Blood use in neurosurgical cases at the University Hospital of the West Indies / El uso de la sangre en los casos de neurocirugía en el Hospital Universitario de West Indies

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.

The development of postgraduate anaesthesia and intensive care training at the University of the West Indies / Desarrollo de la anestesia de postgrado y entrenamiento en cuidados intensivos en la Universidad de West Indies

The one-year Diploma in Anaesthetics (DA) was the first postgraduate programme offered by the then Faculty of Medicine of The University of the West Indies (UWI). It was instituted in 1966, when the need for trained physician anaesthetists became paramount. Over 200 physicians have been awarded the DA which was discontinued in 1994. The four-year Doctor of Medicine in Anaesthetics [DM (Anaesthetics)] was commenced in 1974 and continues to train most of the region's physician anaesthetists. The majority of the 119 graduates (as of December 2011) are providing invaluable services to the people of the Caribbean. The time has come for the establishment of a regional certifying body, the Caribbean College of Anaesthetists. This college would determine the standards for the training and clinical practice of anaesthetists as perioperative physicians including: the conduct of anaesthesia, critical care, acute and chronic pain management. It would also facilitate continuing medical education and recertification of all practising anaesthetists within the region.

El Diploma en Anestesia (DA) de un año fue el primer programa de postgrado ofrecido por la entonces Facultad de Medicina de la Universidad de West Indies. Este diplomado se instituyó en 1966, cuando se hizo patente la necesidad de médicos anestesistas entrenados. Más de 200 médicos han recibido el DA, que fue discontinuado en 1994. El programa de Doctor Especialista en Anestesia, comenzó en 1974 y continúa entrenando a la mayoría de anestesiólogos de la región. La mayor parte de los 119 graduados (a partir de diciembre 2011) están proporcionando servicios inestimables a las personas del Caribe. Ya es hora de establecer un organismo de certificación - el Colegio de Anestesistas del Caribe. Dicho colegio determinaría las normas para el entrenamiento y la práctica clínica de los anestesistas como médicos perioperatorios, incluyendo la conducción de la anestesia, el cuidado crítico, y el tratamiento del dolor crónico y agudo. También facilitaría la continuación de la educación médica y la recertificación de todos los anestesistas practicantes de la región.

The development of anaesthetic services in Jamaica / Desarrollo de los servicios anestésicos en Jamaica

The development of anaesthetic services in Jamaica arose out of the recognition that dedicated physicians offered a better morbidity/mortality profile to patients. From untrained personnel offering anaesthesia at the turn of the 20th century, much progress has been made, such that specialized anaesthetists have been trained for the various surgical subspecialties.

El desarrollo de los servicios anestésicos en Jamaica surgió del reconocimiento de que médicos dedicados ofrecían así un mejor perfil de morbilidad/mortalidad a los pacientes. Desde los tiempos en que un personal sin entrenamiento ofrecía anestesia en las postrimerías del siglo 20, se ha avanzado un gran trecho hasta nuestros días, en que anestesistas especializados reciben entrenamiento para realizar su trabajo en diversas sub-especialidades quirúrgicas.

Anaesthetic morbidity at the University Hospital of the West Indies / Morbilidad anestésica en el Hospital Universitario de West Indies: un estudio transversal prospectivo

OBJECTIVE: There is little information on adverse anaesthetic outcomes from the Caribbean. The aim of this study was to investigate the occurrence of anaesthetic morbidity and mortality at the University Hospital of the West Indies (UHWI) and to identify possible risk factors. METHODS: All anaesthetic procedures at the UHWI were monitored for adverse events and patient outcomes for the 12-month period from March 2004 to February 2005. Possible risk factors for these adverse events were assessed using logistic regression. RESULTS: Of 3185 anaesthetic proceduress, the incidence of intra-operative events was 201 per 1000 (95% CI 187, 215); 151 per 1000 being cardiovascular and 26 per 1000 respiratory. Others included excess blood loss and equipment failure, hyperglycaemia, nausea and vomiting. Patients with intraoperative complications were three times more likely to have complications during recovery (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). The incidence of complications among paediatric patients was 139 per 1000 (95% CI 104, 174) intra-operatively and 58 per 1000 (95% CI 34, 81) during recovery. Risk factors for developing complications (p < 0.05) included age > 50 years, ASA status > II, prolonged anaesthesia, high surgical risk, general or combined anaesthetic techniques, senior anaesthetist, intubated patients and co-morbidities. There were 14 operative mortalities, none of which was anaesthesia-related. CONCLUSION: Anaesthetic complication rates at the UHWI are comparable to those in developed countries, except for higher paediatric complication rates and ICU admissions and lower rates of postoperative nausea and vomiting.

