RESUMO
A case of "tight" mitral stenosis in whom an elective caesarean section was performed at term is presented. The result was satisfactory. Whereas vaginal delivery is the treatment of choice for most cases of pregnancy complicated by mitral stenosis we feel there is a place for elective caesarean section in certain cases of "tight" mitral stenosis with severe pulmonary hypertension, where for one reason or another the patient has refused to undergo antepartum valvotomy (AU)
Assuntos
Humanos , Gravidez , Adulto , Feminino , Estenose da Valva Mitral , Complicações Cardiovasculares na Gravidez , CesáreaRESUMO
The position relating to anaesthetic personnel in Jamaica in order to decide logically on the need and advisability of using paramedical personnel in this specialty. The figures quoted are taken from the Jamaican Anaesthetic Survey carried out from March 16 to September 14, 1970, in which records of the details of anaesthetics administered in all hospitals were collected and analysed. Of 16,000 anaesthetics given in the island in the survey period, over, 700 were given by untrained staff. Out of nineteen rural hospitals, eight had no trained anaesthetic staff for the major part of the survery period. Untrained staff administered 25 percent of the anaesthetics in the rural hospitals, and all these hospitals, except two, rely to some degree on untrained staff for emergency surgery. 40 percent of anaesthetics in emergency situation is given by untrained staff. Figures from the survey suggest a higher mortality rate for the untrained personnel group. It was estimated that there were 4.3 preventable deaths per 1,000 anaesthetics given by nurses who were specially trained as opposed to 1.1 for trained nurses and 1.8 when the anaesthetics were administered by doctors. Recruitment of doctors into anaesthesia is unsatisfactory. In 1966 the figure for full-time Anaesthetic Specialists per 100,000 populatioin in the United Kingdom was 4.7. In 1970 in Jamaica the figure was 1.3. Between 1960 and 1970, 47 junior anaesthetists were trained at the University of the West Indies. Of these, eleven (11) were still in Jamaica 1970, but only one is working in the rural hospital. Only seventeen (17) graduates of the University of the West Indies have received local training in anaesthesia in the same period, and only four (4) of these are working in Jamaica. As a possible solution to this problem it is proposed that six nurses will be required to be trained each year for the next 5 years. Various factors were considered in arriving at this figure. It was estimated for example that the number of anaesthetics giving per arriving at this figure. It was estimated for example that the number of anaesthetics given per year by an anaesthetic nurse in the present hospital system is 400 to 500. Also, the presently low operation rate in this country is expected to increase over the next ten years, i.e. Operation Rate, U.K. (1966) = 3770 ops. per 100,000 Pop. Operation Rate Jamaica (1970) = 1950 ops. per 100,000 Pop. The rate of population increase (2.4 percent) and possible loss of at least 50 percent of those trained were also considered. Certain necessities for optimum functioning of anaesthetic nurses are discussed, as are real and imaginary, diffuculties connected with their employment. It is concluded that paramedical anaesthetic personnel are required in Jamaica. The registered nurse best suits the role of the future trainee. The nurse anaesthetists should be invited and encouraged to take an integrated place in the medical anaethetic hierarchy, but a career structure with satisfactory salary and status, and opportunities for promotion is essential. An independent nurse anaesthetist structure is undesirable (AU)
Assuntos
Humanos , Pessoal Técnico de Saúde , Anestésicos , JamaicaRESUMO
The main purpose of this paper is to review the results of open heart surgery at the University Hospital of the West Indies in the past three years. 18 patients with congenital heart disease have had corrective surgery performed. The mean age at operation was 14.8 years ranging from 6.8 to 28 years. Seven of the patients were under 12 years and all but two 18 years or under at the same time of surgery: Five patients have had total correction of the Tetralogy of Fallot. Four of them, including a girls of 12 1/2 years who had pulmonary embolus one month after operation, are well at follow-up. One patient, a girl of 11 years, who was operated on in June, 1970, had evidence of right ventricular failure for six months, but when last seen was well although signs of tricuspid incompetence persist. Four patients with atrial septal defect, including one with an ostium primum defect and mitral incompetence, are well at follow-up with no evidence of heart disease. Four patients with ventricular septal defect have had their defect repaired. Two of these had significant pulmonary hypertension pre-operatively and one of these developed a leak post-operatively and has required a second operation. Four cases of pulmonary stenosis (two valvular, one infundibular and one both valvular and infundibular) have been corrected and all these patients are now well and active. A young woman of 27 who was thought on cardiac catheterization to have pulmonary stenosis, was found at operation to have a double outlet right ventricle and infundibular stenosis. Right and left outflow tract reconstruction carried out and although she had a stormy post-operative course was well when last seen. Pre- and post-operative electrocardiographic and radiological data will also be presented (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Cardiopatias Congênitas/cirurgia , Ponte CardiopulmonarRESUMO
