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- Volume 16, Issue 6, 2010
Southern African Journal of Anaesthesia and Analgesia - Volume 16, Issue 6, 2010
Volume 16, Issue 6, 2010
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
As the curtain falls on 2010 and we reflect on what a year it has been, we present you with our final edition of the SAJAA for the year. As I write this, I feel this has been quite a year for new publications from SASA's point of view, with the Acute Pain Guidelines and the Paediatric Sedation Guidelines in print and electronic format, and the revised Adult Sedation Guidelines available electronically.
Change or be changed; anaesthetist accreditation in echocardiography : is it time? : guest editorialAuthor A.R. KeeneSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 6 –7 (2010)More Less
Anaesthesiologists worldwide have embraced the emerging technology of transoesophageal echocardiography (TEE) since its introduction to clinical practice almost twenty years ago. Cardiac anaesthetists who were there at its inception were given a fantastic tool, which literally switched on the floodlights and allowed proper visualisation of a game which had up to that point been played in relative darkness. The mysteries of weaning from bypass were solved in an instant and ventricular performance, volume loading, papillary muscle dysfunction and, that condition that had plagued cardiac anaesthetists everywhere, the left ventricular outflow tract obstruction in aortic stenosis and chronic hypertension, became clear and more easily managed during the weaning process. With time and experience, anaesthetists developed skills that they had never thought would be possible, such as the comprehensive assessment of the heart before and after bypass, assessment of left ventricular wall motion abnormalities and, that potential mine field, assessment of valvular structure and, particularly, function after repair.
Vuvuzela adaptation of the Jackson-Rees circuit : an appropriate distraction technique for induction of anaesthesia in South African children during the FIFA World Cup : letter to the editorAuthor C-A. LeeSource: Southern African Journal of Anaesthesia and Analgesia 16 (2010)More Less
Evaluating the effect of preoperative oral gabapentin on postoperative pain in patients receiving spinal anaesthesia for lower limb surgery : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 9 –12 (2010)More Less
Background: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesised that gabapentin might be a useful adjuvant for postoperative analgesia in patients undergoing lower extremity surgery under subarachnoid block.
Method: Ninety male patients undergoing lower extremity surgery under subarachnoid block were randomly divided into three groups. Group I (n = 30) patients received oral gabapentin 1 200 mg one hour prior to surgery. Group II (n = 30) patients received oral gabapentin 600 mg one hour prior to surgery. Group III (n = 30) patients received an oral placebo one hour prior to surgery. Lumbar puncture was done with 23G Quincke's spinal needle and 2.5 mL of 0.5% heavy bupivacaine was administered intrathecally. Patients were monitored at 0, 1, 3, 5, 8, 12 and 24 hours for assessment of pain and side effects. Patients having pain scores 5 received rescue analgesia in the form of intravenous tramadol 0.5 mg.kg-1. If the pain score persisted at 5 after ten minutes, 0.25 mg.kg-1 tramadol was repeated.
Results: Pain scores at zero hour were statistically significantly lower in patients receiving 1 200 mg of gabapentin (group I) when compared with the other two groups. The total rescue analgesia (tramadol) requirement over the study period was also at the minimum in patients receiving 1 200 mg of gabapentin as compared to patients receiving 600 mg of gabapentin or placebo. However, sedation scores were significantly higher in patients receiving gabapentin 1 200 mg or 600 mg than placebo.
Conclusion: Preoperative gabapentin, when administered one hour prior to surgery in a dose of 1 200 mg, decreases postoperative pain scores at zero hour and the rescue analgesia requirement significantly over a period of 24 hours in patients undergoing lower limb surgery under spinal anaesthesia.
Effect of clonidine, by infiltration and by intravenous route, on scalp block for supratentorial craniotomy : original researchSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 13 –21 (2010)More Less
Background: The aim of this research was to study and compare the haemodynamic and analgesic effects of (A) scalp block with bupivacaine 0.25%; (B) scalp block with bupivacaine 0.25% plus clonidine 2 μg/ kg; and (C) scalp block with bupivacaine 0.25%, plus intravenous (IV) clonidine 2 μg/kg in supratentorial craniotomies.
Method: Sixty patients divided into three equal groups (A, B and C) were administered one of the above combinations. All the patients received propofol-based general anaesthesia. Propofol infusion was started at 25 μg /kg/minute, adjusted with an increment or decrement of 5 μg/kg/minute to obtain an A-line ARX index (AAI) of between 20 and 30 throughout the surgery, and stopped after dural closure. Fentanyl 0.5 μg/kg IV was given if a 20% increase in either heart rate (HR) and/or blood pressure (BP) was observed. HR and BP were monitored throughout the surgery and recorded on pin application, incision (planned 15 minutes after pins), at 15-minute intervals thereafter until dural closure, and every five minutes after dural closure. Propofol and fentanyl requirements were recorded for the duration of the surgery.