OBJETIVO: Existe poca información sobre resultados anestésicos adversos en el Caribe. El propósito del presente estudio fue investigar la manifestación de la morbilidad y la mortalidad anestésicas en el Hospital Universitario de West Indies (UHWI) e identificar los posibles factores de riesgo. MÉTODOS: Todos los procedimientos anestésicos en el UHWI fueron monitoreados en busca de eventos adversos y resultados con los pacientes, durante un período de 12 meses a partir de marzo del 2004. Los posibles factores de riesgo para estos eventos adversos fueron evaluados mediante regresión logística. RESULTADOS: De 3185 procedimientos anestésicos, la incidencia de eventos intraoperatorios fue de 201 por 1000 (95% CI 187, 215); siendo 151 por 1000 cardiovasculares y 26 por 1000 respiratorios. Otros incluyeron exceso en pérdida de sangre y fallo de equipos, hiperglicemia, náusea, y vómitos. Los pacientes con complicaciones intraoperatorias presentaron una probabilidad de complicaciones tres veces mayor en la fase de recuperación (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). La incidencia de complicaciones entre pacientes pediátricos fue 139 por 1000 (95% CI 104, 174) intraoperatoriamente y 58 por 1000 (95% CI 34, 81) durante la recuperación. Entre los factores de riesgo que desarrollaban complicaciones (p < 0.05) se hallaban: la edad > 50 años, estatus de ASA > II, anestesia prolongada, alto riesgo quirúrgico, técnicas anestésicas combinadas o generales, anestesiólogos de la tercera edad, pacientes entubados, y comorbilidades. Se produjeron 14 mortalidades operatorias, ninguna de las cuales guardó relación con la anestesia. CONCLUSIÓN: Las tasas de complicación anestésica en UHWI son comparables a las que se producen en países desarrollados, excepto por las tasas de complicación pediátrica más altas, mayor número de ingresos a las UCIs, y tasas más bajas de náuseas y vómitos postoperatorios.

Donor site morbidity following iliac crest bone graft / Morbilidad del sitio donante tras un injerto óseo de cresta ilíaca

OBJECTIVES: To evaluate the complications of harvesting autogenous bone from the iliac crest. METHODS: A retrospective review of patients undergoing iliac crest bone grafting at the University Hospital of the West Indies, during the period 2000-2004, was performed. One hundred and three patients were identified. Thirty-two patients were successfully contacted and 30 completed the questionnaire. There were 18 males (60%) and 12 females (40%). Their ages ranged from 13 years to 80 years (average 45.6 years). RESULTS: Of the 30 patients, 22 (73.3%) had complications. Fourteen (46.6%) patients had temporary pain; five (16.6%) had chronic pain. Two (6.6%) changed position of clothing due to discomfort at the graft site; five (16.6%) experienced difficulty walking, one reported itching of the scar, one had altered sensation and one was unhappy with the scar. Fourteen patients (46.6%) had minor complications and eight patients (26.6%) had major complications. CONCLUSION: Autogenous iliac crest bone grafting is associated with significant complications.

OBJETIVOS: Evaluar las complicaciones de la cosecha de hueso autógeno de la cresta iliaca. MÉTODOS: Se realizó una revisión retrospectiva de pacientes a los que se les practicó el injerto de hueso de cresta iliaca en el Hospital Universitario de West Indies durante el periodo 2000-2004. Se identificaron ciento tres pacientes. Se logró contactar a treinta y dos de ellos, y 30 respondieron el cuestionario. Hubo 18 varones (60%) y 12 hembras (40%). La edad abarcó de 13 años a 80 años (promedio 45.6 años) RESULTADOS: De los 30 pacientes, 22 (73.3%) tuvieron complicaciones. Catorce (46.6%) pacientes tuvieron dolor temporal; 5 (16.6%) tenían dolor crónico. Dos (6.6%) cambiaron la posición de la ropa porque sentían malestar en el sitio del injerto; 5 (16.6%) experimentaron dificultad al caminar; uno reportó sentir comezón en la cicatriz; otro sentía alteración en sus sensaciones, y un último no se sentía satisfecho debido a la cicatriz. Catorce pacientes (46.6%) tuvieron complicaciones menores y ocho pacientes (26.6%) tuvieron complicaciones mayores. CONCLUSIÓN: El injerto de hueso autógeno de la cresta iliaca está asociado con complicaciones significativas.

Extravasation injuries / Lesiones por extravasación

OBJECTIVES: To evaluate the time and type of treatment following extravasation from intravenous infusion and the sequelae of the injuries. METHOD: The charts of 12 patients who were referred to the Plastic and Orthopaedic Services at the University Hospital of the West Indies were reviewed. The study period was between May 2003 and January 2007. Data were collected on age, gender, site of extravasation, extravasated agent, treatment of the extravasation, necrosis interval, duration of hospital stay for treatment of injury and whether the intravenous line was resited and at what site in relation to the injury. RESULTS: The age of patients ranged from three days to 67 years. The female-to-male ratio was 2 : 1. In five patients, the intravenous infusion was discontinued immediately after the swelling was noticed. In two patients, the intravenous infusion was stopped after seven hours and in five patients it was discontinued within 12 to 22 hours. The necrosis interval ranged from 12 hours to three weeks. Immediate treatment following extravasation and discontinuation of the infusion included limb elevation in three patients and application of cold compresses in one patient. Eleven patients developed skin necrosis of varying severities. There was no skin necrosis in one patient. Ten patients spent an average of 31 extra days in hospital for treatment of the extravasation injury. Two patients were treated in an out-patient clinic. CONCLUSIONS: Extravenous leaks can cause severe tissue injuries. Morbidity is increased by delay in recognition and treatment of the extravasation. A protocol for the treatment of extravasation is recommended.