Holothane was injected intravenously into two groups of dogs and the effects on the lungs noted. The nine dogs of group I were unanaesthetized and received no ventilatory support following injection. The dogs were killed at varying time intervals after injection and the macroscopic and microscopic appearances were studied. In the six dogs of group II the the chests were open and they were artificially ventilated with 30 per cent oxygen and 70 per cent nitrous oxide at the time of injection. Serial biopsies were taken. The predominant lesions produced were generalized oedema and patchy alveolar haemorrhages. These changes were more severe in dogs of group I. The aetiology is conjectural, possibly being due to direct capillary damage or to embolization. The danger of accidental intravenous injection of halothane, a not unknown occurrence, is stressed (AU)
Assuntos
Cães , 21003 , Halotano/toxicidade , Pulmão/efeitos dos fármacos , Anestesia Geral , Halotano/administração & dosagem , Hemorragia/induzido quimicamente , Injeções Intravenosas , Pulmão/patologia , Alvéolos Pulmonares/patologiaRESUMO
Since January 1965, 55 patients have been treated in the recovery and intensive therapy unit of U.H.W.I. 12 deaths have occurred - mortality rate 21.8 percent. Based on experience gained in this series and using illustrative rate 21.8 percent. Based on experience gained in this series and using illustative case reports certain aspects regarding causes of death and their prevention are discussed. Deaths in early tetanus almost invariably are related to severe anoxia or possibly due to an increased susceptibility to lesser degrees of anoxia. There have been no early deaths in patients managed in this unit but reference is made to other, essentially preventable, deaths occurring prior to admission. The life threatening complications encountered later in the disease are more varied and have included severe respiratory depression, anoxia and acidosis, exhaustion, hyperpyrexia, infection, pulmonary emboli and iatrogenic difficulties associated with tracheostomy and mechanical ventilation. The necessity for intensive therapy facilities in severe tetanus is emphasized. It is possible that many deaths in this group are also preventable. In 3 patients measurements have been made of ventilatory, acid base and oxygen transport parameters at intervals during their illness. Results are given and significance discussed. In conclusion the precipitating causes of death in this series are clinically obvious even if the exact mechanisms are not clear. We have seen little evidence of the previously described syndrome of fulminating intoxication with myocardial or brain stem involvement. We agree with others who state that the successful outcome in a previously health patient who develops tetanus should rarely be in doubt providing the patient has received ideal treatment based on the well- recognized principles of intensive therapy(AU)
Assuntos
Humanos , Tétano/mortalidade , Hipóxia , Acidose , Embolia PulmonarRESUMO
Several methods of measuring direct arterial pressure without electronic equipment have been described in the past, none of which is truly satisfactory. A method is described using simple components, including a pressurized infusion system and a mercury manometer. This system is easily set up and readily autoclaved. The inertia of the system is high but it is claimed that the apparatus provides a reliable continuous measurement of mean arterial pressure. The slow continuous flush prevents blockage of the arterial cannula, and the extent and significance of any errors caused by this flush rate are discussed. This has been used in fifty patients both in the operating theatre and in the Recovery and Intensive Therapy Units. It has proved to be a satisfactory method and no serious complications have occurred.(AU)
Assuntos
Determinação da Pressão Arterial/instrumentação , MercúrioRESUMO
A preliminary investigation into the possibility of cross infection with Pseudomonas and Klebsiella species by contaminated respiratory equipment in a recovery room was undertaken at the University Hospital, Mona, Jamaica in 1966. Evidence of cross-infection was found and recommendations were made to minimize this in the future (AU)
Assuntos
Infecção Hospitalar/prevenção & controle , Infecções por Klebsiella/prevenção & controle , Infecções por Pseudomonas/prevenção & controle , Unidades de Terapia Intensiva , Ventiladores Mecânicos , JamaicaRESUMO
The benefits of a simple and reliable method of allowing continuous uninterrupted observation of arterial pressure are obvious. For this purpose all indirect method are unsatisfactory and direct cannulation of an artery is necessary. Under many conditions found in major surgery conventional sphygnomanometry is inaccurate, time consuming and tiresome. A method is described wherby a needle or catheter placed into the brachial or radial artery is linked up to a simple mercury manometer and continuously flushing system. Records are shown to illustrate that this method does provide a reasonably accurate measurement of true mean pressure or area pressure. The advantages of being able to follow continuously changes in mean arterial pressure during surgery and intensive therapy are discussed. This method requires no expensive electronic apparatus (AU)