The provision of epidural analgesia during labour at the University Hospital, Jamaica April 1979 - January 1980 - abstract

Pain relief on the labour ward at the University Hospital of the West Indies is afforded mainly by the parenteral administration of narcotic analgesics frequently given in combination with a phenotheazine derivative. This paper describes the introduction of an epidural service to the University Hospital for the relief of pain during childbirth. Fifty patients were studied. The indications included elective pain relief, pre-eclampsia, cardiac disease, premature or high risk foetus and operative delivery. The contraindications to the technique were few and included patients who were unwilling to have this form of analgesia, patients with antepartum haemorrhage, and those with a history of previous uterine surgery. The local anaesthetic agent of choice was bupviacaine (marcaine), but due to limited supplies of this drug, lignocaine in combination with adrenaline was employed in the majority of cases. The local analgesic agents were injected every two hours (bupivacaine) or every 45 - 60 minutes (lignocaine) via an indwelling Teflon epidural catheter. All patients were interviewed during the postpartum period. The forceps rate was not increased and the mothers did not feel deprived of the 'feeling' of parturition in the majority of instances. Backache during the 1st and 2nd days post delivery occurred in 60 percent of these cases. Forty-five patients (90 percent) spoke highly of the procedure and requested this form of analgesia for subsequent pregnancies (AU)

Open heart surgery in patients with sickle haemoglobin, 1968-1978

Thirty-one patients with sickle haemoglobin were scheduled for open heart surgery between 1968 and 1978. The clinical and investigative data, operative morbidity and mortality and autopsy data have been presented. It is unlikely that intravascular sickling has been responsible for the deaths following surgery. It is concluded that the present techniques of anaesthesia, cardio-pulmonary bypass and open heart surgery pose no greater hazard to patients with sickle haemoglobin compared to those with a normal haemoglobin (AU)

Homograft mitral valve replacement in children, 1975-1978

Seventeen children, aged 6 to 12 years, were subjected to Homograft Mitral Valve Replacement (HMVR) for severe Mitral incompetence (MI) at the University Hospital during the period 1975 - 1978. The clinical and investigative data, duration of bypass, operative findings, and results of HMVR have been presented. It is concluded that HMVR is a satisfactory palliative procedure for severe MI in children. Pre-operative cardiac catheter measurements of pulmonary artery oxygen saturation (PASO2) < 50 percent, and or systolic pressure (PA systolic) >100mm Hg and/or left ventriclar end-diastolic pressure (LVEDP) . 20 mm Hg indicate the likelihood of a poor operative result. A more critical selection of patients for HMVR, including the above criteria, should decrease early operative mortality. Late operative mortality due to valve malfunction could possibly be decreased by early re-operation when optimal medical therapy is not successful (AU)

The peri-operative management of the patient scheduled for open heart surgery

The perioperative management of 286 patients scheduled for open heart surgery has been described. Mortality associated with anaesthesia (0.4 percent), patient monitoring and measurement (0.4 percent) and cardio-pulmonary bypass (1.4 percent) has been low. Morbidity produced by these techniques has been reversed with supportive therapy. It is concluded that the techniques of anaesthesia, patient monitoring and measurement, and cardiopulmonary by-pass as reported herein are acceptable and safe for the patient undergoing open heart surgery. Operative mortality in the majority (114 patients) age group of 10-20 years has been relatively low (18 percent). However, cardiac failure is dominant as a major cause of early (operative) and late mortality. It is the authors' opinion that technical problems of intracardiac repair and cardio-pulmonary bypass in patients below 5 years, and errors in deciding operability have largely contributed to refractory cardiac failure. It is hoped that more critical selection of patients for operation and greater experience in operative techniques, would result in a decrease in operative deaths (AU)

Salt wasting in severe tetanus

A 42-year-old man with severe tetanus exhibited two episodes of salt wasting. It was not possible to demonstrate either chronic renal failure or adrenal disease, conditions known to be associated with salt wasting. Studies done in this patient suggested a limitation in maximum tubular reabsorptive rate for sodium. Treatment was purely supportive (AU)

Epidural analgesia during labour at the University Hospital of the West Indies

Thirty-two patients were given epidural analgesia during labour at the University Hospital of the West Indies. The majority were impressed by the quality of analgesia provided by the technique and have requested this form of pain relief for subsequent deliveries. The complications were few and transient. The advantages far outweighed the few disadvantages of the technique. It is hoped that a more frequent and widespread application of this satisfactory form of pain relief will be practised in hospitals throughout the West Indies (AU)

Epidural analgesia during labour

Pain relief during labour, though once frowned upon and regarded as contrary to the commandments of God, is looked upon almost as a sine qua non for the parturient woman. Of all the available techniques of providing analgesia, epidural blockade is probably the most certain and the most effective. Its many merits and advantages have long been recognised by doctors both in North America and the United Kingdom and is being used with increasing frequency today for the relief of pain during labour. The introduction of any technique to a less developed country should be viewed against the background of social attitudes, cost and availability of equipment and drugs, problems of medical staffing and supervision, and of course, the enthusiasm of those involved in this field. This presentation describes the introduction and practice of epidural analgesia in the Labour Ward at the University Hospital of the West Indies, Mona, Jamaica. The aims of this project are two-fold - firstly, to offer the patients in labour pain relief if she so desires, and secondly, to provide training in the techniques and art of epidural blockade for residents in anaesthesia and obstetrics