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- Volume 20, Issue 2, 2014
Southern African Journal of Anaesthesia and Analgesia - Volume 20, Issue 2, 2014
Volume 20, Issue 2, 2014
Author Jenny ThomasSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 99 –101 (2014)More Less
Maternal mortality : the shameful state in the Sudan - What role can the anaesthetist play to improve the outcome of pregnant women? : letter to the editorAuthor Sohel AhmedSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 102 –103 (2014)More Less
Maternal death is the death of a woman while pregnant, or within 42 days of termination of the pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Prone surgery and laryngeal mask airways : an overview of recent studies and personal experience : reviewAuthor M.A. EdgeSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 104 –109 (2014)More Less
Prone surgery is traditionally performed using endotracheal intubation in the supine position, followed by positioning of the patient in the prone position. This method exposes the patient to the disadvantages of neuromuscular blocking agents which can become problematic for short cases. Positioning of the patient in the prone position also involves a variety of complications. Clinicians tend to avoid the use of a laryngeal mask airway (LMA) in the prone position, but several trials demonstrate its low rate of complication if patient selection is performed properly. Obesity is also demonstrated not to be a contraindication to this anaesthetic technique. Patients are more haemodynamically stable if induced in the prone position using an LMA rather than supine induction, followed by an endotracheal tube. Although no trial has demonstrated its safety over that of endotracheal intubation, it appears to be a safe alternative to the traditional technique.
An observational audit of pain scores post-orthopaedic surgery at a level two state hospital in Cape Town : original researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 110 –116 (2014)More Less
Objectives: The aim was to determine whether postoperative pain is satisfactorily controlled in patients undergoing orthopaedic surgery at a level two state hospital in Cape Town.
Design: Two observational audits were performed 12 months apart as part of a full audit cycle.
Setting and subjects: In view of perceived poor postoperative pain control, an audit was performed of acute postoperative pain scores, anaesthesia techniques, and patient satisfaction with pain control. Orthopaedic patients undergoing surgical procedures at a level two state hospital in Cape Town were enrolled in the two audits. Patient groups included both patients admitted to the hospital and day-cases.
Outcome measures: Patients admitted to hospital following major surgery, rated their perceived pain over 48 hours, using a visual analogue scale (VAS). Day-case patients scored their pain in hospital, and were then contacted telephonically after 24 hours, and if required, after 48 hours. A VAS score ≥ 4 was regarded as unacceptable. The interventions employed after the first audit were: pain rounds, staff education and training, increased postoperative epidural time, patient-controlled analgesia pumps and indwelling femoral catheters following total knee replacement.
Results: Data were analysed from 71 patients in each audit. Mean VAS scores were unacceptable 12 and 24 hours after major surgery (range 4 - 5.1 in audit 1). Following the introduction of the aforementioned interventions, the mean pain scores were < 4 at every time point measurement, and significantly lower than in audit 1 at most assessment times (p < 0.05). Patient satisfaction with pain control improved from 32.4% in audit 1 to 54.9% in audit 2.
Conclusion: Acute postoperative pain is an important clinical problem in orthopaedic surgery. Following the demonstration of unacceptable postoperative pain scores in the first audit, specific interventions were shown to significantly improve pain control in the follow-up audit.
The use of ultrasound-guided transversus abdominis plane blocks for total abdominal hysterectomy : a double-blind, controlled trial : original researchAuthor R.A. DyerSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 117 –121 (2014)More Less
Objectives: This study investigated the postoperative analgesic efficacy of bilateral ultrasound-guided transversus abdominis plane (TAP) blocks, in patients undergoing total abdominal hysterectomy.
Design, setting and subjects: This was a prospective, randomised, double-blind, controlled study. Thirty patients were allocated to two groups; a TAP block group (n = 15) and a placebo group (n = 15). The TAP blocks were performed with 0.25% bupivacaine. The placebo group received sham blocks with normal saline, post induction of anaesthesia. Postoperatively, patients received patient-controlled intravenous morphine for analgesia.
