing protocols. There was no significant association between the distribution of adherence scores and sex (p = 0.319), time since completion of basic training (p = 0.595), occupational rank (p = 0.461), or age (p = 0.949).Overall, 19% felt their knowledge of infection control practices was inadequate. Those with working knowledge of infection control practices attained it mostly through informal communication (80.4%) and self-directed research (62.6%). CONCLUSION: New approaches to the problem of nonadherence to infection control guidelines are needed in the Caribbean. Several unique cultural, financial, and environmental factors influence adherence in this region, in contrast to conditions in developed countries.

Leadership in surgery for public sector hospitals in Jamaica: strategies for the operating room.

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.

Minor postoperative complications related to anesthesia in elective gynecological and orthopedic surgical patients at a teaching hospital in Kingston, Jamaica.

BACKGROUND AND OBJECTIVES: Minor postoperative anesthetic complications may increase patient discomfort and dissatisfaction and delay recovery. This paper sought to determine the frequency of minor complications in the first 48 hours postoperatively reported by elective gynecological and orthopedic surgical patients at the University Hospital of the West Indies, Jamaica. Overall satisfaction with anesthetic care and possible risk factors for developing complications were also assessed. METHODS: A prospective, descriptive cohort study was undertaken with patient interviews 24 to 48 hours after anesthesia. Data were analyzed using SPSS version 12 and assessed using the χ(2)-square test and multiple logistic regression models. RESULTS: Five hundred and five (505) patients were included, with 374 females (74%). Most were ASA I (55%) or ASA II (38%) and had general anesthesia (80%). A total of 419 (83%) patients reported at least one complication postoperatively. The most frequently reported complications were sore throat (44%), nausea (30%), vomiting (24%), and thrombophlebitis (20%). The mode of the Verbal Numerical Rating Score (VNRS) for each complication ranged between 2 and 5, suggesting that most did not cause severe distress. Age less than 45 years (OR 2.22, 95% CI 1.34-3.69, p=0.002) and female gender (OR 3.64, 95% CI 2.14-6.20, p<0.001) were identified as significant independent variables. Most patients regarded their anesthetic experience as excellent (51%) or very good (22%). CONCLUSION: This study showed a comparatively high incidence of minor postoperative complications (83%), but low reported severity of symptoms and a high overall satisfaction rate. Special attention should be paid to reduce these minor complications through more meticulous anesthetic technique.

The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica / Incidência de delírio ao despertar e fatores de risco após o uso de sevoflurano em pacientes pediátricos para cirurgia ambulatorial, Kingston, Jamaica / Incidencia de delirio de urgencia y factores de riesgo después del uso de sevoflurano en pacientes pediátricos para cirugía ambulatoria, Kingston, Jamaica

Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3). Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%. .

Justificativa e objetivos: Delírio ao despertar é uma complicação preocupante após o uso de sevoflurano em anestesia geral. Este estudo procurou determinar a incidência de delírio ao despertar e os fatores de risco em pacientes de um hospital pediátrico especializado, em Kingston, Jamaica. Métodos: Estudo transversal e observacional, incluindo pacientes pediátricos com idades entre 3-10 anos, estado físico ASA I-II, submetidos à anestesia geral com sevoflurano para procedimentos eletivos em regime ambulatorial. Os dados coletados incluíram nível de ansiedade no pré-operatório medido com a Escala de Ansiedade Pré-operatória de Yale modificada, cirurgia realizada, duração da anestesia e analgésicos administrados. No período pós-operatório, os pacientes foram avaliados para verificar a incidência de delírio ao despertar, definido como Agitação com movimentos não-intencionais, inquietação ou debatimento; inconsolável e apático à presença de enfermeiros e/ou dos pais. A necessidade de tratamento farmacológico e as complicacões pós-operatórias relacionadas a episódios de delírio ao despertar também foram registradas. Resultados: 145 crianças foram incluídas, com incidência de delírio ao despertar em 28 (19,3%). Os episódios de delírio ao despertar apresentaram uma média de duração de 6,9 ±7,8 min; a intervenção farmacológica foi necessária em 19 pacientes (67,8%) e foi associada ao tempo de recuperação prolongado (49,4 ±11,9 versus 29,7 ±10,8 min para crianças não-agitadas; p<0,001). Os fatores positivamente associados ao delírio ao despertar incluíram idade mais jovem (p = 0,01, OR 3,3, IC95 1,2-8,6) e ansiedade moderada ...

