Anaesthetic practices in the gynaecology and obstetric department in the principal health facilities of Butembo city, Eastern of the Democratic Republic of the Congo

2020 ◽  
Vol 6 (5) ◽  
pp. 233-242
Author(s):  
Moise Muhindo Valimungighe ◽  
◽  
Larrey Kasereka Kamabu ◽  
Rodriguez Mbusa Baraka ◽  
Kambale Mayalunga ◽  
...  
Keyword(s):  
Adverse Events ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Well Being ◽  
Health Facilities ◽  
Team Work ◽  
Continuous Training ◽  
Republic Of The Congo ◽  
Obstetric Department ◽  
Safe Anaesthesia

Background: The practice of anaesthesia should be team work involving Obstetrician and Anesthesiologist to determine the anaesthetic and surgical needs of the patient in order to have a successful plan for the baby and mother. The aim of this survey was to evaluate the practice of anesthesia in obstetric and gynaecology department in the principal health facilities of Butembo city. Methods: A prospective and observational descriptive study was done in four health facilities of Butembo city, from January 1st, 2015 to December 31st, 2019. Results: 64.86% of obstetrical and gynaecological procedures were done under spinal anaesthesia. General anaesthesia with an endotracheal tube was performed in 2.97% of the cases, the laryngeal mask in 0.10% and intra venous anaesthesia without any airway support in 96.93% of the cases. 100% of the cases had benefited from a pre-anaesthetic consultation; 77.75% anaesthesia was administered by anaesthetic officers. 53,27% of the patients were classified as ASA I and 77.25% of cases were electives. Caesareans accounted for 87.83% of emergency cases and 70.73% of elective cases. The pre-medication consisted of atropine and diazepam in 31,02%. Bupivacaine was used for spine anaesthesia in 66.87%. Maintenance during general anaesthesia with ketamine was done in 98.72%. Pethidine was the analgesic used in intraoperative in 48.00%. Tramadol was the most used drugs for pain management in post operative period. Adverse events were recorded in 2.94% of the patients; hypotension was noted in 39,27%. 24 maternal deaths were recorded. Fifteen among them died due to complication related to anaesthesia. There is a dependency between the accidents and complications and qualification of anaesthetists. Conclusion: Anaesthesia is commonly used in the gynaecology and obstetric department. It is important to promote continuous training of Non Physician Anaesthetists as well as Consultants Anaesthesiologists in order to practice safe anaesthesia for the well being of our patients. Spinal anaesthesia was the common used predominantly with few adverse events to the mother and foetus.

scholarly journals Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045 ◽  
Author(s):  
David Sing ◽  
Molly Vora ◽  
Paul Tornetta
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Ankle Fracture ◽  
Operating Time ◽  
Knee Surgery ◽  
Complication Rates ◽  
Improvement Program ◽  
Hip And Knee Surgery

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.

scholarly journals Algorithm for the support of non-related (serious) adverse events in an Ebola vaccine trial in the Democratic Republic of the Congo

2021 ◽  
Vol 6 (6) ◽  
pp. e005726
Author(s):  
Gwen Lemey ◽  
Ynke Larivière ◽  
Trésor Matuvanga Zola ◽  
Vivi Maketa ◽  
Junior Matangila ◽  
...  
Keyword(s):  
Adverse Events ◽  
Democratic Republic ◽  
Vaccine Trial ◽  
Well Being ◽  
Serious Adverse Events ◽  
Response Options ◽  
Low Middle Income Countries ◽  
Republic Of The Congo ◽  
Pharmaceutical Industries ◽  
Ancillary Care

