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- Volume 18, Issue 3, 2012
Southern African Journal of Anaesthesia and Analgesia - Volume 18, Issue 3, 2012
Volume 18, Issue 3, 2012
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 18 (2012)More Less
The autumn edition of our journal has a predominant cardiac and airway flavour and, while most colleagues are not involved in anaesthesia for open heart surgery, many of us may well be required to acquire the skills to perform echocardiography in our patients presenting for both routine and cardiac anaesthesia.
Myocardial ischaemia during coronary artery bypass graft surgery : a review of intervention strategies (Part 2) : review articleAuthor Palesa MotshabiSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 134 –138 (2012)More Less
Low cardiac output syndrome is a common phenomenon in cardiac surgical patients. Myocardial ischaemia, stunning and hibernation often manifest with a low cardiac output state accompanied by segmental wall motion abnormalities. Intracoronary air, direct coronary occlusion due to technical difficulty, hypovolaemia, low systemic vascular resistance, tamponade, diastolic dysfunction, right ventricular dysfunction and intracardiac air may also lead to low cardiac output syndrome. The advent of echocardiography promises to revolutionise the management of this syndrome with early diagnosis and resolution of correctable causes.
The Cardiothoracic Anaesthesia Society of South Africa (CASSA) consensus paper for accreditation of anaesthetists in South Africa in perioperative echocardiography : consensus paperSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 139 –141 (2012)More Less
There is a need to develop an accreditation process for South African physicians who practise perioperative echocardiography. International level accreditation will bring legitimacy to the process of training practitioners in perioperative echocardiography and ensure standards of practice. Accreditation will be developed as a two-year process during which candidates with a College Fellowship or MMed degree may register with a supervisor and submit a portfolio of 120 comprehensive echo reports and five complete digital studies for assessment. If these are judged to be of an adequate standard, the candidate will be eligible to sit an exam consisting of a multiple-choice question theory and echo video paper and an oral exam.
The Laryngeal Mask Airway Supreme : safety and efficacy during gynaecological laparoscopic surgery : original researchSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 143 –147 (2012)More Less
Background : Laryngeal Mask Airway Supreme (LMA Supreme) is a new single-use polyvinyl chloride supraglottic device that offers gastric access. To date, studies that have tested the LMA Supreme) for use in laparoscopic surgery have been reported. We present the largest evaluative study that describes the use of this mask for anaesthesia in gynaecological laparoscopic surgery.
Method : Hospital ethics board approval was obtained, and 140 fasted patients undergoing elective gynaecological laparoscopy were prospectively studied. We evaluated the ease of insertion of the device and the drain tube, the oropharyngeal leak pressure (OLP), incidence of postoperative sore throat, and other adverse events.
Results : Insertion of the LMA Supreme was successful in all patients (first attempt, n = 123; second attempt, n = 16; and third attempt, n = 1). Gastric tube insertion was successful in all patients (easy, n = 135; difficult, n = 5). Initial mechanical ventilation was adequate in almost all cases. Mean OLP at the level of 60 cmH2O cuff pressure was 28.2 ± 5.1 cmH2O. Mean peak airway pressure before pneumoperitoneum was 17 ± 3.5 cmH2O, and 22.1 ± 4 cmH2O, after pneumoperitoneum. Fourteen patients (10%) complained of a mild sore throat postoperatively. Coughing occurred in 10 patients (7.1%), and blood was noted after removal of the LMA Supreme in five cases (3.5%). No other complications were reported.
Conclusion : We conclude that LMA Supreme is an easy to insert, and effective ventilatory device, for gynaecological laparoscopic surgery. It provides a functional airway seal with minimum adverse events.
Comparison of the air-Q ILA and the LMA-Fastrach in airway management during general anaesthesia : original researchSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 150 –155 (2012)More Less
One hundred and sixty patients aged between 20-60 years with ASA physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, double-blinded study to compare the success rate of tracheal intubation between the air-Q intubating laryngeal airway (ILA) and the laryngeal mask airway (LMA)-Fastrach (80 patients in each group). The degree of mouth opening, occurrence of coughing, laryngospasm, ease of insertion, adequacy of ventilation, and number of attempts were recorded during the insertion of the air-Q ILA and the LMA-Fastrach. Tracheal intubation via the supraglottic airway devices was then performed, and cricoid manipulation, ease of insertion and number of attempts, were noted. Postoperatively, the degree to which patients had a sore throat using visual analogue scale (VAS), hoarseness of voice and blood on the air-Q ILA and the LMA-Fastrach were recorded. In terms of ease of insertion, there was no statistically significant difference between the insertion of the air-Q ILA and the LMA-Fastrach. However, in terms of ease of tracheal intubation, the LMA-Fastrach group was superior (p-value = 0.001) in terms of external cricoid manipulation requirement, ease of intubation, and the number of attempts (p-value = 0.009). The success of blind intubation, with up to three attempts, was 77 (97.47%) and 60 (75%) patients, in the LMA-Fastrach and air-Q ILA groups, respectively. In conclusion, there was no statistical difference between the air-Q ILA and the LMA-Fastrach in terms of ease of insertion, incidence of adverse response, and adequacy of ventilation. However, tracheal intubation was superior using the LMA-Fastrach, rather than the air-Q ILA.
