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- Volume 15, Issue 1, 2009
Southern African Journal of Anaesthesia and Analgesia - Volume 15, Issue 1, 2009
Volume 15, Issue 1, 2009
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
It is difficult to believe that a year has flown by since WCA 2008 ... what a wonderful and memorable event! I am sure it has been a real challenge for our KZN colleagues to organise the first "post-WCA" SASA Congress. As can be seen from some of the abstracts that have been submitted, it promises to be an exciting event. Welcome to our SASA 2009 edition of the SAJAA.
Author P.C. GordonSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Nagin Parbhoo passed away peacefully in Cape Town on 21 January 2009 after a long illness. He was born in Wynberg Village, Cape Town in May 1942, matriculated at Livingstone High School and received a Government of India Scholarship for Medical Studies to study medicine at Grant Medical College in Bombay.
Author A. TraversSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 7 –10 (2009)More Less
More and more differences in perioperative responses between the sexes in a wide range of areas are being reported in the literature. Many factors including age and co-morbidity are instinctively considered by the anaesthesiologist when considering peri-operative morbidity. The gender of the patient is emerging as a possible indicator of morbidity which needs to be addressed as more data on differences in cardiac physiology and anatomy, gender differences in pain perception, different outcomes following trauma haemorrhage and brain injury are being reported in the anaesthetic literature. Two of the areas that are particularly pertinent to the anaesthesiologist are gender differences in pain perception, and gender differences in the peri-operative presentation and management of ischaemic heart disease.
Source: Southern African Journal of Anaesthesia and Analgesia 15, pp 13 –15 (2009)More Less
Hemopure® is a cell-free haemoglobin solution that is made from bovine haemoglobin that is designed to carry oxygen in the plasma. It is approved for use in South Africa for the treatment of acute surgical anaemia. We describe the use of Hemopure® at a large tertiary hospital in Cape Town where there is a blood bank on the premises. Four patients received Hemopure® during situations of acute, life-threatening anaemia. Two patients were Jehovah's Witnesses and in two cases the blood bank was not able to find compatible blood due to the presence of antibodies in the patient's blood. Patients were carefully monitored by the anaesthetists or intensive care staff, who were managing the patient. No adverse reactions were experienced. Hemopure® was indispensable in managing these critically ill patients.
Author O.A. OlutoyeSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 17 –21 (2009)More Less
The increased use of ultrasound during pregnancy has allowed early diagnosis of fetal abnormalities including life-threatening conditions affecting the airway. Detection of these anomalies enables advanced planning and coordination of resources to optimise the outcome for the fetus at birth and thereafter. Ultrafast magnetic resonance imaging (MRI), can delineate fetal masses more definitively than ultrasound and can be used to identify those that will benefit from intervention.
A comparison of two-months versus two-weeks of internship anaesthesia training : SASA 2009 Congress prize entriesAuthor S. AshSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Adult perioperative fluid management : "Between Scylla and Charybdis" : SASA 2009 Congress prize entriesAuthor D. BishopSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Current practices in perioperative fluid management have their origins in the late 1950s and 1960s, when theories regarding salt and water distribution led ultimately to liberal perioperative fluid regimens. Classical teaching assumes replacement of a large preoperative deficit, high maintenance fluid requirements and aggressive replacement of presumed third space losses. Central to this teaching is the avoidance of hypovolaemia. While this remains a crucial objective, recent work suggests that hypervolaemia in the perioperative setting results in a number of deleterious consequences, many of which are seen only in the postoperative period and thus not immediately apparent to the anaesthetist. We are left with the dilemma of trying to avoid hypovolaemia and at the same time, limit fluid excess.
Posttetanic facilitation : a clinical test for safe reversal of nondepolarising neuromuscular blockade : SASA 2009 Congress prize entriesSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 25 –26 (2009)More Less
During the 1970s and 1980s, regaining a train-of-four ratio (TOFR) of 0.7 after administration of non-depolarising neuromuscular blocking drugs, was regarded as an indication of return of mechanical respiratory reserve and the ability to maintain a patent airway. Evidence has accumulated that patients sent to recovery rooms with TOFR less than 0.9 have impaired function of their pharyngeal muscles that predisposes them to regurgitation and aspiration, and an increased risk for developing postoperative pulmonary complications. Furthermore it appears that a TOFR < 0.9 is associated with decreased chemoreceptor sensitivity to hypoxia. In spite of being able to maintain a sustained head lift and leg lift, patients had difficulty in swallowing, felt uncomfortable and could not sip water through a straw. Residual neuromuscular block is a major risk factor behind critical events in the immediate postoperative period and should be regarded as a serious adverse event in the same way as we regard ventilatory depression due to opioids and anaesthetic agents.
A comparative study evaluating the effectiveness and safety of the generic sevoflurane (Sojourn, Safeline) and the original sevoflurane (Ultane, Abbott) : SASA 2009 Congress prize entriesSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Minimally invasive cardiac output monitoring during spinal anaesthesia for Caesarean section : SASA 2009 Congress prize entriesAuthor R.A. DyerSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Heart rate and blood pressure are appropriately used as surrogate markers of maternal cardiac output (CO) during spinal anaesthesia (SA) for Caesarean section (CS). Maintenance of baseline maternal blood pressure, using phenylephrine, has been shown to produce the closest to zero umbilical arterial base deficit, despite the fact that phenylephrine may depress maternal cardiac output. However, the maximum change in cardiac output has been shown to correlate better with uteroplacental blood flow than upper arm blood pressure. The maintenance of blood pressure and maternal cardiac output are therefore both important for maternal safety and comfort, and fetal wellbeing. Two studies of cardiac output changes during SA for CS are presented, employing pulse wave form analysis (LiDCOplus, LiDCO Ltd, Cambridge, UK).
