ABSTRACT
OBJECTIVE: Many neurosurgical cases are done without the need for blood transfusion, yet blood is unnecessarily cross-matched, resulting in wasted resources. This study was undertaken to document and compare the number of units of blood components requested, cross-matched and transfused in neurosurgical cases at the University Hospital of the West Indies (UHWI). METHODS: A prospective, observational study was undertaken over one year. Data collected for each patient included demographic information, relevant perioperative data, and blood banking data including blood components requested, cross-matched and transfused. Data were analysed using SPSS version 16. RESULTS: Data were analysed on 152 patients, 71 females (46.7%) and 81 males (53.3%). The mean age was 48.7 ± 19.6 years and 100 of the procedures were done electively (65.8%). Blood components were ordered in 114 (75%) cases, red cells more commonly in 113 (74.3%) patients, and plasma in 19 (12.5%) patients. Overall, 20 patients (13.2%) were transfused. Most patients (90.9%) needed one to two units of blood. Of the 236 units of blood components that were cross-matched or prepared, only 62 were transfused. The cross-match/preparation to transfusion ratio (CTR/PTR) was 6.00 for red cells and 1.31 for plasma. Preoperative haemoglobin < 10.0 g/dL (p = 0.001), estimated blood loss of > 1 litre (p < 0.001), higher American Society of Anesthesiologists (ASA) physical status score (p < 0.03) and a resident as lead surgeon (p < 0.05), were significant predictors of blood transfusion. CONCLUSION: The transfusion rate was low with a high cross-match to transfusion ratio, suggesting that less cross-matching is needed. A new approach to blood ordering for neurosurgical cases is recommended.
OBJETIVO: Muchos casos neuroquirurgicos se realizan sin necesidad de transfusion de sangre. Sin embargo, la sangre es innecesariamente sometida a pruebas cruzadas, lo cual resulta en un malgasto de recursos. Este estudio fue emprendido con el proposito de documentar y comparar el numero de unidades de los componentes sanguineos requeridos, cotejados, y transfundidos en los casos de neurocirugia en el Hospital Universitario de West Indies (HUWI). MÉTODOS: Se realizo un estudio prospectivo observacional por espacio de mas de un ano. Los datos recopilados de cada paciente incluian informacion demografica, datos relevantes perioperatorios, y datos de bancos de sangre, incluyendo los componentes sanguineos solicitados, cotejados, y transfundidos. Los datos fueron analizados utilizando SPSS version 16. RESULTADOS: Los datos se analizaron en 152 pacientes: 71 mujeres (46.7%) y 81 varones (53.3%). La edad promedio fue de 48.7 ± 19.6 anos y 100 de los procedimientos se realizaron de manera electiva (65.8%). Se ordenaron componentes de la sangre en 114 casos (75%), siendo los globulos rojos los mas comunmente requeridos en 113 pacientes (74,3%) y el plasma en 19 pacientes (12.5%). En general, 20 pacientes (13.2%) fueron transfundidos. La mayoria de los pacientes (90.9%) necesito una o dos unidades de sangre. De las 236 unidades de componentes sanguineos que fueron preparados o sometidos a pruebas cruzadas, solo 62 fueron transfundidos. La proporcion de la preparacion/prueba cruzada en relacion con la transfusion (CTR/PTR por sus siglas en ingles) fue 6.00 para los globulos rojos y 1.31 para el plasma. La hemoglobina preoperatoria < 10.0 g/dL (p = 0.001), la perdida estimada de sangre de > 1 litro (p < 0.001), la mayor puntuacion del estado fisico (p < 0.03) segun los criterios de la Sociedad Americana de Anestesiologos (ASA), y un residente como principal cirujano (p < 0.05), fueron predictores significativos de la transfusion de sangre. CONCLUSIÓN: La tasa de transfusion fue baja, con una alta proporcion de la prueba cruzada frente a la transfusion, sugiriendo que se necesitan menos pruebas cruzadas. Se recomienda un nuevo enfoque a la hora de hacer pedidos de sangre para los casos neuroquirurgicos.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Blood Transfusion/statistics & numerical data , Neurosurgical Procedures/methods , Prospective Studies , Hospitals, UniversityABSTRACT
The aim of this article is to review the local experience over the last 18 years (1994-2011) in providing surgical intervention for children with heart conditions in Jamaica. Eight hundred and sixty-three children received cardiac surgery during this period, 441 were done with the assistance of visiting overseas teams and 422 by the local surgical teams. The majority of cases receiving cardiac surgery were for congenital heart defects; however, 3% of cases were for rheumatic heart disease. The overall survival rate was 94% for the period 1994 to 2008.
