Rationalizing the cost of anaesthesia in Zimbabwe: a proposal

A CAJM letter to the journal editor.With the worsening economic situation in the country, it is only prudent to develop ‘survival strategies’ in order to keep afloat . Under such hardships human behaviour manifests the jungle rules of ‘survival of the fittest’. That is exactly what is happening particularly in the health sector, as I will highlight in this letter. The importation of medical drugs in Zimbabwe is controlled, but their resale is liberalized. The same anaesthetic drug may cost a hospital two to three times more by buying it from one company than from the other as shown below (Table I). This information is from an unpublished survey of the buying patterns of three hospitals and two public hospital pharmacies

Sinister unilateral tonsillar enlargement

A CAJM article.Tonsillectomy is one of those routine simple and safe procedures that can be delegated to juniors. The procedure is now even being done as day surgery. Tonsillectomy is commonly bilateral, but unilateral tonsillar enlargement can occur especially in the presence of an infective process. This case report, however, serves to highlight the hazards that could occur with tonsillectomy

The need for peri-operative supplemental oxygen

Molecular oxygen is a colourless and odourless gas which is essential to life. It accounts for 21% of the atmospheric air. Apart from its central role in oxidative phosphorylation to produce biological energy in the form of adenosine triphosphate (ATP), molecular oxygen is used as substrate by two other enzyme systems for the killing of bacteria in the phagocytes and for collagen synthesis by the fibroblast during wound healing.18 In the immediate post operative period atmospheric oxygen might become inadequate for a number of reasons including hypoventilation due to central pharmacological depression, diffusion hypoxia and increased metabolic rate due to shivering (the so called halothane shakes)

Sinister unilateral tonsillar enlargement

Tonsillectomy is one of those routine simple and safe procedures that can be delegated to juniors. The procedure is now even being done as day surgery. Tonsillectomy is commonly bilateral, but unilateral tonsillar enlargement can occur especially in the presence of an infective process. This case report, however, serves to highlight the hazards that could occur with tonsillectomy