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- Volume 17, Issue 6, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 6, 2011
Volume 17, Issue 6, 2011
Author C.A. LeeSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 359 –361 (2011)More Less
The management of postoperative pain in children has historically been poor, but advances have been made in the last decade. As pain is a complex phenomenon, a multimodal approach to treatment is required. This article aims to give a brief overview of the practical aspects of postoperative pain management in children, including non-opioid as well as opioid analgesics, and the salient features of regional anaesthesia.
Author L.N. NienaberSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 363 –369 (2011)More Less
Author Jenny ThomasSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
SAJAA continues to provide South African, and indeed all African, readers with articles relevant to paediatric anaesthesia and pain management. It is one of the few journals publishing case reports which, particularly in paediatric anaesthesia, are an extremely valuable communication, teaching and training resource. I am extremely proud and privileged to write an editorial on paediatric anaesthesia for this edition of SAJAA, which has been compiled to coincide with the 15th Paediatric Anaesthesia Conference of South Africa (PACSA), which will be held in Cape Town from 3-5 November 2011.
Author A.T. AdenekanSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 370 –373 (2011)More Less
Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate patients.
Method: This was a prospective cohort study conducted in a tertiary hospital in a suburban south-western Nigerian town. One hundred and sixteen patients who had cleft lip and palate repair over a five-year period were included. The demographic data, surgical diagnosis, congenital anomalies, procedures performed, medical problems, perioperative anaesthetic and surgical complications were studied.
Results: Adverse airway events were observed in six patients (4.6%). These included postoperative chest infection (n=2), failed intubation (n=1), difficult intubation (n=1), post-extubation bronchospasm (n=1), and laryngeal oedema (n=1). All, except one, who developed complications were patients with combined cleft lip and palate. No mortality was recorded.
Conclusion: Adverse perioperative airway events in cleft lip and palate surgery are common and are more likely to be associated with combined cleft lip and palate than with isolated lip or palate defects. These complications usually occur immediately following extubation or in the early postoperative period. The severity may necessitate intensive care unit admission and specialised care.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 376 –379 (2011)More Less
Background: The aim of this study was to evaluate the pre-emptive analgesic effect and duration of postoperative analgesia after caudal blocks in children.
Method: Forty-five children undergoing distal hypospadias surgery were assigned to group 1 (n = 23), and received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg before the surgical incision. Group 2 (n = 22) received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg at the end of surgery. Anaesthesia was induced with propofol and fentanyl and maintained with sevoflurane and nitrous oxide. Postoperative pain was rated on an objective paediatric pain scale.
Results: The analgesic requirement was greater in the second group.
Conclusion: Pre-emptive analgesia with caudal blocks may prevent the intensity and frequency of postoperative wound pain.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 388 –392 (2011)More Less
The sitting position provides almost ideal access to several areas within the cranium. The high risk of air embolism has led to decreased use of the sitting position. However, improved identification of patients at risk of paradoxical embolism may allow a more calculated, safer use thereof. Despite an improved understanding of the risks, many neurosurgical centres seldom use this position, and the occasional use of a complex patient position can then create additional challenges. This case report of a child requiring pineal surgery in the sitting position includes a review of the use of this position in children, and highlights the current emphasis on assessing the risk of paradoxical embolism before proceeding to the use of such a position.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 390 –395 (2011)More Less
Tetanus is caused by tetanospasmin, a toxin that is produced by the anaerobic bacterium, Clostridium tetani. Despite widespread vaccination, which limits its incidence in many parts of the world, tetanus may still occur owing to lack of immunisation related to religious tenets, cultural beliefs or inaccessibility to medical care. Of major concern during the perioperative care of such patients is control of the muscle spasms and the propensity for autonomic dysfunction, resulting in blood pressure instability. Ongoing muscle spasms may impair upper airway control or respiratory muscle function, thereby resulting in respiratory failure. Autonomic dysfunction may result in profound hypertension followed by hypotension, bradycardia and asystole. The pathophysiology of tetanus, its clinical manifestations, and current treatment options are discussed. The preoperative implications of tetanus and the care of these patients are reviewed.
Source: Southern African Journal of Anaesthesia and Analgesia 17, pp 394 –395 (2011)More Less
In this article we describe the case of a four-month-old male infant with myelomeningocoele, who presented with inspiratory stridor and vocal cord palsy (VCP). Hindbrain dysfunction is a leading cause of mortality and morbidity in children with neural tube defects. It is important to consider the above in the differential diagnosis of infants with breathing difficulties. A discussion of myelodysplasia, Arnold-Chiari malformations, bilateral VCP and anaesthesia management is presented.
Anaesthetic management of laparoscopic assisted bilateral adrenalectomy in a five-year-old child with Cushing's disease : case studySource: Southern African Journal of Anaesthesia and Analgesia 17, pp 396 –399 (2011)More Less