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- Volume 17, Issue 2, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 2, 2011
Volume 17, Issue 2, 2011
Source: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
Percutaneous transtracheal jet ventilation (PTJV) is an accepted method of rescue ventilation following unsuccessful attempts to secure the airway through conventional methods. Pre-emptive use of PTJV in the difficult airway has also been described as using either a specifically designed jet ventilation catheter, or other cannulae, such as a central venous catheter (CVC). We report on the insertion of a single-lumen CVC to establish a means for PTJV or oxygen insufflation prior to induction of general anaesthesia in an 18-year-old man. He had an anticipated difficult airway and potentially difficult rescue airway access, having been booked for biopsy of neck masses and formal tracheostomy.
Author Peter Crichton GordonSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
The oil-on-canvas painting, entitled Surgery, was painted by Eastern Cape artist, Dorothy Kay, in 1937 and donated to UCT by her daughters. The original, depicting a patient undergoing a cholecystectomy, hangs in the UCT department of surgery. The surgery depicted in the painting was performed by Dr Bruce Macrae, and assisted by Dr T Oates. The anaesthetist was Major "Pom" Moore-Dyke, who, in 1943, was instrumental in the foundation of SASA. In the completed work, the artist portrays members of her family. Her husband, Hobart (Dr WHA Kay, FRCS, Ireland) is clearly seen facing the viewer. The artist's daughter, Patricia, poses as the nurse on the left, and the scrub sister on the right depicts the artist herself.
Source: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
To the Editor: We are all academics. We love to read new studies. Randomised controlled trials whip us into a frenzy. We thrive on case reports, literature reviews and prospective analyses. Our food is data and extracurricular activities extend to detail analysis, making criticisms and fantasising about improvements in physiology, pharmacology, and ultimately, patient morbidity and mortality.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 168 –173 (2011)More Less
Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressure control must be allowed, and there is no place for sudden "cosmetic" correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management.
Continuous measurement of heart rate variability following carbon dioxide pneumoperitoneum during nitrous oxide/sevoflurane anaesthesia : original researchSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 174 –176 (2011)More Less
Background: Previous studies of autonomic nervous system activity through analysis of heart rate variability (HRV) have demonstrated increased sympathetic activity during positive-pressure pneumoperitoneum. We employed an online, continuous method for rapid HRV analysis (MemCalc™, Tarawa, Suwa Trust, Tokyo, Japan) to demonstrate rapid changes in autonomic nervous system during pneumoperitoneum for laparoscopy.
Method: The powers of low-frequency (LF) (0.04-0.15 Hz) and high-frequency (HF) (0.15-0.4 Hz) components of HRV in 20 healthy adult patients were monitored under sevoflurane anaesthesia for 10 minutes after the initiation of carbon dioxide pneumoperitoneum at 10 mmHg.
Results: Heart rate increased promptly, but transiently, just after peritoneal insufflation. At that time, the ratio between the LF and HF components increased on HRV. Similar, but small, changes occurred following head-up positioning.
Conclusion: By monitoring HRV continuously, we have demonstrated that the change in autonomic nervous system balance induced by peritoneal insufflation was prompt and transient. The change in autonomic nervous system activity could have been due to increased sympathetic activity, reduced vagal activity, or both.
An audit of preoperative evaluation of general surgery patients at Dr George Mukhari Hospital : original researchSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 177 –180 (2011)More Less
Background: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. The aim of the study was to conduct an audit of the anaesthetic preoperative evaluation of general surgery patients at Dr George Mukhari Hospital (DGMH), Garankuwa.
Method: This was a retrospective study, using a sample of 88 files of general surgery patients who underwent elective surgery during 2008 at DGMH. The proportion of complete information recorded on the PEF used at DGMH was compared with a modified standardised PEF that uses the Global Quality Index (GQI).
Result: Seventy-five of the 88 files (85%) that were retrieved contained the PEF. The modified GQI scores for the sample of 75 patients ranged between 33.3-100%. The mean modified GQI score was 72.2 ±13.9%. The median was 73.3%, while the lower quartile was 60%, and the upper quartile, 80%. The GQI scores were low for the following criteria: preoperative diagnostic procedure (46.7%), medications prescribed by surgeons (46.7%), and preoperative fasting status (32%); and very low in terms of recording patients' weight (34.7%) and the history of allergies (34.7%) reported during the preoperative assessment. The PEF was completed in full in line with the modified GQI score in only in 1.3% of the files.
Conclusion: The overall quality of the preoperative evaluation was relatively incomplete with regard to a number of the modified GQI score criteria, suggesting the need for improvement in the completion of preoperative assessment of patients by anaesthetists at the hospital.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 182 –184 (2011)More Less
In this article, we describe the anaesthetic management and laser excision of a subglottic tumour that caused upper airway obstruction. Stridor was the presenting feature. A good history and careful assessment will reduce the likelihood of erroneous or delayed diagnosis and will improve patient outcome.This case report highlights the use of target-controlled infusions and jet ventilation (high-pressure source ventilation) in the surgical excision of a subglottic tumour.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 190 –192 (2011)More Less
Epiglottic cysts are of particular interest to both surgeons and anaesthetists because of the way in which they encroach on the airway. An epiglottic cyst in a 29-year-old woman was scheduled for endoscopic excision. It was located at the vallecula, and measured around 3 x 4 cm. As a fibre-optic bronchoscope was not available in our institution, endotracheal intubation was achieved with the help of a rigid endoscope and video-camera system.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 193 –195 (2011)More Less
The need for radiological studies using contrast media has increased. Diagnostic radiological procedures remain an essential part of patient assessment, while interventional radiology is a burgeoning field that is replacing open procedures, especially in high-risk patients. Contrastinduced acute kidney injury (CIAKI) has subsequently become the third most common reason for the development of in-hospital acute kidney injury in the USA, accounting for 12% of cases. Consequently, anaesthesiologists are more likely to encounter patients who are either at risk of developing CIAKI, or who have already acquired it.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 198 –199 (2011)More Less
Critical care medicine remains a fast developing field. The advent of novel pharmacological agents, development of new monitoring and therapeutic technologies, and a better understanding of physiology and pathology, allow us to appropriately manage an expanding population needing aggressive resuscitation, challenging organ support and sympathetic terminal care. Yet, such advances only serve to make us come full circle and refocus on the basic steps of effective health care.
So, what's new and at the cutting edge in intensive and critical care? On what are critical care practitioners focusing? Medscape looked at the top 10 articles that critical care practitioners read in 2010. Not surprisingly, readers were keenly interested in clinical news that could potentially affect the day-to-day care of their patients. Below are the highlights.
Author J. RamosSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 202 –204 (2011)More Less