Knowledge and fears of anaesthesia and surgery: the Jamaican perspective

This study was undertaken to assess patients' knowledge and perceptions, fears and concern regarding perioperative management. 300 patients were interviewed consecutively and a questionnaire was completed for each patient. 25 percent admitted to having anxiety about their upcomming operation. The prevalence of preoperative fear was significantly higher in younger patients (age <40 years, p<0.05) and in more educated patients (secondary and tertiary levels, p<0.001). The commonest fears were those of a morbid nature (eg. death on the operating table). 34 percent of the patients did not realize than anaesthetists were qualified doctors, and only 10 percent recognized the central role played by anaesthetists in the monitoring of vital signs throughout an operation. There is continuing need for public education on the role of the anaesthetists in health care, and anaesthetists must ensure that preoperative concerns of their patients are adequately addressed.(AU)

Tetanus: a recurring intensive care problem

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70 percent), with peak incidence occurring amongst the young and the elderly. In 57 percent the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80 percent), predominantly as a result of infection. Dysautonomia, exhibited by 55 percent of patients, presented the greatest difficulty in management. Mortality was high (20 percent), with sudden cardiac arrest being the most common cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurrence of this preventable disease represents a drain on existing intensive care funds. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries (AU)

Nasal non-invasive positive pressure ventilation

This case report is presented to illustrate the advantages of Nasal Non-Invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercanic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exists

Nasal non-invasive positive pressure ventilation

This case report is presented to illustrate the advantages of Nasal Non-Invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercanic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exists (AU)

Anaesthesia: the medical students' perspective - abstract

Traditionally the number of doctors specialising in anaesthesia is low, an occurrence even more marked in the Caribbean. This study presents an analysis of the attitude of 219 medical students to anaesthesia at the University Hospital of the West Indies. Three groups of medical students - the preclinical group, the first clinical year group and the final year group were surveyed, using a questionnaire containing 10 knowledge and 15 attitude questions. The mean knowledge scores (out of ten) were 7.29 ñ 1.56 for the preclinical group, 8.52 ñ 1.33 for the first clinical year group and 9.28 ñ 0.86 for the final year group. The score of the final year group was significantly higher (p<0.001) than that of both other groups, this group having completed a five-week mandatory rotation in anaesthesia. Significant differences were found between the responses of the different groups in 3 of the attitude questions, but the overall response in all groups generally indicated a positive attitude to anaesthesia; 25.5 percent of the preclinical group, 32 percent of the first clinical year group and 40.5 percent of the final year group indicated an interest in anaesthesia as a post-graduate speciality (p = 0.13). However, the number of residents entering the anaesthetic postgraduate programme does not reflect such a high level of interest. This may indicate a change in attitude during the internship period resulting in a decreasing level of interest in the specialty. Measures need to be instituted so that this level of interest may be sustained throughout internship and encourage admission into the specialty (AU)

Tetanus: a recurring intensive care problem in Jamaica - abstract

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70 percent), with peak incidence occurring among the young and the elderly. In 57 percent, the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80 percent) as a result of infection. Dysautonomia, exhibited by 55 percent of the patients, presented the most difficulty in management. Mortality was high (20 percent), with unexplained cardiac arrest being the commonest cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurence of this preventable disease represents a drain on existing intensive care facilities. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries (AU)

Ethical issues in intensive care: a look to the 90s - abstract

With the advent of Intensive Care Units has come the ability to offer life support technology to patients with failure of the vital systems, patients who would die without this type of support. Ethical decisions have now to be made as to the selection of patients who would have the optimum response to such technology. Such decisions are not easily made as the factors on which they are sometimes based are neither objective nor well-defined. These factors are not subject to patients pathology only, but als to the availability of the necessary equipment and personnel. Although such decisions have to be made in every country offering intensive care, they become more important in those countries with scarce resources, e.g., the West Indian Islands. In addition to the above issues, newer issues will be discussed, e.g., the impact of the AIDS patient on ICU personnel, "Living Wills", etc (AU)

Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam

Comparison of the ease of upper endoscopy, patient tolerance, and amnestic effect, using diazepam, midazolam, or no sedation, was performed on 149 patients. Midazolam and diazepam sedation produced better conditions and improved patient acceptability. Midazolam was associated with better patient tolerance, less thrombophlebitis, and more amnesia than diazepam, but shared a similar recovery time. Midazolam should replace diazepam as the drug of choice in those patients requiring sedation for upper endoscopy. (AU)

Microcomputers in medical practice - abstract

The introduction of the microcomputer has brought within every professional's reach the ability to process text, as well as store and retrieve data electronically. These features have proved useful in the areas of research and teaching. The basic components of a microcomputer will be explained to provide the average physician with adequate information about the type of hardware and software needed to carry out word processing and data storage. Graphics programmes which can further manipulate text and data to produce slides and other teaching aids will be mentioned and the results shown. Other uses of popular programmes on the market will be discussed with particular emphasis on their application to medical practice (AU)

Early experiences with anaesthesia and the first recorded use of ether in Jamaica, 1847

A search of the local newspapers between 1840 and 1850 revealed that the first experiences with ether anaesthesia were reported in Jamaica less than three months after its first reported use in Great Britain and two months before its first use in Australia. A variety of apparatuses were described and used effectively. Newspapers of an era can provide a wealth of information on such momentous events as the introduction of anaesthesia to countries. Hospitals records are often incomplete or may not be available for the period. However, most libraries or newspaper publishers maintain a complete record of their issues on microfilm. Related to this is the fact the first experiences with ether anaesthesia often occurred outside hospitals, for example, in a doctor's house or office, and such were more likely to be carried as news items and not recorded in hospital records (AU)

Knowledge and fears of anaesthesia in Jamaican patients

One hundred Jamaican patients between the ages of 12 and 80 years were interviewed pre-operatively to determine their knowledge and fears of anaesthesia/surgery. Only 15 percent knew what role the anaesthetist would play in their care. Sixty-two per cent thought that he/she worked under the direction of the surgeon. Eighty-three per cent expressed no fear of going to sleep for surgery and 60 percent actually expressed a specific fear of anaesthesia. The patients utilised doctors and nurses as their main sources of information to gain knowledge pre-operatively of the operative experience. The importance of simple, comprehensive explanations given to patients by this group of personnel, particularly by the anaesthetist at a pre-operative visit, is emphasised. Other methods to explain the role of anaesthesia to patients are described, and their suitability for use in developing countries is discussed (AU)