ABSTRACT
The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam (Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5 percent). Adverse reactions to the procedure such as nausea, vomitting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.
Subject(s)
Adult , Aged , Humans , Adolescent , Middle Aged , Conscious Sedation , Hernia, Inguinal/surgery , Anesthesia, Local , Midazolam/administration & dosage , Cost-Benefit Analysis , Ambulatory Surgical Procedures , Hypnotics and Sedatives/administration & dosage , Anesthesia, IntravenousABSTRACT
One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67 percent) patients had stab wounds and thirty-seven (33 percent) sustained gunshot wounds. There were 10 deaths (27 percent) from gunshot wounds, and seven deaths (9 percent due to stab wounds. Using a protocol of selective conservatism for stab wounds, 41 (60 percent) were observed, 27 (40 percent) explored and 5 (12 percent) patients had negative laparotomy. The male to female ratio was 10: with 88 percent in the age group 16-35 years. A decision to perform laparotomy was used and is recommended