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- Southern African Journal of Anaesthesia and Analgesia
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- Volume 16, Issue 5, 2010
Southern African Journal of Anaesthesia and Analgesia - Volume 16, Issue 5, 2010
Volume 16, Issue 5, 2010
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 5 –6 (2010)More Less
Should a patient be dissatisfied with your management of his or her case, he or she currently has the options of going elsewhere, complaining to the HPCSA or, alternatively, suing you. One would have thought that that was protection enough but, apparently, this is not so; a further arrow is to be added to the patient's quiver in the form of the Consumer Protection Act. In fairness, the Act was not introduced to specifically protect patients but, given its broad scope and the fact that healthcare has not been excluded, patients may seek to use the Act against you.
Anaesthetic gas analysers : potential for confusion and errors if you live and work at moderate altitude, SAJAA 2010, 16(4) : erratumSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 6 –8 (2010)More Less
Alternative anaesthetic management of an infant with Wolf-Hirschhorn syndrome during repair of an atrial septal defect using total intravenous anaesthesia : letter to the editorSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 6 –7 (2010)More Less
To the Editor: Wolf-Hirschhorn syndrome (WHS) is a rare chromosomal disorder caused by a deletion of the short arm of chromosome 4 with an incidence of 1:50 000 births and a 2:1 female preponderance. Characteristic features of WHS are craniofacial dysmorphisms such as microcephaly, micrognathia, prominent glabella ("Greek helmet facies"), dysplastic ears, preauricular tags, hypertelorism, broad and/or beaked nose, short philtrum, cleft palate, down-turned corners of the mouth and dental anomalies. Further clinical features are low birth weight and developmental delay, mental and motoric retardation, muscular hypotonia, congenital heart defects, feeding, genital and renal anomalies, and seizures. However, many children with this disease require general anaesthesia for diagnostic or therapeutic procedures such as magnetic resonance imaging (MRI), anti-reflux surgery, dental surgery, repair of a cleft palate or urological surgery.
Anaesthetic challenges in emergency peripartum hysterectomy in West Africa : a Nigerian perspective : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 8 –11 (2010)More Less
Background: To determine the foeto-maternal outcome and the anaesthetic challenges in emergency peripartum hysterectomy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
Method: A retrospective study was carried out on parturients that had had emergency peripartum hysterectomy at UNTH in Nigeria, from July 1998 to June 2006. Data collected included demographics, anaesthetic and obstetric records, foeto-maternal outcomes and the need for critical care management.
Results: There were a total of 6 798 deliveries and 6 485 live births, with 16 emergency peripartum hysterectomies. The incidence of emergency peripartum hysterectomy was 0.23% of all deliveries (2.3/1 000 deliveries). The causes of emergency hysterectomies were ruptured uterus (11 patients or 69%), placenta accreta/morbidly adherent placenta (4 patients or 25%) and uncontrollable postpartum haemorrhage following vaginal delivery (1 patient or 6%). Eight patients had subtotal hysterectomy, while eight had total abdominal hysterectomy (TAH). All the patients received general anaesthesia and blood transfusion. There were two postoperative admissions to the intensive care unit (ICU) and two procedure-related deaths due to hypovolaemic shock. There were nine stillbirths but no documented neonatal deaths.
Conclusion: Emergency peripartum hysterectomies challenge the anaesthetist and the obstetrician who have to maintain haemodynamic stability in patients who may have lost volumes of blood, in a setting where blood and colloid availability is often limited. The maternal mortality was higher than that of most of the studies reviewed.
The role of coping responses in the relationship between perceived stress and satisfaction with life amongst chronic pain patients : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 13 –17 (2010)More Less
Background: This study aimed to determine the effect of coping responses on the relationship between perceived stress and satisfaction with life in a sample of chronic pain patients.
Methods: One hundred and seventy-two adult outpatients at the Pain Control Unit at Universitas Hospital in Bloemfontein completed measures of perceived stress (Perceived Stress Scale), satisfaction with life (Satisfaction with Life Scale) and coping responses (Coping Responses Inventory - Adult Version). Descriptive statistics were calculated for the sample. Correlation coefficients were calculated between perceived stress and satisfaction with life. Regression analyses were employed to determine the effect of coping responses on the relationship between perceived stress and satisfaction with life.
Results: A statistically significant negative correlation was found between perceived stress and satisfaction with life. Approach coping moderates the relationship between perceived stress and satisfaction with life, while avoidance coping has no effect on the relationship. The relationship between perceived stress and life satisfaction therefore appears to change as a function of the level of approach coping that patients with chronic pain exhibit.
Conclusion: Approach coping moderates the relationship between perceived stress and satisfaction with life amongst chronic pain patients.
Cardiac arrest during transurethral resection of the prostate : the overzealous restriction of intravenous fluids - a possible cause? : case studySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 20 –22 (2010)More Less
Cardiac arrest during spinal anaesthesia has been widely reported in literature, with several mechanisms being described. There have so far, however, been no reports of cardiac arrest after spinal anaesthesia during transurethral resection in prostate surgery. We report on a case of near-cardiac arrest during transurethral resection in prostate surgery, and possible mechanisms and strategies to prevent the same.
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 24 –26 (2010)More Less
Antiphospholipid antibody syndrome (APS) is an acquired autoimmune disorder characterised by venous and/or arterial thromboses. When present in women of reproductive age, it is associated with recurrent loss of pregnancy. Antiphospholipid antibodies are directed against various phospholipids in the body, and include anticardiolipin antibodies and the antibodies responsible for the lupus anticoagulant. The prevalence of anticardiolipin antibodies has been reported to be between 2.7 and 7% in the general obstetric population. For many years, an association between circulating maternal antiphospholipid antibodies and recurrent pregnancy loss has been acknowledged. Pregnancy loss is thought to be caused by thrombosis of placental vessels. Various interventions have been recommended to assist in the maintenance of the pregnancy until delivery of a live infant. The mainstay of treatment has included low-dose aspirin, either alone or combined with unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). However, this anticoagulation predisposes the patient to haemorrhage, and may be a contraindication to regional anaesthesia. Here, we highlight a case of a parturient with APS and discuss the anaesthetic implications.
Anaesthetic management of a parturient with severe pulmonary stenosis undergoing Caesarean section : case studySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 28 –30 (2010)More Less
We report the successful management of a parturient with severe pulmonary stenosis undergoing Caesarean section. Anaesthesia was managed with combined spinal and epidural anaesthetic technique. During the intraoperative period, haemodynamic parameters were well maintained. There were no episodes of haemodynamic fluctuations or oxygen desaturation. The patient delivered a full-term, normal foetus.
Source: Southern African Journal of Anaesthesia and Analgesia 16, pp 32 –34 (2010)More Less
This case report of neuraxial anaesthesia for emergency orthopaedic surgery serves to highlight the dilemma faced by anaesthetists when surgical intervention becomes necessary in a patient on anti-rabies vaccine. The two issues of importance are the possible reduction in the efficacy of vaccination by an immunosuppressive effect of anaesthesia and surgery, and the possible need to avoid local anaesthetics for the provision of postoperative analgesia to assist in the early detection of any neurological deficit.