Implementing an Ebola vaccine trial in a remote area in the Democratic Republic of the Congo (DRC), and being confronted with a dysfunctional health care system and acute unmet health needs of participants, ethical considerations were made regarding the ancillary care obligations of the sponsor and researchers. Spurred by the occurrence of non-related (serious) adverse events (NR-SAEs), the Universities of Antwerp and Kinshasa jointly developed an algorithm, accompanied by an algorithm policy. The algorithm consists of a set of consecutive questions with binary response options, leading to structured, non-arbitrary and consistent support and management for each NR-SAE. It is the result of dialogue and collaboration between the sponsor (University of Antwerp) and the principal investigator (University of Kinshasa), consultation of literature, and input of research ethics and social sciences experts. The characteristics of the project and its budgetary framework were taken into account, as well as the local socioeconomic and healthcare situation. The algorithm and related policy have been approved by the relevant ethics committee (EC), so field implementation will begin when the study activities resume in November 2021. Lessons learnt will be shared with the relevant stakeholders within and outside DRC.If NR-SAEs are not covered by a functioning social welfare system, sponsors and researchers should develop a feasible, standardised and transparent approach to the provision of ancillary care. National legislation and contextualised requirements are therefore needed, particularly in low/middle-income countries, to guide researchers and sponsors in this process. Protocols, particularly of clinical trials conducted in areas with ‘access to care’ constraints, should include adequate ancillary care arrangements. Furthermore, it is essential that local ECs systematically require ancillary care provisions to enhance the well-being and protection of the rights of research participants. This project was funded by the European Union’s Horizon 2020 research and innovation programme, European Federation of Pharmaceutical Industries and Associations, and the Coalition for Epidemic Preparedness Innovations.

L'Impatto Della Patologia Neoplastica Sullo Stato di Benessere Del Paziente

1998 ◽  
Vol 84 (1_suppl1) ◽  
pp. S20-S23
Author(s):  
Enrico Cortesi ◽  
E. Ballatori ◽  
P. Casali ◽  
E. Cortesi ◽  
M. Costantini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Family Relationship ◽  
Well Being ◽  
Health Facilities ◽  
Common Interest ◽  
Careful Study ◽  
Medical Environment ◽  
Disease Information

The peculiar characteristics of the italian neoplastic patients, as far as their knowledge concerning the disease (information, prognosis, therapeutic options, etc) and the different cultural, environmental and health realities, place different problems on the routine application of the quality of life questionnaires wich were constructed and edited in North European or North American Countries, even if correctly translated and validated in Italy. The QVonc (Quality of Life in Oncology) Project started five years ago from the common interest of medical oncologists who felt the need to make a careful study on some aspects regarding the evaluation of italian patient's quality of life. A multidisciplinary working group, comprehensive of statisticians, epidemiologists, psychologists, nurses and methodologists, was then put together. During the last three years the Group produced a deep analysis of the different aspects and determinants of the italian patient's quality of life, mainly about their disease and medical environment perception. A prospective research was started in 1995 with the aims of identifying the contents of quality of life, using a sample of cancer patients as “experts” and of measuring the relevance of selected contents in different subgroups of patients. In the first study the quality of life dimensions were analysed as perceived from 248 neoplastic patients, uniformely and randomly distributed for pathology and place of residence in Italy, through an open questionnaire and interviews conducted by our psychologists. Some peculiar aspects of the quality of life perception in italian patients were evidenced: relationship with the family, with the medical team and health facilities, economic problems and occupational difficulties. The study confirmed that the information on the contents of quality of life can be derived only studying people suffering the specific disease and cast a doubt on the available QL instruments currently used. The second study evaluated the quality of life perception in 6939 consecutive cancer patients referred in the second week of July 1996 to 79 Italian medical oncology/radiotherapy Institutions. Patients were asked to fill out a questionnaire concerning the importance of 46 domains of QL, each one scored on 4 levels (not at all, a little, much and very much). Domains were derived from a previous content analysis of 268 pts answers to 4 questions related to their own QL: “in your experience, what is QL?”, “what is a bad QL?”, “what is a good QL?”, “Did the diagnosis and treatment received modify your QL?”. 6939 patients entered the study; of these, 820 (11.8%) did not fill out the questionnaire due to various reasons. Among the 6,119 evaluable pts, the most frequent cancers were: breast (2,328), colo-rectal (968), lung (517), lymphoma (351), gastric (225). The most frequently chosen domains (much or very much) were related to health facilities or communication between patient-physician/nurse. Family relationship and general well being were also found important, while from the negative perspective the presence of the disease and the related anxiety were the most relevant problems. In conclusion, when choosing or constructing QL instruments, at least for Italian cancer pts, factors such as health facilities and pt ‘- physician/nurse relationship should be more adequately considered. Most currently used QL questionnaires are probably lacking in this regard.

