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- Volume 15, Issue 5, 2009
Southern African Journal of Anaesthesia and Analgesia - Volume 15, Issue 5, 2009
Volumes & issues
Volume 15, Issue 5, 2009
Author D.F. MorrellSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 5 –6 (2009)More Less
In the context of our current economic climate, more and more pressure is being put on us to use generics, as a means of cost containment. One can, of course debate at length who benefits from this cost containment. Nevertheless, in the interests of being the advocates for our patients it behoves us to explore generics as an option.
Generic substitution is the interchangeable use of different brands of chemically equivalent medications i.e. those which contain the same active pharmaceutical ingredients and have the same quantities thereof in the same pharmaceutical dosage form, or as they are more commonly named, "generics".
Source: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
In 1985 Professor Pat Foster from Tygerberg Hospital under the auspices of the SA Society of Anaesthesiologists (SASA) and South African Bureau of Standards (SABS) pioneered the development of a national standard of colour-coded syringe labels for anaesthetic drugs. This colour coding system has been modified and adopted by authorities in Australasia, Canada, the United Kingdom and the United States of America.
The influence of anaesthetic drug selection for scoliosis surgery on the management of intraoperative haemodynamic stability and postoperative pain - pharmaceutical care programme : original researchSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 10 –14 (2009)More Less
Aim : The aim of this study was to conduct a pharmaceutical care programme for two different anaesthetic methods used during scoliosis surgery, to investigate which method ensured better intraoperative haemodynamic stability and postoperative pain control.
Methods : A clinical pharmacist actively participated in a prospective randomised double blind study for 40 patients who had a physical status class I-II ASA, scheduled for scoliosis surgery, who were randomly allocated into two groups, 20 in each group. Both groups received midazolam preoperatively, propofol, sevuflorane, atracurium, and either remifentanil infusion 0.2 µg/kg/min for (Group 1 = G1), or the same dose of remifentanil infusion and low dose ketamine infusion 1 µg/kg/min (Group 2 = G2), antidote medications and postoperative morphine. Patients were subject to a pharmaceutical care programme. Heart rate HR, MAP, vital signs, surgical bleeding, urine output, time to accomplish the wake up test, duration of surgery and duration of anesthesia were recorded. In postanesthesia care unit (PACU) for 24 hours, the recovery time, the first pain score and analgesic requirements were assessed. All drugs used were documented in medical charts for statistical analysis.
Results : Intraoperative heart rate and arterial blood pressure were significantly less (p < 0.05) in G1 as compared with G2. In the (PACU) the first pain score recordings were significantly less (p < 0.05) in G2 than G1. The time which passed until the first patient analgesia demand dose was greater in G2 and morphine consumption was greater in G1 than G2 (p < 0.05). The rest of the results were not significantly different between the two groups. None of the patients had any allergic or adverse drug reaction to any of the medications.
Conclusions : Adding a low dose ketamine hydrochloride infusion during scoliosis surgery could be applied as a routine therapy to improve the haemodynamic stability during the surgery and reduce the postoperative morphine consumption. A pharmaceutical care programme tested in this study gave a high score for patient satisfaction.
Source: Southern African Journal of Anaesthesia and Analgesia 15, pp 16 –18 (2009)More Less
Massive blood loss requiring allogenic blood product transfusion has been a major problem during liver resection and transplantation surgery. The transfusion of red blood cell units (RBCs) and plasma has been adversely linked to 1-year survival rates. In a series of 1 803 consecutive cases undergoing hepatic resection surgery, total blood loss and the number of liver segments resected were the only independent predictors of morbidity and mortality. Improved surgical and anaesthetic techniques have resulted in a dramatic reduction of blood product requirements during orthotopic liver transplantation (OLT) and liver resection surgery compared to historical controls. Recent publications report that between 17.5% and 81% of OLT operations and > 90% of hepatic resections can now be performed without red blood cell transfusions. In both groups, reduction in blood transfusions has led to improved outcome. Severe bleeding still occurs in a minority of cases and efforts to define clinical and blood test predictors for major bleeding during liver surgery remain elusive.
Source: Southern African Journal of Anaesthesia and Analgesia 15, pp 20 –28 (2009)More Less
Despite increasing safety of regional anaesthesia, the growth in the popularity therof implies that local anaesthetic toxicity will occur occasionally. Local anaesthetic cardiotoxicity, even when using "safer" modern local anaesthetics, is notoriously resistant to standard resuscitation. The aim of this paper is to review current knowledge regarding the use of lipid emulsions to treat local anaesthetic toxicity.
Cardiac arrest after submucosal infiltration with lignocaine 2% - epinephrine in nasal surgery : a case report : case studiesSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 29 –31 (2009)More Less
A case of a 26-year-old ASA I physical status male undergoing septoplasty had an abrupt pulseless ventricular tachycardia following submucosal infiltration of lignocaine 2% with epinephrine 1:200,000 combination. Ventricular tachycardia associated with unconsciousness and absent peripheral pulse was transient and easily reverted by precordial thump, but was recurrent. Ventricular tachycardia was replaced by ventricular bigeminy and subsequently by sinus tachycardia.
Anaesthesia for a morbidly obese patient with schizophrenia and intellectual disability : case studiesSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 32 –33 (2009)More Less
We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had been taking several antipsychotic agents, including haloperidol. Tracheal intubation was performed smoothly and anaesthesia was maintained uneventfully using propofol and remifentanil.
This case demonstrates that the method of general anaesthesia presented here can be used safely in managing patients with these kinds of disabilities.