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- Volume 14, Issue 4, 2008
Southern African Journal of Anaesthesia and Analgesia - Volume 14, Issue 4, 2008
Volume 14, Issue 4, 2008
Author M.F.M. JamesSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 3 –4 (2008)More Less
Controversies regarding fluid management remain unresolved mainly due to the lack of good quality data on which firm conclusions may be based regarding the crystalloid-colloid debate, the choice between colloid solutions and the best way to assess adequate volume therapy.
Melatonin as premedication for laparoscopic cholecystectomy : a double-blind, placebo-controlled study : scientific letterSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 8 –11 (2008)More Less
Background There are only a few studies involving the use of melatonin for premedication for anaesthesia. The goal of our study was to compare the effects of melatonin and midazolam administered as premedication for laparoscopic cholecystectomy.
Methods This double-blind, placebo-controlled study included 53 patients (ASA I, II) undergoing laparoscopic cholecystectomy under general anaesthesia. The patients were divided into three groups : group 1 (n = 18) included patients receiving 3 mg melatonin the night before and as premedication; group 2 (n = 17) included the patients receiving 3,75 mg midazolam (1 / 2 of a 7,5 mg tablet) by the same protocol as for melatonin; and group 3 (n = 18) included patients receiving placebo tablets. Preoperatively, the anxiety and sedation scores, as well as the quality of preanaesthetic sleep, were evaluated. Postoperatively, the anxiety and sedation scores and the number of remembered pictures were evaluated at 15 and 60 minutes and 6, 12 and 24 hours respectively. The intra-anaesthetic opioid requirements were also evaluated.
Results Preoperatively the lowest anxiety score was registered in the midazolam group; also the difference between the melatonin and midazolam groups was not significant. In the placebo group the anxiety score was significantly higher as compared with melatonin or midazolam. Postoperatively anxiety scores were lowest in the melatonin group at every time interval. The scores for the remembered pictures were consistently better in the melatonin group. The sedation score was lower in the melatonin group as compared with midazolam, as were the intra-anaesthetic opioid requirements.
Conclusions Melatonin (3 mg) can be successfully used as premedication for laparoscopic cholecystectomy, especially for day case surgery. Advantages over midazolam and placebo include better perioperative anxiolysis, and a better recovery profile as assessed by sedation and memory.
Increasing use of regional anaesthesia for prostatectomy - University of Benin Teaching Hospital experience : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 13 –17 (2008)More Less
Introduction Regional anaesthesia is widely used for urological procedures. It may be better tolerated in the elderly, avoiding the cardiovascular and respiratory depressant effects of general anaesthesia, provided that there are no contraindications. Bladder outflow obstruction due to benign prostatic hyperplasia is common in the elderly. Our aim was to determine the preference of neuraxial block technique for prostatectomy in our institution.
Patients and methods This was a prospective study of patients scheduled for elective prostatectomy with ages ranging from 49 to 94 years for a period of eighteen months. They were seen by anaesthetists, two or three days before surgery and all received oral diazepam, 5mg on the morning of surgery. Choice of anaesthesia was determined by the attending anaesthetist. Standard questionnaires were used to document patients' characteristics, technique of anaesthesia, intraoperative and postoperative complications, management and outcome.
Results One hundred and twelve male patients aged 49-94 years (mean age 67.38 ± 11.33) were recruited in the study. Eighty six (77%) patients were 60 years and above while 26 (23%) were below 60 years. Intercurrent medical diseases were common in patients above 60 years. Fifty two patients (46.4%) had intercurrent medical diseases, with hypertension being the leading among them [31(59.6%)] followed by diabetes mellitus [7(13.5%)].
Seventy six patients (68%) had suprapubic transvesical prostatectomy, 21(19%) had retropubic (Millin) anaesthesia while 15 (13%) had transurethral resection of the prostate. The techniques of anaesthesia used were general for 6 (5%) patients, epidural anaesthesia for 39 (35%) patients and spinal anaesthesia for 67 (60%) patients. Intraoperative hypotension occurred in 17 (56.6%) patients in the spinal group and in 3 (21.42%) in the epidural group.
The incidence of intraoperative and recovery room complications was higher in the spinal group than in the epidural group, 32 (63%) compared to 19 (37%). The difference was not statistically significant. P = 0.5257, OR = 0.6933, CI : 0.2977 - 1.107.
