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- Volume 21, Issue 2, 2015
Southern African Journal of Anaesthesia and Analgesia - Volume 21, Issue 2, 2015
Volume 21, Issue 2, 2015
Life Time Achievement Award by the International Society of Anaesthetic Pharmacology (ISAP) : Prof Johan CoetzeeAuthor Andre CoetzeeSource: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
Johan ("Jeff") Coetzee was born in Zambia, he attended Rondebosch Boys High School and obtained a BSc (Chemistry and Physics) from Stellenbosch University in 1962. This was followed by another BSc (Anatomy and Physiology) and then MB ChB (Stellenbosch) in 1967. He then became a Registrar at Karl Bremer Hospital /Stellenbosch University and obtained the MMed(Anes) in 1972.
Recommendations and regulations to decrease bias, increase access to clinical data and improve the quality of evidence-based medicine for all : editorialAuthor Bruce BiccardSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 3 –4 (2015)More Less
In our endeavour to improve public health outcomes, we have to ensure that we are providing medicine and care which is evidence based. Therefore, we should strive to provide care for which there is unequivocal evidence that it improves the outcome of our patients. Unfortunately, in anaesthesia, there is surprisingly little good evidence of interventions that improve perioperative outcomes.
Author Erna MeyerSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 5 –8 (2015) http://dx.doi.org/10.1080/22201181.2015.More Less
Globally, more than 10 million people are affected every year by acute kidney injury (AKI) and approximately 6% of hospital patients sustain some degree of kidney injury during their hospital event. Reducing perioperative kidney injury may significantly improve patient outcomes. As perioperative physicians, we are in a position to have some influence on renal outcomes.This article is a review of the current literature on the relevance of renal protection, definitions, mechanisms and new biomarkers of AKI, as well as improved renal perfusion strategies. It specifically considers the renal effects of general and regional anaesthesia, intra-abdominal pressure and abdominal compartment syndrome. The usefulness of certain drugs is investigated. Mechanisms of injury by nephrotoxins, as well as strategies to minimise these injuries, are discussed. Intravenous fluids are briefly mentioned as they relate to renal function.
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 13 –16 (2015) http://dx.doi.org/10.1080/22201181.2015.1028216More Less
Background: This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam versus fentanyl as an adjunct to bupivacaine for endoscopic urology surgery.
Methods: Sixty adult ASA grade Iâ??II patients undergoing transurethral resection of prostate or bladder tumor under spinal anesthesia were randomly allocated into three groups. Group B (control group) received 2 ml 0.5% hyperbaric bupivacaine while group BM received midazolam 2 mg and group BF received fentanyl 25 µg along with 2 ml of 0.5% bupivacaine in subarachnoid block. Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of sensory and motor blockade, postoperative pain and the time to 1st rescue analgesia was noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea-vomiting.
Results: The onset times and the duration of motor blockade were comparable among groups while the time to sensory block regression was longer in group BM and group BF as compared to group B (p<0.001). The duration of postoperative analgesia was significantly prolonged in group BM and group BF as compared with group B (p<0.001) while there was no difference between group BM and BF. The incidence of pruritus and vomiting was more in group BF.
Conclusions: Addition of midazolam to intrathecal bupivacaine provides prolonged postoperative analgesia similar to intrathecal fentanyl and appears safe in patients undergoing endoscopic urology surgery.
Dexmedetomidine premedication in cataract surgery under topical anaesthesia : to assess patient and surgeon satisfaction : researchSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 17 –21 (2015) http://dx.doi.org/10.1080/22201181.2015.1028225More Less
Background: Dexmedetomidine is a potent non-opioid analgesic that may enhance analgesia for cataract surgery under topical anaesthesia. This study was undertaken to assess sedation and analgesia provided by dexmedetomidine and evaluating patients' satisfaction. Secondary aims were: (1) To study the effect of dexmedetomidine in decreasing the intraocular pressure. (2) The impact on surgeons' satisfaction. (3) Hymodynamic effects.