Outcome measures: The primary outcome was morphine consumption during the first 24 hours postoperatively. Secondary outcomes were adequacy of pain relief, as assessed by pain scores at 0, 6 and 24 hours postoperatively, and side-effects.
Results: Our study showed a significant between-group difference in morphine requirements (5.2 ± 3.9 vs. 9.7 ± 4.3 mg, p = 0.007, and 12.9 ± 8.9 mg vs. 25 ± 12.1 mg, p = 0.006) for the TAP group, compared with the placebo group at six and 24 hours, respectively. There were no significant between-group differences in pain scores. There were no complications with any of the blocks.
Conclusion: Bilateral ultrasound-guided TAP blocks significantly reduced postoperative morphine consumption in a multimodal postoperative analgesia regimen for abdominal hysterectomy.
The impact of chronic pain on the quality of life of patients attending primary healthcare clinics : original researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 122 –126 (2014)More Less
Objectives: The objective was to study the nature and magnitude of the impact of pain on the quality of life of patients with chronic pain.
Design: This was a descriptive, cross-sectional quantitative study.
Setting and subjects: One thousand and sixty-six adult patients were screened between October and December 2010 in four primary healthcare clinics in south-west Tshwane.
Outcome measures: Patients reporting persistent pain for six months or longer were considered to be chronic pain patients (437, 41%), and were interviewed with regard to the impact of chronic pain on their quality of life using the Wisconsin Brief Pain Questionnaire.
Results: Four hundred and nineteen patients (95.9%, 95% confidence interval (CI): 93.6-97.6) of chronic pain patients reported that chronic pain impacted on their quality of life and functioning. Sixty-eight per cent of patients (95% CI: 63.3-72.4) reported being severely adversely affected by chronic pain. Pain had a severe impact on sleep quality in 39.2% patients, walking ability (37.4%), routine housework (33.8%), mood (20.1%), interpersonal relationships (15.3%) and enjoyment of life (16.3%). The more intense the experience of severe pain was, the greater the impact of chronic pain on everyday life (p-value < 0.001). Equally, patients with better pain relief enjoyed a better quality of life (p-value < 0.001).
Conclusion: A substantial proportion of patients attending primary healthcare clinics experience chronic pain which impacts on their lives in multiple and significant ways.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 127 –131 (2014)More Less
Background: A clinical audit is a method of addressing the clinical environment to bring about change and improvement. This paper describes the obstacles encountered while carrying out a clinical audit in a national referral teaching hospital in Botswana.
Method: A record was kept over a period of three months of reasons for the referral and admission of patients to the intensive care unit (ICU) and of major obstacles that could not be overcome during a clinical audit. This paper discusses the obstacles that may be faced in this regard.
Results: The following obstacles were found when carrying out the clinical audit. The medical records were difficult to find, both in the unit and in the medical records department. This led to abandonment of a retrospective pilot of the audit. When the medical records were available, the documentation was poor and unsatisfactory for the purposes of the study. Lack of local criteria and guidelines for ICU admission resulted in inappropriate referrals. Proposed guidelines had still not been adopted after 10 years. There was a fear by the many departments that refer patients to ICU of being "audited", which resulted in reluctance to participate in the audit without assurance from hospital management.
Conclusion: Although the problems that were faced during our audit are not novel to the auditing process, it is important that they are resolved in order to develop an audit culture.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 132 –135 (2014)More Less
Anaesthesiologists frequently encounter rare congenital diseases and syndromes. Osteogenesis imperfecta (OI) is a fibro-osseous disorder of the collagen tissue. OI is also known as brittle bone disease, and is a genetic disorder of connective tissue in which bones fracture very easily, often for no apparent reason. The aetiology of the disease is a gene defect that produces very little or poor quality type 1 collagen, an important building block of bones. Usually, patients inherit the disease from a parent, but sometimes cases are sporadic and the result of new genetic mutation.
Source: Southern African Journal of Anaesthesia and Analgesia 20 (2014)More Less