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- Volume 16, Issue 1, 2010
Southern African Journal of Anaesthesia and Analgesia - Volume 16, Issue 1, 2010
Volume 16, Issue 1, 2010
Author C.J. CoteSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 6 –11 (2010)More Less
Safe anaesthesia for neonates is based on understanding their unique physiology and response to medications so as best to provide analgesia and amnesia, depress stress responses, maintain cardiovascular stability, and return them to baseline status. Medications administered by any route have a similarly rapid uptake (alpha phase) followed by the slower elimination phase (beta phase) as adults. However, the duration of these phases is altered by changes in body composition, protein binding, and maturation of organ function.
Epidermolysis bullosa in children : pathophysiology, anaesthesia and analgesia : paediatric anaesthesiaAuthor J. ThomasSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 12 –15 (2010)More Less
Epidermolysis bullosa (EB) is a rare, genetically determined mucocutaneous, mechanobullous group of disorders. Three types have been described, but all show the same tendency for the skin or mucous membranes to separate from the underlying tissue, with minimal mechanical trauma, resulting in blistering. The disease runs a very variable course from minor disability, to those patients who have a longer life-span with pain and suffering, and to death in infancy. The cycle of trauma, secondary infection, healing, scarring, and deformity forms the pattern of their lives. Over time, many physical and emotional complications arise as these patients, because of their disabilities, face social challenges, their exclusion from normal activities and, because of frequent hospital visits, time away from school.
Author E. DekkerSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 18 –21 (2010)More Less
The anaesthetic management of paediatric patients with neuromuscular disease can be very complicated and requires careful peri-operative planning. These children commonly present for anaesthesia for diagnostic procedures (muscle biopsy, MRI), or surgery relating to their underlying disorder (gastrostomy, corrective orthopaedic procedures, strabismus surgery), or incidental surgery.
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 23 –24 (2010)More Less
Neurologic complications present commonly following cardiac surgery, with an impact on patients' quality of life. Several mechanisms are implicated, including cerebral embolism, cerebral hypoperfusion and inflammation. All of these mechanisms cause an imbalance between oxygen delivery and oxygen consumption in the brain. Neuromonitoring during cardiac surgery might help to prevent injurious events or to detect them in the early hours in order to employ strategies to minimise secondary cerebral damage.
Author A.Y. SchureSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 25 –27 (2010)More Less
In the early 1950s the pioneers of congenital cardiac surgery, among them Bigelow, Lewis and Gibbon, realised that hypothermia and inflow occlusion alone would not allow further advances in the field. In 1954, Lillehei introduced the technique of controlled cross circulation, where the patient's parent functioned as the extracorporal oxygenator. Only the development of mechanical cardiopulmonary bypass circuits in the late 1950s made advanced congenital cardiac surgery possible. Since then, extracorporal perfusion circuits have come a long way: from monkey lungs, film and bubble oxygenators, to modern miniature membrane oxygenators with centrifugal pumps, vacuum-assisted venous drainage and in-line gas monitoring.
The following is a short review of the important differences between adult and paediatric cardiopulmonary bypass (CPB), and a discussion of recent trends and developments.
Author S. RobertsonSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 28 –29 (2010)More Less
Anaesthesia for transcatheter aortic valve implantation (TAVI) in severe aortic stenosis : cardiac anaesthesiaAuthor J. BenceSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 30 –31 (2010)More Less
In our centre, transcatheter aortic valve implantation (TAVI) is performed under general anaesthesia, as is preferred by most other teams in Europe. is the British National Institute for Clinical Excellence (NICE) advises that only experienced cardiac anaesthesiologists should be involved in these procedures. A cardiac anaesthesiologist must be involved in the selection, administration of anaesthesia and postoperative care of these patients.
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 33 –34 (2010)More Less
In 1954, Joseph Murray performed the first successful renal transplantation on identical twins. Due to improvements in immunosuppressant medication and surgical techniques in the past decades, the organ survival rate has increased significantly. A study comparing kidney recipients, patients on the waiting list and patients on dialysis showed a significant reduction in mortality in the patients that have been transplanted. The kidney donor pool has been expanded and even marginal organs are being transplanted, as they provide survival benefit in comparison to dialysis. The indication for renal transplantation was extended to older patients with worse medical prognosis than before. Particularly the recipients in the Eurotransplant Senior Program "old-for-old" require an individualised intra- and postoperative management by the attending anaesthetist.
Author M. RaffSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 35 –41 (2010)More Less
Renal protection has remained a highly topical subject for years. The focus of any prophylactic strategy remains adequate hydration. It has become clear that the liberal hydration policy practised for years by most anaesthetists has been based on flawed logic and has been, to a large extent, inappropriate and even harmful to patients.
We see an increased usage of invasive radiology techniques for both diagnostic and therapeutic procedures. The radiocontrast media used in these procedures may cause a reversible form of acute renal failure.
Source: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Patients undergoing orthopaedic surgery have one of the highest risks of developing Venous Thrombo Embolism (VTE) - and until now, it has been necessary for patients to self-inject with an anticoagulant after discharge from hospital. However, the advent of oral anticoagulants offers new possibilities.
