Schoolteachers' knowledge of common health problems in Bahrain.

Schoolteacher could be a useful source of health information for students but that they themselves would have to possess adequate and accurate knowledge of health issues. We assessed Bahraini schoolteachers' knowledge of some common health problems using a pre-tested, structured questionnaire which requested information on schools, teachers' demographic data, and knowledge about 5 common health problems in Bahrain: bronchial asthma, sickle-cell anaemia, hypertension, diabetes mellitus and the dangers of smoking. We analysed the data on 1140 respondents from a random selection of teachers in all schools in Bahrain. The schoolteachers scored only around 50% on average for knowledge about common health problems which indicates a need to educate schoolteachers about health in order to improve their knowledge and their capability to disseminate health knowledge and information to students.

Schoolteachers' knowledge of common health problems in Bahrain

Schoolteacher could be a useful source of health information for students but that they themselves would have to possess adequate and accurate knowledge of health issues. We assessed Bahraini schoolteachers' knowledge of some common health problems using a pre-tested, structured questionnaire which requested information on schools, teachers' demographic data, and knowledge about 5 common health problems in Bahrain: bronchial asthma, sickle-cell anaemia, hypertension, diabetes mellitus and the dangers of smoking. We analysed the data on 1140 respondents from a r and om selection of teachers in all schools in Bahrain. The schoolteachers scored only around 50% on average for knowledge about common health problems which indicates a need to educate schoolteachers about health in order to improve their knowledge and their capability to disseminate health knowledge and information to students

Decreased mivacurium constant infusion requirements with defasciculating doses of pancuronium.

This study was designed to verify a technique in which the pharmacologic profile of mivacurium infusions could be altered by small doses of pancuronium to reduce the infusion requirement without altering the subsequent recovery kinetics. Thirty ASA physical status I or II patients were randomized into two groups in a blinded fashion. One group was administered pancuronium 10 micrograms/kg followed by pancuronium 2.5 micrograms.kg-1.h-1 thereafter. The control group was given identical volumes of saline. Subsequently, all patients were given an initial bolus of mivacurium, and anesthesia was maintained using a nitrous oxide/ alfentanil technique. When the thenar electromyogram response to supramaximal train-of-four stimulation returned to 5% of baseline, a mivacurium infusion was begun in both groups, and the infusion rate required to maintain the electromyographic response at 1%-10% of baseline was determined. At the conclusion of the procedure, the infusion was terminated and the recovery profile ascertained. The mivacurium infusion requirement for the group receiving the pancuronium supplementation was 2.77 +/- 1.38 micrograms.kg-1.min-1 (mean +/- SD), which represented a 49% decrease compared with the group that used mivacurium alone which required an infusion rate of 5.43 +/- 1.85 micrograms.kg-1.min-1. No statistically significant difference was found in the recovery profiles of the two groups when the infusion was terminated. We conclude that the addition of a small amount of pancuronium decreased the required mivacurium infusion rate by nearly 50% without affecting the spontaneous recovery when terminating the infusion.

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) pathophysiology and anesthetic considerations.

HELLP syndrome in the parturient (hemolysis, elevated liver enzymes, and low platelet count) is associated with poor maternal and fetal outcomes. Maternal mortality has been estimated to be as high as 24%. Patients with HELLP syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, disseminated intravascular coagulation, ruptured liver hematomas, and acute renal failure. Perinatal mortality is equally high, ranging from 79 to 367 per 1,000 live births, and neonatal complications correlate with the severity of maternal disease. Many clinicians view HELLP syndrome as an entity of preeclampsia, and because of varied symptomatology, the initial diagnosis may be obscured. Prodromal signs include: (1) weakness and fatigue, (2) nausea and vomiting, (3) right upper quadrant and/or epigastric pain, (4) headache, (5) changes in vision, (6) increased tendency to bleed from minor trauma, (7) jaundice, (8) diarrhea, and (9) shoulder or neck pain. Before delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems, if possible, and timely interruption of the pregnancy in the early phase of the accelerated disease progression. Definitive therapy is delivery. Parturients with HELLP syndrome are often critically ill; their infants are frequently premature and their conditions are compromised. Management criteria should include a multidisciplinary approach in a tertiary care center. Obstetric anesthesia personnel should perform a thorough preanesthetic evaluation and be familiar with the pathophysiologic changes of this syndrome. Determining the anesthetic of choice depends on the patient's condition, fetal well-being, and the urgency of the situation. In the presence of severe coagulopathy, regional anesthesia is contraindicated.

Efficacy of subarachnoid meperidine for labor analgesia.

Meperidine is an opioid agonist with known weak local anesthetic properties. To determine the efficacy of subarachnoid meperidine as a labor and delivery analgesic, 20 term parturients were given 10 mg meperidine via continuous spinal catheter. Visual analog pain scores on a ten-point scale and patient satisfaction scores on a four-point scale were measured before and after establishment of the block and one hour after maximum block was achieved. Time to pain relief and return of pain was recorded. Additional doses of 7 mg meperidine were given subarachnoid via the catheter when patients requested additional analgesia. Follow-up assessment 24 hours postpartum was used to determine overall patient satisfaction. Visual analog pain scale scores (mean +/- SD) were 8.57 +/- 1.43 before block, 0.62 +/- 0.89 immediately after block, and 0.33 +/- 0.57 at one hour after block (p less than 0.0001). Patient satisfaction scale scores (mean +/- SD) were 0.83 +/- 0.88 before block, 3.90 +/- 0.37 immediately after block, and 3.85 +/- 0.31 at one hour after block (p less than 0.0001). At follow-up, 14 of 18 patients rated satisfaction as excellent, with the remaining 4 rating it as good. Expulsive efforts were excellent in 14, good in 3, and fair in 1; 2 patients had cesarean sections. Mean time to onset of pain relief was 3.9 minutes (range, 2-12), with analgesia lasting a mean of 83 minutes (range, 38-180). Two patients developed slight motor block. Side effects appeared insidiously and are similar to those observed with other neuraxial opioids.

Sensory analgesia for vaginal deliveries: a preliminary report of continuous spinal anesthesia with a 32-gauge catheter.

Our initial experience in providing pain relief during labor and delivery for 20 parturients using a 32-gauge continuous spinal microcatheter using 1% lidocaine is described. The technique significantly reduced the pain of labor, which was assessed as severe by 18 of the patients, and provided adequate perineal anesthesia for vaginal delivery with 18 patients indicating pain during delivery to be minimal. The major advantage of continuous spinal anesthesia is the ability to rapidly establish sensory anesthesia with the flexibility to reinject additional local anesthetic should a complete sensory or sensory and motor block be required for forceps or cesarean delivery. Technical difficulty was the main disadvantage with the use of the 32-gauge microcatheter. An inability to thread the catheter (two patients) through the 26-gauge spinal needle or kinking of the catheter (two patients) making injection impossible, and unintentional catheter removal (one patient) resulted in a 25% failure rate with this technique.

Continuous spinal blockade: an old technique revisited.

In this paper we describe a technique for continuous spinal anesthesia, first described at the turn of the 20th century and long thought to have become obsolete. We discuss reasons for discontinuance and neglect of the technique, as well as its indications, applications, and specific advantages, and we report a significant illustrative case.