Lorna Charles

A successful heterotopic cardiac transplantation was performed between sibling female Yorkshire Juvenile swine. Adequate pre-medication with azaperone and a smooth induction were ensured for both pigs, which were anaesthetized simultaneously with sodium thiopentone followed by endotracheal intubation and intermittent positive pressure ventilation. Inhalation anaesthetic agents were used for maintenance, neuromuscular blockade was achieved with cisatracurium and both fentanyl and tramadol were used to provide analgesia. Invasive monitoring was used in both the donor and recipient. Central venous pressure (CVP) was maintained at > 10 cm H2O and mean arterial pressure (MAP) > 60 mmHg. Heparin was injected during the surgical dissection of the heart in the donor to prevent coronary thrombosis and prior to aortic side clamping for end-to-side anastomosis of the donor heart in the recipient abdomen. After transplantation, the cardiovascular parameters of the recipient showed a MAP o...

A 54-year-old female patient admitted with a diagnosis of tetanus had her sedation reversed with an infusion of flumazenil. Flumazenil appears to be of use in reversal of sedation in patients with accumulation of benzodiazepine after prolonged administration.

SummaryThis study evaluated the costs of intensive care in Trinidad applying the cost‐blocks method. Data regarding demographics, severity of illness, therapeutic interventions and length of stay were prospectively recorded for 111 patients admitted to four intensive care units during a 3‐month period. Annual costs, cost per admission, cost per patient‐day and cost per therapeutic intervention score point were derived. The cost‐block for staff, especially medical staff, was the largest proportion of the expenditure. Process of care and outcome were comparable, whereas costs were lower than the developed countries. The median cost per intensive care unit bed per year and cost per patient per day in Trinidad were £133 117 and £366, respectively, in comparison with £265 163 and £904 in the UK. The cost‐blocks method is a useful framework for evaluating the costs of intensive care and for comparing costs between countries.

Off-pump coronary artery bypass surgery has been adopted enthusiastically worldwide. However, despite more than 6 years' experience and refinement, many surgeons use it only sporadically and some hardly at all. This reluctance persists despite support for the procedure because of the lack of properly designed risk models and/or randomized studies. Although it has not been overwhelmingly shown that off-pump surgery is superior to the conventional on-pump procedure, the technique has its place in our specialty. It has been shown to be better for noncritical end points in selected patients in the hands of selected surgeons. That there are differences in surgical skill among surgeons is something we all know but rarely discuss in public. Until now, disparities in skill have been most salient with uncommon and extraordinarily challenging operations. Perhaps the off-pump procedure should be regarded as the "challenging" aspect of coronary artery bypass surgery, and self-restraint may need to remain in force if we are to continue to achieve the highest level of clinical excellence.

Dedicated out-patient preanaesthetic clinics are relatively recent phenomenon and information is sparse from developing world. This study attempted to evaluate the utilization of adult and paediatric preanaesthetic clinics and its impact on the cancellations of surgery in Trinidad. All patients scheduled to have elective surgery during the period of twelve weeks were enrolled for prospective collection of data including demographics, the admitting diagnoses, surgical procedure, category of surgery and specialty, and the patients' attendance to preanaesthetic clinics. Cancellations on the day of surgery along with reasons were recorded. The difference between patients who attended and did not attend the clinic was analysed. Of 424 patients scheduled for procedures during the study period, 213 were adults and 211 were children. Overall 39% of adults and 46% of the children scheduled for surgery had previously attended the preanaesthetic clinic. Among adults, general surgery patien...

... Correspondence Address: Seetharaman Hariharan The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad (West Indies) Login to access the Email id. ... The mean cost per patient per day was 414 US dollars. ...

ABSTRACT The aim of this study is to determine the prevalence of herbal medicine usage among surgical patients in three hospitals in Trinidad. The study population comprised 303 surgical outpatients randomly selected from the three hospitals. All patients were over 18 years of age. Eligible participants either had surgery within the previous year or were due for surgery within the following 6 months. Of the 303 subjects, 121 (40%) reported the use of herbal medicines. Twenty-five percent of patients attending Hospital 1 used herbal medicines, compared with 41% at Hospital 2 and 55% at Hospital 3. The difference between the three hospitals was statistically significant (P=0.023). Allium sativum (garlic) was the most common herb used (74%), followed by Citrus sinensis (orange peel) tea (47%), Cymbopogon citratus (lemongrass) (39%), Aloe vera (aloe) (31%) and Panax ginseng (Asian ginseng) (26%). The prevalence of herbal medicine usage among interviewed patients in Trinidad is similar to the prevalence rate reported in the USA and Italy. The reported use of garlic was high, which is a concern as this herb may impact on bleeding in surgical patients. Herbal medicines may also influence heart rate, blood clotting and anaesthesia, which could put surgical patients at further risk. Due to the risk of potential complications, an accurate herbal medicine history should be obtained for all surgical patients.