| dc.description.abstract | A prospective study was carried out during the period of six
months from 14th March,1985 to 13th September 1985 on three
hundred and nine patients who were given general ~naesthetics
at the Kenyatta National Hospital,with the aim of determining
the cost of anaesthesia per hour, per patient.
Kenyatta National Hospital, the largest hospital in the
country,is a referral, as well as a teaching hospital ~ith a
bed capacity of 1866 beds. The oldest part of 'the hospital,
originally called the NalLve Civil Hospital, was built in
1901 with an initial bed capacity of 45(1). In 1951 the old
theatre block and Ismail Rahimtula Wing were completed and
opened. At this time the hospital had six operating theatres.
Four clinical officers and one qualified consultant anaesthestist
were responsible for general anaesthesia, as well as
running the polio unit at the Infectious Diseases Hospital
(IDH). With the building of the new tower block the number
of operating theatres has increased to 20.
Considering the history of anaesthesia over the last thirty
years, general anaesthesia has moved from a predominant
diethyl-ether with or without muscle relaxants followed by
introduction of trichlorethylene in the sixties. At present
halothane and enflurane have been introduced in the general
practice of anaesthesia.
With the increasing number of operations requiring general
anaesthetics, about 10,000-15,000 each year, the cost of
anaesthesia has tremedously increased.
The author embarked on this study with the aim of determrning
the cost of general anaesthesia in this hospital and to
make suggestions on how to reduce the cost and at the same
time make improvements on the present standards.
Considering the drugs,intravenous fluids, blood, equipment,
salaries of staff, cost of maintaining anaesthetic machines
involved in the period of study and other essential services
like telephone, electricity and water, the cost of ana8sthesia
per hour was calculated. This was three hundred and five
shillings and ninety-five cents (Ksh.305.95) or fourteen
point one two pounds sterling (£14.12).
Finally suggestions have been made with the aim of improving
the safety of patients in operating theatres and at the same
time reducing the cost of anaesthesia while maintaining the
efficiency. These include:-
1) Training of our own personnel for service and
repair of anaesthetic machines and vaporisers.
2) To train anaesthetic nurses for proper handling
of anaesthetic machines and maintenance.
3) Encourage the wide usage of local analgesics
4) Reappraise the use of ether and trichlorethylene
with or without muscle relaxants.
5) Increase the salaries of the health workers in
order to boost the morale and at the same time
stop the brain drain from government to private
hospitals.
6) Charge a minimal fee to all patients coming for
surgery.
7) Set up foundations to which well-wishers cat
send their money for the improvement of health
services in this hospital.
8) Encourage the use of closed system with carbon
dioxide absorber.
9) Stop grouping and cross-matching of blood for
routine surgery where not more than 20% of
blood loss is anticipated in adults.
10) Avoid unnecessary investigations before surgery
particularly routine chest x-ray, and electrocardiographs
(ECG).
11) Make sure that oxygen, nitrous oxide and volatile
anaesthetic agents are switched off after every
operation.
12) Improve the monitoring and resuscitation facilities
in the recovery ward and~eproy more qualified
nursing staff there so that the ratio of nurse
to patient is 1:1. | en_US |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
