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- Southern African Journal of Anaesthesia and Analgesia
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- Volume 20, Issue 5, 2014
Southern African Journal of Anaesthesia and Analgesia - Volume 20, Issue 5, 2014
Volume 20, Issue 5, 2014
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 4 –6 (2014)More Less
Paracelcus (1493-1541), a scientist of the Middle Ages, exclaimed: "All things are poison and nothing is without poison; only the dose permits something not to be poisonous".
Might this be true of oxygen during Caesarean section? Should oxygen, like most other drugs that we use in medicine, be administered within a tight therapeutic range, where too much of the drug may result in side-effects, but too little will allow insufficient benefit to be conferred by the drug on the patient? Should oxygen only be administered when indicated; thoughtfully and for a limited duration, with the dose being reviewed at regular intervals?
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 7 –13 (2014)More Less
Anaesthesia and pain management for paediatric burns continues to challenge and frustrate healthcare professionals in this field of medicine. This review aims to provide some practical management strategies to enable the improved care of burned children. The pathophysiology of burns, toxic shock syndrome, inhalational injuries and perioperative care of paediatric burns is addressed.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 14 –18 (2014)More Less
Many systems that are relevant to anaesthetists may be affected in syndromic children. These include the spine, airway, respiratory, cardiovascular, genitourinary and neuromuscular systems, as well as coagulation, endocrine and metabolic functions. Embryological development may explain some co-existing anomalies. Although each syndromic child must be managed individually, an approach to evaluating syndromic children and knowledge of common syndromes may be useful.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 19 –25 (2014)More Less
Oesophageal atresia, with or without tracheo-oesophageal fistula, is one of the most challenging conditions with which the anaesthesiologist has to deal during the perioperative period. The patients are usually in their first few days of life, and might be premature with inherent airway problems. This is then compounded by airway and respiratory complications presented by this lesion. These patients often present with a multitude of other congenital anomalies that may have a bearing on the oxygen cascade. With improvements in antibiotic choices, prenatal diagnosis, neonatal intensive care and surgical options, outcomes in this patient group have improved immensely. This manuscript serves to highlight the anaesthetic considerations of these conditions, while also examining recent developments in this patient population.
An audit of the perioperative anaesthetic management of ventriculoperitoneal shunt insertion in the paediatric population at Inkosi Albert Luthuli Central Hospital : researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 27 –31 (2014)More Less
Objective : Our study included an assessment of current anaesthetic practice in paediatric ventriculoperitoneal shunt insertion (VPSI), a review of shunt revision and complication rates, an evaluation of the incidence of congenital syndromes, retroviral disease and tuberculosis meningitis, and differentiation with regard to the age groups in which shunt surgery most commonly occurs.
Method : This is was a retrospective audit study. We reviewed information obtained from the computerised database on children from birth to 18 years of age undergoing VPSI at Inkosi Albert Luthuli Central Hospital from 1 September 2012 to 1 September 2013.
Results : One hundred and ten children were included in the study. Arnold-Chiari II and Dandy-Walker syndrome were associated with 8 (7.3%) and 9 (8.2%) of the children, respectively. Tuberculosis meningitis was documented in 21 (19.1%) of the cases. The majority of the anaesthetic techniques included a volatile induction and maintenance of anaesthesia (VIMA) approach, with opioid-sparing practice. Laryngoscopy was not difficult and most of the children were extubated. Half of the shunt insertions were performed in infancy. One fourth of the children required shunt revisions within three months, and these were mostly blocked shunts.
Conclusion : The anaesthetist needs to be cognisant of differences in the anatomy and physiology in these patients, and to have an awareness of associated syndromes and co-morbidities. A VIMA approach seems to be appropriate and the anaesthetist must be prepared to manage the infant age group, together with complications that result in revision surgery.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 32 –35 (2014)More Less
Anaesthetic and critical care staff play a governing role in the comprehension of a hospital's oxygen delivery system and associated contingency plans for internal disaster management. Therefore, staff must be thoroughly prepared and properly trained to support an institution-wide emergency response in the event of central oxygen pipeline failure.
Intubation of a neonate with glossopalatine ankylosis using a paraglossal approach and a laryngoscope with a straight blade : case reportSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 36 –37 (2014)More Less
Glossopalatine ankylosis presents a challenge to the anaesthesiologist because of its intraoral attachment which obstructs the view of the oral cavity. When preoperative assessment by direct laryngoscopy is possible, a paraglossal approach using a straight blade can be used in such cases. We share our anaesthesia experience of a neonate with glossopalatine ankylosis.