ABSTRACT
BACKGROUND: General endotracheal relaxant anaesthetic technique is favoured for laparoscopic gynaecological procedures, in order to prevent inadequate ventilation, regurgitation and aspiration resulting from pneumoperitoneum and steep trendelenburg position during the procedure. However, simple brief laparoscopic procedures have been performed safely over the years in adult population using alternative airway devices. We report our experience over a fifteen-year period, of using general anaesthesia by face mask ventilation for short diagnostic laparoscopy in gynaecologic practice. PATIENTS & METHODS: A retrospective, cross- sectional observational study involving 823 consecutive elective patients for diagnostic gynaecological laparoscopic procedures. The 823 patients were classified as American society of Anesthesiologists (ASA) I or II patients and were studied over the fifteen year period. They were all premedicated with atropine & metoclopramide after overnight fast, and had general anaesthesia by facemask with assisted ventilation; using thiopentone for induction, paracetamol & piroxicam for analgesia and oxygen-halothane via Bain's breathing circuit for maintenance. Monitoring procedures employed in this study included pulse rate (PR), non-invasive blood pressure (NIBP) and oxygen saturation (SPO2). RESULTS: Out of a total of 823 patients studied, majority (93.8%) of the patients were investigated for infertility. The mean duration for the procedure was 18.2±2.5 minutes. The complications observed included post-operative nausea and vomiting in 58(7.0%) of the patients, regurgitation & desaturation in 2(0.2%) of patients each, while laryngeal spasm & colonic insufflations each occurred in 1(0.1%) patient. Three patients (0.3%) had unplanned admission for observation overnight. There was no case of mortality. CONCLUSION: General anaesthesia by facemask ventilation is a safe alternative to endotracheal intubation for short diagnostic gynaecological laparoscopy when fasting guidelines are observed.
ABSTRACT
OBJECTIVE: Specific risk behaviours and practices promote the spread of HIV/AIDS. Identification of those at risk of the Human Immunodeficiency Virus (HIV) infection is an important step toward prevention of both vertical and horizontal transmission of HIV. This study sought to identify risk factors for HIV infection in pregnant women attending a rural antenatal clinic in Northern Nigerian. METHODS: A cross-sectional descriptive study of pregnant women attending antenatal clinic at a rural mission hospital in Northern Nigeria between June and October 2005 was conducted. Data were collected with a structured questionnaire. HIV screening and confirmation were done for the pregnant women after voluntary counselling. RESULTS: The study enrolled 350 pregnant women with a mean (± SD) age of 26.8 ±6.4 years. HIV infection was not associated with smoking habits in women, alcohol intake in the women or their partners, prior blood transfusion, history of sexually transmitted infection or history ofscarification. In multiple logistic regression, HIV infection was independently associated with suspecting their partner of extramarital sex (adjusted odds ratio 3.8, 95% CI 1.6, 9.0), post-primary education (AOR 2.4, 95% CI 1.1, 5.3), multiple sexual partners (AOR 2.4, 95% CI 0.97, 6.2) and cigarette smoking by a partner (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSION: Multiple partners and extramarital sex remain a hindrance to the fight against HIV infection. Promoting the ABC approach (abstinence, be faithful, condom) may reduce risky behaviour as it has in other parts of Africa.
OBJETIVO: Las prácticas y los comportamientos de riesgo específicos promueven la propagación del VIH/SIDA. La identificación de quienes se encuentran en riesgo de infección por el virus de la inmunodeficiencia humana (VIH) es un paso importante hacia la prevención de la transmisión vertical y horizontal del VIH. Este estudio buscó identificar los factores de riesgo de infección de VIH en las mujeres embarazadas que asisten a una clínica prenatal rural en el norte de Nigeria. MÉTODOS: Se llevó a cabo un estudio descriptivo transversal de mujeres embarazadas que asisten a la clínica prenatal en un hospital rural misionero en Nigeria Norte, entre junio y octubre de 2005. Los datos fueron recogidos mediante un cuestionario estructurado. El pesquisaje y confirmación del virus de la inmunodeficiencia humana fueron realizados para las mujeres embarazadas tras recibir aconsejamiento voluntario. RESULTADOS: El estudio enroló a 350 mujeres embarazadas con una edadpromedio (± SD) de 26.8 ± 6.4 anos. La infección por VIH no estuvo asociada con el hábito defumar entre las mujeres, la ingestión de alcohol por las mujeres o sus companeros, las transfusiones de sangre previas, una historia de infecciones de transmisión sexual, o una historia de escarificación. En la regresión logística múltiple, la infección por VIH estuvo independientemente asociada con sospechas de relaciones sexuales extramaritales por parte de sus companeros (odds ratio ajustado 3.8, 95% CI 1.6, 9.0), educación postprimaria (AOR 2.4, 95% CI 1.1, 5.3), parejas sexuales múltiples (AOR 2.4, 95% CI0.97, 6.2) y el hábito defumar cigarrillos por parte del companero (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSIÓN: Las parejas múltiples y el sexo extramarital siguen siendo un estorbo para la lucha contra la infección por VIH. Promover el enfoque ABC puede reducir el comportamiento riesgoso, como ha ocurrido en otras partes de Africa.
