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- Volume 17, Issue 1, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 1, 2011
Volumes & issues
Volume 17, Issue 1, 2011
Author T. NgubaneSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 76 –80 (2011)More Less
Ventilatory management of a brain-injured patient is challenging. Injury to the brain initiates an inflammatory cascade that may result in secondary brain injury and extracranial organ dysfunction. The lung is often the most compromised in this process, and at multiple stages of brain injury. Lung pathology can be part of the initial injury process, or result from sequelae of the brain injury and critical care course. Principles of lung protection and brain-directed therapies are often in direct conflict. There are limited randomised controlled trials from which clinicians can draw conclusions regarding management of this controversial cohort of patients. Physiological interactions between the brain and lung should be clearly understood. Injurious ventilation should be avoided. Secondary brain injury should be prevented. Risk factors for this must be identified early and treated promptly. Hypoxaemia should be avoided. Arterial CO2 tension should be managed. Hyperventilation should be reserved for intractable intracranial hypertension. There is no role for prophylactic hyperventilation as primary therapy. Hypocarbia can precipitate cerebral ischaemia. Novel ventilatory strategies are in the infancy stages. By using these therapeutic modalities, more positive outcomes are hoped for.
Author C. BreckonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 81 –82 (2011)More Less
In vivo optical spectroscopy (INVOS) and arterial lines : a must in shoulder surgery? : refresher courseAuthor N. BaxSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 83 –85 (2011)More Less
Monitoring physiological parameters has changed the face of anaesthesia. We have become accustomed to the safety margins that the pulse oximeter, capnograph, non-invasive blood pressure (BP) and electrocardiogram (ECG) leads provide us, especially in the supine position. However, it is a changing science as new monitoring systems come into the market, and as such, we have to adjust our anaesthetic techniques in order to provide the safest anaesthetic for our patients, especially if it is performed on patients in unusual positions.
Author P. StuartSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 86 –89 (2011)More Less
Various drugs have been added to the local anaesthetic agents given intrathecally in an attempt to improve on the analgesic effect of the local anaesthetic agent, as well as the duration of analgesia. They range from the accepted to the bizarre. It is difficult to cover all drugs ever injected intrathecally in a short paper such as this one, particularly if one includes drugs injected intrathecally in animal models and that have as yet not been used in humans.
Author C-A. LeeSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 93 –95 (2011)More Less
"Early exposure to anesthesia and learning disabilities in a population-based birth cohort" was published in Anaesthesiology in March 2009. Wilder et al studied the association between anaesthesia before the age of four and the development of learning disabilities (LD), and found that, while a single anaesthetic was not associated with an increased risk of LD, receiving two or more anaesthetics was associated with a increased risk of LD (hazard ratio 1.59 for two anaesthetics, and 2.60 for ≥ three exposures). The risk for LD increased with longer cumulative duration of anaesthetic exposure.
Author J. ShungSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 96 –99 (2011)More Less
The agitated child in the recovery room is distressing, not only for the staff, but also for the parents. This often creates a false impression of the "quality" of the anaesthesia. Before attributing this distress to emergence delirium, other more serious causes should be excluded.
Author J. ThomasSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 100 –101 (2011)More Less
Which airway devices should be on difficult intubation trolleys in resource-constrained settings? : refresher courseAuthor R.E. HodgsonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 102 –106 (2011)More Less
Airway management publications tend to prevail in Europe and the USA predominantly, with an emphasis on technology that may be unaffordable in countries where resources are far more constrained. However, difficult airways present just as often or even more frequently in South Africa due to a large burden of trauma, late-presenting infectious diseases and cancer.
Author E. WelchSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 107 –109 (2011)More Less
A challenge for any anaesthetist is intubating a patient for short procedures that last 10 or 15 minutes during a busy list. While most day-case surgery can now be performed using a pharyngeal airway device, certain procedures, such as dental work, laparoscopy, microsurgery, open-eye surgery, ENT and some paediatric procedures, require intubation. Unfortunately, most of the literature focuses on how to achieve a successful, rapid intubation under optimal conditions, without any regard for needing to extubate a spontaneously breathing, awake patient within a few minutes of putting the tube in. Many techniques have been described, all of which are successful in the hands of the person describing the technique, but for everyone else, result in either a coughing, bucking, recently intubated patient, or an apnoeic patient needing half an hour's ventilation post-surgery.
