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- Volume 16, Issue 3, 2010
Southern African Journal of Anaesthesia and Analgesia - Volume 16, Issue 3, 2010
Volumes & issues
Volume 16, Issue 3, 2010
Source: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
When I paged through this issue of our journal, it gave me great hope for the future of Anaesthesia in our country. We have a large number of South African submissions, and all of the registrar submissions for the registrar communication prize at our 2010 SASA congress. I am sure you will all agree that the standard of these entries is high, and thus bodes well for our future specialists.
After attending the recent New York School of Regional Anesthesia (NYSORA) world congress in Dubai, it would appear that the practice of regional anesthesia without ultrasound (US) guidance seems irresponsible.
Source: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Securing of the endotracheal tube in situ is essential for the conduction of safe anaesthesia during surgical procedures. In the operative setting, adhesive tape is commonly used to secure the endotracheal tube (ETT). However, this technique may not adequately secure the ETT in patients with facial hair. In such patients, bandage may be tied around the neck to secure the tube. Tied bandage around the neck can cause obstruction of venous return, leading to complications such as raised intracranial pressure in susceptible patients, as well as compromised access to the internal or external jugular veins. Moreover this technique is not feasible in patients who are undergoing posterior fossa craniotomies or cervical spine surgery via the posterior approach.
Author V. AroraSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 7 –8 (2010)More Less
I am describing a case of difficult intubation as a result of inspissated secretions. I am unaware that inspissated secretions as such have been reported as a cause of a difficult airway. A 17-year old, 48 kg male with no significant past history was admitted with head injury and fractured femur.
Author I. BabuSource: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Plastic coated stylets form an integral part of the armamentarium of the anaesthesiologist when dealing with the airway. The plastic coating renders the stylet less traumatic and easier to remove from the endotracheal tube. But they are not without their drawbacks. Shearing of the plastic coating of stylets has been reported in the paediatric population. We report the breaking of a plastic coated stylet in an adult.
Author R. GargSource: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Anaesthetic management in the MRI suite is a challenge for any anaesthesiologist. Various MRI compatible gadgets required for anaesthetic management are available. Though we ensure the availability of sophisticated instruments like anaesthesia machines and monitoring devices, we often oversee the availability of MRI compatible airway adjuncts such as Magill's forceps, which can be life saving in emergencies.
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 10 –13 (2010)More Less
Subarachnoid haemorrhage (SAH) is a devastating neurological insult, and is increasingly understood as a multi-system condition initiated in the central nervous system. Perioperative investigation of patients presenting for aneurysm surgery often includes a routine electrocardiogram (ECG) which frequently reveals an abnormality. We describe a patient who presented with SAH and who was found to have significant Q waves on the ECG suggestive of a trans-mural myocardial infarction, despite a negative medical history for such an event. We briefly highlight the issues faced by the anaesthesiologist when dealing with the patient with SAH and ECG abnormality, and the implications for cardiovascular dysfunction.
Pandemic influenza A (H1N1) 2009 : a case series from intensive care units in Port Shepstone, South Africa : case studiesSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 17 –22 (2010)More Less
This article presents a series of seven ventilator-dependent patients with pandemic influenza A (H1N1) 2009 and one with seasonal influenza at two hospitals - a government regional hospital and a private hospital - in the Ugu District, KwaZulu-Natal. The clinical features of these patients are described, and an attempt is made to highlight the problems encountered in managing such patients in a regional South African setting.
Spinal anaesthesia in young patients : evaluation of needle gauge and design on technical problems and postdural puncture headache : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 24 –28 (2010)More Less
Background : The well-known complication of spinal anaesthesia, postdural puncture headache (PDPH), is especially troublesome in young patients. The needle gauge and configuration of needle tip appear to be the important factors in reducing the incidence of PDPH; however it may increase the incidence of technical problems.
Objective : To evaluate the role of 25 and 27 gauge Quincke and Whitacre spinal needles on technical difficulties and incidence of PDPH in patients between 16 and 40 years of age.
Methods : Eight hundred patients receiving spinal anaesthesia for urological surgery were divided into four groups of 200 each according to spinal needle used. Group Q-25 and group Q-27 received spinal anaesthesia with 25 gauge and 27 gauge Quincke needles whereas in group W-25 and group W-27, 25 gauge and 27 gauge Whitacre needles were used. The parameters observed were technical problems in terms of number of attempts, failure rate, time to cerebrospinal fluid (CSF) detection and incidence and severity of PDPH.
