RESUMO
PURPOSE: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the government-owned Queen Elizabeth Hospital (QEH): and to describe the Department's approaches to optimise safety and cost-effectiveness of anaesthesia at QEH. SOURCE OF INFORMATION: Authors (KBS, HSLM, RAH), who collectively provided more than 50 yr of anaesthesia at QEH; the Dean (ERW) of the University of West Indies Medical School (Barbados campus); archives of Barbados; and records of QEH. PRINCIPAL FINDINGS: The government of Barbados provides modern health care services to all of its citizens, primarily at QEH. Barbados, however, has tight financial constraints, infrastructural limitations, and a bureaucratic administration that predispose QEH's Anaesthesia Department to unexpected depletions of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain equipment: purchasing an oxygen concentrator to reduce oxygen costs: decreasing nitrous oxide use (expensive in Barbados): and initiating its own quality and safety standards. CONCLUSION: Continuous delivery of high quality, cost-effective anaesthesia care requires thoughtful planning by administrators and judicious resource allocations. Health care administrators and clinical departments need to work together closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial resources are best allocated to meet the departmental priorities.
Assuntos
Anestesia , Barbados , Atenção à Saúde , Humanos , Auditoria Médica , Monitorização IntraoperatóriaRESUMO
The trend in modern surgery is to do more and more cases as "Day Care". This approach saves money by promoting the efficient use of available bed space and the time of hospital-based health professionals. The main objective of the anaesthetic technique is to produce conditions satisfactory to surgeon and patient, using agents that allow for the safe and rapid discharge of the patient from the hospital. Inhalation techniques with halothane and by using narcotics for post-operative analgesia are the standard techniques used in the Queen Elizabeth Hospital in Barbados. However, studies have shown that the combination of various narcotics such as Fentanyl and Alfentanyl for analgesia in total intravenous anaesthesia techniques, using continuous intravenous Propofol, will produce satisfactory anaesthesia for many types of surgical procedures with short recovery periods. Substitution of analgesics in the non-steroidal anti-flammatory drug group (NSAIDs), in combination with Propofol, offers the opportunity for avoiding the side-effects of narcotics. Accordingly, the effectiveness of total intravenous anaesthesia, using Propofol with the NSAID Diclofenac for analgesia in patients undergoing laparoscopic gynaecological surgery as day-care patients was compared with the standard inhalation anaesthetic technique, using a narcotic (Fetanyl) analgesia. The thirty-eight female patients studied were induced with Propofol (2.5 mg/kg-1) for muscle relaxation. Nineteen received Fentanyl (1-1.5 ægm kg-1) i.v. immediately prior to induction and anaesthesia was continued, using 50 percent nitrous oxide (2-1 min-1) in oxygen and Halothane (1-1.5 percent). The other nineteen received Diclofenac (75 mg i.m.) one hour before surgery and anaesthesia was continued with an infusion of Propofol, using an Ohmeda 9000 syringe pump at 12 mg. kg-1.h-1. Conditions for surgery were satisfactory in both groups and there was no signidicant difference in the degree of post-operative analgesia or the time to awaken under anaesthesia and all patients said they would be happy to have the anaesthetic technique used again. However, the total intravenous technique is expensive and therefore its use is recommended only when inhalation methods or the use of narcotics in undesirable (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Diclofenaco/administração & dosagem , Anestesia IntravenosaRESUMO
Sixteen patients requiring general anaesthesia for termination of pregnancy by dilatation and evacuation of the uterus were studied. Arterial and end-tidal carbon dioxide tensions were determined during anaesthesia. The mean arterial to end-tidal carbon dioxide tension difference was 0.07 kPa (-0.02-0.16, 5-95 per cent confidence limits). These results were similar to those observed during Caesarean section and those during anaesthesia for post-delivery tubal ligations. The physiological changes such as increased cardiac output, haemodilution, and increased blood volume which manifest by 12 weeks of gestation probably result in a reduced (a-E')PCO2 value.