El objetivo de este artículo es pasar examen a la experiencia local durante los últimos 18 años (1994-2011) en cuanto a brindar intervención quirúrgica a niños con problemas cardíacos en Jamaica. Ochocientos sesenta y tres niños recibieron cirugía cardíaca durante este periodo. De estas, 441 se realizaron con ayuda de equipos formados por personal médico visitante extranjero, y 422 por equipos de cirujanos locales. La mayoría de los casos que recibieron cirugía cardíaca presentaban defectos cardíacos congénitos. Sin embargo, un 3% de los casos presentaban la enfermedad reumática del corazón. La tasa de supervivencia global fue 94% para el periodo 1994 a 2008.
Subject(s)
Child , Humans , Cardiology Service, Hospital/organization & administration , Heart Diseases/surgery , Cardiac Surgical Procedures/statistics & numerical data , Jamaica , Program Development , Retrospective StudiesABSTRACT
Pulmonary hypertension (PH) is defined as a systolic pulmonary artery pressure (PAP) above 30 mmHg and a mean PAP above 25 mmHg. Pulmonary hypertensive diseases (PHDs) encompass a myriad of conditions that cause pulmonary hypertension (PH), hence the Evian Classification was developed for the categorization of the various causes. Pulmonary hypertensive diseases are complex conditions that are difficult to treat and in the case of primary pulmonary hypertension, there is no known cure. Dyspnoea on exertion is the main symptom. This usually worsens as the disease progresses and can lead to syncope as a result of right ventricular failure. Prostacyclin has been the mainstay of treatment for decades, but several new drugs and alternate methods of treatment are currently available.
La hipertensión pulmonar (HP) se define como presión arterial pulmonar sistólica (PAP) por encima de 30 mmHg y una PAP por encima de 25 mmHg. Las enfermedades hipertensivas pulmonares (EHPs) comprenden un sinnúmero de condiciones que causan hipertensión pulmonar (HP), razón por la cual fue desarrollada la Clasificación de Evian para la categorización de las diversas causas. Las enfermedades pulmonares hipertensivas son condiciones complejas que son difíciles de tratar y en el caso de la hipertensión pulmonar primaria, no se conoce cura. La disnea al realizar un esfuerzo es el síntoma principal. Esta condición por lo regular empeora a medida que la enfermedad progresa, y puede llevar al síncope como resultado del fallo del ventrículo derecho. Durante décadas, la prostaciclina ha sido el soporte principal del tratamiento, pero varios medicamentos nuevos y métodos de tratamiento alternativos se hallan disponibles en el presente.
Subject(s)
Humans , Hypertension, Pulmonary , Disease Progression , Hypertension, Pulmonary/classification , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapyABSTRACT
Day surgery is cheaper and allows for less time delay. In developing countries with limited health budgets, these factors lead to higher patient turnover and shortened waiting lists. The decreased psychological trauma for both parents and children is significant. Paediatric day surgery (PDS) has been done at the University Hospital of the West Indies (UHWI) for over 40 years. A total of 975 paediatric general surgical (PGS) procedures were performed on 963 patients at the UHWI during the four-year period, January 2001 to December 2004. Paediatric day surgery numbered 727 (74.6%). Males outnumbered females 2:1, the age range was 2 weeks to 15 years, with an average age of 4 years. Ninety-seven (13.3%) of these patients were less than six months old, including eight neonates. One hundred and forty-five (20%) had more than one surgical procedure. Most children, 314 (43.2%) had inguinal hernia repair. Umbilical/supra-umbilical/epigastric herniorrhaphy (20.1%) was the next most frequently performed procedure, followed by circumcision (13.3%) and orchidopexy (5.9%). Ninety per cent of these patients were discharged home within 2-4 hours after surgery. Unplanned admissions were 2.1% of the cases. These were due to age, unplanned extensive surgical procedure, drug reaction and fever There was no mortality in this study population. This review showed that the number of PDS has increased from 60% in 1984 to 75%. These procedures were performed safely with a low complication rate. Further expansion of the service is recommended.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Infant , Infant, Newborn , Male , Humans , Middle Aged , Pain, Postoperative/drug therapy , Hospitals, University , Ambulatory Surgical Procedures , Patient Discharge , Program Evaluation , Retrospective Studies , West IndiesABSTRACT
