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

Intensive Care Unit admissions and outcome in a university teaching hospital: a 6-year review

Background: Critically ill patients are a significant source of morbidity and mortality in hospitals. In resource-challenged economies like Nigeria, the number of deaths due to conditions requiring critical care is alarming. As in most other tertiary hospitals, critically ill patients are usually admitted into the Intensive Care Unit (ICU) of Nnamdi Azikiwe University Teaching Hospital (NAUTH).Objectives: We sought to find out the pattern of admissions and the spectrum of disease conditions of patients and also, to assess the outcome of the cases admitted into the Intensive Care Unit (ICU).Methodology: We undertook a six-year retrospective review of all admissions into the multi-disciplinary six-bed ICU of NAUTH Nnewi, August 2007 to July 2013. Data collected were analyzed using the Statistical Packages for the Social Sciences (SPSS) version 24.0, and presented in relevant charts and tables.Results: During the period, the total number of hospital admissions was 36,386, out of which there were 933 (3%) ICU admissions but, only 521 (56%) case notes were available for analysis. There were 346 males and 175 females with a male:female ratio of 2:1. Trauma admissions were mostly emergencies 42.7%, with a mean ICU length of stay of 37.6days. Survivors had a statistically significant longer length of stay (LOS) 103.8 days than non-survivors 51.7days (p = 0.0001). Mortality rate of trauma patients was 9.7%, and road traffic accidents were responsible for most deaths 32.2%.Conclusion: Intensive care admissions cover a broad spectrum of diseases and specialties. Trauma, especially, due to road traffic accidents and burns, is a very important cause of morbidity and mortality in ICU. Management strategies should include early admission and active life support measures. There is need to improve trauma and hospital care of these patients in order to improve their outcome

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