A national survey on preoperative fasting policies and practices in Jamaican hospitals

Controversy has arisen regarding the length and nature of the preoperative fast that should be required of patients with normal gastric emptying time undergoing elective surgery. Various studies and editorials have indicated that the traditional preoperative fasting policy of [quot ]NPO after midnight[quot ] may be illogical as it makes no distinction between solid foods and clear fluids. Successive National Surveys conducted in the United States of America (USA) have shown an increasing number of Ambulatory Surgery Hospitals adopting more liberal preoperative fasting guidelines. Jamaican practitioners have also begun implementing some of these new liberal practices, even in institutions where [quot ]NPO after midnight[quot ] remain the official policy of the institution in which they practice. This has created a discordance between individual practice and institutional policy. In view of the fact that the extent of this discrepancy has not yet been studied and documented in Jamaica, and in an effort to better characterize the nature of the changes taking place in preoperative fasting practices in Jamaican hospitals, including those related to knowledge and attitude of practitioners, we embarked on this National Survey. The survey consisted of a questionnaire comprised of 13 questions which were to be completed by all surgeons and anaesthetists practising in a wide cross-section of public hospitals throughout Jamaica, providing an initial sample size of 201 subjects. We had a response rate of 74, or 148 responses. At all the hospitals surveyed, the traditional NPO policy continued to be the official institutional policy. However, at the individual level, 37 of respondents had already revised their policy, and were allowing their patients to have clear fluids up to three hours before the induction of anaesthesia. Also, 66, 68, and 73 of respondents stated that, in the future, they were prepared to allow their patients a solid meal up to eight hours, light breakfast up to six hours, and clear fluids up to three hours, respectively. We concluded that, whilst the traditional NPO policy remained firmly entrenched at the institutional level, many anaesthetists and surgeons show a positive inclination towards more liberal fasting practices. We recommend the formation of a local task force to determine what aspects of the new liberal guidelines may be safely and effectively adopted, taking account of local circumstances

Initial experience with beating-heart single valve replacement surgery at the University Hospital of the West Indies, Kingston, Jamaica

The objective of this study was to examine the consequences of performing single cardiac valve replacement procedures utilizing a beating-heart technique on typical patients presenting to the cardiothoracic surgery service for aortic or mitral valve replacement. Beating heart aortic (4) or mitral valve (1) replacement was performed on patients from July 2000 to November 2002. A stratified sample of five patients who underwent standard arrested-heart single valve replacement procedures between April 1997 and November 2002 was selected for retrospective comparison with the beating-heart group. Operative and post-operative variables were compared between the two groups of patients and subjected to statistical analysis. There was no statistical difference between the two groups with respect to age, pre- or post-operative New York Heart Association (NYHA) scores, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative blood transfusion, or post-operative hospital stay. Post-operatively, in the beating heart group, ventilation time, mediastinal blood loss and requirements for inotropic drugs were significantly reduced (p = 0.0054), p = 0.0019 and 0 = 0.02 respectively) compared to the arrested-heart group. Single cardiac valve replacement surgery utilizing a beating heart technique may offer benefits to patients over traditional arrested-heart surgery. Post-operative blood loss, inotrope requirements and ventilation times are significantly reduced, possibly resulting in better recovery and potentially fewer complications in the post-operative period. There may be cost benefits, important in the context of healthcare delivery in developing nations. These early results suggest the need for a regional prospective randomized trial to compare beating-heart single valve replacement surgery with traditional techniques

Thymic surgery in Jamaica 1992-2000

The treatment for thymic tumours and/or myaesthenia gravis (MG) includes thymectomy. Controversy exists as to the optimal timing and operative approach to thymectomy. At the University Hospital of the West Indies, Kingston, Jamaica, the results of thymic surgery during the period 1992 to 2000 were studied retrospectively. There were 26 patients operated on, 17 females and nine males. Twenty-three underwent thymectomy to treat MG, and three to remove a thymoma. The average age for females was 30.7 years, and 25.1 years for males. Average duration of symptoms prior to surgery was 16 months (all patients), and the interval between diagnosis and referral averaged 2.6 months. All patients underwent thymectomy via median sternotomy with a cervical extension of the incision if required. A policy of phrenic nerve preservation, even if residual tumour was left behind, was followed. Patients with thymomas were given post-operative radiotherapy. Chemotherapy was not given to any patient. The medium and long term results of thymic surgery in a developing country are presented. The results are within international norms, although the small patient population makes statistical analysis difficult. There appears to be no need to change current practice, despite the reported efficacy of less invasive approaches to thymic surgery

Knowledge and fears of anaesthesia and surgery. The Jamaican perspective

This study was undertaken to assess patients' knowledge and perceptions, fears and concerns regarding perioperative management. 300 patients were interviewed consecutively and a questionnaire was completed for each patient. 25admitted to having anxiety about their upcoming 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 (e.g. death on the operating table). 34of the patients did not realize that anaesthetists were qualified doctors, and only 10recognized 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.