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- Volume 14, Issue 3, 2008
Southern African Journal of Anaesthesia and Analgesia - Volume 14, Issue 3, 2008
Volumes & issues
Volume 14, Issue 3, 2008
Airway management resources in operating theatres : recommendations for South African hospitals and clinics : guideline for difficult airway equipmentSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 1 –11 (2008)More Less
General anaesthesia (GA) requires airway instrumentation to facilitate spontaneous or mechanical ventilation. The endotracheal tube (ETT) is still considered the airway management device of choice in intensive care, emergency medicine and anaesthesia, particularly where muscle relaxants are used. Endotracheal intubation is an essential skill for anaesthesia practitioners.
A wide variety of airway devices is now available for management of situations where intubation is required, but may prove to be difficult or impossible. The intention of this paper is to provide a suggested guideline for the equipment that should be available in healthcare facilities (HCFs) where intubation is performed for GA.
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 14 (2008)More Less
In this day and age of BIS monitoring, transthoracic bioimpedance, TCI and the like, we seem to get totally distracted by our machines and gadgets, and sometimes forget basic clinical monitoring of our patients. Many of us were taught this during an era when the hand and eye were all we had, and were certainly more reliable than the pulsometer or oscilloscope screen.
Author S. RobertsonSource: Southern African Journal of Anaesthesia and Analgesia 14 (2008)More Less
The topic of awareness under anaesthesia strikes fear into the hearts of anaesthesiologists, their patients, and their medical protection societies. It is a subject which has been scrutinised by the anaesthetic community since the early forties but is now being thrust into mainstream public consciousness.
Source: Southern African Journal of Anaesthesia and Analgesia 14 (2008)More Less
To the Editor : Upper airway obstruction may be due to loss of muscle tone of the upper airway, with mechanical obstruction from the tongue, or foreign bodies such as teeth, dentures, secretions or tumours present in the airway. Loss of skeletal muscle tone of the upper airway is related to the inhibition of the gamma motor neuron system, which results in relaxation of the tongue and pharyngeal constrictor muscles.
Author A.T. BosenbergSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 11 –14 (2008)More Less
Job's syndrome, an autosomal dominant disorder, was first described by Davis et al in 1966. He called the disorder 'Job syndrome' after the biblical figure Job : 'So went Satan forth from the presence of the Lord, and smote Job with sore boils from the sole of his foot unto his crown' (Job 2 : 7). Davis et al described two unrelated girls with lifelong histories of indolent Staphylococcal abscesses. Both had eczema soon after birth and had persistent weeping lesions on the ears and face.
Glass particle contamination of parenteral preparations of intravenous drugs in anaesthetic practice : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 17 –19 (2008)More Less
This was a prospective, randomised, single-blinded comparative study to assess the amount of glass particle contamination in single-use drug ampoules, and to compare the differences between the filter straw (B Braun Filter Straw® 5 micron), 23G hypodermic needles and 18G drawing-up needles in reducing contamination. A total of 360 ampoules of expired drugs was collected and randomised into three groups. The content of each ampoule was syringed out using either a 23G needle, an 18G needle or a B Braun 5 micron Filter Straw®. The content was then emptied onto white filter paper, which was examined under microscopy. Glass particle contaminations were seen in 15 of the 360 ampoules (4.2%). The Filter Straw® group yielded no contaminants when compared with the 18G needle group (p = 0.001). The difference was not significant between the Filter Straw® and the 23G needle group (p = 0.644). The use of smaller gauge (23G) needles prevented glass particle contamination significantly when compared to bigger (18G) needles (p = 0.021). It can be concluded that larger ampoules (10 ml) produce significantly (p = 0.01) higher percentages of contaminants, even when compared to the smaller three ampoule groups combined (1 ml, 2 ml and 5 ml).
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 23 –26 (2008)More Less
Introduction Tracheal intubation is accompanied by an increased blood pressure and heart rate. The aim of this study was to find the most important source of this haemodynamic response, namely laryngoscopy or intubation.
Method A standard induction technique was used for all patients. Eighty patients were randomly allocated to one of two groups, one group to undergo laryngoscopy followed by intubation (Group I), and the other laryngoscopy only of duration similar to intubation (Group L). Blood pressure and heart rate were recorded in the ward, before induction of anaesthesia and one, two, three, and four minutes after instrumentation.
Results The instrumentation times did not differ significantly (p = 0.20). Over time mean arterial pressures were significantly higher in Group I than in Group L (p = 0.038). Over time the ratios of mean blood pressure and heart rate relative to the preoperative heart rate were significantly greater in Group I than in Group L (p < 0.01).
Conclusion Blood pressures and heart rates were significantly greater after laryngoscopy followed by intubation than after laryngoscopy of the same duration not followed by intubation. The induction technique, consisting of lignocaine, alfentanil, and propofol, may have attenuated expected increases in blood pressure but not increases in heart rate after intubation.
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 29 –33 (2008)More Less
There is a vast body of evidence to suggest that osteoarthritis is a heterogenous condition that involves not only the articular cartilage but also an adaptive response of the bone and the synovium to a variety of environmental, genetic and biomechanical stresses. There is also growing evidence pointing towards long term potentiation as the most likely mechanism for the transition of acute nociception to a chronic pain (CP) state.
The complexity and plasticity of the nociceptive system not only serve survival needs but also provide research opportunities for pharmacologic modulation of human suffering resulting from osteoarthritis.