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- Volume 19, Issue 6, 2013
Southern African Journal of Anaesthesia and Analgesia - Volume 19, Issue 6, 2013
Volume 19, Issue 6, 2013
Author Clover-Ann LeeSource: Southern African Journal of Anaesthesia and Analgesia 19 (2013)More Less
It gives me great pleasure to introduce this year's PACSA edition of the journal.
What is PACSA? Many readers of the journal will be familiar with the acronym for the Paediatric Anaesthesia Congress of South Africa, the annual meeting of anyone with an interest in paediatric anaesthesia. That familiarity led us to retain the acronym "PACSA" when the Paediatric Anaesthesia Community of South Africa was officially established as a special interest group under the auspices of the South African Society of Anaesthesiologists at the end of last year.
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 19, pp 280 –281 (2013)More Less
Author A.T. BosenbergSource: Southern African Journal of Anaesthesia and Analgesia 19, pp 282 –288 (2013)More Less
Regional anaesthesia for children continues to grow in popularity. The potential benefits of regional anaesthesia over more conventional methods are well recognised, but the level of evidence is small since there are few well designed randomised controlled studies on infants or children. Practice patterns have changed over the past decade. Peripheral nerve blocks are increasingly more favoured than neuraxial blocks. This change has been fuelled by the lower reported incidence of complications associated with peripheral nerve blocks, and is also in keeping with the increase in laparoscopic and thoracoscopic surgery. There has been renewed interest in children following recently described transversus abdominis plane, maxillary nerve and lumbar plexus blocks. The analgesic effect of a "single-shot" block is limited to approximately five hours, irrespective of whether or not bupivacaine, ropivacaine or levobupivacaine are used. Peripheral nerve catheters and adjuvants are two options that are used to prolong the duration of analgesia. Clonidine and ketamine have essentially replaced opiates as the most popular adjuvant in many institutions. Technological advancements are likely to make regional anaesthesia both safer and easier to perform in the future.
Source: Southern African Journal of Anaesthesia and Analgesia 19, pp 290 –294 (2013)More Less
Children presenting for liver resection form a challenging population with co-morbidities that require adequate preoperative assessment and planning to improve postoperative outcomes. With the development of new surgical equipment and techniques, the anaesthestist is in a precarious position in which a delicate balance is needed between delivering organ-protective anaesthesia and providing haemodynamic stability that will allow for optimal surgical results. This review will highlight some of these aspects.
Avoiding adverse outcomes in anaesthesia. The relevant As : allergy, asthma airway and anaphylaxis : PACSA Congress reviewsAuthor A. BosenbergSource: Southern African Journal of Anaesthesia and Analgesia 19, pp 296 –300 (2013)More Less
The perioperative preparation of children presenting for surgery aims to identify medical problems that might influence the outcome and to institute management strategies to reduce those risks. Adverse respiratory events remain a significant cause of morbidity and mortality in modern paediatric anaesthesia. This manuscript addresses some common medical problems that may impact on the anaesthetic. These include upper respiratory tract infections, and allergy and asthma; conditions whose optimal management should invoke daily discussions, and which can have significant implications if not managed correctly.
Source: Southern African Journal of Anaesthesia and Analgesia 19, pp 301 –305 (2013)More Less
Tuberculosis is a common problem in South Africa, and provides a number of challenges for the anaesthetist. Patients may present in a variety of ways. Constitutional and pulmonary symptoms are the most common. These may impact on fitness for surgery and choice of anaesthesia. Tuberculosis treatment has the potential for a number of significant drug interactions. These are primarily mediated through induction of the cytochrome P450 enzyme system by rifampicin. Guidelines for the prevention of tuberculosis in the theatre environment need to be followed to avoid placing staff and other patients in danger.
Source: Southern African Journal of Anaesthesia and Analgesia 19, pp 306 –313 (2013)More Less
Objective : The purpose of this study was to create a global medical earnings index, called the Medical MAC Index, to enable a comparison of what medical specialists earn in the countries included in the study.
