W Indian Med J
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Comparative Study
Comparison of general anaesthesia and spinal anaesthesia for caesarean section in Antigua and Barbuda.
Regional anaesthesia has become the anaesthetic of choice for Caesarean section (CS) in developed countries, with use extended to smaller, less developed countries in the past decade. This study is a comparison of maternal and neonatal outcomes comparing general anaesthesia (GA) and the early experience with spinal anaesthesia (SA) for CS in Antigua and Barbuda. Data obtained included maternal age, gravidity, parity, indication for operation, emergent versus routine operation and type of anaesthesia used. ⋯ There were no maternal deaths. Babies demonstrated no difference in birthweight (mean 3238 vs 3258 g) but those born to mothers who underwent GA had significantly lower one minute (mean 6.84 vs 8.17, p < 0.0001) and five minute (mean 8.13 vs 8.91, p < 0.001) Apgar scores, with a trend toward more frequent neonatal special care unit admission (26.2% vs 17.7%, p < 0.20) and perinatal death (3.9 vs 0%, p < 0.30). GA and SA appear equally safe, but SA was associated with significantly better outcome for both mothers and babies.
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Vascular injuries from penetrating trauma to the base of the neck are accompanied by significant morbidity and potential mortality. These injuries require several diagnostic adjuncts in order to facilitate early diagnosis and appropriate treatment. Herein reported is the case of a patient who sustained penetrating injury to the thoracic inlet but had a fortuitous anomaly that prevented vascular injury and its attendant complications.
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A cross-sectional, descriptive study utilizing data collected in the 'Trauma Registry' of the Department of Surgery, Radiology, Anaesthesia and Intensive Care at the University Hospital of the West Indies (UHWI) was undertaken to document injury severity, surgical requirements and intensive care needs of head-injured patients transferred to the UHWI over a three-year period Of 144 patients studied, the majority (71%) were young males. Overall, injury tended to be mild Twenty-three patients (16.0%) had severe head injury and 27 patients (18.8%) were admitted to the intensive care unit. Concussion with (33%) or without (36%) skull fracture was the commonest neurological admission diagnosis. ⋯ The majority of patients (79.2%) were discharged home; 56 (39%) made a good Glasgow outcome score recovery. Seventeen patients (11.8%) died in hospital. As most of the transferred patients with head injuries in this study had only mild injury, most commonly concussions, and their prognosis was good, we recommend that appropriate educational and training programmes and transfer policies be implemented to minimize inappropriate transfers.
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To evaluate the outcome of a multidisciplinary Intensive Care Unit (ICU) by applying the Acute Physiology and Chronic Health Evaluation (APACHE II) and Paediatric Index of Mortality (PIM)--version-2 scoring systems. ⋯ Evaluation of risk-adjusted outcome in multidisciplinary ICUs is challenging because of the need to apply more than one prognostic scoring system.
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This cross-sectional, descriptive study identified 857 head-injured patients who were admitted to the University Hospital of the West Indies (UHWI) over a four-year period. Their median age (IQR) was 28 (16, 45) years and 629 (73.5%) were males. Median length of hospital stay (IQR) was 2 (1, 6) days. ⋯ Head injury in admitted patients is mainly due to road traffic accidents, falls and interpersonal violence. Prevention and interventional strategies including education, law enforcement, physical and social engineering must focus on these aetiologies. Current measures are clearly insufficient and more effective strategies are urgently warranted.