Introducción y objetivos: El delirio de urgencias es una complicación angustiante del uso del sevoflurano en anestesia general. Este estudio intentó determinar la incidencia de delirio de urgencias y los factores de riesgo en pacientes de un hospital pediátrico especializado en Kingston, Jamaica. Métodos: Estudio transversal y observacional que incluía pacientes pediátricos con edades entre 3 y 10 años, estado físico ASA I-II, sometidos a la anestesia general con sevoflurano para procedimientos electivos en régimen ambulatorio. Los datos compilados incluyeron un nivel de ansiedad en el preoperatorio medido con la Escala de Ansiedad Preoperatoria de Yale modificada, cirugía realizada, duración de la anestesia y analgésicos administrados. En el período postoperatorio los pacientes fueron evaluados para verificar la incidencia de delirio de urgencias, definido como agitación con movimientos no intencionales, inquietud o desesperación; inconsolable y apático a la presencia de los enfermeros y/o de los padres. También se registraron la necesidad de tratamiento farmacológico y las complicaciones postoperatorias relacionadas con los episodios de delirio de urgencias. Resultados: Se incluyeron 145 niños, con una incidencia de delirio de urgencias en 28 (19,3%). Los episodios de delirio de urgencias tuvieron una media de duración de 6,9 ± 7,8 min; la inter-vención farmacológica se hizo necesaria en 19 pacientes (67,8%) y se asoció con el tiempo de recuperación prolongado (49,4 ± 11,9 versus 29,7 ± 10,8 min para niños no agitados; p < 0,001). Los factores positivamente asociados con el delirio de urgencias incluyeron la edad más joven (p = 0,01, OR: 3,3, IC 95%: 1,2-8,6) y la ansiedad moderada y grave preinducción (p < 0,001, OR: 5.6, IC 95%: 2,3-13,0). Las complicaciones del delirio ...

Complicações pós-operatórias menores relacionadas à anestesia em pacientes de cirurgias eletivas ginecológicas e ortopédicas em um hospital universitário de Kingston, Jamaica / Minor postoperative complications related to anesthesia in elective gynecological and orthopedic surgical patients at a teaching hospital in Kingston, Jamaica / Complicaciones postoperatorias menores relacionadas con la anestesia en pacientes para cirugías electivas ginecológicas y ortopédicas en un hospital universitario de Kingston, Jamaica

JUSTIFICATIVA E OBJETIVOS: As complicações anestésicas pós-operatórias menores podem aumentar o desconforto e a insatisfação do paciente e retardar sua recuperação. Este trabalho procurou determinar a frequência das complicações menores relatadas nas primeiras 48 horas do período pós-operatório por pacientes de cirurgias eletivas (ginecológicas e ortopédicas) no University Hospital of the West Indies, Jamaica. A satisfação geral com os cuidados anestésicos e os possíveis fatores de risco para desenvolver complicações também foram avaliados. MÉTODOS: Um estudo prospectivo e descritivo de coorte foi realizado por meio de entrevistas com pacientes operados 24 e 48 horas após a anestesia. Os dados foram analisados usando SPSS versão 12 e avaliados pelo teste do χ2-quadrado e modelos de regressão logística múltipla. RESULTADOS: Foram incluídos 505 pacientes, sendo 374 do sexo feminino (74 por cento). A maioria era ASA I (55 por cento) ou ASA II (38 por cento) e foi submetida à anestesia geral (80 por cento). Um total de 419 (83 por cento) pacientes relataram pelo menos uma complicação pós-operatória. As complicações mais relatadas foram dor de garganta (44 por cento), náusea (30 por cento), vômito (24 por cento) e tromboflebite (20 por cento). A moda do Índice de Classificação Numérica Verbal (ICNV) para cada complicação variou entre 2 e 5, sugerindo que a maioria não causa desconforto grave. Idade inferior a 45 anos (OR 2,22, IC de 95 por cento 1,34-3,69, p = 0,002) e sexo feminino (OR 3,64, IC de 95 por cento 2,14-6,20, p < 0,001) foram identificados como variáveis independentes significativas. A maioria dos pacientes considerou sua experiência anestésica como excelente (51 por cento) ou muito boa (22 por cento). CONCLUSÃO: Este estudo mostrou uma incidência relativamente alta de complicações menores pós-operatórias (83 por cento), mas baixa gravidade dos sintomas relatados e um alto grau de satisfação geral. Deve ser dada atenção especial à redução dessas complicações menores por meio de técnicas anestésicas mais meticulosas.