Design : The study gathered data on the earnings of specialist anaesthetists employed in state hospitals with five years' work experience, across 49 developed and developing countries.
Setting and subjects : The earnings of anaesthetists were deemed to be indicative of all medical specialities because anaesthesia is one of the largest specialities, and most state hospitals do not distinguish between medical specialities from an earnings perspective. It is likely that a specialist with five years' work experience would have reached the higher echelons of state salary scales, but it is unlikely that he or she would have moved into a management role yet.
Outcome measures : To calculate a Medical MAC Index for a specific country, the net earnings of anaesthetists in the countries included in the study were converted into USA dollars, and adjusted using Xpatulator's purchasing power parity model, and then compared to the net earnings of an anaesthetist in that specific country. The specific country was the baseline. Countries above the line pay more, and those below the line, less.
Results : The Medical MAC Index for South Africa showed that medical specialists employed by the state in South Africa earn more than they would in most developing countries, but their earnings lag behind those of many developed countries.
Conclusion : South Africa could become more competitive if tax incentives were used to manipulate the data.
Anaesthetic management of endoscopic resection of juvenile nasopharyngeal angiofibroma : our experience and a review of the literature : case studySource: Southern African Journal of Anaesthesia and Analgesia 19, pp 314 –320 (2013)More Less
Background : Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumour in adolescent males with potential life-threatening complications. Advances in endoscopic surgery, invasive monitoring and hypotensive anaesthesia have made JNAs amenable to endoscopic surgical resection. We present the anaesthetic management of endoscopic resection of 14 JNAs, together with a review.
Method : The medical records of patients who underwent endoscopic excision of JNAs within the last seven years were reviewed retrospectively. Information was collected and analysed with regard to demographics, preoperative evaluation, intraoperative management, complications and postoperative course. Fourteen patients were included in the study. If the surgery needed to be converted to open surgery, the patients were excluded from the study.
Results : The age of the patients ranged from 10-18 years. Two patients had preoperative embolisation of the feeding vessel. Standard anaesthesia induction technique, together with invasive monitoring, was used. Controlled hypotension (mean arterial pressure of 60 ± 5 mmHg) was achieved with the help of inhalational anaesthetics, vasodilators and beta blockers. Mean duration of surgery was 197.14 ± 77 minutes, and median blood loss was 500 ml (100- 4 300 ml). Seven patients were extubated in the operating room. The other seven patients remained intubated for 24 hours owing to extensive surgery with a risk of postoperative bleeding, and were monitored either in the postoperative care unit (five patients) or the intensive care unit (two patients). There was no significant morbidity or mortality in any of the patients.
Conclusion : JNAs remain a challenge for anaesthesiologists because of excessive intraoperative bleeding. Anaesthetists should be aware of recent techniques to reduce tumour vascularity, such as embolisation of the feeding vessel and controlled hypotension. Invasive monitoring, together with multimodal blood conservation strategies, decreases blood loss and provides a clear field of vision for endoscopic surgery.
Thoracotomy in a spontaneously breathing neonate undergoing tracheo-oesophageal fistula repair : case studySource: Southern African Journal of Anaesthesia and Analgesia 19, pp 321 –322 (2013)More Less
Tracheo-oesophageal fistulae present a unique ventilator problem in the neonatal population. We describe the use of a caudal epidural catheter in a neonate who had to undergo carinal tracheo-oesophageal fistula repair. The epidural administration of a local anaesthetic enabled the provision of optimal analgesia, while simultaneously allowing maintenance of comfortable spontaneous ventilation during the thoracotomy.
Source: Southern African Journal of Anaesthesia and Analgesia 19, pp 323 –324 (2013)More Less
Transverse myelitis is an acute or subacute inflammatory disorder involving the spinal cord. Clinical signs are due to the involvement of the ascending and descending tracts in the transverse plane of the spinal cord. The most common cause is autoimmune. These patients may present with various clinical findings with which it is important for the anaesthesiologist to be familiar in order to manage such cases during the intraoperative and postoperative period. This report discusses issues relating to management of such cases.