Obstetric and gynecologic patients' attitudes and perceptions toward medical students in Saudi Arabia

To identify patients' attitudes, preferences and comfort levels regarding the presence and involvement of medical students during consultations and examinations. A cross-sectional descriptive study was conducted from September 2011 to December 2011 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Participants were randomly selected from the outpatient and inpatient clinics at the Department of Obstetrics and Gynecology and the Emergency Department, provided they were admitted for obstetric or gynecology-related conditions. Data were collected using a structured questionnaire, and data analysis was performed using the Statistical Package for Social Sciences. Of the 327 patients who were recruited, 272 [83%] were elective patients who were seen at the outpatient and inpatient clinics of the Department of Obstetrics and Gynecology [group I]. The other 55 [16.8%] were seen at the Emergency Department or the Labor and Delivery Ward [group II]. One hundred seventynine participants [160 [58.8%] in group I and 19 [34.5%] in group II] reported positive attitudes about the presence of female medical students during consultations. Fewer participants [115 [42.3%] were in group I and 17 [30.9%] in group II] reported positive attitudes regarding the presence of male medical students during consultations [p=0.095]. The gender of the medical student was the primary factor that influenced patients' decision to accept or decline medical student involvement. No significant associations were observed between patients' attitudes and perceptions toward medical students and the patients' age, educational level, nationality or the gender of the consultant. Obstetrics and Gynecology patients are typically accepting of female medical student involvement during examinations. Student gender is the primary factor that influences patient attitudes regarding student involvement during physical examinations

Painless injection of propofol: pretreatment with ketamine vs thiopental, meperidine, and lidocaine

Propofol, a commonly used anesthetic, often causes pain on injection. Several methods have been described to reduce this pain, however, complete inhibition has not been achieved. Our randomized, placebo controlled, double blind study has been conducted to compare the analgesic efficacy of iv pretreatment of ketamine, meperidine, thiopental, lidocaine to minimize the injection pain of propofol. 125 patients ASA I and II were randomly allocated into 5 groups and received. Group K, ketamine 0.4 mg/kg; Group T, thiopental 0.5 mg/kg; Group M, meperidine 0.4 mg/kg; Group L, lidocaine 1 mg/kg; Group S, saline 3 ml. All pretreatment drugs were made into 4 ml solutions and were accompanied by manual venous occlusion for 1 min, followed by tourniquet release and slowly IV administration of propofol. Pain was assessed with a four point scale. All treatment groups had a significantly lower incidence of pain than placebo group [p < 0.05]. However, it has been observed that pretreatment with ketamine was the most effective in attenuating pain associated with propofol injection [p < 0.05]. For painless injection of propofol, routine pretreatment with ketamine 0.4 mg/kg along with venous occlusion is recommended

Anesthesia for cesarean section in a patient with a transposition of great arteries - case report

Transposition of great arteries [TGA] is one of the mixing lesions between right and left side with a prevelance of 0.21 per 1,000 live births. A 25 years old lady from KSA, Gravida 3, Para 1 + 1, at 34 weeks gestational age was admitted to KAUH with symptoms suggestive of heart failure [NYHA Class IV]. She was born with congenitally corrected TGA and coarctation of the aorta for which she under went several operations, the last one of which was tricuspid valve replacement, she being on chronic anti-coagulation. On hospital admission, she was treated with anti-failure measures with stoppage of the oral anti-coagulant intake and shift to I.V. heparin. Cesarean section was performed under subarachnoid block using 2 ml of hyperbaric bupivacaine 0.5% with several precautions to avoid abrupt decrease in the systemic vascular resistance. Baby was delivered with APGAR score 10 after 5 minutes. Postoperatively, the patient was admitted to the ICU for monitoring of the vital signs, and subcutaneous heparin was resumed immediately