General anaesthesia for day-care dental procedures

OBJECTIVE: To study the safety and cost-effectiveness of the use of general anesthesia in selected dental cases in a day unit dental surgery (DUD-surgery). METHOD: Over a two and a half-year period, the outcome of dental procedures performed at a DUD-surgery under general anaesthesia was documented and reviewed. The age, gender, nature of the procedure, duration and cost were noted. The safety of such procedures under general anaesthesia was critically assessed in each case. The recommendation in the Poswillo report were strongly adhered to, with the DUD-surgery being well equipped with an anaesthetic machine, cardiac monitor, pulse oximeter and other instruments and equipment for intra-and post-operative care of patients. RESULTS: A total of 152 patients were induced in the DUD-surgery, 101 (66.4 percent) females and 51 (33.6 percent) males. No crisis/anaesthetic accident was encountered. Occasionally, much pain was experienced during the post-operative period. CONCLUSION: Day unit dental surgery under general anaesthesia is safe if the recommendations of the Postwillo report are adhered to.(Au)

Availability of suitable kidney transplant donors from an ICU population - abstract

In establishing a renal transplant service in the Bahamas, a review of the availability of suitable cadaveric organ donors in the Intensive Care Unit (ICU) was carried out over the period January, 1988 to October, 1988. Clinical criteria for suitable organ donation and brain deaths were applied to all patients who died in the ICU. Over the nine-month period, 351 patients were admitted to the ICU and 107 died; 8 of 107 deaths fulfilled the criteria for cadaveric organ donation. All suitable victims succumbed to head inury. The mean age was 27 years with 6 to 8 deaths occuring within 4 days of admission. Issues affecting donor procurement rate in major transplant centres are not applicable in the centralized stem under study where all patients requiring critical care are referred to the ICU. It is concluded that cadaveric organ donation alone is inadequate to fulfill the criteria for cadaveric organ donation. All suitable victims succumbed to head injury. The mean age was 27 years with 6 to 8 deaths occuring within 4 days of admission. Issues affecting donor procurement rate in major transplant centres are not applicable in the centralized stem under study where all patients requiring critical care are referred to the ICU. It is concluded that cadaveric organ donation alone is inadequate to fulfill the organ demand for renal transplantation. In the Bahamas a policy of using living related donor organs whenever possible is favoured. Casual observation of road traffic and ICU mortalities fosters an erroneous assumption of potential donor organs (AU)

Continuous supraclavicular brachial plexus block using indwelling cannulae for prolonged analgesia of the upper extremity - abstract

The upper extremity has a specially organized innervation, the brachial plexus, which can be easily blocked by a supraclavicular approach. However, its use for prolonged intra-operative and post-operative analgesia has only been recently explored. The rising costs of general anaesthetic agents and the associated hospital stay, together with the desirability of reducing, or eliminating, the need for systemic narcotic analgesics, prompted us to investigate prolonged brachial plexus analgesia. The method is inexpensive, usually not technically difficult, as safe as conventional local anaesthesia and suitable for both emergency and elective cases. A pilot study on 10 healthy patients was carried out between June and November, 1987. Patients of either sex, from 14 to 47 years old, were included. The three-dimensional approach to the brachial plexus of McIntosh and Mushin, using an intravenous cannula, was employed throughout. After injecting an initial test dose of local anaesthetic, the cannula was left in-situ for further "top up" doses, through a suitable injection port. Xylocaine (1-2 percent) was used for the initial block and bupivacaine, (0.5 percent) for the post-operative maintenance of analgesia. The mean dose of xylocaine for surgical anaesthesia was 5.42 mg/kg body weight, and the mean duration of anaesthesia 137.8 minutes. The mean time lapse to the first "top up" dose was 225.4 minutes and the mean duration of effect to the 2nd "top up" dose 412.5 minutes. No patient required more than two post-operative doses. This pilot study appears to be sufficiently promising to warrant a more extensive trial of prolonged brachial plexus analgesia (AU)

A prospective study of 200 cardiopulmonary arrests at the University Hospital of the West Indies

This is a prospective study of 200 cardio-pulmonary arests, occuring at the University Hospital of the West Indies. There was an 18 per cent successful resuscitation rate but only 7 per cent of survivors left hospital. These results compare favourably wth those from other centres with similar patient populations. There is a need for improvement, however, particularly the continuation of in-service training in cardio-pulmonary resuscitation for all staff members and better selection of patients who are suitable for resuscitation (AU)

Transtracheal ventilation using an intravenous canula and ambient air for managing asphyxia - abstract

Some patients may be impossible to intubate due to anatomical or pathological obstruction of the airway, and conventional methods of ventilation cannot be employed. One of us (J.H.) has successfully applied transtracheal ventilation in such an emergency. Under the circumstances it was not possible to measure the adequacy of ventilation by this method using arterial blood gas studies. A laboratory experiment using dogs was therefore devised. Five dogs acting as their own control were alternately ventilated by conventional expired air (mouth to endotracheal tube) (M.E.T.T.) and via a transtracheal cannula and insufflation of room air with a blood pressure cuff inflation bulb. (T.T.V.A.). The result showed an oxygen saturation of more than 80 percent in all cases and no significant difference in pH between the groups. There was a statistically significant differences in PO2 in two dogs (p<0.05) and in PCO2 in three instances )p<0.05). However, the differences in favour of M.E.T.T. did not appear clinically significant, and the quality of T.T.V.A. was certainly sufficient to sustain life for the duration of the experiments (AU)