scholarly journals Difficult and Failed Tracheal Intubation in Obstetrics: A Seven-year Review in a Saudi Maternity Hospital

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bassey E. Edem ◽  
Khaled M.F. Elbeltagy
Keyword(s):  
Caesarean Section ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Medical Records ◽  
Maternity Hospital ◽  
Failed Intubation ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
The Mean ◽  
Surgery Outcomes

Background: Airway difficulty is a major contributor to mortality and morbidity during caesarean section (CS) under general anaesthesia. Though general anaesthesia is safe, the changes associated with pregnancy make securing airway more difficult. The purpose of this study was to investigate the pattern and factors associated with airway difficulty in the parturient in the region. Methods: This was a retrospective, descriptive study of parturients who suffered airway difficulty during caesarean section under general anaesthesia over seven-year period. Their medical records were reviewed and data collected included total CS done under general anaesthesia, age, weight, nature of airway difficulty, coexisting diseases, and timing of surgery, outcomes and Apgar scores. Data was analysed using SPSS version 23 for Windows®. Results: General anaesthesia was used in 51.3% of 10,275 CS with 42 documented as “difficult airway” giving 0.8% incidence and incidence ratio of 1:125. Failed intubation was recorded in 58% while difficult intubation was 42% of those with difficult airway. Among these, the CS was in 55% of cases “emergent”. The mean age was 33.32±5.96 years. The weight ranged from 60 to 163kg. Over 58% weighed more than 90kg. In 50% of cases, the airway was rescued with LMA and in 50%, reintubation succeeded. Outcome was good for mother and fetus in all cases. Conclusion: Obstetric airway difficulty remains a valid concern. Effort should be made to use regional anaesthesia to reduce the risk. High awareness and preparation during obstetric general anaesthesia are recommended.

Anaesthesia for Caesarean section: General anaesthesia

2020 ◽  
pp. 325-354
Author(s):  
Stephen Morris ◽  
Rhidian Jones
Keyword(s):  
Caesarean Section ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Current Evidence ◽  
Failed Intubation ◽  
Airway Assessment ◽  
Obstetric Anaesthetist ◽  
Obstetric Surgery

There will always be the need to give GA to pregnant womrn, and it is paramount that the obstetric anaesthetist is well prepared to perform a GA quickly and safely. This chapter reviews the current evidence, drugs, and conduct of GA for CS, with emphasis on exemplary communication within the delivery suite team and meticulous airway assessment to identify features suggestive of additional anticipated difficulty. A helpful ‘pre-induction’ checklist illustrates the need for team-based communication in preparation and planning to mitigate against complications following induction. The latest guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society on the management of failed intubation and ventilation have been included. The chapter also includes up-to-date information on accidental awareness in obstetric surgery from NAP4, and the steps to avoid and manage aspiration if it occurs.

scholarly journals The utility of the records medical: factors associated with the medication errors in chronic disease

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Hellen Lilliane da Cruz ◽  
Flávia Karla da Cruz Mota ◽  
Lorena Ulhôa Araújo ◽  
Emerson Cotta Bodevan ◽  
Sérgio Ricardo Stuckert Seixas ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Medication Errors ◽  
Medical Records ◽  
Secondary Data ◽  
Diabetic Patients ◽  
Medication History ◽  
Factors Associated ◽  
Compromise Patient Safety ◽  
History Of ◽  
The Mean

ABSTRACT Objective: This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. Methods: retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. Results: The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. Conclusion: Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families.

scholarly journals Gambaran kadar hemoglobin pasien pra dan pasca operasi seksio sesarea yang tidak mendapat transfusi darah

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Herry Y. Tia ◽  
Lucky T. Kumaat ◽  
Diana Ch. Lalenoh
Keyword(s):  
Caesarean Section ◽  
Blood Transfusion ◽  
Medical Records ◽  
Mean Value ◽  
Age Group ◽  
Mean Values ◽  
Life Threatening ◽  
The Mean ◽  
Using Data ◽  
Length Of Hospitalization

