Trauma admissions to the Intensive Care Unit of the University Hospital of the West Indies, Kingston 7, Jamaica [abstract]

OBJECTIVE: Trauma is the single most common reason for admission to the surgical wards at the 500-bed University Hospital of the West Indies in Kingston, Jamaica. This study was undertaken to assess the impact of trauma on the Intensive Care Unit (ICU) in terms of time, resources, staffing and cost. It also assesses the pattern profile, frequency and outcome of trauma cases admitted to the multidisciplinary 8-bed ICU. METHODS: Records of all trauma patients admitted to the ICU over a period of a 5-year period between October 1995 and September 2000 were reviewed. Approval for this study was obtained from the institutional ethics committee. Data collected included age, gender, diagnosis, cause of trauma, referring specialities, duration of admission and outcome. RESULTS: During the study period 161 patients with severe trauma were admitted to the ICU, representing 12 percent and 16 percent of total and emergency ICU admission, respectively. There was a preponderance of men (M:F = 4:1), and they were generally younger than the average ICU patient (mean age 35 vs. 42 years). Trauma admission were almost exclusively emergencies (98 percent) and came mainly from the operating theatre/recovery room (67.3 percent) and Accident and Emergency (16.4 percent). The length of ICU stay of all trauma patients was a mean (SD) of 6.3 (8.4) days. More than one-half of the non-survivors (55 percent) died within 24 hours of ICU admission and 84 percent died by 7th ICU day. Road traffic accidents remain the leading cause of severe trauma (45 percent), but there was also a high prevalence of intentional and interpersonal violence (42 percent). CONCLUSION: Severe trauma in Jamaica is a major cause of hospitalization and intensive care utilization, and hence consumes a significant amount of already under-funded healthcare budget. In most instances it is preventable. Trauma prevention is therefore the most effective management. The need for a high dependency unit and expansion of the existing ICU is also underscored. (AU)

Pain control after major surgery

OBJECTIVE: To assess the adequacy and efficacy of postoperative pain management. DESIGN: A prospective clinical study. SETTING: The Georgetown and New Amsterdam Public Hospitals, Guyana. SUBJECTS: Two hundred consecutive patients undergoing major abdominal surgery. MAIN OUTCOME MEASURES: Presence or absence of significant postoperative pain during the first 24 hours. RESULTS: All the patients experienced pain postoperatively. Sixty one percent of patients considered their pain severe, 30 percent rated it moderate and only 9 percent mild. Reasons for this deficiency of care are partly attributable to the patients themselves and also the health care staff. CONCLUSIONS: Postopertive pain is poorly managed in our general hospitals. (AU)

Pain control after major surgery.

OBJECTIVE: To assess the adequacy and efficacy of postoperative pain management. DESIGN: A prospective clinical study. SETTING: The Georgetown and New Amsterdam Public Hospitals, Guyana. SUBJECTS: Two hundred consecutive patients undergoing major abdominal surgery. MAIN OUTCOME MEASURES: Presence or absence of significant postoperative pain during the first 24 hours. RESULTS: All the patients experienced pain postoperatively. Sixty one per cent of patients considered their pain severe, 30% rated it moderate and only 9% mild. Reasons for this deficiency of care are partly attributable to the patients themselves and also the health care staff. CONCLUSIONS: Postoperative pain is poorly managed in our general hospitals.

Anaesthetic and intensive care management of rupture of the gravid uterus: a review of 50 cases.

Fifty emergency laparotomies were performed over a period of 5 years for rupture of the gravid uterus at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The associated morbidity and mortality rates were very high. Contributory factors were lack of antenatal care, high parity, late presentation, inadequate resuscitation, delayed surgery and poor perioperative monitoring and anaesthetic management. More widespread and efficient antenatal care and better referral centre services will improve patient outcome.

Anaesthetic considerations in exomphalos repair: a report of 2 cases.

The anaesthetic management of two neonates with exomphalos associated syndromes for surgical repair are described. The technical advancements in the surgical and anaesthetic management of these neonates which have resulted in reduction in morbidity and mortality are discussed. The high incidence of associated anomalies and the problems they pose to the anaesthetist in addition to the usual challenges of neonatal anaesthesia are highlighted.