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- Volume 20, Issue 6, 2014
Southern African Journal of Anaesthesia and Analgesia - Volume 20, Issue 6, 2014
Volumes & issues
Volume 20, Issue 6, 2014
Author Paul WhiteheadSource: Southern African Journal of Anaesthesia and Analgesia 20 (2014) http://dx.doi.org/10.1080/22201181.2014.983728More Less
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 20 (2014) http://dx.doi.org/10.1080/22201181.2014.1004608More Less
The final edition of our journal for this year closes a few chapters in the history of the Southern African Journal of Anaesthesia and Analgesia (SAJAA), and heralds the start of an exciting future, with a new international publisher joining forces with Medpharm Publications, and Bruce Biccard becoming the new Editor-in-Chief. This will be my final editorial after 13 years at the helm, and it is a very sad one for me as we bid farewell and celebrate the life of our friend and publisher, Dr Douw Greeff. Douw died on 11 November, five days after celebrating his 40th birthday.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 221 –225 (2014) http://dx.doi.org/10.1080/22201181.2014.983711More Less
This review considers traditional medicine, with an emphasis on traditional African medicine and its influence on perioperative care. Western and Eastern herbal remedies are widely used. The paucity of good quality evidence concerning these medicinal products has led to only some of the effects of these medicines being known. The wide range of preparatory methods and lack of regulation has resulted in patient exposure to unknown side-effects. The nature of the use of African traditional medicine is even less known, and probably disclosed to the Western health practitioner even less. This review aims to raise awareness of African traditional medicine healthcare practice and its implications in a perioperative population.
Author E.C. ConradieSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 226 –232 (2014) http://dx.doi.org/10.1080/22201181.2014.983713More Less
Background : Patient safety during sedation for closed rhizotomies is improved when analgesia is optimised, rather than relying on deep sedation for patient comfort. This retrospective study determined the appropriate effect-site concentration (Ce) for alfentanil, in combination with a constant propofol infusion, for optimal pain control during sedation for closed rhizotomies. Airway maintenance is ensured by keeping patients responsive to verbal commands, albeit at the price of inevitable ventilatory depression.
Method : The records of patients who received rhizotomies over a six-month period were studied retrospectively. Sixty-three outpatients were included. Patients rated the level of analgesia with each needle placement. If the Ce for alfentanil was adequate, it was kept constant. Otherwise, it was increased in 5 ng/ml increments with each needle placement until analgesia was effective, or up to the maximum Ce for alfentanil of 100 ng/ml. Propofol infusion at a constant Ce of 200 ng/ml was added.
Results : Forty-eight per cent of patients reported being comfortable at a Ce for alfentanil of 70-75 ng/ml. Only 5% of patients requested the maximum Ce for alfentanil of 100 ng/ml. All of the patients experienced ventilatory depression, but a patent airway was maintained. The haemodynamic observations were within normal limits. According to the ward records, 16% of the patients complained of nausea, and there was one incident of vomiting.
Conclusion : Combining alfentanil at a Ce for alfentanil of 70-100 ng/ml with propofol at 200 ng/ml is a safe and effective method for analgesia during sedation for closed rhizotomies.
Source: Southern African Journal of Anaesthesia and Analgesia 20, pp 233 –237 (2014) http://dx.doi.org/10.1080/22201181.2014.983717More Less
Background : The South African National Committee for Confidential Enquiries into Maternal Deaths has shown that anaesthesia-related maternal deaths continue to increase at district hospitals. This has been attributed to substandard anaesthesia care and resuscitation. This study investigated the anaesthesia practices, work circumstances, support structure and access to training by doctors involved in obstetric anaesthesia in KwaZulu-Natal district and regional hospitals.
Method : This was an observational study, which included 48 district and regional hospitals offering operative obstetrics in KwaZulu-Natal. Separate questionnaires were given to medical managers and doctors providing obstetric anaesthesia.
Results : The authors assessed 254 doctors' questionnaires. Ninety-eight per cent were full-time appointments and 75% had been employed for less than five years. Almost all of the doctors routinely used spinal anaesthesia, 96% used uterine displacement and 77% measured blood pressure every 1-2 minutes. Appropriate vasopressors were used by 98% of the doctors to treat post-spinal hypotension. Thirteen per cent (32 of 254) of the doctors "frequently or always" performed or assisted with surgery after anaesthetising the patient. Only 22% (54 of 248) of the doctors had an anaesthetic-trained nurse as usual assistance. Thirty per cent (35 of 115) of the doctors in the district hospitals reported feeling insecure or having experienced difficulties during general anaesthesia. Nine per cent (22) of the doctors reported not having after-hours supervision and 53% (134 of 253) did not receive any structured training at their base hospitals.