Abstract: The occurence of increased or decreased levels of hemoglobin of post-caesarean patients depends on the intake of nutrients during pregnancy, bleeding, and anemia. In case of massive and life-threatening bleeding during the caesarean section, blood transfusion has to be administered to revive the patient in critical condition. This study was aimed to obtain the patients’ levels of hemoglobin in either pre- and post-operative caesarean section without blood transfusion. This was a retrospective descriptive study using data of medical records at the Installation of Medical Record Department of Prof. Dr. R. D. Kandou Hospital Manado from September 2015 to August 2016. There were 32 patients in this study. The result showed that the mean values of pre-operative Hb was 12.4 g/dL and of post-operative Hb was 11.5 g/dL with a difference of 0.9 g/dL. Decreased levels of hemoglobin occured in 28 patients. It is discerned that the mean value of pre-operative Hb was 12.4 g/dL while of post-operative Hb was 11.3 g/dL with a difference of 1.1 g/dL. Furthermore, increased levels of hemoglobin occured in 4 patients, showing that the mean value of pre-operative Hb was 12.1 g/dLwhereas of post-operative Hb was 12.5 g/dL with a difference of 0.4 g/dL. Based on the characteristics of pregnant women, 23 cases (71.9%), were in the age group of 20-35 years; 18 cases (56.3%) of hemorrhage of 500-1000 ml; and 25 cases (78.1%) of 6-10 days length of hospitalization. Conclusion: In this study, there was increased as well as decreased hemoglobin levels in caesarean patients who were not administered blood transfusion during surgery.Keywords: hemoglobin, caesarean section, blood transfusion Abstrak: Terjadinya peningkatan maupun penurunan kadar hemoglobin pada operasi seksio sesarea tergantung pada asupan zat-zat nutrisi saat kehamilan, perdarahan, dan anemia. Jika terjadi perdarahan hebat selama operasi seksio sesarea berlangsung yang mengakibatkan penurunan kadar hemoglobin mendekati batasan untuk dilakukan transfusi darah, maka transfusi darah diberikan untuk menolong pasien pada kondisi kritis. Penelitian ini bertujuan untuk mengetahui gambaran kadar hemoglobin pasien pra dan pasca operasi seksio sesarea yang tidak mendapat transfusi darah. Jenis penelitian ialah deskriptif retrospektif menggunakan data rekam medik pasien seksio sesarea di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado periode September 2015 sampai Agustus 2016. Hasil penelitian memperlihatkan 32 pasien yang memenuhi kriteria inklusi. Nilai mean kadar Hb pra 12,4 g/dL dan kadar Hb pasca 11,5 g/dL dengan selisih 0,9 g/dL. Penurunan kadar hemoglobin terdapat pada 28 pasien dengan nilai mean kadar Hb pra 12,4 g/dL dan kadar Hb pasca 11,3 g/dL (selisih 1,1 g/dL). Peningkatan kadar hemoglobin terdapat pada 4 pasien dengan nilai mean kadar Hb pra 12,1 g/dL dan kadar Hb pasca 12,5 g/dL (selisih 0,4 g/dL). Karakteristik ibu hamil didapatkan terbanyak kelompok usia 20-35 tahun berjumlah 23 kasus (71,9%), perdarahan 500-1000 cc berjumlah 18 kasus (56,3%), dan lama rawat inap 6-10 hari berjumlah 25 kasus (78,1%). Simpulan: Pada pasien operasi seksio sesarea yang tidak mendapat transfusi darah dapat terjadi penurunan maupun peningkatan kadar hemoglobin. Kata kunci: hemoglobin, seksio sesarea, transfusi darah

scholarly journals Factors associated to the length of time on mechanical ventilation in the postoperative period of cardiac surgery

2014 ◽  
Vol 35 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Laura Fonseca ◽  
Fernando Nataniel Vieira ◽  
Karina De Oliveira Azzolin
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Medical Records ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Factors Associated ◽  
Continuous Sedation ◽  
The Mean

