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- Volume 14, Issue 5, 2008
Southern African Journal of Anaesthesia and Analgesia - Volume 14, Issue 5, 2008
Volume 14, Issue 5, 2008
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 5 –6 (2008)More Less
Aging is a universal and progressive physiological phenomenon clinically characterised by degenerative changes in :
- The structure of organs and tissue
- The functional capacity of organs and tissues
Source: Southern African Journal of Anaesthesia and Analgesia 14 (2008)More Less
We would like to report a problem we encountered with laryngeal mask airway (LMA)-Proseal (The Laryngeal Mask Company (UK) Limited), intended for use in a healthy 30-year-old female presenting for an elective orthopaedic procedure. During the routine pre-insertion preparation, whilst we were deflating the LMA-Proseal with a gentle pull on the inflation line, the inflation line along with the pilot balloon broke at the point of its attachment to the cuff (Figure 1). As a buffer stock of the same size was not available at that time, Classic LMA was used for the procedure. This Proseal LMA had been cleaned and sterilised as per the manufacturer guidelines but we have no record of the number of times it had been autoclaved and used.
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 10 –11 (2008)More Less
We present a case report of a 19 year old mentally challenged male child admitted with Ludwig's angina who was posted for surgical incision and drainage. The clinical scenario was further compounded by restricted mouth opening since childhood. Endotracheal intubation was successfully accomplished with awake fibreoptic bronchoscopy. Alternative methods for securing airway in such patients are discussed.
Author A. BosenbergSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 13 –15 (2008)More Less
Often called "funny looking kids" in the corridors and tearooms of medical institutions worldwide, these children may challenge the paediatric anaesthesiologist. So what makes a child look funny? Is it the child's face or body stature that does not conform to the clinician's concept of normal? Is it that the child is too fat, too short, too tall, too hairy, too stiff, too floppy, too distorted? Or is it simply that the child has features of a genetic, metabolic, or dysmorphic syndrome that the clinician, through ignorance, labels as funny looking. Far from being funny, these disorders may have significant anaesthetic implications, and ignorance may lead to a disastrous outcome when these children undergo surgery or diagnostic procedures.
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 18 –23 (2008)More Less
Anaesthetic safety in the use of the Macintosh oral laryngeal spray
Anaesthetic-induced apoptotic neurodegeneration in the neonatal rat spinal cord
Effect of lipid emulsion infusion on the levobupivacaine-induced cardiac toxicity on newborn piglet
Intercostal nerve block for post-appendectomy pain relief in children
Neuraxial ultrasound findings in neonates with anorectal malformation
Operating room extubation in pediatric congenital heart surgery
Preoperative anxiety in children managed with the music telephone and midazolam
Psoas compartment catheters for perioperative pain management in children
Severe hypoxic brain injury in a neonate despite continuous pulse oximetry
Ten years of paediatric epidurals - the Christchurch experience
The value of preoperative bronchoscopy in oesophageal atresia
Transversus abdominis plane block as an alternative analgesic for children undergoing appendicectomy : a preliminary report
Early extubation and weaning with bilevel positive airway pressure ventilation after cardiac surgery (Weaning with BiPAP ventilation after cardiac surgery) : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 25 –31 (2008)More Less
Objective(s) : To evaluate the use of bilevel positive airway pressure (BiPAP) ventilation in early extubation after fast-track cardiac surgery.
Design : Prospective observational study.
Setting : Postoperative intensive care.
Patients : Sixty consecutive patients eligible for early extubation after cardiac surgery. Patients were predominantly male (42 men [70%]) and middle aged (54.62 ± 10.66 years).
Interventions : Patients were randomly assigned to continuous pressure or BiPAP (Group I or Group II, respectively) and were extubated as soon as possible.
Measurements : Blood gases and haemodynamics were determined on arrival in the ICU (baseline, or T0) and 1, 2, 4, 6, 8, and 12 hours later. All data were expressed as (±SD) and analysed using the Student t-test and Mann-Whitney test (continuous data) or χ2 test (categorical data). P < 0.05 was considered statistically significant.
Main results : PaCO2 levels were statistically significantly higher in Group II than in Group I at 2, 4, 6, 8, and 12 hours (P < 0.05, P < 0.01). Within each group, PaCO2 levels were statistically significantly higher at 4, 6, 8, and 12 hours than at baseline (P < 0.01 ).
Extubation time was significantly longer in Group I than in Group II 7.90 (7.90 [2.13] vs 3.83 [1.20], P=0.001). Respiratory rates were significantly higher in Group II than in Group I after 2, 4, and 6 hours (P < 0.01). Pmax was higher in Group I than in Group II after 1 hour but similar up to 4 hours.
Conclusions : Early extubation and weaning to BiPAP ventilation after cardiac surgery is safe and effective.
