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- Volume 17, Issue 1, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 1, 2011
Volume 17, Issue 1, 2011
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 3 –4 (2011)More Less
Our congress edition of the SAJAA contains a large variety of articles, reflecting the contents of our exciting SASA 2011 refresher course. As we do not practice anaesthesia in isolation, we are privileged to have articles written by surgical, medical and intensive care colleagues, as well as anaesthetic colleagues from all over the world. Numerous topics have been covered, and much of the information does not appear in our standard anaesthesia textbooks. So enjoy the literary feast.
Author S.S.F. FischerSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 9 –12 (2011)More Less
1977: Andreas Gruentzig performs the first successful percutaneous transluminal coronary angioplasty (PTCA). However, widespread use is limited by two major complications - acute vessel closure during or immediately after procedure, and restenosis of the vessel due to elastic recoil, smooth muscle proliferation and neointimal hyperplasia.
Author M. AlisonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 13 –15 (2011)More Less
Thirty-day mortality associated with moderate to high-risk non-cardiac surgery in recent large cohorts and population-based studies exceeds 2%, and surpasses 5% in patients at high cardiac risk. Cardiac complications constitute the most common cause of postoperative morbidity and mortality, impacting considerably on length and cost of hospitalisation.
Author N. RosencherSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 17 –18 (2011)More Less
Patients undergoing major orthopaedic surgery are at high risk of venous thromboembolism (VTE), with morbid and potentially fatal consequences. Anticoagulant VTE prophylaxis reduces rates of postoperative deep vein thrombosis by up to 60-70% in these patients. Therefore, pharmacological prophylaxis with low-molecular-weight heparins (LMWHs), vitamin K antagonists, or fondaparinux and now new oral anticoagulants, is recommended by current guidelines.
Author B. TippingSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
Postoperative delirium is an acute brain failure syndrome. It is a manifestation of complex interactions between the patient's intrinsic neural reserve/compensation, disease processes (systemic versus localised), medical/surgical therapies, and the health care environment. Older age, comorbid neurodegenerative disease and the use of anticholinergic drugs predispose to more severe and prolonged delirium, with neurodegeneration as a consequence. There is an associated 30-40% one-year mortality following an episode of delirium in the older person.
Author S. RobertsonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 20 –21 (2011)More Less
The amateur or professional athlete presents for surgery for many reasons, often related to his or her particular sport. Rarely, this may occur in the emergency setting, immediately after cessation of exercise. While there are several issues to be dealt with in anaesthetising this group of patients, the choice of anaesthetic technique will be focused upon here.
Author E. WelchSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 22 –24 (2011)More Less
The administration of any pharmaceutical agent to a professional or elite sportsman is fraught with danger. There is the risk of giving a banned substance to an ailing athlete and destroying a career. Then there are the potential problems of drug interactions with any of the multitude of agents that the sportsman may be taking. One should also be alert to being asked to treat the side-effect of a banned, illegal, experimental or veterinary agent. The rules for banned substances apply not only to able-bodied athletes, as athletes with disabilities are governed by the same rules and may need treatment for their chronic conditions.
Reducing postoperative pulmonary complication in non-cardiothoracic surgery patients : refresher courseAuthor A. MilnerSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 27 –30 (2011)More Less
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 32 –33 (2011)More Less
Author E. TurtonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 34 –35 (2011)More Less
Erik Sloth from Aarhus University Hospital, Skejby, Denmark, proposed Focused Assessed Transthoracic Echocardiography (FATE) in 2004. In 2010, there was a revision of the FATE protocol to include an extended FATE examination (extended views) by his group. FATE is a rapid and systematic protocol for cardiopulmonary screening and monitoring. Many other models and protocols have been described.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 35 –37 (2011)More Less
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 38 –41 (2011)More Less
Every complete transoesophageal echocardiographic (TEE) examination should include a careful assessment of the aortic valve. Aortic valve disease is very common in Western populations. About 25% of people over 65 years of age have aortic sclerosis and 3% over 75 years have severe stenosis 7. TEE can define the severity and mechanisms of aortic stenosis (AS) and aortic regurgitation (AR). Although in general cardiology TEE is rarely needed for evaluating the aortic valve, it may be appropriate when transthoracic image quality is poor and to evaluate other structures more fully, including the mitral valve.
