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- Volume 20, Issue 3, 2014
Southern African Journal of Anaesthesia and Analgesia - Volume 20, Issue 3, 2014
Volumes & issues
Volume 20, Issue 3, 2014
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 20 (2014)More Less
What can a local, scholarly journal, like SAJAA offer its authors and readers that high-impact international journals cannot? This is a very challenging and exciting question that many scholarly journals in South Africa face. In particular, there is enormous pressure from public higher education institutions to publish in international journals that carry a high-impact factor and which are Medline and ISI listed. Is it sufficient to be accredited with the Department of Higher Education and Training (DHET) and indexed in Scopus? DHET will pay the subsidy for peer-reviewed articles published in journals listed in ISI, Medline and with respect to the South African list of journals accredited by DHET (and ASSAf). Clearly we would like to aim higher, and with this edition we will be embarking on this journey.
Author Analee MilnerSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 137 –142 (2014) http://dx.doi.org/10.1080/22201173.2014.936773More Less
Seventy-five to one hundred per cent of patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) have a head and neck manifestation. These manifestations may impact on anaesthetic management, but more importantly often allow the anaesthetist to diagnose the disease before the patient or the surgeon may be aware of possible contagion. Immune compromise, arising from the onslaught of CD4 cells, results in severe infections (overwhelming fungal and bacterial) and cancers. Vasculitides also become prevalent, resulting in bizarre unpredictable manifestations such as aneurysmal formation in the vessels of young patients, and bleeding or clotting diathesis in all ages. The World Health Organization classification, based on specific pathology, allows for accurate clinical staging of the disease. Grave concerns for the anaesthetist are the constant threat of needle-stick injuries and the contraction of tuberculosis, which is becoming resistant to treatment. It should be noted that many of the signs and symptoms described herein will be attenuated or absent once the patient is on antiretroviral therapy (ART). However, in South Africa, only 500 000 of an estimated five million patients infected with HIV are receiving ART. Therefore, it is still of value to recognise and understand the pathology caused by degrees of immune compromise from HIV/AIDS. Ironically, ART may impact on the airway owing to immune reconstitution inflammatory syndrome and lipodystrophy.
The pitfalls of postoperative theatre to intensive care unit handovers : a review of the current literature : reviewSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 143 –146 (2014) http://dx.doi.org/10.1080/22201173.2014.936776More Less
Postoperative handovers present a critical step in the management of intensive care unit (ICU) patients. There are many challenges in the transportation of unstable patients with complex medical histories from theatre to the ICU, and the subsequent transfer of responsibility for care from one group of caregivers to another. Communication between the providers of the handover report (anaesthetists, surgeons and theatre nursing staff) and receivers of the report (ICU physicians and ICU nursing staff) is often poor. The unstructured presentation of information, the noisy ICU environment, and discussions between healthcare workers from different disciplines at different levels of training adds to the burden of communication. The handover report may be seen as a sentinel event in the ICU patient's stay. ICU staff use the handover process as an important source of information to coordinate management input from multiple disciplines. Despite its importance, the practice of a structured postoperative handover protocol in our region's hospitals is non-existent. The authors reviewed the current literature to better understand the challenges facing proper handover processes and suggest some interventional strategies.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 147 –151 (2014) http://dx.doi.org/10.1080/22201173.2014.936778More Less
Background : Airway skills education is important for the safe and effective care of patients. Interns often encounter critical airway situations. Their ability to cope derives from the recall of formal lectures and tutorials, as well as accumulated experience. We tested whether human patient simulators enabled trainees to enhance skills and knowledge in a safe and realistic environment.
Method : An airway training programme was developed using a high-fidelity lifelike human patient simulator (METI®) to simulate realistic airway scenarios. An equivalent programme using traditional methods (lectures and tutorials) contained the same information. A written assessment [(multiple-choice questions (MCQ)] and four assessment stations [objective structured clinical examination (OSCE)] were administered before and after instruction. A questionnaire documented previous exposure to the simulator, airway management techniques and devices, and participants' subjective opinions on the instruction received.
Results : Eighty-two participants were enrolled into two groups of 41. Groups were comparable in terms of previous exposure and experience, as well as in pre-training scores. Both groups showed significant improvement in post-training scores. However, subjects receiving simulator training achieved significantly higher test scores in the MCQ (median 43 out of 50, interquartile range (IQR) 42-45, versus 41 out of 50, IQR 39-43); and OSCE assessment station 3 (median 15 out of 15, IQR 13-15, versus 14 and 12-15), and OSCE assessement station 4 (median 13 out of 15, IQR 12-14, versus 12 and 10-13). The simulator group showed greater participant satisfaction (95% vs. 34%).
Conclusion : There was improved immediate retention of knowledge and performance of airway management skills using the simulator. Participant satisfaction was much better in the simulator group. The importance of psychomotor reinforcement should be borne in mind when designing simulation courses.