Author E. GroenewaldSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Cardiopulmonary bypass (CPB) necessary for valve replacements and coronary artery surgery is associated with various metabolic changes intraoperatively which we as anaethetists must understand to protect our patients. The aim of this review is to look at potassium changes intraoperatively during CBP. Potassium is the principal intracellular cation of our body that plays an important role in the excitability of vital cell membrane physiology, especially in cardiac muscles to maintain resting membrane potentials and cardiac conduction. Therefore, any extreme intraoperative K+ changes should be corrected to prevent arrhythmias that influence cardiac output and oxygen delivery intraoperatively.
Ischaemic preconditioning - the molecular mechanisms andthe influence of general anaesthesia : SASA 2009 Congress prize entriesAuthor M.D. HeynsSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
The modern anaesthetist is in a privileged position to favourably influence cardiac outcomes during surgery. Poor myocardial protection rather than inadequate anatomical repair is recognised as the primary determinant of low cardiac output after cardiac bypass. The phenomenon of ischaemic preconditioning and more recently post-conditioning, is known to increase the heart's resistance to ischaemic insults. Ideally, the physician would like to activate the intracellular mechanisms instrumental in bringing about ischaemic preconditioning by means of a pharmacological agent, without inducing ischemia per se. Specifically, the use of halogenated inhalational anaesthetics to induce preconditioning has garnered attention recently for its role in manipulating the cellular mechanics instrumental in enhancing the heart's resistance to ischaemic insults. This review details the specific cellular mechanisms involved in ischaemic preconditioning together with a discussion of the pharmacological manipulation of these pathways.
Author O. MeyerSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Coagulopathy in renal dysfunction is a well known phenomenon. Much has been researched and written on the topic and it is clear that the pathogenesis is multifactorial. Most emphasis has been on the uraemic platelet dysfunction but it is now clear that other factors also play an important role.
Author A. MilnerSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Management of airway is central to practice of anaesthesia. Failure to maintain adequate gas exchange is catastrophic. ASA Closed Claims Analysis shows 37% of adverse outcomes associated with respiratory events were attributable to anaesthesia. Brain damage occurred in 85% and 72% were considered preventable. Care was considered substandard in 90% of claims associated with inadequate ventilation.
Author I. ShaikhSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Cricoid pressure was popularised by Sellick in 1961 as a simple method to reduce the risk of aspiration during induction of anaesthesia. It has since become the standard of care for most anaesthetists. Although it appears to be a mechanically simple and anatomically correct manoeuver, it is in fact complex and difficult to perform optimally. There is also continued controversy regarding its safety and efficacy. Understanding the role of cricoid pressure in our practice requires knowledge of anatomic relationships, physiology of regurgitation, modes of application, timing, amount of force required to apply it effectively and the impact of cricoid pressure on airway management.
The clinical characteristics and outcomes of patients with lone atrial fibrillation at Groote Schuur Hospital : SASA 2009 Congress prize entriesSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Atrial fibrillation (AF) is a common arrhythmia and is often difficult to manage. The classical risk factors for AF include hypertension, valvular disease, thyroid disease, cardiomyopathies, including ischaemic cardiomyopathies. When AF represents an electrophysiological phenomenon in structurally normal hearts it is termed lone AF. There are currently no studies to describe the clinical characteristics and outcomes of patients with lone AF in Africa. This study's purpose is to describe the clinical characteristics and outcomes of Lone AF patients attending Groote Schuur Hospital (GSH).
Source: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Is endovascular aortic aneurysm repair intermediate risk noncardiac surgery? A meta-analysis of cardiac morbidity reported in the randomised controlled trials comparing open and endovascular aortic aneurysm repair : SASA 2009 Congress prize entriesSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
The American College of Cardiology (ACC) / American Heart Association (AHA) guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery has classified endovascular aortic aneurysm repair (EVAR) as intermediaterisk surgery. This guideline is not evidence-based. The aim of this study was to determine the incidence of major cardiac morbidity and mortality reported in the prospective randomised controlled trials of elective open abdominal aortic aneurysm (AAA) repair versus EVAR. By definition, intermediate surgery should have a combined incidence of 30-day cardiac death and nonfatal myocardial infarction of 1 to 5%, and major surgery should exceed 5%.
Author M. VenterSource: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
Although the basic principles of interpretation of the electrocardiogram (ECG) are identical in children and adults, the paediatric ECG differs significantly from the adult ECG. Interpretation of the paediatric ECG depends on patient age, reflecting the developmental changes in anatomy and physiology that occur in the growing infant or child. In order to avoid errors in interpretation, anaesthesiologists, paediatricians, emergency physicians, etc should be familiar with the normal paediatric ECG and should be aware of the common ECG abnormalities occurring in children.