Conclusion We conclude that neuraxial block technique for prostatectomy has gained overwhelming popularity in our institution.
A study to compare continuous epidural infusion and intermittent bolus of bupivacaine for postoperative analgesia following renal surgery : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 19 –22 (2008)More Less
Background Extradural administration of local anaesthetics, opioids or a combination of both is now a well-established technique for managing postoperative pain following upper abdominal, pelvic and thoracic procedures or orthopaedic procedures on the lower extremities. There are two techniques of administration of drugs via epidural catheter - one is by continuous infusion and the other is by intermittent boluses. At present there is controversy in the literature regarding the analgesic effects of the techniques.
Methods This study was conducted in a prospective, randomised manner on 60 patients of either sex of ASA class I or II, scheduled to undergo elective renal surgery. The general anaesthetic technique was standardised. The patients were divided randomly into two groups of 30 each. The patients in group 1 received a continuous infusion of 0.166% bupivacaine, while the patients in group 2 received intermittent boluses through epidural catheter. The efficacy of postoperative analgesia was assessed using pulmonary function tests up to 12 hours. The generated data were analysed statistically.
Results There were no significant changes in pulse rate and arterial pressure at different time intervals from the preoperative values. Respiratory rates in both the groups were found to be significantly higher than the preoperative values in the two groups (p < 0.05). Forced vital capacity (FVC) and peak exploratory flow rate (PEFR) were significantly lower than the preoperative values at all points in time in both groups, but the drop was greater in group 2 and pain scores on movement were also found to be significantly higher than those in group 1 at the times when the effect of the bupivacaine bolus was wearing off (p < 0.05). Pain scores at rest were found to be comparable in both groups postoperatively.
Conclusions We conclude that continuous infusion of bupivacaine (8.3 mg / h) provides better analgesia at rest and on movement than intermittent boluses, and is not associated with fluctuations in the level of analgesia. Incidences of adverse effects are similar and not insignificant with both schedules.
Alkalinisation does not enhance the antimicrobial properties of local anaesthetic solutions : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 25 –28 (2008)More Less
Background The purpose of the study was to examine the previously reported finding that the addition of bicarbonate to lignocaine enhanced the antimicrobial effect of the local anaesthetic agent on a range of bacteria implicated in epidural infections and to determine if this would also hold true for bupivacaine.
Methods Bupivacaine at a concentration of 0.25% and lignocaine at a concentration of 1% with and without an alkaline buffer were inoculated with suspensions of Staphylococcus epidermidis, Staphylococcus aureus or Escherichia coli. The mixtures were plated on 2% blood agar plates immediately (T = 0) and after 24 hours at room temperature (T = 24), and numbers of colonies were recorded. The difference in the number of colonies between T = 0 and T = 24 was expressed as a fraction of the T=0 value, giving a percentage inhibition of colony growth. Statistical testing was performed using Kruskal-Wallis non-parametric One Way Analysis of Variance (ANOVA) followed by multiple comparisons of mean ranks between all groups.
Results At concentrations of 0.25% bupivacaine and 1% lignocaine, these findings suggest that 1% lignocaine has no antibacterial activity. The addition of bicarbonate has no influence.
Conclusions Bupivacaine has significant antibacterial activity, but the addition of bicarbonate has no influence.
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 32 –36 (2008)More Less
Fixed dose vs adjusted dose of 0.5% hyperbaric bupivacaine for spinal anaesthesia for Caesarean section
Cardioprotective role of sevoflurane as volatile anaesthetic during gynaecological surgery treatments in cardiovascular patients - prospective study
Development and validation of a dynamic model for predicting pain scores during the first stage of labour
Comparison of continuous spinal anaesthesia and continuous epidural anaesthesia for labour and vaginal delivery
Audit of intra-operative pain during Caesarean section under spinal anaesthesia at Edendale Hospital in KwaZulu Natal, South Africa
Echocardiographic assessment of left ventricular filling during elective Caesarean section under spinal anaesthesia
Invasive haemodynamic monitoring during spinal anaesthesia for Caesarean section
Placenta praevia - three year retrospective study
Routine oxygen supplementation during elective Caesarean section under regional anaesthesia