Results : Subarachnoid space was successfully located at first attempt in 92% cases of group Q-25, 89% cases of group W-25, 63.5% cases of group Q-27 and 61% cases of group W-27. Failure rate was 4% in group Q-27 and 7% in group W-27. Time to CSF detection was comparable between group Q-25 and group W-25 and between group Q-27 and group W-27. PDPH was observed in 14% cases of group Q-25 and 7% of cases of group Q-27 respectively.
Conclusion : A 25G Whitacre needle seems to be a suitable choice in young patients because of its ease of handling without an introducer and low incidence of PDPH.
Correlation between spinal column length and the spread of subarachnoid hyperbaric bupivacaine in the term parturient : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 30 –33 (2010)More Less
Background : Anaesthetists frequently tailor the subarachnoid local anaesthetic dosage according to parturient height to achieve sensory blockade up to the T4 dermatome for lower segment Caesarean sections (LSCSs). Studies that have been conducted have demonstrated that height does not affect the spread of subarachnoid hyperbaric bupivacaine. This study aimed to find the correlation between the spinal column length of term parturients and the highest level of sensory blockade after spinal anaesthesia.
Methods : The authors studied 60 singleton term parturients of American Society of Anesthesiologists (ASA) physical status I or II scheduled for elective LSCSs. The length of the spinal column was taken as an average of three measurements from the C7 spinous process to the sacral hiatus in a sitting upright and facing forward position. Spinal anaesthesia was given by administering 1.8 ml of 0.5% hyperbaric bupivacaine and 25 g fentanyl through the L3/L4 or L4/L5 intervertebral space. The level of sensory blockade was assessed using pin-prick testing for pain sensation. Linear regression analysis was used to analyse the correlation; R < 0.25 indicates no correlation with the level of significance being < 0.05.
Results : The spinal column lengths measured were between 42.2 cm and 85.8 cm (median : 58.5 cm). Spinal anaesthesia given was adequate for all patients, with the highest levels of anaesthesia ranging from T8 to T2 with sensory levels between T6 and T4. The parturients' spinal column length showed no correlation with the highest level of sensory blockade achieved, namely R = 0.11.
Conclusions : The study found no correlation between the parturients' spinal column length and the highest level of sensory blockade achieved.
Nitrous oxide in 2010 : who will have the last laugh? (part 3) : Registrar Communication prize winnerAuthor K. De VasconcellosSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 35 –40 (2010)More Less
In the first two parts of this series, the basic science of nitrous oxide (N2O) was reviewed and some of its claimed risks and benefits were analysed. In this, the third and final instalment, the remaining risks and benefits will be assessed and the alternatives to nitrous oxide will be evaluated. It will be shown that many of the claimed adverse effects of nitrous oxide either do not exist or are overstated. Nitrous oxide is a versatile agent with many potential benefits during all phases of anaesthesia.
Author C. AdamsSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 42 –49 (2010)More Less
Alcohol has been a substance of abuse for centuries. The discovery of late Stone Age beer jugs has established the fact that purposely fermented beverages existed at least as early as c. 10,000 BC. It has been suggested that beer may have preceded bread as a staple food. Throughout history, alcohol has been praised for its innumerable medicinal qualities. In the Bible, it is mentioned 191 times. Current studies and meta-analyses are still promoting moderate use of alcohol for the potential beneficial effects, but some studies have shown the contrary, where the risks of alcohol consumption seem to outweigh these benefits.
Author N. AfshaniSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 50 –56 (2010)More Less
Dexmedetomidine is a highly selective and potent alpha2-adrenoreceptor (AR) agonist offering dose-dependent sedation, anxiolysis and analgesia. It is a relatively new drug, approved for sedation for up to 24 hours in mechanically ventilated post-cardiac surgery patients. Yet, because of its unique drug profile, it has been increasingly studied and used in various clinical settings, albeit off label, with promising results. The purpose of this review is to discuss dexmedetomidine in terms of its pharmacokinetics and pharmacodynamics, and to focus on its various clinical applications. A PubMed search, using the keyword "dexmedetomidine", identified approximately 1,000 articles, the earliest being animal studies published in 1988.