Author B.M. BiccardSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 44 –46 (2010)More Less
Patients with, or at risk for, cardiac disease have a 3,9% (95% confidence interval (CI) 3,3% - 4,6%) chance of suffering a major peri-operative cardiac event. This is associated with a significant in-hospital mortality of 15 - 25%, and subsequent cardiovascular death or myocardial infarction at 6 months (hazard ratio 18; 95%CI 6 - 57).
This paper focuses on our understanding of the pathophysiology of peri-operative myocardial infarction, the flaws associated with the proposed definition of peri-operative myocardial infarction, and the management of peri-operative myocardial infarction.
Author B. RiedelSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 47 –48 (2010)More Less
While peri-operative macrovascular events (e.g. myocardial infarction, stroke, etc) are readily evident, their absolute incidence remains relatively low. In contrast, microvascular dysfunction and its role in peri-operative morbidity is not readily appreciated nor easily measured. Given the ubiquitous presence of endothelium in all organs, microvascular dysfunction is likely to have a greater impact, through impaired perfusion, on non-cardiovascular complications (e.g. wound healing and end organ failure) than that which is readily appreciated.
How does vascular disease associated with retroviral infection differ from atherosclerosis? : anaesthesia for vascular surgeryAuthor R. BarrySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 51 –53 (2010)More Less
Author S.A. Kozek-LangeneckerSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 55 –56 (2010)More Less
The important role of platelets in the physiology and pathophysiology of haemostasis was acknowledged after the introduction of the cell-based model of coagulation. Hyperactive platelets may contribute to stent thrombosis or disseminated microembolism, leading to organ dysfunction. Platelet inhibition may provoke peri-operativen bleeding, independent of platelet counts. Taken together, on-site diagnosis of actual platelet reactivity may permit rapid and goal-directed therapeutic interventions in patients at risk. There is still no consensus on the appropriate method for measuring platelet function. In this refresher course lecture Platelet Funktion Analyzer PFA-100 and Multiple Electrode Aggregometry MEA will be discussed among other tests for the peri-operative use.
Source: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Myeloma is the malignant proliferation of plasma cells. It is the second most common haematological malignancy after non-Hodgkin's lymphoma, comprising 10% of all haematological malignancies and 1% of all cancers. There is a slight predominance in males and blacks. The aetiology is still uncertain, but an increased risk of myeloma has been noted in survivors of the Hiroshima and Nagasaki disasters, radiation workers and sheet metal workers. There is a direct relationship with increasing age and it is very rarely seen in patients below the age of 40.
Author G.A. RichardsSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 58 –59 (2010)More Less
Fluid overload is associated with an increase in ventilator days, ICU stay, PEEP requirements, and transfusions. In addition, it is associated with an increase in intra-abdominal pressure, even in medical patients, which, in turn, is associated with adverse outcomes in the ICU.
Resuscitation requires restoration of DO2 and VO2.
Author C. DanielSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 60 –68 (2010)More Less
Aneurysmal subarachnoid haemorrhage (SAH) accounts for approximately 85% of all episodes of non-traumatic subarachnoid haemorrhage. Bleeds from arteriovenous malformations in the brain and the spine account for a further 5%. The remainder are due mainly to intracerebral haemorrhages. Acute SAH is associated with a high mortality. Even for those who survive the acute event, the associated morbidity is significant. Involvement in the management of a patient who has suffered an aneurysmal SAH will depend on each anaesthesiologist's individual practice profile. For many anaesthesiologists, this may be restricted to the immediate preoperative, intra-operative and postoperative care of the patient. For anaesthesiologists involved in critical care medicine, the care period may extend right from the initial resuscitation and investigation on admission to the management of vasospasm post-operatively. Regardless of the degree of involvement, a clear understanding of the underlying pathophysiology of the disease process is essential in order to manage SAH patients appropriately and effectively. This review will be restricted to the discussion of aneurysmal SAH.
Long term effects of anaesthesia : neurotoxicity at the extremes of age : the brain and neuroanaesthesiaAuthor L. ZuccherelliSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 70 –74 (2010)More Less
Historically, anaesthetists have believed that their actions only have immediate or short-term consequences. Morbidity or mortality that occurs after discharge is invariably assumed to be secondary to the patient's underlying medical condition. Recently, a growing body of evidence has emerged suggesting that anaesthesia may have long term implications in susceptible individuals, particularly in patients anaesthetised at the extremes of age. Research suggests that anaesthetic agents may be neurotoxic under certain circumstances, and has raised the possibility that even a routine anaesthetic might pose a risk in vulnerable brains at the extremes of age: the very young and the elderly.
The changing profile of patients presenting for Caesarean section in South Africa : obstetric anaesthesiaAuthor M.G. SenekalSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 76 –78 (2010)More Less
The new challenges facing those practicing obstetric anaesthesia are reflective of changes in the demographics of the South African parturient.
Factors such as HIV and AIDS, obesity, advanced maternal age, and co-existing diseases are known to increase the risk of maternal morbidity and mortality. As more high risk patients present for Caesarean section, anaesthetic challenges increase. Predisposing factors for anaesthesia-related maternal mortality are inexperienced anaesthesia personnel, airway problems, and a lack of appropriate monitoring or resuscitation equipment.