Author R.K. MirakhurSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
Application of cricoid pressure has been considered an important part of rapid sequence induction (RSI) of anaesthesia and is standard textbook teaching. The aim is to prevent regurgitation of gastric contents into the oesophagus and their aspiration into the respiratory tract. Application of cricoid pressure is supposed to compress the oesophagus between the cricoid cartilage and the vertebral body. An effective cricoid pressure is in the range of 30-40 N.
Author R.A. DyerSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 110 –112 (2011)More Less
The increased use of regional anaesthesia for Caesarean section (CS) has been a consequence of the risk of failed intubation associated with general anaesthesia (GA) for CS, as well as the provision of an improved birth experience and quality of postoperative analgesia. This trend has led to a lack of experience in the practice of rapid sequence intubation and GA in trainee anaesthetists, prompting the suggestion that simulators may become an essential part of anaesthesia training in this scenario. In the USA during the period 1984- 2002, the case fatality rate for general anaesthesia decreased from 32.3 to 6.5 per million, while the rate of regional anaesthesia was lower, but increased from 1.9 to 3.8 per million.
A journal article that changed my practice : predictive value of the stomach wall pH for complications after cardiac operations : comparison with other monitoring : refresher courseAuthor M.G. MythenSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
The ability to predict impending complications after elective cardiac operations from measurements of blood pressure, cardiac index, arterial pH, and urine output on the day of operation, was compared with that of indirect measurement of stomach wall pH in 85 patients. We found that acidosis in the stomach wall was the most sensitive predictor for complications.
Author A. RantloaneSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
Trauma, surgery and anaesthesia are known triggers of the stress response and this has been shown in many studies to present as a hyperglycaemic response. These elevated blood glucose levels have, in turn, been linked in many studies to increased mortality and morbidity in hospitalised patients and most certainly in patients undergoing surgical procedures of one type or another. Poor perioperative clinical outcomes are true of both diabetic and non-diabetic patients, except that they occur to varying extents.
Author B.M. BiccardSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
The American College of Cardiology/American Heart Association (ACC/AHA) has incorporated the Revised Cardiac Risk Index (RCRI) into the algorithm for Perioperative cardiovascular evaluation and care for noncardiac surgery (Fleisher et al, 2007). However, it does not successfully discriminate higher from lower risk patients. In comparison, biomarkers can accurately stratify vascular surgical patients.
Author S. NaickerSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 118 –119 (2011)More Less
The National Institutes of Health (NIH) Biomarkers Working Group has defined a biological marker (biomarker) as "a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention".
Author M.A. EagarSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 120 –123 (2011)More Less
There is significant risk involved in subjecting patients with liver cirrhosis to surgery. Advanced liver disease is associated with systemic dysfunction affecting the cardiovascular, respiratory, renal, gastrointestinal, immunological, haematological, coagulation, endocrine and central nervous systems. Perioperative risk stratification can be very challenging. This is aggravated by the fact that cirrhosis is often indolent and asymptomatic until patients present with complications of the disease.
Author A. BeetonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 124 –125 (2011)More Less
Scope of ERCP
- Much of simple diagnostic endoscopic retrograde cholangiopancreatography (ERCP) now supplanted by magnetic resonance cholangiopancreatography (MRCP).
- Therapeutic ERCP growing exponentially: sphincterotomy; stenting as interim management in cholelithiasis; cholangitis; extrahepatic obstructive jaundice.
- Endoscopic ultrasound for screening and diagnosis of pancreatic and biliary neoplasms.
Author M.F.M. JamesSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 127 –130 (2011)More Less
Considerable attention has been given to so-called "balanced solutions" (such as Ringer's lactate, and more recent derivatives) as alternatives to the less physiological "abnormal" 0.9% saline. Colloids prepared in "balanced" electrolyte solutions have also been developed, alongside similar colloids in saline. This is a consequence of the observation that excessive use of saline will result in hyperchloraemic acidosis, which has been identified as a potential side-effect of saline-based solutions. There is debate about the extent of the morbidity associated with this condition, although the risk is probably quite low. It has been suggested that the use of balanced solutions may avoid this effect.