BACKGROUND AND OBJECTIVES: Minor postoperative anesthetic complications may increase patient discomfort and dissatisfaction and delay recovery. This paper sought to determine the frequency of minor complications in the first 48 hours postoperatively reported by elective gynecological and orthopedic surgical patients at the University Hospital of the West Indies, Jamaica. Overall satisfaction with anesthetic care and possible risk factors for developing complications were also assessed. METHODS: A prospective, descriptive cohort study was undertaken with patient interviews 24 to 48 hours after anesthesia. Data were analyzed using SPSS version 12 and assessed using the χ2-square test and multiple logistic regression models. RESULTS: Five hundred and five (505) patients were included, with 374 females (74 percent). Most were ASA I (55 percent) or ASA II (38 percent) and had general anesthesia (80 percent). A total of 419 (83 percent) patients reported at least one complication postoperatively. The most frequently reported complications were sore throat (44 percent), nausea (30 percent), vomiting (24 percent), and thrombophlebitis (20 percent). The mode of the Verbal Numerical Rating Score (VNRS) for each complication ranged between 2 and 5, suggesting that most did not cause severe distress. Age less than 45 years (OR 2.22, 95 percent CI 1.34-3.69, p = 0.002) and female gender (OR 3.64, 95 percent CI 2.14-6.20, p < 0.001) were identified as significant independent variables. Most patients regarded their anesthetic experience as excellent (51 percent) or very good (22 percent). CONCLUSION: This study showed a comparatively high incidence of minor postoperative complications (83 percent), but low reported severity of symptoms and a high overall satisfaction rate. Special attention should be paid to reduce these minor complications through more meticulous anesthetic technique.

JUSTIFICATIVA Y OBJETIVOS: Las complicaciones anestésicas postoperatorias menores pueden aumentar la incomodidad y la insatisfacción del paciente y retardar la recuperación. Este trabajo intentó determinar la frecuencia de las complicaciones menores relatadas en las primeras 48 horas del período postoperatorio por pacientes de cirugías electivas (ginecológicas y ortopédicas), en el University Hospital of the West Indies, Jamaica. También se evaluaron, la satisfacción general con los cuidados anestésicos y los posibles factores de riesgo para desarrollar complicaciones. MÉTODOS: Un estudio prospectivo y descriptivo de cohorte fue realizado por medio de entrevistas con pacientes operados 24 y 48 horas después de la anestesia. Los datos fueron analizados usando SPSS versión 12 y evaluados por el test del χ2-cuadrado y modelos de regresión logística múltiple. RESULTADOS: Se incluyeron 505 pacientes, siendo que 374 eran del sexo femenino (74 por ciento). La mayoría era ASA I (55 por ciento) o ASA II (38 por ciento) y se sometió a la anestesia general (80 por ciento). Un total de 419 (83 por ciento) pacientes relataron por lo menos una complicación postoperatoria. Las complicaciones más relatadas fueron el dolor de garganta (44 por ciento), náusea (30 por ciento), vómito (24 por ciento) y tromboflebitis (20 por ciento). La moda del Índice de Clasificación Numérica Verbal (ICNV), para cada complicación varió entre 2 y 5, lo que sugiere que la mayoría no causa una grave incomodidad. La edad inferior a 45 años (OR 2,22, IC de 95 por ciento 1,34-3,69, p = 0,002) y el sexo femenino (OR 3,64, IC de 95 por ciento 2,14-6,20, p < 0,001), fueron identificados como variables independentes significativas. La mayoría de los pacientes consideró su experiencia anestésica como excelente (51 por ciento) o muy buena (22 por ciento). CONCLUSIONES: Este estudio mostró una incidencia relativamente alta de complicaciones menores postoperatorias (83 por ciento), pero con una baja gravedad de los síntomas relatados y un alto grado de satisfacción general. Debemos darle una atención especial a la reducción de esas complicaciones menores por medio de técnicas anestésicas más meticulosas.

Vomiting post tonsillectomy with or without other upper airway and/or aural procedures

OBJECTIVE: The incidence of vomiting post tonsillectomy has been quoted to be 30-73 percent. Vomitting can cause considerable patient suffering. Our aim was to assess the incidence at this institution and to determine its effects and casual factors in our patient population. METHODS: This study was conducted both retro- and prospectively over the period January 1, 2000 to December 31, 2000. The medical records of all patients who underwent tonsillectomy with or without upper airway or aural procedure/s were reviewed. Data collected included: age, gender, body weight, diagnosis, premedication, type of induction of anaesthesia, blood loss, duration of anaesthesia and recovery room stay, peri-operative analgesia, antibiotic, steroid, atropine and anti-emetic administration. Approval from the institutional ethics committee was obtained. RESULTS: A total of 76 patients underwent tonsillectomy during the study period. The medical records of 75 of these patients were reviewed. The age range for the study sample was 10 months to 38 years. The majority, 66 of the patients, were children (<13 years) and hence they accounted for 88 percent of the study sample. Most were in the 0-5 year-age group and accounted for 57 percent of the study sample. Thirteen patients (17 percent of the study sample) vomited. Most of the vomiters (nine) were in the 0-5-year-age group, three in the 6-12-year-age group, and one in the adult group. Overall, there were equal numbers of male and female vomiters. CONCLUSION: Opioid analgesia (pethidine) was a significant risk factor for vomiting, while trimeprazine tartrate (a premedicant) and steroid were significant preventive factors. Studies have shown that one dose of dexamethasone (administered pre- or intra-operatively) decreases vomiting as well as the need for analgesia (especially opioid) post-operatively. There is therefore the need for a follow-up study to assess the effect of dexamethasone in this patient population. (AU)