Comparison of forced expiratory spirometric flow changes following intrathecal bupivacaine and bupivacaine with fentanyl : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 33 –37 (2008)More Less
Background : Higher dermatomal block following spinal anaesthesia impairs inspiratory capacity and decreases forced expiratory flow rates. This decrease in forced expiratory flows can in turn decrease the effectiveness of cough. Intrathecal opioids are important adjuncts to intrathecal local anaesthetics. The objective of our study was to compare the decrease in forced expiratory flows from the baseline values after subarachnoid block with bupivacaine and bupivacaine with fentanyl.
Methods : Institutional ethics committee approval was obtained. Forty ASA I and II adult males, scheduled for elective surgery were included in the study. Informed written consent was obtained from all patients who were randomly allocated into two groups. Group B received intrathecal anaesthesia 15 mgs of bupivacaine with 0.5 ml of normal saline and Group BF received 15 mgs of bupivacaine with 0.5 ml of fentanyl (25 µg) intrathecally. The patients were instructed about the performance of the spirometry on the previous evening of the surgery. Forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate and maximum expiratory pressure (Forced expiratory flows) were measured in supine position before intrathecal block and at 10, 60 and 120 minutes, following the establishment of the block. Highest dermatomal level of sensory blockade was noted.
Results : There was no statistically significant difference in the baseline values of FVC (Group B: 4.188 ± 0.821, Group BF: 4.186 ± 0.575, p - 0.127), FEV1 (Group B: 3.301 ± 0.846, Group BF: 3.276 ± 0.825, p - 0.240), PEFR (Group B: 458.6 ± 43.024, Group BF: 452.6 ± 41.036, p -0.091 ) and PEmax (Group B: 52.64 ± 4.029, Group BF: 53 ± 3.162, p 0 0.119 ) between the two groups. There was highly significant reduction in the values of FVC, PEFR and PEmax when compared to the baseline in both the groups at all three study periods. There was an acute reduction in the values of FVC, FEV1, PEFR and PEmax at 10 minutes. The graphs then achieve a plateau from 10 minutes to 60 minutes. From 60 to 120 minutes there was a gradual upslope in the graph. With regards to FEV1, though at 10 and 60 minutes there were statistically significant reductions when compared to the baseline values in both the groups, at 120 minutes the reductions were not significant. At all three time periods there was no difference in the reductions in FVC, FEV1, PEFR and PEmax values among the two groups. None of the patients in both the groups had PEFR and PEmax values below the critical value.
Conclusion : The addition of 25 µg of fentanyl to intrathecal bupivacaine did not have any adverse effect on forced expiratory flows. There was a decrease in forced expiratory flows in both groups, but the decrease in PEFR and PEmax were never below the critical values. It is unlikely that a combination of intrathecal local anaesthetic and opioids will impair the normal patient's ability to cough effectively.
Esomeprazole as a prophylactic agent for acid aspiration syndrome in adult patients undergoing elective surgery : a triple blind placebo controlled clinical trial : original researchSource: Southern African Journal of Anaesthesia and Analgesia 14, pp 39 –42 (2008)More Less
Background : To explore the effect of single oral dose of esomeprazole 20 mg, administered a night before surgery, on intragastric pH and volume in adult patients undergoing elective surgery by excluding cases contaminated with duodenogastric refluxate.
Patients and Methods : This prospective, triple blind, randomised and placebo controlled clinical trial was conducted to explore the effect of single oral dose of esomeprazole 20 mg, administered a night before surgery, on intragastric pH and volume on 120 adult inpatients of either sex, American Society of Anaesthesiologist physical status I-II, and aged 15-70 years. The patients in Group C (control) received placebo while Group E (Esomeprazole) received esomeprazole orally at 9.00 pm, the night before elective surgery. On the day of surgery, the gastric contents were aspirated with a large bore, multi-orifice gastric tube passed through an endotracheal tube placed blindly in the oesophagus after tracheal intubation and analysed for pH, volume and the presence of bile salts.
Results : Thirty nine samples (33%) out of 117 were contaminated with duodenal contents. Duodenogastric reflux significantly affected pH and volume in Group C (p value 0.0003 and 0.0016) and E (p value 0.0401 and < 0.0001). Esomeprazole, after excluding samples contaminated with duodenal fluid, significantly increased pH (p < 0.0001), decreased volume (p 0.0068) and the percentage of the patients (2.56% versus 30.76%) considered "at risk" compared with placebo (p 0.0015) according to the criteria defined (pH ≤ 2.5 and volume ≥ 25 ml).
Conclusion : Esomeprazole 20 mg administered orally a night before elective surgery improved the gastric environment (pH < 2.5 and volume > 25 ml / kg) at the time of induction of anaesthesia excluding samples contaminated with duodenogastric reflux.
Source: Southern African Journal of Anaesthesia and Analgesia 14, pp 45 –46 (2008)More Less
Minimally invasive transhiatal oesophagectomy (THE) is a common operative procedure for carcinoma of the oesophagus. This technique has many advantages over other surgical approaches to oesophagectomy. Common complications associated with THE are pulmonary in nature and can lead to increased morbidity and mortality. We present a case where a tension capnothorax developed during laparoscopic THE.