Southern African Journal of Anaesthesia and Analgesia - latest Issue
Volume 22, Issue 6, 2016
The role of dexamethasone in peripheral and neuraxial nerve blocks for the management of acute pain : reviewSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 163 –169 (2016) http://dx.doi.org/10.1080/22201181.2016.1251063More Less
Dexamethasone has an emerging role as an additive in regional anaesthesia for the management of acute pain. However, outcomes in terms of improvement and prolongation of analgesia, as well as the methods of administration and potential adverse effects, have yet to be clarified. This semi-structured review examines the current literature available with regard to supplemental dexamethasone in regional and neuraxial anaesthesia.
Comparison of lung ultrasound with transpulmonary thermodilution in assessing extra-vascular lung water : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 170 –174 (2016) http://dx.doi.org/10.1080/22201181.2016.1216663More Less
Background: Increased extra-vascular lung water (EVLW) is common in critical care and correlates with the severity of acute lung injury, length of intensive care unit stay and mortality. Lung ultrasound (LUS) can assess EVLW by determining the amount of 'B-lines': artefacts signifying alveolar-interstitial oedema. This study's aim was to determine whether EVLW estimation with the help of LUS correlates with the more accurate PiCCO2® cardiac output system utilising transpulmonary thermodilution.
Methods: This prospective observational study was undertaken at Universitas Academic Hospital, Bloemfontein. Patients were scanned according to a fixed protocol, followed by transpulmonary thermodilution. The cumulative B-line count was compared with the EVLW index generated by the PiCCO2® system.
Results: Four males and six females were enrolled. The mean EVLW index was 9.1 ml/kg/m2 (standard deviation 1.45), and the median cumulative B-line count was 14 (interquartile range 6-25). A positive, but not statistically significant, correlation was found (r = 0.40, p = 0.25) between the B-line count and EVLW index.
Conclusion: This study investigated a possible correlation between LUS interpretation and transpulmonary thermodilution in assessing EVLW. Results seem promising, but the small sample could indicate only that LUS might be of use for the assessment of EVLW. Further studies are needed.
Microbial contamination and labelling of self-prepared, multi-dose phenylephrine solutions used at a teaching hospital : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 175 –179 (2016) http://dx.doi.org/10.1080/22201181.2016.1251062More Less
Background: Common practice at Chris Hani Baragwanath Academic Hospital (CHBAH) is to use boluses from a self-prepared, multi-dose phenylephrine solution to treat spinal anaesthesia-induced hypotension in patients undergoing a Caesarean section. The aims of this study were to determine if there was microbial contamination of the solutions and to evaluate whether healthcare workers adhered to appropriate labelling and aspiration practices.
Methods: A sample was collected and the labelling data were documented from the solutions found in the two obstetric theatres at CHBAH over a three-month period. The samples were sent to a laboratory for microbial investigation.
Results: Microbial contamination was identified in 6.4% of samples collected. The name of the solution was indicated on 100% ofthe containers and the concentration of the solution was on 96.4%. The date the solution was prepared was indicated on 74.6% of containers and the time the solution was prepared was on 57.3%. Only 8.2% of healthcare workers who prepared the solution confirmed it by placing a signature on the container. Labelling data were written directly on 100% of the containers and a spikedevice was used in 64.5% of the containers.
Conclusions: This study demonstrated microbial contamination of the solution and may indicate an infection hazard. Healthcare workers also did not adhere to appropriate labelling and aspiration practices. This is important for all patients from a patient safety perspective and the need to improve quality of care.
Dexmedetomidine in premedication to attenuate the acute hyperdynamic response to ECT : a randomised, double-blind, controlled study : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 180 –184 (2016) http://dx.doi.org/10.1080/22201181.2016.1244316More Less
Background: The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic and recovery parameters. The aim of the study was to assess the effects of dexmedetomidine premedication on haemodynamic, seizure duration, recovery characteristics and agitation following ECT.
Material and method: 60 patients aged 18-60 years scheduled for ECT were enrolled in the study. Dexmedetomidine (0.5 µg/kg) diluted to 10 ml with 0.9% saline or 10 ml 0.9% saline (control) were infused intravenously over 10 min before induction of anaesthesia with thiopentone. Motor seizure duration, heart rate, mean arterial blood pressure, time to spontaneous respiration, obeying verbal commands and post-ECT agitation score were recorded. Statistical analysis was carried out using MS Excel and Primer of Biostatistics.
