Summary This paper is intended to provide an overview of the Colonial War Memorial Hospital’s response to the Covid-19 pandemic in Fiji. It presents the management and organizational systems and processes developed to ensure effective and timely management of potential COVID-19 cases presenting within CWM. It presents the theoretical model developed to support the Outbreak Management Team in determination of appropriate responses that required to be modified in the light of new knowledge and experience. The paper describes actions taken to ensure the preparedness of CWM; the development of process algorithms required to ensure consistency across the organization; the establishment of an Emergency Management Centre that provides 24 hour oversight of the CWM Covid-19 response; arrangements for quarantine of staff etc. It will also present the Covid-19 Preparedness Assessment Tool that was developed in CWM and subsequently used to assess the state of preparedness at other facilities nationally.

Introduction: Perioperative pain is a major problem for patients undergoing surgery. Inadequate pain relief can lead to complications like pneumonia, extended hospital stay, re-admissions and patient dissatisfaction. The aim of this research was to determine adequacy of perioperative pain management on immediate post-operative analgesia for elective Intra-abdominal procedures done under general anaesthesia. Method: This is a retrospective study which involved auditing inpatient folders from the 1st of January to 31st of December, 2015.The inclusion criteria were those between the ages of 18 to 60years who had Elective Intra-abdominalprocedure done under general anesthesia.Each folder was audited for perioperative pain management from surgical and anaesthetic charts and data were entered into a proforma list. EpiInfo 3.1 software and Microsoft Excel Spreadsheetwere used for analysis of the extracted data. Results: 159 records met the inclusion criteria but only 127 folders were recovered. 28% of patients recorded pain in the immediate postoperative period. There were more females than males and Total Abdominal Hysterectomies was the most common procedure. The age between 31 to 40 years, reported the most pain. Open cholecystectomy’s procedures recorded the most pain complaints and hernia repairs had the least. Verbal response was the highest pain indicator used and 11% of patients who indicated having some pain went from PARU untreated. There were no records of usage of pain scales in any folder retrieved. Discussion: Pain recording in the recovery unit was heavily dependent on the recovery nurse and the patient. The incidence of immediate postoperative pain from this study group was lower when compared to other studies. This could be due to a lack of documentation or a reflection on how well perioperative pain treatment has been done in Lautoka. Conclusion Overall management of perioperative pain still needs improvement. The anaesthetic team should seriously look at this problem as Anaesthetists are still unaware of their patients pain. It is highly recommend that the formulation of an Acute Pain Management Protocol for Fiji to ensure that Pain be included as the 5th vital sign.

Introduction: Hypothermia and shivering have been known to occur with spinal anaesthesia intra-operatively. We carried out the present study to assess the incidence and associated factors of hypothermia and shivering amongst women undergoing Caesarean section under spinal anaesthesia. Methods: A cross-sectional study was carried out amongst 300 pregnant women requiring spinal anaesthesia for Caesarean section with American Society of Anaesthesiology category I/II. The following details were captured for each eligible patient: demographics, foyer temperature, time spent in the foyer, patients calf (leg) temperature and pre-anaesthesia patient temperature, intra-operative axillary temperatures at 10, 30, 60 and 90 minutes after spinal anaesthesia depending on the duration of surgery, time spent in the operating theatre and the room temperature was documented. Any active or passive warming provided to the patients before and after spinal blockade was also documented. Other information collected include the details of drugs used in the spinal blockade, amount of IV fluids given, amount of ephedrine used, and the details of any blood products required intra-operatively. Results: Out of the total 300 study participants, 63 (21%) patients received spinal anaesthesia for elective caesarean section while 237 (79%) women had emergency surgery. A total of 233/300 (77.7%) had perioperative hypothermia of which only 50/233 (21.5%) had shivering. Only 140 (46.7%) women were warmed during their caesarean delivery. Seventy two participants out of the total 135 (53.3%) who were warmed intra-operatively developed hypothermia while 116/156 (74.4%) of those who did not undergo any warming intra-operatively developed the same (P=0.0002). Average pre-anaesthesia temperature of patients who became hypothermic was lower than that of patients who maintained temperatures more than 36⁰C after spinal block (36.5 ±0.5 vs. 37.0 ±0.5; P=0.0001). Postoperative hypothermia was less common in those patient who were warmed inside OT than those who were not warmed (53.3% vs. 74.4%; P= 0.0002). There was a more significant difference in hypothermia between the patients who were actively warmed with a convection warmer and those who were not (26/75, 34.7% vs. 43/50, 86%; P= 0.0001). Only 21.6% of the hypothermic patients had shivering while 49.3% of the normothermic patients were noted to have shivering after spinal anaesthesia (P=0.0001). Conclusion Perioperative hypothermia is a major problem in women who have caesarean section under spinal anaesthesia at CWMH. Efforts directed toward routine temperature monitoring and aggressive maintenance of intraoperative normothermia in these women will very likely improve clinical outcomes and patient satisfaction.