Our objective was to identify factors associated with the duration of mechanical ventilation (MV) postoperative to cardiac surgery and assess the association between duration of endotracheal intubation, length of stay in the Intensive Care Unit (ICU) and hospital. Longitudinal, retrospective study of medical records of 116 adults undergoing cardiac surgery from March 2012 to May 2013. The mean age was 57±14 years, predominantly male and coronary artery bypass grafting surgery (52.6%). The MV time was 15.25(7.66 to 23.68) hours. Associated with longer MV was the age (r=0.5,p<0.001), comorbidities (r=0.344,p<0.001), cardiopulmonary bypass time (r=0.244,p=0.008), duration of continuous sedation (r=0.607,p<0.001), sedative doses (r=0.4, p<0.001), time of vasoconstrictors and vasodilators (r=0.711, p< 0.001, r=0.368, p<0.001), drainage of the 1st time (r=0.201, p<0.031), presence of drains (r=0.445, p<0.001), postoperative complications (r=0.524, p< 0.001) and hospital stay. Our data confirms that both preoperative, transoperative and postoperative variables prolong the VM and therefore the hospital stay.

scholarly journals Magnitude and Predisposing Factors of Difficult Airway during Induction of General Anaesthesia

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Sileshi Abiy Workeneh ◽  
Amare Hailekiros Gebregzi ◽  
Zewditu Abdissa Denu
Keyword(s):  
Difficult Airway ◽  
General Anaesthesia ◽  
Difficult Intubation ◽  
Mouth Opening ◽  
Predisposing Factors ◽  
Difficult Laryngoscopy ◽  
Failed Intubation ◽  
Predisposing Factor ◽  
Specific Test ◽  
Cross Sectional

Objective. To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia. Methods. Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable. Result. The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening < 30 mm and Mallampati classes III and IV are the most sensitive tests and second high specific test next to combination of tests to predict difficult intubation and laryngoscopy (P value < 0.001). Unrestricted multiple attempt without alternative airway techniques resulted in exponential increase in desaturation episodes and further difficulty of airway management (P value < 0.001). Discussion and Conclusion. Mallampati classes III and IV, mouth opening ≤ 30 mm, jaw slide grade C, attempt > 3, and ineffective alternative technique have increased predictability value of difficult airway.

scholarly journals Development of Macular Holes after Rhegmatogenous Retinal Detachment Repair in Japanese Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Mamiko Shibata ◽  
Toshiyuki Oshitari ◽  
Fusae Kajita ◽  
Takayuki Baba ◽  
Eiju Sato ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Medical Records ◽  
Pars Plana Vitrectomy ◽  
Rhegmatogenous Retinal Detachment ◽  
Japanese Patients ◽  
Scleral Buckling ◽  
Factors Associated ◽  
Macular Holes ◽  
Pars Plana ◽  
The Mean

Purpose. To determine the factors associated with the development of a macular hole (MH) after successful rhegmatogenous retinal detachment (RRD) surgery.Methods. Of 1260 eyes that underwent surgery for RRD between April 2005 and March 2010 in our hospital, the medical records of 4 cases from our hospital and one case from another hospital that had undergone RRD surgery and later developed MH were reviewed. This is a retrospective study.Results. 837 eyes underwent pars plana vitrectomy (PPV) with or without scleral buckling (SB), and 423 eyes underwent SB. The four cases that developed MH had PPV alone and one case had PPV with SB. After including the results of three earlier reports, the mean interval for the MH to develop after SB alone was significantly shorter than after PPV alone or after PPV with SB.Conclusions. The SB procedures might accelerate the development of MH after RRD surgery.

scholarly journals Prevalence and Factors Associated With Caesarean Section in Rwanda: a Trend Analysis of Rwanda Demographic and Health Survey 2000 to 2019-20

2021 ◽  
Author(s):  
Peter M. Kibe ◽  
Grace Wambura Mbuthia ◽  
Duncan Shikuku ◽  
Catherine Akoth ◽  
James Oguta ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Health Survey ◽  
Mode Of Delivery ◽  
Medical Intervention ◽  
Health Facilities ◽  
Demographic And Health Survey ◽  
Sub Saharan Africa ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
The Past

Abstract Background: Caesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades.Methods: We used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019-20. All births in the preceding three years to the survey were assessed for the mode of delivery. The participants’ characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys.Results: The population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8–2.6) in 2000 to 15.6% (95% CI 13.9–16.5) in 2019-20. Despite increasing in all health facilities over time, there was an almost four-fold difference in the rate of CS between private (60.6%) and public health facilities (15.4%) in 2019-20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies. Conclusion: Over the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.

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