Southern African Journal of Anaesthesia and Analgesia - latest Issue
Volume 22, Issue 4, 2016
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 101 –107 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1216664More Less
A research protocol is best viewed as a key to open the gates between the researcher and his/her research objectives. Each gate is defended by a gatekeeper whose role is to protect the resources and principles of a domain: the ethics committee protects participants and the underlying tenets of good practice, the postgraduate office protects institutional academic standards, the health authority protects provincial resources etc. The protocol must explicitly address the issues likely to be raised by these gatekeepers, demonstrating evidence of a clear understanding of the issues involved and that all components of the research plan have been addressed. The purpose of this paper is to add flesh to the skeleton provided in step six ('write the protocol') of the Biccard and Rodseth paper of 2014, orientated towards the first-time researcher working towards the MMed degree. Although occasional reference will be made to qualitative approaches, it is likely that the majority of these studies will be quantitative designs and these form the focus of this paper.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 108 –113 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1191214More Less
Background: Breast cancer is one of the most common cancer diagnoses in women. Surgical treatment is indicated in most patients. Postmastectomy pain syndrome (PMPS) is a debilitating neuropathic pain syndrome that develops after breast surgery. A review of the literature revealed no studies determining the prevalence of PMPS conducted in South Africa. The current anecdotal perception is that the prevalence of PMPS in the African population is low.
Objectives: The objectives of this study were to determine the prevalence of PMPS in adult female breast cancer patients following general anaesthesia without regional anaesthesia at the Chris Hani Baragwanath Academic Hospital (CHBAH), as well as the impact of various clinical and demographic variables on the prevalence of PMPS.
Methods: The research design was that of a cross-sectional descriptive study. The validated DN4 pain questionnaire was used in this study.
Results: The study included 92 patients. The prevalence of PMPS was found to be 38.04% (n = 35). The average duration that patients experienced neuropathic pain symptoms was 12.22 months (range 3 -39 months). The average age of patients interviewed was 58.54 years (range 30 -90 years). There was no statistically significant difference between age group and PMPS (p = 0.47). The study also showed that no statistically significant association existed between pain experienced and adjuvant therapy administered.
Conclusion: Even though surgical procedures are becoming less invasive, the prevalence of PMPS after treatment for breast cancer remains a clinically significant problem, comparable to international literature. This necessitates the development of more effective prevention and treatment strategies to improve patients' quality of life.
Author Catherine CurranSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 114 –120 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1191227More Less
Background: The manufacturers of Perfalgan®, a formulation of intravenous paracetamol, recommend that each ampoule be used once only. This is most likely due to concerns regarding degradation of paracetamol or other ingredients in the solution, and sterility issues. However, in South Africa, where the expense of this drug limits use, some centres use one ampoule for multiple paediatric cases over the course of 12-24 hours. No obvious clinical adverse effects have been reported.
Aim: The aim of this study was to examine this practice by assessing drug bioavailability as well as the in vitro stability of the paracetamol and excipients in Perfalgan® on exposure to air and specific stressors over time.
Methodology: High-performance liquid chromatography (HPCL-UV) was used to determine the concentration of paracetamol and the presence of degradation products in samples taken at set time intervals following exposure of Perfalgan® to air and stressors. Since changes in other components, or excipients, may impact efficacy, these were measured using nuclear magnetic resonance (1H NMR). The octanol:water partition coefficient was used as an indicator of bioavailability. Ultraviolet spectroscopy was used to calculate the penetration of paracetamol in Perfalgan® into the lipid layer.
Results: The paracetamol in Perfalgan® did not degrade on exposure to air over 24 hours. Neither did it degrade on exposure to acid, alkali, oxidative or heat stress. 1H NMR revealed no change in the formulation of Perfalgan® except for the conversion of the oxygen scavenger cysteine to cystine. The octanol:water partition coefficient likewise stayed constant and was in agreement with the value of 0.46-0.49 quoted in the literature.
Conclusion: Paracetamol and the excipients in Perfalgan® did not degrade on exposure to air and other stressors over 24 hours. The drug retained its lipid permeability over this period.
Postoperative neuromuscular function following non-depolarising muscle blockade in patients at Inkosi Albert Luthuli Central Hospital, Durban : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 121 –124 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1201293More Less
Background: Residual neuro-muscular blockade after the end of general anaesthesia may occur when non-depolarising muscle relaxant (NDMR) drugs are used. Train-of-four (TOF) stimulation is used to quantify the degree of residual paralysis, with a TOF ratio of less than 0.9 postoperatively associated with increased morbidity in patients. The aim of this study was to survey the degree of residual paralysis in patients in the post-anaesthesia care unit (PACU) at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, over the survey period.
Methods: This cross-sectional observational study was performed over a two-month period at IALCH, assessing the postoperative neuromuscular function of patients who had received NDMR drugs (rocuronium (n = 64) or cisatracurium (n = 6)) intraoperatively. Muscle function was assessed using acceleromyography and TOF stimulation, utilising a TOF Watch SX device, with function grouped according to previously defined targets as less than a ratio of 0.7, less than a ratio of 0.9 and less than a ratio of 1.0.
Results: Recovery to a TOF ratio of less than 0 7, 0.9 or 1.0 was observed in 5 (7.1%), 20 (28.6%) and 44 (62.9%) of patients respectively.
Conclusions: Although the results obtained compare favourably with other studies in similar patient populations, a considerable subset of patients still arrive in the PACU with inadequate return of neuromuscular function.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 125 –128 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1202605More Less
Background: Autonomic nervous function, as quantified by heart rate variability (HRV), has shown promise in predicting clinically important outcomes in the critical care setting; however, there is debate concerning its utility. HRV analysis was assessed as a practical tool for outcome prediction in two South African hospitals and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring.
Method: In a dual centre, prospective, observational cohort study of patients admitted to the intensive care units (ICU) of two hospitals in KwaZulu-Natal, South Africa frequency domain HRV parameters were explored as predictors of: all-cause mortality at 30 days after admission; ICU stay duration; the need for invasive ventilation; the need for inotrope/vasopressor therapy; and the need for renal replacement therapy. The predictive ability of HRV parameters against the APACHE II score for the study outcomes was also compared.
Results: A total of 55 patients were included in the study. Very low frequency power (VLF) was shown to predict 30-day mortality in ICU (odds ratio 0.6; 95% confidence interval 0.396-0.911). When compared with APACHE II, VLF remained a significant predictor of outcome, suggesting that it adds a unique component of prediction. No HRV parameters were predictive for the other secondary outcomes.
Conclusion: This study found that VLF independently predicted all-cause mortality at 30 days after ICU admission. VLF provided additional predictive ability above that of the APACHE II score. As suggested by this exploratory analysis larger multi-centre studies seem warranted.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 129 –130 (2016) http://dx.doi.org/http://dx.doi.org/10.1080/22201181.2016.1208333More Less
Rothmund-Thomson syndrome (RTS) or poikiloderma congenitale is a rare autosomal recessive disorder. Approximately 300 cases of this syndrome have been reported in the scientific literature worldwide. This study reports the case of an 11-year-old female child with RTS undergoing diagnostic oesophago-gastro-duodeno (OGD) scopy as a result of dysphagia to solids. Adequate knowledge of the condition is needed when planning anaesthesia in such a case as associated anomalies can interfere with anaesthesia management.