OBJETIVOS: Evaluar el tiempo y tipo de tratamiento tras la extravasación de una perfusión intravenosa y las secuelas de las lesiones. MÉTODO: Se revisaron las historias clínicas de 12 pacientes que fueron remitidos a los Servicios de Ortopedia y Cirugía Plástica del Hospital Universitario de West Indies. El periodo del estudio tuvo lugar entre mayo de 2003 y enero de 2007. Los datos fueron recopilados en relación con edad, género, lugar de la extravasación, agente extravasado, tratamiento de la extravasación, duración del intervalo de necrosis, duración de la permanencia en el hospital para el tratamiento de la lesión, y reubicación o no de la línea intravenosa, así como la especificación de su lugar en relación con la lesión. RESULTADOS: La edad de los pacientes fluctuó de tres días a 67 años. La proporción hembra/varón fue de 2:1. En cada uno de los casos, una sustancia capaz de causar la necrosis se había infiltrado por goteo en el tejido subcutáneo a partir de una perfusión intravenosa. En cinco pacientes, la perfusión intravenosa fue discontinuada inmediatamente después de que se observó la inflamación. En dos pacientes, la perfusión intravenosa fue detenida después de siete horas y en cinco pacientes fue discontinuada dentro de 12 a 22 horas. El rango de intervalo de la necrosis fue de 12 horas a tres semanas. El tratamiento inmediato tras la extravasación y el cese de la perfusión incluyeron la elevación de miembros en tres pacientes y la aplicación de compresas frías en un paciente. Once pacientes desarrollaron necrosis cutánea de diversos grados de severidad. No hubo necrosis cutánea alguna en un paciente. Diez pacientes pasaron un promedio de 31 días extras en el hospital para el tratamiento de la lesión de la extravasación. Dos pacientes fueron tratados en una clínica ambulatoria. CONCLUSIONES: El goteo extravenoso puede causar lesiones severas del tejido. La morbosidad aumenta con la demora en el reconocimiento y tratamiento de la extravasación. Se recomienda un protocolo para el tratamiento de la extravasación.

Paediatric day surgery: revisiting the University Hospital of the West Indies experience

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.

Ethylene glycol poisoning following ingestion of brake fluid / Envenenamiento con glicol de etileno tras la ingestión de líquido de frenos

A 32-year old male, with a history of depression and previous suicide attempts, was brought to hospital comatose after ingestion of brake fluid. He developed severe metabolic acidosis with an increased anion gap, hypotension, seizures and mild renal impairment. He required intensive care treatment for ventilatory and inotropic support. The clinical features, diagnosis and treatment of this unusual poison are discussed.

Un sujeto masculino de 32 años de edad, con una historia de depresión y previos intentos de suicidio, fue llevado en estado comatoso al hospital, luego de haber ingerido líquido de freno. El paciente desarrolló una acidosis metabólica severa con aumento del gap aniónico, hipertensión, convulsiones, e insuficiencia renal moderada. Requirió tratamiento mediante cuidados intensivos con apoyo ventilatorio e inotrópico. El trabajo analiza las características clínicas, el diagnóstico y el tratamiento de este envenenamiento inusual.

Open splenectomy in Jamaican children with sickle cell disease / Esplenectomía abierta en niños jamaicanos con la enfermedad de células falciformes

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.

Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice / La Anestesia en los Partos Operativos en el Hospital Universitario de West Indies Un Cambio de Práctica

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.

Paravertebral anaesthesia for breast surgery an initial experience at the University Hospital of the West Indies

Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. This retrospective review was undertaken to report the initial experience with this block. We reviewed the notes of all patients who were given a PVB alone, or in combination with general anaesthesia (GA). Twenty-one patients had P VB: twenty females and one male, with age range of 24 to 90 years. Six were attempted with PVB alone, but two of these needed supplementation with a GA. Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods

Preoperative starvation and pulmonary aspiration. New perspectives and guidelines

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

Patients' desire for peri-operative information: Jamaican attitudes

The desire for peri-operative information has been examined in patients from other countries. This study was undertaken to assess the peri-operative information needs in Jamaican patients and to compare them to those from other populations. A questionnaire examining the desire for information about impending anaesthesia was administered to 93 patients awaiting elective surgery at the University Hospital of the West Indies. Responses were assessed across age and gender, and were compared to results from five industrialized countries. Although Jamaican patients expressed a desire for information concerning anaesthesia and surgery, they did not regard it as their right to get information, and this was the most important factor in the Jamaican sample providing a significantly less positive response than patients from other nations (p < 0.01 versus each country). Information priority was given to practical aspects of anaesthesia and post-operative outcome-mobility, pain, and the consumption of food and drink. Meeting the anesthetist was high on the list of desires. Female patients were 1.9 (Confidence Interval 1.4, 2.5) times more likely to express a positive desire for information. There were no age-related differences.