Southern African Journal of Anaesthesia and Analgesia - Volume 11, Issue 4, November 2005

Extracted from text ... South African Journal of Anaesthesia & Analgesia ? November 2005 117 GUEST EDITORIAL 1 Is a rethink of our approach to hypertension necessary? Introduction The risks and management of hypertensive patients for elective anaesthesia are often debated. There is a perception that patients with untreated or ineffectively treated hypertension are at risk, in particular for cardiac and cerebrovascular events. The change in internal to external diameter of the vasculature results in an altered vascular pressure-flow relationship in the hypertensive patient. This gives rise to the exaggerated hypertensive and hypotensive response seen. The hypotensive tendency is aggravated by the diastolic ..

The article explores the historical, legal and philosophical background and justification of informed consent. Anaesthesiologists have a responsibility to obtain separate informed consent, both to prevent litigation and to satisfy the requirement of rationality and respect for personal autonomy. The three-tiered model - competence, information, and consent - is described. The inherent nature and current practice of anaesthesiology problematizes proper informed consent. This includes timing, time-constraints, managed care, same-day surgery and emergencies. Wider use of pre-op clinics is advocated. There is a move towards written consent. Properly documented consent relieves the burden of proof, yet is neither a legal requirement nor confirmation of a proper interview. Authors generally advocate written consent in obstetric analgesic practice. Pre-printed forms do not replace an interview. The interview should be tapered to the needs and requirements of the particular patient. The reason why information is provided should be explained. Appropriate illustrative material and aids are advised. The uninformed patient cannot give consent. The supply of information empowers the patient to engage in an interactive conversation with the anaesthesiologist, and broadens the base for further discussions and questions. At least a full explanation of the procedure and techniques (particularly of all invasive procedures), information about the chances of success, incidence of complications, risks involved, available alternatives, the relative risks and complications of alternatives, costs, and the role of the anaesthesiologist is required. Particular reference to the training of students is mandatory. Separate consent is required for all research purposes.

&lt;I&gt;Objective:&lt;/I&gt; To determine the knowledge of HIV transmission and of post exposure management, following an HIVinfected needlestick injury, in a population of Nigerian anaesthetists. <br><I>Subjects and Method:&lt;/I&gt; A cross-sectional, prospective assessment was conducted voluntarily in anaesthetists at an annual healthcare provider's forum, and at a major general hospital, using a structured questionnaire. &lt;br&gt;&lt;I&gt;Results:&lt;/I&gt; 63 Anaesthetists participated in the study. One anaesthetist knew the percentage of infected HIV needlestick injury that would result in HIV infection. ALL the high risk body fluids were correctly identified by 7 (11.1%) respondents. Twelve (19.0%) knew the correct immediate management when injured by a HIV-infected needlestick. Fifty eight (92.1%) were aware of post exposure prophylaxis (PEP), 25 (39.7%) had a PEP policy in their institutions and 57 (90%) knew when to commence PEP. &lt;br&gt;&lt;I&gt;Conclusion:&lt;/I&gt; Nigerian anaesthetists, though acutely aware of post exposure prophylaxis, are not aware of the fluids at risk and have not demonstrated adequate knowledge in the management, when injured by a HIV-infected needlestick.

Extracted from text ... South African Journal of Anaesthesia & Analgesia ? November 2005 135 SYNDROMIC VIGNETTES IN ANAESTHESIA Anaesthesia and Rubinstein-Taybi syndrome Synopsis of patients Case 1: An 11 month old boy was admitted for probing and syringing of the lacrimal ducts. He had presented with history of recurrent infections of the right eye and a mucocoele of right lacrimal sac. On examination, the patient was noted to have micrognathia, heavy eyebrows, blepharophimosis, an epicanthus, broad thumbs and clinodactyly. There was no obvious micrognathia or microstomia but he was noted to have a high arched palate. His milestones were delayed - he ..

The influence of psychological variables on the experience of chronic pain continues to be underestimated by many healthcare practitioners. This literature review attempts to highlight the applicability of the conceptualization of chronic pain within the biopsychosocial model and diathesis-stress framework. Within these paradigms the emotional disorders more frequently associated with the experience of chronic pain are explored. Attention is also paid to mechanisms underlying the development and maintenance of chronic pain-related emotional disorders. Finally, the implications of a more holistic conceptualization of chronic pain for clinical practice are investigated.

A retrospective study was conducted on all patients admitted to the Intensive Care Unit (ICU) of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over a 10 - year period (October 1991 - Sept. 2001). This period marks the first decade of the establishment of our ICU. The purpose of this study is to describe the pattern of admission of patients into the ICU, highlighting the variety of cases, indications for admission, outcome and causes of death, and the problems of medical and administrative management of the unit. No similar study has previously been carried out in this institution. <br>A total of 295 patients, consisting of 185 males (62.7%) and 110 females (37.3%) were admitted to the ICU during the study period. The commonest indication for ICU admission was for postoperative high care (54.9%), with postlaparotomy patients accounting for 59.9% of these cases. Medical indications for admission accounted for 21.3%, with respiratory failure and asthma being the commonest and each accounting for 11.5%. One hundred and ten patients (37.3%) died during their ICU admission, giving an ICU survival rate of 62.7%. Late presentation of cases and inadequate staffing and equipment were important factors which may have contributed to mortality in these patients. <br>Improved funding, training of additional staff and acquisition of advanced monitoring and life support equipment would improve the efficiency of our intensive care unit and patient survival.

Extracted from text ... SAJAA CPD ANSWER FORM - NOVEMBER 2005 Subscribe to the SAJAA CPD programme and earn 16 CPD points per year CPD reference number A008/085/03/2005 Continuing Professional Development Point Questionnaire Accredited by the Wits CPD Office Instructions 1. Read the journal to find all the answers 2. Answer the questions and mark the answer form by putting an "X" in the appropriate square. 3. Make a photocopy for your records in case the form is lost in the mail. 4. Tear out page and place the answer form in a envelope, seal it and send to:- In House Publications, SAJAA ..