OBJECTIVES: The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors. METHOD: A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications. RESULTS: The case notes of 62 patients (68.9%) were obtained for analysis. There were 47 (75.8%) males and 15 females (24.2%)--a 3:1 ratio. The prevalence of HTN and DM in the study sample was 78% and 72% respectively, hypercholesterolaemia was 31% and a previous MI was 29%. There were no differences based on gender. Post CABG complications were: persistent postoperative hypotension (6.8%), congestive cardiac failure (CCF) (6.8%), arrhythmia (6.8%), sepsis (6.8%), lower respiratory tract infection (LRTI) and pleural effusion (5.1%), heart block (3.4%), pulmonary embolism (1.7%), cellulitis and haematoma formation were 1.7%. Three patients had increases in postoperative creatinine values > 89 micromol/L over the postoperative value resulting in a prevalence of ARF of 5%. One of the three patients died and none received dialysis. There were no statistical difference in pre-operative clinical and biochemical characteristics based on the presence or absence of ARE. The presence of diabetes and increased length of stay were significant predictors of increasing postoperative creatinine values adjusting for pre-operative creatinine values. In addition, the presence of diabetes mellitus and...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Acute Kidney Injury , Postoperative Complications , Coronary Artery Bypass/adverse effects , Acute Kidney Injury , Diabetes Complications , Acute Disease , Retrospective Studies , Risk Factors , Time Factors , Hypertension/complications , Hospitals, University , Incidence , Jamaica/epidemiology , PrevalenceABSTRACT
A total of 110 patients with sickle cell disease who had open splenectomy at the University Hospital of the West Indies over a 10-year period are reviewed Patients with homozygous sickle cell disease numbered 94, S beta0 and S beta+ thalassaemias (11 and 4 respectively) and one patient with SC disease. Postoperative acute chest syndrome was the most common complication (9 of 110). There were no life threatening emergencies and no mortalities. Eleven patients received preoperative blood transfusion and operative times were short averaging 60 minutes among the 110 patients. Open splenectomy remains the gold standard for patients with sickle cell disease requiring splenectomy.
El presente trabajo revisa un total de 110 pacientes con la enfermedad de células falciformes, que fueran sometidos a una esplenectomía abierta en el Hospital Universitario de West Indies, a lo largo de un período de 10 años. Los pacientes con enfermedad de células falciformes homocigóticas fueron 94, con talasemias S b0 y S b+ fueron 11 y 4 respectivamente, y un paciente presentaba la enfermedad por hemoglobina SC. El síndrome torácico agudo postoperatorio resultó ser la complicación más común (9 de 110). No hubo emergencias con riesgo de vida ni mortalidades. Once pacientes recibieron transfusión de sangre en el postoperatorio y los tiempos de operación fueron cortos, con un promedio de 60 minutos entre los 110 pacientes. La esplenectomía abierta sigue siendo la norma de oro para los pacientes con la enfermedad de células falciforme que requieren esplenectomía.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Anemia, Sickle Cell/surgery , Splenectomy/methods , Splenic Diseases/surgery , Anemia, Sickle Cell/complications , Splenectomy/adverse effects , Splenic Diseases/etiology , Hospitals, University , Jamaica , Treatment OutcomeABSTRACT
There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction
Ha habido una tendencia creciente mundial a usar la anestesia regional en los partos operativos. La Encuesta Confidencial sobre las causas de las muertes maternas en el Reino Unido, ha demostrado un descenso constante de los casos de muertes relacionadas con la anestesia, a partir de la introducción de la anestesia regional. Los perfiles de morbosidad son más bajos en las madres que dan a luz con anestesia regional, en tanto que los infantes presentan una mejor puntuación Apgar. En 1997, se toma la decisión de que al menos el 60% de todas las secciones cesáreas electivas en el Hospital Universitario de West Indies (UHWI) fueran realizadas bajo anestesia espinal. El presente trabajo constituye un resumen que examina la técnica anestésica aplicada en las cesáreas practicadas en el UHWI desde 1996. Se examinaron los Registros de Partos y Anestesia del salón de partos, tomándose nota del tipo de anestesia usado en las cesáreas electivas y de emergencia en el período de enero de 1996 a diciembre de 2001. A principios del periodo bajo estudio, más del 90% de las secciones cesáreas se hacían con anestesia general. A mediados de 1998, la anestesia espinal se empleaba más comúnmente que la anestesia general en las cesáreas. Y para diciembre de 2001 más de ocho de cada diez cesáreas se realizaban con anestesia espinal. Las razones principales para el cambio exitoso de práctica consistieron en que se llevo a cabo bajo la dirección de un consultante, hubo buena comunicación entre los departamentos pertinentes, el personal subalterno estaba debidamente entrenado, hubo un suministro consistente de los medicamentos apropiados, y finalmente un alto nivel de satisfacción de los pacientes.
