Adaptation of the rubber bandage for safe use as tourniquet

The safety of the pneumatic tourniquet lies in the fact that the pressure generated beneath it can be determined and is reproducible unlike the rubber bandage tourniquet with subjective and irreproducible tissue pressure. Application of the rubber bandage over the cuff of an aneroid sphygmomanometer enabled direct determination of tourniquet pressure in sixty-four patients with associated low rate of tourniquet related complications. Seventy-eight limbs, in sixty-four patients, were operated using this composite tourniquet and evaluation after surgery as well as out-patients' clinic follow-up for tourniquet complications revealed complications in six out of eight patients in whom the tourniquet time exceeded 120minutes. In conclusion, the inclusion of an aneroid sphygmomanometer to record tourniquet pressure enhanced the safety of the rubber bandage tourniquet in our study and offers an alternative to the pneumatic type in the attainment of bloodless field where the latter is unavailable

Necrology

No Abstract

A snap-shot survey of spinal anaesthesia for caesarean section: The Nigeria experience

Background and Objective: In the last several decades, there has been a shift from general anaesthesia to regional anaesthesia for caesarean section worldwide. This rise notwithstanding, it is pertinent to determine the factors associated with the wholesome application of spinal anaesthesia for caesarean section in Nigeria. Method: A snap-shot survey was conducted in some selected hospitals in Nigeria. The survey determined the sociodemographic characteristics of patients, indication for surgery, grade of anaesthesia provider, contraindication to spinal anaesthesia and any other factor that may be noticed in the selected hospital (lack of appropriate drugs, spinal needles, absence of relevant expertise etc). Result: A total of 99 patients were attended to in four of the selected six hospitals within the study period. Thirty six (36.4%) women were nulliparous and maternal factors (82.8%) were the leading indications for caesarean section. Consultant anaesthetists (23.2%) and Senior Registrars (35.4%) were the leading anaesthesia providers for the caesarean sections. Eighty five (85.9%) patients received spinal anaesthesia and 14 (14.1%) had general anaesthesia for the Caesarean section. Fetal indication for Caesarean section was associated with a 3-fold chance of using general anaesthesia for the surgery (p = 0.0138, RR = 3.6, 95%CI 1.44 – 9.1). Conclusion: Over 85% of Caesarean sections in some hospitals in Nigeria were conducted under spinal anaesthesia. Fetal indications for caesarean section provoked over a 3-fold increase in general anaesthesia for caesarean section. The use of general anaesthesia for caesarean delivery was due to fetal indications for surgery, antepartum haemorrhage and failed spinal anaesthesia

Adaptation of the rubber bandage for safe use as tourniquet

The safety of the pneumatic tourniquet lies in the fact that the pressure generated beneath it can be determined and is reproducible unlike the rubber bandage tourniquet with subjective and irreproducible tissue pressure. Application of the rubber bandage over the cuff of an aneroid sphygmomanometer enabled direct determination of tourniquet pressure in sixty-four patients with associated low rate of tourniquet related complications. Seventy-eight limbs, in sixty-four patients, were operated using this composite tourniquet and evaluation after surgery as well as out-patients' clinic follow-up for tourniquet complications revealed complications in six out of eight patients in whom the tourniquet time exceeded 120minutes. In conclusion, the inclusion of an aneroid sphygmomanometer to record tourniquet pressure enhanced the safety of the rubber bandage tourniquet in our study and offers an alternative to the pneumatic type in the attainment of bloodless field where the latter is unavailable