Conclusion : The majority of doctors provided safe obstetric anaesthesia according to the indicators used. The unsafe practice of administering anaesthesia and then performing other theatre duties, thus leaving the mother without dedicated medical supervision, must be stopped. Efforts should be made to improve the supervision and support of district hospital doctors. Resources to optimise safe practices need to be improved.
Postoperative atrial fibrillation in patients on statins undergoing isolated cardiac valve surgery : a meta-analysis : researchSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 238 –244 (2014) http://dx.doi.org/10.1080/22201181.2014.983726More Less
Introduction : The efficacy of perioperative statin therapy in decreasing postoperative morbidity in patients undergoing valve replacements and repairs is unknown. The aim of our study was to determine whether or not the literature supports the hypothesis that statins decrease postoperative atrial fibrillation (AF), and hence improve short-term postoperative outcomes in patients undergoing isolated cardiac valve surgery.
Method : We conducted a meta-analysis of studies on postoperative outcomes associated with statin therapy following isolated valve replacement or repair. The data was taken from published studies on valvular heart surgery patients. Participants were patients who underwent either isolated cardiac valve replacement or repair. Patients in the intervention group received statins prior to their surgery. Three databases were searched: Ovid Healthstar, 1966 to April 2012; Ovid Medline, 1946 to 31 May 2012; and Embase, 1974 to 30 May 2012. The meta-analysis was conducted using Review Manager® version 5.1.
Results : Statins did not decrease the incidence of postoperative AF in patients undergoing isolated cardiac valve surgery [odds ratio (OR) 1.19, 95% confidence interval (CI): 0.80-1.77)], although there was significant heterogeneity for the outcome of postoperative AF (I2 55%, 95% CI: 27-72). Statins were associated with a decrease in 30-day mortality (OR 0.43, 95% CI: 0.24-0 75).
Conclusion : Although this meta-analysis suggests that chronic statin therapy did not prevent postoperative AF in unselected valvular heart surgical patients, the heterogeneity indicates that this outcome should be viewed with caution and further research is recommended.
The use of ultrasonography in the perioperative management of penetrating chest trauma with indwelling blade : case reportSource: Southern African Journal of Anaesthesia and Analgesia 20, pp 245 –248 (2014) http://dx.doi.org/10.1080/22201181.2014.983703More Less
We report on the anaesthetic and postoperative analgesic management of a patient presenting with a single penetrating thoracic injury, with radiological confirmation of a foreign object still present in the thorax. The patient underwent an emergency right posterolateral thoracotomy. We discuss the use of ultrasound for the insertion of a paravertebral catheter for perioperative analgesic management, and its efficacy in the emergency setting. Furthermore, we discuss the use of perioperative focus assessed transthoracic echocardiography, which had a positive impact on our management, although the case highlights the need for further large multi-centre trials.
Unexpected sneezing after a peribulbar injection in a patient for elective cataract surgery : case studySource: Southern African Journal of Anaesthesia and Analgesia 20, pp 249 –250 (2014) http://dx.doi.org/10.1080/22201181.2015.959364More Less
Sneezing or the sternutatory reflex, inborn in most animals, is a primitive neuromuscular physiological response to irritation. Sometimes, unusual sneezing occurs during and immediately after a peribulbar block, which is generally performed with a local anaesthetic in awake patients. We present a case report of an awake elderly male who experienced unexpected continuous sneezing immediately after the removal of the needle used for the peribulbar block, which was subsequently relieved with pheniramine maleate.
Author Des LinesSource: Southern African Journal of Anaesthesia and Analgesia 20 (2014) http://dx.doi.org/10.1080/22201181.2014.985487More Less
It is with immense sadness that the anaesthetic community learnt of the death of Dr Kurt Whiffler on 31 October 2014. Kurt was a great man and a wonderful doctor. His legacy as a teacher, and in particular, his passion for teaching regional anaesthesia, extended beyond his immediate environment.