Subject(s)
Humans , Female , Pregnancy , Infant , Anesthesia, Obstetrical/methods , Cesarean Section , Anesthesia, Conduction , Retrospective Studies , Hospitals, University , Infant Mortality , Maternal Mortality , Anesthesia, Spinal , Pregnancy Outcome , Patient Satisfaction , West Indies/epidemiologyABSTRACT
A three-year observational study of patients undergoing tonsillectomy at the University Hospital of the West Indies was conducted to determine the incidence of postoperative vomiting. Data were collected to assess possible risk factors for vomiting as well as possible alleviating agents. Two hundred and fifty-two patients were included in the study and a thirteen per cent incidence of postoperative vomiting was found. This is significantly less than that quoted in other studies (40-73). Results also showed that steroids significantly reduced the incidence of postoperative vomiting in the study population. Muscle relaxants reversal agents and antibiotics particularly co-trimoxazole and ceftriaxone significantly increased its incidence. Usual antiemetic agents including dimenhydrinate (gravol) and promethazine (phenergan), as well as drugs known to possess antiemetic properties such as midazolam and propofol, lacked any significant protective effect against emesis. Opioid analgesia, inhalational induction and blood loss of greater than 10 of estimated blood volume appeared to increase emesis but failed to achieve statistical significance
Un estudio de observación a pacientes de tonsilectomía en el Hospital Universitario de West Indies, fue realizado durante tres años, a fin de determinar la incidencia de vómitos post-operatorios. Se recogieron datos con el propósito de evaluar los posibles factores de riesgo por vómitos así como los posibles agentes para aliviarlos. Doscientos cincuenta y dos pacientes fueron incluidos en el estudio y se halló una incidencia de trece por ciento de vómitos post-operatorios. Esta cifra es significativamente menor que las citadas en otros estudios (40-73%). Los resultados también mostraron que los esteroides redujeron significativamente la incidencia de vómitos post-operatorios en la población del estudio. Los agentes de reversión de los relajantes musculares y los antibióticos co-trimoxazol y ceftriaxona aumentaron significativamente la incidencia. Los agentes antieméticos usuales, incluyendo incluso el dimenhidrinato (gravol) y la prometazina (fenergan), así como drogas conocidas por sus propiedades antieméticas, tales como el midazolam y el propofol, no mostraron efecto significativo alguno de protección contra la émesis. La analgesia opioide, la inducción por inhalación, y la pérdida de sangre mayor al 10% del volumen de sangre estimada, parecían aumentar la émesis, pero no alcanzaron a tener importancia estadística.