Author D.G. BishopSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 58 –61 (2010)More Less
Autonomic neuropathy is a common problem encountered by anaesthetists, both in operating theatres and in the critical care setting. There are a wide variety of causes, many of them associated with significant co-morbidity. It is clear that it is a problem which involves every system on a number of levels, and many of the issues are of particular significance to the anaesthetist. This review will cover briefly the aetiology and diagnosis of autonomic dysfunction, before discussing the clinical manifestations and consequences of the disorder. The major focus will be on cardiovascular autonomic neuropathy (CAN) and its implications for the peri-operative phase. In addition, it will briefly look at the involvement of the enteric nervous system, as well as deal with some of the new concepts emerging in the literature.
Author C. HanauerSource: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
It has been suggested that postoperative nausea and vomiting (PONV) is more debilitating than postoperative pain and results in extensive morbidity. Stimuli for nausea and vomiting are multifactorial. The necessity for multimodal antiemesis, and the efficacy of different pharmacotherapeutic agents, is thus riddled with debate and controversy.
Author H. KrugerSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 63 –69 (2010)More Less
Many patients admitted to an intensive care unit (ICU) will undergo a surgical procedure for correcting the underlying cause of their disease, to deal with the complications of their disease or the treatment of their disease, or to undergo diagnostic procedures which will direct the course of their treatment. The majority of these procedures are performed in the operating theatre, but a small number of these cases will be managed in the ICU environment, which will place the anaesthetic and surgical team in an unfamiliar environment.
Perioperative beta blockade : a practice in need of optimisation : Registrar Communication prize entryAuthor R.B. LawsonSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 71 –77 (2010)More Less
As anaesthetists, one of our primary objectives is to prevent complications in the perioperative period. Cardiovascular complications, in particular, are a leading cause of morbidity and mortality. The introduction of beta blocker medication around the time of major non-cardiac surgery continues to be one of the most controversial practices in perioperative medicine. The practice targets a reduction in the incidence and severity of major cardiovascular events.
Movement of the patient and the concept of minimum alveolar concentration (MAC) : Registrar Communication prize entrySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 78 –81 (2010)More Less
I am certain that you have been there. There is a hush as the surgery proceeds; the quiet interrupted only occasionally by the words "artery forceps" and "diathermy, please". You're resting, perched on your stool and listening to the reassuring sound of bleeps from the ECG monitor. Then suddenly the patient moves and the bellow of "the patient is awake" resounds from beyond the green drapes.
Author S. SchuleinSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 84 –87 (2010)More Less
The long QT syndrome (LQTS) describes the phenotype of a group of disorders characterised by a prolonged QT interval on ECG and a propensity to develop torsades de pointes (TdP) ventricular tachycardia. This frequently leads to syncope or sudden cardiac death (SCD) in otherwise healthy individuals.
Endotracheal tubes in paediatric anaesthesia : the cuffed versus uncuffed debate : Registrar Communication prize entrySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 88 –91 (2010)More Less
The paediatric airway demands respect, and appropriate and safe management of this delicate structure is of utmost importance. With development of polyvinyl chloride (PVC) in the 1960s, uncuffed endotracheal tubes (ETTs) replaced tracheostomies for long-term intubation and ventilation in the intensive care unit (ICU). Since then, uncuffed ETTs have traditionally been used in infants and children under the age of eight (or even ten) years for both short- and long-term intubation in theatre and ICU. Cuffed ETTs were not considered appropriate in this age group, and until fairly recently many manufacturers of ETTs did not produce cuffed sizes smaller than a 5 mm internal diameter (ID). However, debate in the literature over the last decade questions this teaching, some saying that the routine use of uncuffed ETTs in infants and children is not based on scientific evidence. It is clear that the strongly emerging role of cuffed ETTs in the paediatric population has come to the fore.
Author M. VenterSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 92 –95 (2010)More Less
It is estimated that 20-25% of HIV-positive patients will require surgery at some stage during their illness. In a study conducted among patients presenting for theatre at Chris Hani Baragwanath Hospital in 2006, a prevalence of HIV infection of 30% was found. In one subgroup, the prevalence was as high as 43%. Thirty percent of these patients (10% of the study population) had a CD4 count of < 200 cells/µL.