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- Volume 17, Issue 4, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 4, 2011
Volume 17, Issue 4, 2011
Author Anthony BeetonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 276 –280 (2011)More Less
On 20 April 2011, the Medicines Control Council (MCC) announced its decision to withdraw all dextropropoxyphene-(DPP-) containing products from the South African market within three months, because of stated safety risks and an insufficiently weighted risk-benefit profile. These risks refer to dose-related cardiac conduction abnormalities associated with QT prolongation, provoked by the main metabolite of DPP, norpropoxyphene.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 282 –285 (2011)More Less
Trauma-related injuries are the second leading cause of death and disability in South Africa. The traditional approach to surgery and resuscitation of severely injured patients has undergone change over the past 10 years. New concepts like damage control surgery and damage control resuscitation radically changed the practice of conventional resuscitation. Bleeding trauma patients die as a consequence of the so-called lethal triad or bloody vicious cycle: acidosis, coagulopathy and hypothermia. Effective initial management of trauma patients can help to improve outcomes.
Addition of adenosine to hyperbaric bupivacaine in spinal anaesthesia does not prolong postoperative analgesia in vaginal hysterectomy : original researchSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 288 –292 (2011)More Less
Background: Systemic administration of adenosine produces anti-nociception. Although literature supports intrathecal adenosine for neuropathic pain, its efficacy in postoperative pain remains unproven. There has been no study on the efficacy of adenosine on postoperative pain when administered with hyperbaric bupivacaine. The aim of our present study was to evaluate the efficacy of two different doses of intrathecal adenosine as an adjunct to 0.5% hyperbaric bupivacaine in patients undergoing vaginal hysterectomy under spinal anaesthesia.
Method: Seventy-five women, aged 40-60 years and scheduled for vaginal hysterectomy under spinal anaesthesia, were included. Patients were allocated to three groups of 25 patients each to receive 500 µg adenosine (group I), 1000 µg adenosine (group II) and normal saline (group III) with 2.6 ml of 0.5% hyperbaric bupivacaine. Postoperative analgesia was provided with patient-controlled fentanyl. Time of administration of rescue analgesia and total dose of fentanyl were recorded. The times to full recovery of sensory and motor block were noted.
Results: There were no differences in time to rescue analgesia and postoperative fentanyl consumption over 24 hours among the groups. There was no significant difference in onset of sensory and motor block or regression of sensory block, although statistically significant difference was noted in the time taken for regression of motor block.
Conclusion: Intrathecal adenosine does not affect the postoperative analgesic requirement when administered with hyperbaric bupivacaine.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 293 –298 (2011)More Less
The authors report and discuss the anaesthetic management of a transvenous transcatheter tricuspid valve replacement. The conduct of anaesthesia, the challenges encountered and the specific risks associated with the procedure will be discussed. Percutaneous tricuspid valve replacement may be safely performed under general anaesthesia, provided that the procedure is understood and all possible eventualities considered. As the quality of percutaneous prostheses improves, and if longterm follow-up confirms this as a safe option, anaesthesiologists will be expected to provide perioperative care for a growing number of these cases.
Positive maternal and foetal outcomes after cardiopulmonary bypass surgery in a parturient with severe mitral valve disease : case studySource: Southern African Journal of Anaesthesia and Analgesia 17, pp 299 –302 (2011)More Less
This case study describes the successful management of a parturient with severe mitral stenosis and moderate mitral regurgitation who underwent cardiopulmonary bypass (CPB) surgery. A healthy baby was delivered by Caesarean section 11 days later. The effects of CPB surgery and mitral valve replacement on parturient and foetus are discussed.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 304 –305 (2011)More Less
The efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block in patients undergoing open cholecystectomy : case studySource: Southern African Journal of Anaesthesia and Analgesia 17, pp 308 –310 (2011)More Less
Background: Ultrasound-guided oblique subcostal transversus abdominis plane (TAP) blockade has been described recently as providing a wider analgesic blockade than the posterior approach, with the possibility of being suitable for surgery both superior and inferior to the umbilicus. The objective of this study was to report the authors' experience of intraoperative oblique subcostal TAP blockade during open cholecystectomy.
Case report: This is a case series of 10 patients who had bilateral oblique subcostal TAP blockade for elective laparoscopic cholecystectomy which was subsequently converted to open cholecystectomy. Intraoperative haemodynamic parameters (pulse rate, systolic and diastolic blood pressure and mean arterial blood pressure) were recorded every five minutes. A rescue bolus of intravenous fentanyl (0.5 µg/kg) was given when any of the above-mentioned parameters were raised more than 15% from the baseline. The postoperative visual analogue score (VAS) was recorded in the recovery room. Intraoperative administration of rescue fentanyl bolus was minimal with a mean postoperative VAS of 2.1 ± 1.60. No complications were noted related to TAP blockade.
Conclusion: Ultrasound-guided oblique subcostal TAP blockade can be effective as intraoperative analgesia in abdominal surgery. Randomised controlled studies comparing TAP blockade with other modes of analgesia are needed to determine its efficacy for abdominal surgery.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 312 –314 (2011)More Less
Although tracheobronchial injuries occur rarely during oesophagectomy, the outcome of such injuries is mostly unfavourable. We report the case of a 50-year-old female, American Society of Anesthesiologists (ASA) class 1, who suffered a tracheobronchial injury during transthoracic oesophagectomy. The defect was repaired with an intercostal muscle flap but tracheobronchial disruption occurred again on extubation. As a result, she developed a profuse air leak postoperatively, through the bilateral thoracic and abdominal drains. A second surgical procedure using a single-lumen endotracheal tube was undertaken. During the procedure the patient deteriorated, owing to an increase in the tracheal rent, which resulted in a severe impairment of ventilation. This crisis was initially managed through advancement of the endotracheal tube into the left main bronchus. Subsequently, oxygenation and ventilation of both lungs was achieved by intubating both the main bronchi with microlaryngeal tubes, with the patient in the left lateral position.