Results: Post-ECT rise in mean arterial blood pressure (MAP) and heart rate (HR) in the dexmedetomidine group was significantly less (p < 0.001) compared with the control group at 1, 3, and 5 mins. Motor seizure duration was comparable in both groups. Mean agitation score was significantly low in the dexmedetomidine group (1.5 ± 0.50) compared with the control group (1.93 ± 0.52).
Conclusion: A dexmedetomidine dose of 0.5 µg/kg IV administered over 10 min before the induction of anaesthesia may be useful in preventing the acute hyperdynamic responses to ECT and post-ECT agitation without altering the duration of seizure activity and recovery time.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 185 –189 (2016) http://dx.doi.org/10.1080/22201181.2016.1237066More Less
Background: The sedation of children in the medical and allied professional fields has been a topic of controversy and debate internationally. Limited information is available on the use of sedation for auditory electrophysiology testing in South Africa.
Objectives: The aim of this study was to determine how sedation information is recorded in electrophysiology audiology reports where diagnostic electrophysiology testing was used, and to obtain baseline information on sedation procedures and medications used during diagnostic electrophysiology testing.
Methods: Audiology reports of 169 children undergoing auditory electrophysiology testing were reviewed for sedation information.
Conclusion: Sedation data is not clearly documented and the use of medical or anaesthetist monitoring during sedation is not routinely included in reports. Sedation medication is varied and does not always include medications listed as safe for use with the paediatric population. This places doubt on procedures and protocols as well as the safety mechanisms in place for auditory diagnostic testing of children in South Africa.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 190 –194 (2016) http://dx.doi.org/10.1080/22201181.2016.1244317More Less
Background: Standardised handoff protocols have become necessary patient safety tools in the perioperative venue. In this study, the authors took a validated standardised perioperative handoff protocol and implemented it into their institution to improve the perioperative handoff communications from the cardiac operating theatres to the ICU.
Methods: This was a prospective, unblinded cross-sectional study. During a 6-week pre-intervention phase, 30 perioperative handoffs were observed and data were collected. Then a new structured hand-off protocol was implemented for one month,which focused on training all participating healthcare providers. This was followed by a post-intervention audit consisting of 30 operating room theatre-to-ICU handoffs using the same methodology as the pre-intervention period.
Results: Overall attendance significantly increased from 20 to 86.7%. The percentage of parallel conversations decreased from 100% pre-intervention to 60% post-intervention (p < 0.0001). The mean number of interruptions of the anaesthesiology handoff report decreased from 3.37 to 0.77 (p < 0.0001) and of the surgery report from 1.84 to 0.27 (p < 0.0001). Information-sharing scores improved among all handoff attendees with the Overall Information Sharing Score (OISS) increasing from 51.47 to 88.24% (p < 0.0001).
Conclusions: The implementation of a perioperative handoff protocol resulted in a drastic improvement in attendance, decrease in the number of interruptions, and improved information sharing. Future research should focus on patient-specific outcomes.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 195 –197 (2016) http://dx.doi.org/10.1080/22201181.2016.1244315More Less
Aspiration of a broken tracheostomy tube fragment is a relatively rare complication with the potential to result in serious airway complications. Case reports of tracheal fragment aspiration have been documented infrequently in the past, with the earliest documented case in 1960. What follows is a case report of an 80-year-old male patient whose tracheostomy was replaced a year ago. While at home, the tracheostomy broke and the fragment lodged in his right main bronchus. He was unable to recall when the tracheostomy broke and only presented to the ear, nose and throat clinic for his annual follow-up appointment. The discussion highlights similar reported cases and emphasises some concerns regarding the long-term use of tracheostomies.
An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery : case reportSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 198 –200 (2016) http://dx.doi.org/10.1080/22201181.2016.1223925More Less
Venous air embolism (VAE) is the entrainment of air either from a surgical site or from the environment into the venous orarterial vasculature, which can subsequently cause systemic effects. Many cases are subclinical but large volume and high rate of accumulation of air entrainment are potentially life-threatening. The relative risk is high in sitting position craniotomy and posterior fossa surgery but low in burr hole neurosurgery such as in deep brain stimulation (DBS) surgery. The authors report their experience of managing an unusual case of repeated VAE during both sides of burr-hole and electrode insertion in awake bilateral DBS surgery.