Evaluation of three adjusting manoeuvres and type of endotracheal tube in the success of air-Q aided tracheal intubation : original researchSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 157 –160 (2012)More Less
Background : The present study observed whether the use of three different adjusting manoeuvres and use of an armoured tracheal tube would increase the success rate of tracheal intubation, aided by the air-Q intubating laryngeal airway (air-Q ILA).
Method : Fifty American Society of Anesthesiologists (ASA) I and II patients undergoing elective surgical procedures were randomly assigned to two groups. In the endotracheal tube (ETT) group, standard ETT was used, while in the armoured ETT (AETT) group, tracheal intubation was performed using AETT. After a uniform premedication, induction and relaxation technique, an appropriate sized air-Q ILA with ETT in-situ, was placed. After good ventilation, a flexible fibrescope was passed down the ETT, and the percentage of glottic opening (POGO) was documented. Subsequently, three adjusting manoeuvres were applied in sequence. These included firstly, backward pressure over the larynx; secondly, head extension; and lastly, neck flexion. After noting the POGO score with each adjusting manoeuvre, the incidence of successful intubation was noted, with and without manoeuvres.
Results : The best POGO score (84%) was observed with the application of backward pressure. Successful tracheal intubation was achieved in 56-60% of patients without the use of any manoeuvres, using either type of tracheal tube. For the rest, tracheal intubation was achieved using backward pressure, except in one patient from the ETT group. The incidence of successful tracheal intubation was nearly identical with either type of ETT.
Conclusion : Successful tracheal intubation can be achieved in 96% of cases using adjusting manoeuvres. The nature of the tracheal tubes did not influence the success rate.
Comparison of ultrasound-guided vs. anatomical landmark-guided cannulation of the femoral vein at the optimum position in infant : original researchSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 162 –166 (2012)More Less
Background : Femoral vein cannulation can be a routine process during major surgery in infants and children, and may prove to be lifesaving under certain conditions. This study compared ultrasound (US)-guided cannulation of the femoral vein in infants with the traditional anatomical landmark-guided technique.
Method : Eighty infants who had been prepared for major elective surgery under general anaesthesia were randomly assigned either to Group I, in which the femoral vein cannulation was guided by anatomical landmarks in optimally positioned patients, or to Group II in which the US-guided technique was used for cannulation.
Results : The procedure was successful in 35 cases in Group I, and in all cases in Group II. The number of needle passes was higher in Group I, compared to Group II [4 (1-22) vs. 1 (1-8); p-value = 0.001]. First-pass success was achieved in 20 cases in Group I, and in 35 cases in Group II. The time to complete cannulation was significantly shorter in Group II, compared to Group I [145 (40-650) vs. 350 (40-1 600) seconds; p-value = 0.02]. Three cases of arterial puncture occurred in Group I, while there were no complications in Group II.
Conclusion : The US-guided technique for femoral vein cannulation is useful as it results in greater success, shorter cannulation times, fewer attempts, and fewer complications.
Source: Southern African Journal of Anaesthesia and Analgesia 18, pp 168 –170 (2012)More Less
Coronary arteriovenous fistula (CAVF) is a rare congenital anomaly. Literature on CAVF perioperative anaesthetic management is limited, but the consequences of mismanaging symptomatic CAVF are dire, with the potential risk of perioperative myocardial infarction, and even death. We present a 48-year-old male with symptomatic congenital coronary cameral fistulae, who underwent a successful surgical repair of the fistulae. This case study describes this very rare phenomenon, and its perioperative anaesthetic management, including the lessons learnt.
Cervical epidural anaesthesia for shoulder arthroscopy and effective postoperative physiotherapy for a frozen shoulder : a case study : case studySource: Southern African Journal of Anaesthesia and Analgesia 18, pp 172 –175 (2012)More Less
Shoulder arthroscopy is used to treat various diseases of the shoulder, including refractory adhesive capsulitis. Effective postoperative pain relief is critical for these patients, as the success of surgery largely depends on early and regular physiotherapy. Although traditionally, various methods of postoperative analgesia have been described, each has its own disadvantages. We report a case of adhesive capsulitis, for which arthroscopic capsular release was carried out under cervical epidural anaesthesia with general anaesthesia, resulting in excellent intraoperative and postoperative analgesia, with a better patient compliance for physiotherapy, and a significant improvement in the range of movement at the shoulder joint.