Results: There was a significant fall in HR, SBP (systolic blood pressure), MAP (mean arterial blood pressure) and RPP (rate-pressure product) after pin application in group B (HR p = 0.018, SBP p = 0.003, MAP p = 0.0042, RPP p = 0.000) and group C (HR p = 0.412, SBP p = 0.01, MAP p = 0.0084, RPP p = 0.001) when compared to group A. Propofol and fentanyl requirements were significantly lower in group B (propofol 67.9% and fentanyl 34.85% less) and group C (propofol 59.21% and fentanyl 36.36% less) when compared to group A.
Conclusions: The addition of clonidine, either to the scalp block or intravenously, offers better haemodynamic stability intraoperatively, and reduces analgesic and anaesthetic requirements.
Anaesthetic management of a patient with sick sinus syndrome for exploratory laparotomy : case studySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 24 –26 (2010)More Less
Sick sinus syndrome is a generalised abnormality of cardiac impulse formation that may be caused either by an intrinsic disease of the sinus node, which makes it unable to perform its pacemaking function, or by extrinsic factors. It commonly affects elderly persons. While the syndrome can have many causes, it usually is idiopathic. Abnormalities encompassed by this syndrome include sinus bradycardia, sinus arrest or exit block, combinations of sinoatrial and atrioventricular nodal conduction disturbances and atrial tachyarrhythmias. Diagnosis of sick sinus syndrome can be dificult because of its nonspecific symptoms and elusive findings on an electrocardiogram or a Holter monitor. Here, we present the perioperative management of an elderly patient with sick sinus syndrome with seminoma of undescended testis posted for exploratory laparotomy.
Anaesthetic management of appendectomy in a patient with cerebral arteriovenous malformation : case studySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 27 –29 (2010)More Less
Background: The aim of anaesthetic management for appendectomy in a patient with cerebral arteriovenous malformation (AVM) is to maintain a stable cardiovascular system. As this condition is rare, there are no definitive guidelines regarding the anaesthetic management of such patients.
Case report: We report a case of appendectomy in a patient with cerebral AVM. The patient was diagnosed with cerebral AVM four years prior to presentation with acute appendicitis and was advised surgical intervention, which he refused. Management of this patient presenting with acute appendicitis is discussed.
Conclusion: General anaesthesia may be used successfully for appendectomy in a patient with cerebral AVM if haemodynamic fluctuations at times of stress are minimised.
Emergency Caesarean section in a patient with known sickle-cell disease and myasthenia gravis : case studySource: Southern African Journal of Anaesthesia and Analgesia 16, pp 32 –36 (2010)More Less
A 33-year-old patient with known sickle-cell disease (SS) booked for antenatal care at the Lagos University Teaching Hospital at six weeks gestational age. She had been diagnosed with myasthenia gravis three years prior to presentation and placed on oral anticholinesterase and steroid therapy, but her compliance was poor. She had had an operative delivery six years previously, under a general anaesthesia relaxant technique. It had been complicated by delayed emergence and residual muscle weakness, necessitating postoperative ICU admission for mechanical ventilation. In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under a combined spinal-epidural technique. A level of sensory block of T6 was achieved with 2.8 mL of 0.5% hyperbaric bupivacaine administered intrathecally. Towards the end of surgery, analgesia was supplemented through the epidural catheter with injection of 25 μg fentanyl in 6 mL of 0.25% plain bupivacaine. Supplemental oxygen was administered via a Hudson mask at 4 L/min. A live male baby with Apgar scores of 9 and 10 at one and five minutes, respectively, was delivered. The intraoperative period was uneventful. Postoperatively, she was managed in the high care unit. Postoperative analgesia was achieved via the epidural catheter with 6 mL of 0.125% bupivacaine and 2 μg/mL fentanyl four hourly for 48 hours. Subsequent recovery was uneventful. She was discharged to the postnatal ward on the fourth day postsurgery, and home with her baby 10 days later.
The perioperative management of Bernard-Soulier syndrome : a case report and review of the role of perioperative factor VIIa : case studyAuthor R.N. RodsethSource: Southern African Journal of Anaesthesia and Analgesia 16, pp 37 –39 (2010)More Less
This article presents the perioperative anaesthetic management of a patient with Bernard-Soulier syndrome (BSS). A literature search was conducted to examine the perioperative haemostatic management of BSS, with particular focus on the developing role of recombinant factor VIIa. The early use of factor VIIa at doses of 90 to 100 μg/kg as a first-line therapy, alongside platelet transfusion, may result in a reduction in the perioperative use of blood products.