Intraoperative echocardiography assessment of left and right ventricular function : refresher courseSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 42 –48 (2011)More Less
Over the past 25 years, echocardiography technology has improved tremendously and intraoperative transoesophageal echocardiography (TOE) has become the gold standard cardiac monitor and diagnostic tool. Although there is limited scientific evidence to substantiate this belief, there is a perception that intraoperative TOE provides valuable information that significantly influences clinical management and improves patient outcome. Several investigators have documented its benefits in the critically ill patient and during complex cardiovascular surgery. Two recent retrospective analyses related to alterations during routine cardiac surgery from intraoperative TOE have also suggested its cost effectiveness.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 49 –51 (2011)More Less
HEARTscan is an acronym for the limited transthoracic echocardiography study "Haemodynamic Echocardiography Assessment in Real Time". It has been developed by the University of Melbourne ultrasound group (see www.heartweb.com). The registered name "H.A.R.T.scan®" refers to the training package developed by the University of Melbourne.
Arenavirus outbreak with nosocomial transmission : infection control and the lessons learned : refresher courseAuthor N. SewlallSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 54 –55 (2011)More Less
Anaesthesiology is generally practised in operating theatres, under controlled circumstances and with some degree of foresight. However, this expertise is frequently being sought in areas like the ICU and emergency department and during emergency medical evacuation. As such, a more than rudimentary knowledge of infection control principles is required.
Author A. HoldSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 56 –64 (2011)More Less
Our primary role as anaesthesiologists is to give effective and safe anaesthetics. The anaesthetic mortality rates have decreased from approximately seven per 100 anaesthetics administered in the early part of the last century, to two deaths per 10 000 in the 1980s, to about one death per 200 000-300 000 today. A single anaesthetist would have to give anaesthetics for a very long time to make a difference either way.
Author J. WingSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
Type 2 diabetes has assumed a pandemic prevalence. In the absence of metabolic control, life expectancy in patients with diabetes is reduced by a mean of 15 years, and morbidity in relation to vascular and neuropathic complications, some three- to fourfold. Adequate metabolic control remains elusive and worldwide, fewer than 40% of patients with diabetes achieve glycaemic targets. This poor outcome is attributable in part to the suboptimal, non-physiological glucose-lowering therapies that are currently available and in routine use. More specifically, effective glucose lowering is currently limited by the concurrent adversities of hypoglycaemia and weight gain.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 66 –68 (2011)More Less
An unexpected phaeochromocytoma represents one of the most serious events in anaesthesia, and unless well managed, carries a very high mortality. Although the problem is not common, anaesthetists may be faced with an unexpected phaeochromocytoma either in intensive care, or as a complication of almost any surgical procedure. Phaeochromocytoma is frequently undiagnosed as it may present with a bewildering array of symptomatology (Table I) and patients may be normotensive or even hypotensive, depending on the nature and expression of the tumour. Preoperative absence of symptoms does not exclude the diagnosis. Patients may also present with a variety of medical emergencies. The most hazardous presentation is that of phaeochromocytoma multisystem crisis which carries a very high mortality.
Author M. MorfordSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 70 –72 (2011)More Less
Glycaemic control has been an area of active research over the past decade. To a large extent, this was kick-started by the seemingly impossible beneficial effects of tight glycaemic control demonstrated by van den Berghe et al in 2001. Subsequent to this, numerous trials were conducted which have not shown the same degree of benefit and, in addition, numerous concerns have been raised with regard to the potential harmful effects related to hypoglycaemic events.
Author J. NienaberSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 73 –75 (2011)More Less
Hydrocephalus is usually the result of obstruction to cerebrospinal fluid flow. The aetiology may be congenital as in Arnold-Chiari malformation, or acquired as in brain tumours or intraventricular haemorrhage. The incidence of hydrocephalus is between 0.3-1.5 per 100 live births in the United States. Ventriculomegaly alone occurs in approximately 0.5-2 per 100 live births. Surgical correction involves draining fluid from the ventricular system to one of three places: peritoneum, atrium, or the pleural cavity. The most common choice is a ventriculoperitoneal shunt. As the child grows, the shunts often require replacement or revision making ventriculoperitoneal shunt placement or revision, one of the most common pediatric neurosurgical procedures.