CME : Your SA Journal of CPD - Volume 30, Issue 6, 2012
Volume 30, Issue 6, 2012
Author Bridget FarhamSource: CME : Your SA Journal of CPD 30 (2012)More Less
There are only two certainties in life - death and taxes. So why don't we talk about the former? There has been a spate of articles in the British Medical Journal in recent months about the lack of planning for end-of-life care by the British medical profession - a serious omission in a country where the majority of people are older than 60 - and we are no different.
Author Johan DiedericksSource: CME : Your SA Journal of CPD 30 (2012)More Less
In South Africa the majority of anaesthetics are provided by non-specialists. In most cases this involves anaesthesia for small, brief procedures. Many of these cases are anaesthesia for caesarean section. Unfortunately the reports on maternal death indicate that South Africa has a relatively high rate of deaths associated with anaesthesia for caesarean section. This may be an indicator of all anaesthesia care. Many factors contribute to this situation, but the loss of experienced practitioners in rural areas, inadequate training, and high turnover of personnel are factors that are important.
Author Mari Jansen van RensburgSource: CME : Your SA Journal of CPD 30, pp 193 –196 (2012)More Less
This article focuses on sedation for procedures outside the operating room (OOR).
Sedation providers come from a range of backgrounds and unlike anaesthesia providers often receive their training in the form of 'see one, do one, teach one'. This might have been sufficient in the days when diazepam and pethidine were used to immobilise patients for procedures and left them sleeping for many hours thereafter. However, modern-day drugs are potent, rapid-acting and have a predictable offset. They are often controlled by target-directed infusion pumps, thereby elevating sedation to a science in its own right.
Author Edwin W. TurtonSource: CME : Your SA Journal of CPD 30, pp 197 –202 (2012)More Less
Anaesthesia is uneventful in the majority of cases but in a small percentage of routine and emergency cases there will be an anticipated or an unforeseen acute incident. These incidents need immediate theoretical knowledge and clinical skills to be managed effectively and to prevent further morbidity and mortality. Therefore all providers of anaesthesia, at different levels of experience, should be able to provide basic and advanced cardiopulmonary resuscitation (CPR).
Author Eddie OosthuizenSource: CME : Your SA Journal of CPD 30, pp 203 –206 (2012)More Less
Dental anaesthesia is often underestimated and considered ideal for the less experienced practitioner. This perception has proved to be devoid of truth and is a dangerous notion. The 'simple' general dental anaesthetic has proven time and time again to be fraught with caveats that may, if ignored, ultimately lead to serious patient harm or even death. The patient who receives dental treatment under general anaesthesia is usually a child, one with special needs, or one who requires an extensive dental procedure. The term 'simple' general dental anaesthetic is therefore a misnomer. The concept of procedural sedation for dentistry is beyond the scope of this article. It deals with general dental anaesthesia.
Author Mariane Gertruida SenekalSource: CME : Your SA Journal of CPD 30, pp 207 –210 (2012)More Less
Spinal anaesthesia is relatively easy to perform and can potentially be excellent for below the umbilicus. However, it can also give rise to serious side-effects and complications. To perform a safe procedure, the anaesthetist must have adequate knowledge of the indications and contra-indications, and of the relevant anatomy, physiology and pharmacology of spinal anaesthesia. The patient must be assessed before administration of the spinal anaesthetic and the theatre must be correctly prepared. The anaesthetist must be familiar with the correct technique. After administration of the anaesthetic, the patient must be monitored so that side-effects and complications are recognised immediately and treated early. Sedatives must be titrated with care. During the postoperative period the patient should be admitted to the recovery room and monitored.
Author Maria ReynekeSource: CME : Your SA Journal of CPD 30, pp 211 –214 (2012)More Less
Tonsillectomy is one of the most common procedures performed by general practitioners and ENT specialists annually. It is frequently performed as an outpatient procedure after insufficient pre-operative investigations. Indications for this procedure include severe recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, obstructive sleep apnoea (OSA) and biopsy for possible malignancy.
Author L. Van der NestSource: CME : Your SA Journal of CPD 30, pp 215 –216 (2012)More Less
The introduction of cocaine in 1884 as a local anaesthetic agent started an entire new era in medicine. Since then, the use of local anaesthetic agents has increased as an important part of medicine. Local anaesthesia is widely and regularly used by general practitioners and specialists, but a recent survey in a UK hospital showed that among non-anaesthetists there is a poor understanding of local anaesthesia toxicity and treatment. Local anaesthetic agent systemic toxicity occurs in about 1 in every 1 000 peripheral nerve blocks and, although it is an infrequent complication, it is potentially fatal.
Author Hennie OosthuizenSource: CME : Your SA Journal of CPD 30, pp 217 –219 (2012)More Less
This article gives a brief overview of the influence/impact of the new Consumer Protection Act 68 of 20081 and the Regulations on the practising of medicine by the general practitioner (GP) anaesthetist. The Act came into force/operation on 1 April 2011. Aspects such as the purpose of the Act, the rights of patients, obligations/responsibilities of the medical practitioner (who is the supplier of services and/or goods), no-fault liability and recourse available for the consumer, are discussed.
Source: CME : Your SA Journal of CPD 30 (2012)More Less
Author Roger PebodySource: CME : Your SA Journal of CPD 30, pp 223 –224 (2012)More Less
People who have both tuberculosis (TB) and human immunodeficiency virus (HIV) infection experience 'a unique and overlapping double stigma', according to research published in the May issue of Social Science and Medicine. Having TB sends a signal that the person also has HIV. As a consequence, identities associated with TB are now strongly influenced by HIV stigma. Some co-infected individuals distance themselves from others with HIV and foreground their TB infection to minimise stigma. This finding may have implications for the uptake of services which integrate TB and HIV care.