scholarly journals Corrected Scoliosis, Cholinesterase Deficiency, and Cesarean Section: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Roy Somers ◽  
Yves Jacquemyn ◽  
Luc Sermeus ◽  
Marcel Vercauteren
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Cesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Regional Anaesthesia ◽  
Previous Caesarean Section ◽  
Corrective Surgery ◽  
Ultrasound Guided ◽  
Severe Scoliosis

We describe a patient with severe scoliosis for which corrective surgery was performed at the age of 12. During a previous caesarean section under general anaesthesia pseudocholinesterase deficiency was discovered. Ultrasound guided spinal anaesthesia was performed enabling a second caesarean section under loco-regional anaesthesia.

scholarly journals Deep Venous Thrombosis after Ad26.COV2.S Vaccination in Adult Male

2021 ◽  
Vol 2021 ◽  
pp. 1-2
Author(s):  
Habiba Hussain ◽  
Matthew Sehring ◽  
Sheryll Soriano
Keyword(s):  
Young Adult ◽  
Adverse Events ◽  
Adult Male ◽  
Immune Thrombocytopenia ◽  
Well Being ◽  
Allergic Reactions ◽  
Healthy Young Adult ◽  
Loss Of Life ◽  
Safety And Efficacy ◽  
First Case

With extensive loss of life and well-being seen since the beginning of the SARS-CoV-2 pandemic, the initiation of vaccinations has come with enormous hope towards the end of this pandemic. Detailed discussions regarding the safety and efficacy of these vaccines led to their approval. With such success, there have also been reports of vaccine-associated adverse events—allergic reactions, anaphylaxis, immune thrombocytopenia, and thrombosis. We discuss and report the first case of a healthy young adult male developing extensive thrombosis, after receiving the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine.

scholarly journals Parental Self-Efficacy and Parenting through Adversity

2021 ◽  
Author(s):  
Christian Scannell
Keyword(s):  
Adverse Events ◽  
Self Efficacy ◽  
Parenting Practices ◽  
Well Being ◽  
Mediating Role ◽  
Sense Of Competence ◽  
Parenting Expectations ◽  
Potential Factors ◽  
Long Term Impact ◽  
Societal Expectations

This review examines the relationship between life adversities, parental well-being, parental self-efficacy, and social support as potential factors mediating parent-child relationships and children’s outcomes. Generally, research on adversity has focused on children’s experiences and the long-term impact of adversity on development and health trajectories. More recently, a focus on resilience and growth after adversity has received increasing attention. Existing literature has identified how parents can best support their children through adverse events and suggested parenting programs that emphasize skill-building to parent children who have experienced adversity. Yet often overlooked is the critical impact of adverse events on the parent and how this may interfere with the cultivation of an environment of support and increase stigmatization due to unmet parenting expectations. While parenting occurs in context, it is often judged based upon societal expectations of childrearing practices and optimal outcomes with little understanding of the factors that contribute to parenting behaviors. The experience of adversity has the potential to impact parental sense of competence and parenting practices. However, parental self-efficacy and social supports can play mediating role in the experience of adversity and parenting stress. The integration of these contextual factors allows for the development of expectations that are best suited to meet the needs of vulnerable family systems.

SPINAL ANAESTHESIA USING TAYLOR’S APPROACH SAVES THE DAY IN OBESE PARTURIENT.

2021 ◽  
pp. 228-228
Author(s):  
Vishal Vashist ◽  
Roohani Mahajan ◽  
Bhanu Gupta
Keyword(s):  
Caesarean Section ◽  
General Anesthesia ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Case History ◽  
Breech Presentation ◽  
Lower Segment ◽  
Subarachnoid Block ◽  
Lower Segment Caesarean Section ◽  
History Of

Subarachnoid block is commonly employed for caesarean deliveries, by virtue of its simplicity in terms of performance, safety for the parturients as compared to general anesthesia. The case history of a 27-yearold female parturiant patient is presented. She was posted for emergency lower segment caesarean section in view of primigravida with breech presentation in labour . She was obese with bodyweight of 102 kg. She had a thick scaly plaque over the back in midline from L1 to L5 area, which is contraindication for administration of spinal anaesthesia via standard median and paramedian approach . Taylor’s approach for administration of the same was tried and proved successful, thus saving the patient from receiving general anaesthesia .

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