The association between preoperative clinical risk factors and in-hospital strokes and death following carotid endarterectomy in South African patients : researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 152 –154 (2014) http://dx.doi.org/10.1080/22201173.2014.936777More Less
Background : Current surgical management of carotid artery disease includes carotid endarterectomy (CEA). In-hospital strokes and death following CEA might be associated with preinduction blood pressure (BP) measurements and other clinical risk factors.
Method : The aim of our study was to determine whether or not there is an association between preinduction BP, other clinical risk factors, and in-hospital strokes or death following CEA in a cohort of South African patients. We collected data from medical records relating to clinical risk factors in patients, preinduction BP measurements, and in-hospital strokes and death, following CEA. The association between preinduction BP and clinical risk factors, and postoperative neurological morbidity and mortality, was analysed using univariate statistical methods.
Results : Our cohort consisted of 76 patients who underwent CEA. Eight of these patients had in-hospital strokes or death following their surgery. An association between a history of hypertension or other clinical risk factors and an in-hospital stroke and death was not identified in these 76 CEA patients following univariate analysis. However, patients with preinduction BP within the lowest or highest quartile for preinduction BP were at a significantly increased risk of an in-hospital stroke and death following their surgery (p-value = 0.003). A subanalysis of patients who were hypertensive also showed this univariate association (p-value = 0.003).
Conclusion : It is possible that extremes of preinduction BP might be associated with in-hospital strokes and death in CEA patients following their surgery, although further research is required to confirm this.
Effectiveness of tramadol/paracetamol compared with etoricoxib as postoperative analgesia in daycare surgery : researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 155 –159 (2014) http://dx.doi.org/10.1080/22201173.2014.936750More Less
Objective : The objective was to evaluate the effectiveness of a fixed, tramadol/paracetamol combination when compared with etoricoxib as postoperative analgesia following day care surgery.
Design : This was a prospective, randomised, single-blind study.
Setting and subjects : Sixty-two patients were randomised to receive either etoricoxib (n = 29) or tramadol/paracetamol (n = 33) by mouth prior to surgery. Patients were given general anaesthesia with fentanyl for intraoperative and rescue analgesia.
Outcome measures : The primary efficacy variables that were investigated were total pain relief and sum of pain intensity differences at 1, 2, 3, 4, 6, 24 and 48 hours. Data were collected by an independent observer through an interview or by telephone after discharge.
Results : Total pain relief (p-value 0.001) was significantly different between the two groups for the first four hours. The total dose of fentanyl use was comparable between the two groups. There was also a significant difference in the occurrence of nausea with tramadol/paracetamol (p-value 0.001), and dizziness with etoricoxib (p-value 0.024).
Conclusion : Tramadol/paracetamol provided significantly better pain relief than etoricoxib in the early postoperative period.
A comparison of non-invasive versus invasive methods of haemoglobin estimation in patients undergoing intracranial surgery : researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 160 –163 (2014) http://dx.doi.org/10.1080/22201173.2014.936749More Less
Background : Until recently, invasive monitoring techniques were the only ones available for the estimation of haemoglobin (Hb) in the blood. However, following the introduction of a new non-invasive monitor, Hb concentration could be non-invasively and continuously monitored. It allows immediate and ongoing Hb changes to be displayed during surgery, which may aid in the rapid detection of clinically significant blood loss. To test the accuracy of this non-invasive monitor, we compared Hb levels obtained using standard invasive techniques (laboratory and arterial blood gas machine analysis) with those derived from a non-invasive monitor.
Method : Thirty patients undergoing various intracranial surgeries were enrolled in the study. Blood samples were withdrawn for Hb estimation from the laboratory [total haemoglobin mass (tHb)] and arterial blood gas (ABG) machine (aHb), using automated Hb analyser techniques randomly at any point during the surgery. At the same time, the Hb values displayed on the non-invasive monitor [Radical-7® Pulse Co-oximeter (SpHb®)], together with the perfusion index (PI), were also noted.
Results : The perfusion index (PI) was less than 1.4 in eight patients. The obtained Hb values were unreliable, as per the manufacturer's recommendations. Statistical analysis showed poor correlation between the invasive and non-invasive techniques of Hb estimation in the remaining 22 patients.
Conclusion : Non-invasive Hb monitoring (SpHb®) may not have sufficient accuracy to minimise the need for invasive Hb monitoring. However, it may allow continuous monitoring of Hb and could guide clinicians as to the need for invasive monitoring.
Paravertebral block as a sole technique for the anaesthetic management of a patient with myalgic encephalomyelitis undergoing breast cancer surgery : case studySource: Southern African Journal of Anaesthesia and Analgesia 20, pp 164 –166 (2014) http://dx.doi.org/10.1080/22201173.2014.936754More Less
Myalgic encephalomyelitis (ME) is a multifaceted organic disease which, owing to its non-specific multiple symptoms that include incapacitating fatigue, deeply affects the quality of life of diseased patients. It carries a perceived risk of an adverse reaction to drugs, including anaesthetics. However, there is very little information in the medical literature on the anaesthetic management and outcomes of patients with this condition. According to current scientific literature, there is no causal relationship between ME relapse and anaesthesia, surgery or both. We present the anaesthetic management of a ME patient who underwent breast cancer surgery.