Sublingual misoprostol allergy: a case report

Misoprostol is being used in obstetrics especially during the first and third trimesters of pregnancy. It has become a good drug for prevention and treatment of postpartum haemorrhage. It is considered a safe drug with few side effects. However, we present a report of a rare severe hypersensitivity reaction in a patient who had sublingual misoprostol for prevention of postpartum haemorrhage.Keywords: Misoprostol; Sublingual, Postpartum Haemorrhage; Hypersensitivit

Anaesthetic Agent Usage and Wastage during Caesarean Deliveries Done with Spinal Anaesthesia in a Labour Ward Theatre: A Concern for the Financial Implication

Background: Local anaesthesia usage and wastage are common in the operation rooms. The wastage is often not given due considerations. Budgetary allocation for drugs is an identifiable area for cost-cutting and savings. Hence, the need to minimize wastageObjectives: To assess and estimate the amount of local anaesthesia usage and wastage in the labour ward theatre. Also, to analyze the financial implications of the wastages and suggest appropriate steps to reduce the wastages.Methodology: A prospective observational study conducted in the labour ward theatre of a tertiary care hospital. The amount of local anaesthesia administered to the patient during spinal anaesthesia prior to caesarean section was considered the dose used. The wastage was considered as the amount of local anaesthetic agents left unutilized in the syringes, ampules or vials after completion of each caesarean delivery. An estimation of the cost of wasted local anaesthetic agents was made.Result: The local anaesthetic agents being used in significant quantities were hyperbaric bupivacaine, plain lidocaine and lidocaine with adrenaline. The wastage was found more during the use of hyperbaric bupivacaine as the cost of its wastage formed the bulk (N75,000.00/ $210.10) of the estimated total cost of wasted local anaesthetic agents during the study period which was N88, 100.00 ($246.77).Conclusion: There were appropriate uses of the local anaesthesia with respect to the choice and doses for caesarean deliveries but there were wastages often ignored as infinitesimal. In the long run, the wastages become significant and the financial implication scale up the burden of health bills. Effective waste reduction strategies have input in the overall reduction of financial burden associated with health care. Emphasis should be t ailored towards awareness of these wastages among resident doctors and their prudent use of local anaesthesia. Key words: Cost, Lignocaine, Waste, Theatre