Southern African Journal of Anaesthesia and Analgesia - latest Issue
Volumes & issues
Volume 23, Issue 1, 2017
Source: Southern African Journal of Anaesthesia and Analgesia 23, pp 1 –5 (2017) http://dx.doi.org/10.1080/22201181.2017.1286064More Less
Background: A perioperative death can be a devastating event for which anaesthetists’ training does not necessarily prepare them. Previous authors have documented a range of reactions to this event. This study set out to explore individual personal and professional reactions amongst a group of senior anaesthetic trainees.
Methods: A qualitative methodology was employed and purposive sampling used to select participants. Ten registrars in their fourth year of specialist training in the University of KwaZulu-Natal Department of Anaesthesia were interviewed. Transcripts of the interviews were thematically analysed.
Results: Themes expressed by participants fell into three broad categories: professional role (responsibility, coping, functioning after a death), relationships with patients and families (nature of the case, emotional distress, bearing bad news), and personal impact (guilt, physical sequelae, support, desensitisation).
Conclusion: Participants’ perceptions supported the notion of potential second (anaesthetist) and third (subsequent patient) victims after a perioperative death. These underscore the importance of the expressed need for debriefing and an interval before resuming duty. The phenomenon of desensitisation was expressed as a spectrum between being dissociated from the event and disconnected from the people involved, raising the possibility of perioperative death as a contributing factor to burnout. This study hopes to improve awareness of the potential consequences of perioperative death and the need for these consequences to be addressed.
Source: Southern African Journal of Anaesthesia and Analgesia 23, pp 6 –10 (2017) http://dx.doi.org/10.1080/22201181.2016.1251052More Less
Background: Obstructive sleep apnoea (OSA) in pregnancy is associated with an increased morbidity and mortality to both mother and foetus. In the South African setting the proportion of pregnant females suffering from OSA has not been well studied; nor has the association with pre-eclampsia. This study aimed to determine the prevalence of OSA in females before 35 weeks gestation using the STOP-BANG questionnaire and to determine the association with pre-eclampsia in a local South African setting.
Methods: A cross-sectional analytical study including 234 patients was conveniently sampled from Kalafong Hospital’s antenatal ward, clinic and labour ward. Participants were of more than 20 weeks and less than 35 weeks gestation. All participants were interviewed with a modified STOP-BANG questionnaire. Patients were consecutively enrolled without prior knowledge of the presence of pre-eclampsia. At Kalafong hospital all pregnant patients are routinely screened and investigated for pre-eclampsia according to standard criteria.
Results: The median gestational age in this sample was 28 weeks; 80.3% (CI 74.62–85.2%) of pregnant females had a low risk for OSA, 15.4% (CI 11.01–20.65%) had an intermediate risk and 3% (CI 6.47–14.58%) had a high risk for OSA. A modified STOP-BANG questionnaire had a sensitivity of 62.5% and a specificity of 82.1% for pre-eclampsia when a score of 3 and more was scored. Females at high risk of OSA had an OR of 8.4 (CI 2.88–24.6) for having pre-eclampsia.
Conclusions: The authors report 15.4% of the study’s pregnant population to be at intermediate risk and 3% at high risk of OSA. The association between the hypertensive disorders and OSA must be considered and screening implementation considered.
Patients’ knowledge and perception of anaesthesia and the anaesthetist at a tertiary health care facility in GhanaSource: Southern African Journal of Anaesthesia and Analgesia 23, pp 11 –16 (2017) http://dx.doi.org/10.1080/22201181.2017.1281518More Less
Background: Anaesthesia has always been misconstrued as a ‘behind the scenes’ specialty. Despite advancements in anaesthesia, there is inadequate public knowledge regarding the specialty, the scope of the functions of anaesthetists, and the pivotal role anaesthetists play in the healthcare delivery system. This study therefore assessed the knowledge and perception of anaesthesia and the role of anaesthetists among patients in a tertiary healthcare facility.
Methods: A cross-sectional study was conducted over 3 months in 2015 among 279 patients accessing services at the preanaesthetic clinic of the Korle-Bu Teaching Hospital. Patients were interviewed using a structured questionnaire assessing sociodemographic characteristics, their knowledge and perceptions about anaesthesia, and the role of anaesthetists.
Results: The majority of patients (62.4%) had heard about anaesthesia. Most (85%) knew that specially trained doctors or nurses were responsible for the delivery of anaesthesia. Nearly half the patients indicated anaesthesia was all about ‘putting people to sleep and waking them up’. Less than 15% of patients had knowledge of the role of anaesthetists outside the confines of the operating theatre suites.
Conclusion: A considerable number of patients had heard about anaesthesia and knew the people responsible for the delivery of anaesthesia. The perception of most patients is that anaesthesia is all about ‘putting patients to sleep and waking them up’. There was poor knowledge of patients regarding the role of anaesthetists beyond the confines of the operating theatre.
Anaesthetic management for ventriculoperitoneal shunt insertion in an infant with Dandy–Walker SyndromeSource: Southern African Journal of Anaesthesia and Analgesia 23, pp 17 –20 (2017) http://dx.doi.org/10.1080/22201181.2017.1283741More LessDandy–Walker Syndrome (DWS) is a rare congenital brain anomaly affecting the cerebellum and the fourth ventricle. The chief components of the syndrome include cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis. These abnormalities are typically associated with hydrocephalus. Patients often present in infancy for cerebrospinal fluid shunt procedures. Anaesthetic concerns include those related to other frequently associated congenital abnormalities. Airway management requires particular attention. The limited literature on this subject suggests that these patients require postoperative intensive care admission. This is not always possible in the resource-limited environment. This case report describes the successful anaesthetic management of an infant with Dandy–Walker Syndrome without postoperative intensive care admission.
Dilated cardiomyopathy in a child with abdominal neuroblastoma and normal serum catecholamine levels : anaesthetic management and review of literatureSource: Southern African Journal of Anaesthesia and Analgesia 23, pp 21 –23 (2017) http://dx.doi.org/10.1080/22201181.2017.1283742More LessNeuroblastoma is the most common extracranial solid tumour of childhood. Dilated cardiomyopathy as an initial presentation of neuroblastoma is rare. We report the case of a three-year-old child with giant abdominal neuroblastoma encasing the abdominal aorta who presented with dilated cardiomyopathy in heart failure without hypertension or elevated serum catecholamine levels. The probable pathophysiological mechanism for such an occurrence and review of similar cases along with perioperative management is presented.
Source: Southern African Journal of Anaesthesia and Analgesia 23, pp 24 –25 (2017) http://dx.doi.org/10.1080/22201181.2017.1281519More LessSupraclavicular brachial plexus block is a popular procedure for surgeries of the upper limb. Although separate instances of Horner’s syndrome and recurrent laryngeal nerve palsies have been previously reported with this approach and one combined incidence has been reported following an interscalene approach, a combined incidence following a supraclavicular approach has not been previously documented. A 21-year-old male patient, who presented with a laceration and suspected vascular injury over his right palm, had a supraclavicular block placed with a tourniquet inflated to minimise bleeding. He developed Horner’s syndrome and hoarseness of voice in the immediate postoperative period. There was complete resolution of symptoms after eight hours. The presence of an external force in the form of a tourniquet may influence the spread of the local anaesthetic due to compressive effects on the axillary fascial sheath. However, further studies are required to prove this.