Subject(s)
Humans , Male , Female , Child , Adolescent , /epidemiology , Tonsillectomy , Risk Factors , Incidence , /prevention & control , West IndiesABSTRACT
A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months. The common surgical procedures were valve surgery--replacement and repair (37.65), correction of patent ductus arteriosus (25.2) and repair of congenital heart disease (24.2). Coronary arterial bypass grafting procedures constituted a small percentage (4.1) of the cardiac surgical operations. A considerable number of patients have undergone CS in Jamaica, but much more needs to be done as the patient load exists. The future of the cardiac surgical service therefore depends on improvement in the facilities at both institutions and the cadre of the intensive care nursing staff The building of the Cardiothoracic-Neurosurgical Unit (commenced in March, 2003) is an essential step towards this
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Thoracic Surgery/trends , Hospitals, University , Cardiac Surgical Procedures , Utilization Review/statistics & numerical data , Survival Analysis , Thoracic Surgery/statistics & numerical data , Retrospective Studies , Time Factors , Jamaica/epidemiology , Cardiac Surgical Procedures/classification , Cardiac Surgical Procedures/mortalityABSTRACT
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
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Chi-Square Distribution , Retrospective Studies , Hospitals, University , Jamaica , Treatment Outcome , Aortic Valve/surgery , Mitral Valve/surgeryABSTRACT
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
Subject(s)
Humans , Male , Female , Adult , Myasthenia Gravis/surgery , Thymus Neoplasms/surgery , Thymectomy , Thymoma/surgery , Jamaica , Treatment OutcomeABSTRACT
The fear of aspiration of gastric contents and its life-threatening consequences in patients(aspiration pneumonitis and respiratory failure), has caused many medical practitioners, particularly anaesthetists, to rigidly follow conservative (i.e. prolonged) preoperative fasting standards. This is the nil per os (NPO) order for clear fluids/liquids and solids overnight or six to eight hours preceding the induction of anaesthesia. This practice neither takes into account the differences in the rate of gastric emptying for solid food (which may exceed six hours) and clear liquids (which is one to two hours), nor the differences in scheduled times of surgery. Long-term prospective studies and retrospective reviews have shown that the incidence of significant clinical aspiration is low: 1.4-6.0 per 100,00 anaesthetics for elective general surgery. Risk factors for pulmonary aspiration include: a high American Society of Anaesthesiologists (ASA) physical status score; emergency surgery; difficult airway management; increased gastric volume and acidity; increased intra-abdominal pressure; gastro-oesophageal reflux; oesophageal disease; head injury with impaired consciousness and extremes of age. Experimental studies and reviews have consistently shown the safety of clear liquid ingestion up to two hours before induction of anaesthesia in healthy patients without risk factors, and the fact that a longer fluid fast does not necessarily offer any added protection against pulmonary aspiration. The conservative pre-operative fasting standard causes discomfort and in some cases, suffering of patients and is therefore unnecessary for patients without risk factor(s). Anecdotal reports at the University Hospital of the West Indies (UHWI) have shown that application of the liberalized guidelines for preoperative fasting and fluid intake has not resulted in increased pulmonary aspiration, morbidity or mortality. Instead it has resulted in decreased irritability, anxiety, thirst and hunger in the peri-operative period. Patients, especially children are more comfortable and the perioperative period is better tolerated. It is therefore time that all medical personnel adopt the liberalized guidelines
Subject(s)
Humans , Intraoperative Complications , Preoperative Care/standards , Fasting , Pneumonia, Aspiration/prevention & controlABSTRACT
During the period January 1994 to December 1999, a total of 395 patients--adults and children--underwent various types of open heart surgical (OHS) procedures. The age range of these patients was 10 days to 77 years. Most (43.5) of these patients underwent valve replacement--first time and 'redo'--as a result of rheumatic heart disease of varying duration and severity. The other large group was the complex congenital heart abnormalities (16), followed by the group that underwent repair of atrial septal defect (13), coronary artery bypass graft (13) and repair of ventricular septal defect (12). Open valve repair (2) and excision of atrial myxoma (0.5) were uncommon OHS procedures. Nine patients (2.3) developed severe neurological complications (NCs) post-OHS. These included: a short period (< 48 hours) of irritability and fluctuating consciousness level; seizure activity associated with hemisparesis and/or blindness; severe encephalopathy and vegetative state. Four patients showed complete recovery, but one died as a result of complications of the anti-seizure medication. Of the other five, four died as a result of the NCs, and one was discharged in a vegetative state. Such severe neurological complications after an otherwise successful cardiac surgery represent a devastating outcome for patients and their families, and the social and economic impacts are enormous. Several risk factors were identified. The main ones being mitral valve replacement (MVR), especially 'redo' surgery, female gender, age over 60 years, high New York Heart Association functional class and post-operative hypotension. However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre- and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first time and 'redo'.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Heart Diseases , Postoperative Complications , Nervous System Diseases/etiology , Paresis , Seizures , Retrospective Studies , Coma , Cardiac Surgical Procedures , Jamaica , Postoperative Complications/epidemiology , Nervous System Diseases/epidemiology , ReoperationABSTRACT
This case report is presented to illustrate the advantages of Nasal Non-Invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercanic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exists