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- Volume 12, Issue 4, 2006
Southern African Journal of Anaesthesia and Analgesia - Volume 12, Issue 4, 2006
Volume 12, Issue 4, 2006
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 12 (2006)More Less
Extracted from text ... Southern African Journal of Anaesthesia & Analgesia ? October 2006 121 EDITORIAL Risk is defined as the chance of something happening that will impact on one's ability to achieve one's objectives. Therefore in anaesthesia risk lies in the quality of patient care (which can lead to disability and death should things go wrong), as well as liability exposure for us as anaesthesiologists. Risk management comprises all the activities involved in identifying, measuring and controlling this exposure to risk. This in turn allows us to reduce unintentional harm to our patients, many of whom are high-risk anyway, from the medical point ..
Scope of Practice of Anaesthesia in the Republic of South Africa : recommendations drawn up by the South African Society of Anaesthesiologists : November 2002 : guidelinesSource: Southern African Journal of Anaesthesia and Analgesia 12, pp 127 –129 (2006)More Less
Extracted from text ... Southern African Journal of Anaesthesia & Analgesia ? October 2006 127 GUIDELINES Introduction One of the new factors of importance in medical practice in South Africa is the growing recognition of the role of hospital licensing and credentialing. Part of the process of consideration for accreditation of hospitals will include the level of qualifications and expertise that a hospital expects of the medical practitioners to whom that hospital grants clinical privileges. In addition, the Health Professions Council of South Africa has requested the College of Anaesthetists of South Africa to define the "scope of practice" in the speciality of Anaesthesia. ..
Source: Southern African Journal of Anaesthesia and Analgesia 12, pp 131 –133 (2006)More Less
Extracted from text ... Southern African Journal of Anaesthesia & Analgesia ? October 2006 131 SYNDROMIC VIGNETTES IN ANAESTHESIA SYNOPSIS OF PATIENTS Case 1 A 14-year old male weighing 54.9kg, height 178cm, presented for foot reconstruction. He had bilateral cavovarus deformities that were painful. He was otherwise healthy. He first presented as a 7-year old with some difficulty running, and a tendency to fall. He had walked on his toes since he started walking at 14 months. He complained of occasional cramps and pain in both legs that improved with stretching exercises. He did physical exercise at school but could not climb ropes. His ..
Source: Southern African Journal of Anaesthesia and Analgesia 12, pp 135 –138 (2006)More Less
<I>Rationale:</I> Adrenal insufficiency occurs with varying frequency in critically ill patients. It is usually associated with a high mortality and poor clinical outcome. <BR><I>Objective:</I> To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit. <BR><I>Design:</I> Prospective observational study, over a two year period (June 2003 - June 2005). <BR><I>Setting:</I> University hospital multi-disciplinary intensive care unit in South Africa. <BR><I>Patients:</I> One hundred and fifty-two patients with severe sepsis and septic shock. Patients with a history of adrenal insufficiency, those on steroid therapy and all those who received etomidate within a week prior to enrollment were excluded. <BR><I>Interventions:</I> None. <BR><I>Measurements and main results:</I> A random plasma cortisol level was measured in consecutive patients with severe sepsis and septic shock. Adrenal insufficiency was defined as a cortisol level below 20µg/dL. The incidence of adrenal insufficiency was 26, 97% (CI: 19, 97% - 34, 03%). Patients with adrenal insufficiency had lower APACHE II scores and better short-term survival rates. The occurrence of adrenal dysfunction in patients with septic shock was low with an incidence of 15.6%. The type of infecting organism, site of infection and the origin of the sepsis were not associated with differences in the incidence of adrenal deficiency. <BR><I>Conclusion:</I> Absolute adrenal insufficiency is not uncommon among our critically septic patients. The presence of adrenal failure was inversely correlated with illness severity and mortality.
Source: Southern African Journal of Anaesthesia and Analgesia 12, pp 141 –146 (2006)More Less
Atenolol has been proposed as a peri-operative cardioprotective agent in patients with coronary disease. However, recent reports have cast doubt over the cardioprotective efficacy of atenolol in patients with hypertension and coronary artery disease. There is therefore doubt whether atenolol is the correct cardioprotective drug in the surgical setting. It is possible that some of the physiochemical properties of atenolol (hydrophilic and cardioselective) may decrease it's efficacy in comparison to its more lipophilic congeners (such as propranolol, metoprolol, bisoprolol and carvedilol). The issue of prevention of perioperative cardiac events is complicated by many confounders. As a result, the role of the physicochemical properties of beta-blockers can only be determined in the simpler setting of myocardial infarction. Therefore, we conducted a restricted systematic review to evaluate the effect of initiating atenolol and metoprolol on the prevention of ventricular fibrillation following acute myocardial infarction. Neither atenolol nor metoprolol significantly decreased the incidence of in-hospital ventricular fibrillation following acute myocardial infarction. The number-needed-to-treat to prevent in-hospital ventricular fibrillation equals or exceeds 200 with metoprolol and atenolol respectively. Based on the findings of this systematic review and the recently published Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT), it can be concluded that the prevention of peri-operative myocardial ischaemia with a betablocker is clinically more important to peri-operative cardioprotection than whether the beta-blocker is lipo- or hydrophilic.
Hemodynamic effects of sevoflurane versus propofol anesthesia for laparoscopic radiofrequency ablation of liver tumors : scientific letterSource: Southern African Journal of Anaesthesia and Analgesia 12, pp 149 –152 (2006)More Less
Extracted from text ... Southern African Journal of Anaesthesia & Analgesia ? October 2006 149 SCIENTIFIC LETTER THE EDITOR Curative liver resection is suitable for only 10-20% of patients with metastatic liver cancer.1 Several interstitial ablation techniques have been employed for the treatment of inoperable hepatic neoplasm.2 Laparoscopic cryo-ablation of the liver caries the risk of hemodynamic instability, due to bleeding, hypothermia and reperfusion injury.3-4 This may be worsened by the cardiovascular effects of laparoscopy and anaesthetic agents.5-7 As opposed to cryoablation, laparoscopic radiofrequency ablation (LRFA) has not been associated with hemodynamic instability.8 Sevoflurane may attenuate arterial baroreflex function during anesthesia, which may ..
Source: Southern African Journal of Anaesthesia and Analgesia 12 (2006)More Less
Extracted from text ... SAJAA CPD ANSWER FORM - OCTOBER 2006 Subscribe to the SAJAA CPD programme and earn 16 CPD points per year CPD reference number A008/085/03/2006 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 CPD ..