Methods: We conducted a prospective randomized study on ASA I/II patients presenting for cataract surgery under topical anaesthesia. Patients were randomly assigned to two groups: group D received dexmedetomidine premedication 1 mcg/kg over 10 minutes and group C received saline at the same rate. Sedation and pain score, intraocular pressure, patient and surgeon satisfaction score and hemodynamics were monitored and compared.
Results: There was a significant increase in sedation assessed by the Ramsay sedation score at all times in group D after receiving dexmedetomidine (p <0.0001). However, pain scores (numeric rating scale) were similar in both groups (p > 0.05). Dexmedetomidine decreased the intraocular pressure and the difference was statistically highly significant (p < 0.0001). Group D had better patient and surgeon satisfaction score as against group C (p = 0.0001). Noticeably, the incidence of dry mouth was higher in group D. Hemodynamic parameters were well maintained in both groups with no adverse events in either group.
Conclusions: Dexmedetomidine can be used safely for cataract surgery under topical anesthesia surgery. Administration of dexmedetomidine was associated with better patient and surgeon satisfaction.
A randomised clinical trail comparing the analgesic and anxiolytic efficacy and tolerability of Stilpane® and Tramacet® after third molar extraction : clinical trailSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 22 –27 (2015) http://dx.doi.org/10.1080/22201181.2015.1028229More Less
Background: successful treatment of moderate to severe acute pain often necessitates several analgesics that target different sites of the nociceptive pathway. Fixed-dose combination analgesics facilitate a reduction in dose of individual components, increased compliance and strong-opioid sparing. The aim of this study was to compare the analgesic and anxiolytic efficacy and tolerability of two widely prescribed combination analgesics, Stilpane® (paracetamol/codeine/meprobamate) and Tramacet® (paracetamol/tramadol).
Methods: A prospective randomised parallel group phase IV clinical trial was conducted in 100 patients experiencing moderate to severe pain after third molar extraction at the Oral and Dental Hospital, University of Pretoria. Pain intensity and pain relief were assessed using Likert and visual analogue scales. Medication efficacy, time to perceptible pain relief and meaningful pain relief were also assessed. Primary variables included the Pain Intensity Difference (PID) between baseline and scheduled visits, and hourly pain relief (PAR). The Summed Pain Intensity Difference (SPID), Sum of hourly PAR, hourly PAR, hourly PIDs from baseline (SPRID) and Total Pain Relief (TOTPAR) were calculated according to standard methods. Beck Anxiety Questionnaire assessed anxiety. Tolerability was assessed chiefly by the reporting of adverse events.
Results: Stilpane® and Tramacet® were equally effective at relieving moderate to severe acute pain. No differences in anxiolytic efficacy were found between the two treatment arms and differences in tolerability failed to reach statistical significance.
Conclusions: Despite their distinctive compositions and mechanisms of action, Stilpane® and Tramacet® are equally effective and well-tolerated combination analgesics in patients experiencing moderate to severe acute pain.
Successful difficult airway intubation using the Miller laryngoscope blade and paraglossal technique - a comparison with the Macintosh blade and midline technique : case reportSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 28 –30 (2015) http://dx.doi.org/10.1080/22201181.2015.1028217More Less
In anaesthetic practice clinicians are often faced with difficult airway situations. The conventional approach to intubation is the midline technique using a curved Macintosh blade for direct laryngoscopy. However, we have been successful in such a case using old technology and a seldom-used technique. This case raised the question whether older, alternative, methods of tracheal intubation may o er an advantage in airway management above the conventional practice.
During pre-operative evaluation a patient presented with a large visible epiglottis on evaluation of the mouth and oropharynx. On direct laryngoscopy with a Macintosh 3 laryngoscope blade and the midline technique, a Cormack and Lehane grade-3b view was obtained due to the long epiglottis but normal position of the larynx. The Miller 4 blade and the paraglossal technique yielded a Cormack and Lehane grade-1 view and the trachea was successfully intubated using this approach. Use of the Miller blade and the paraglossal technique provided a perfect view of the glottis. Based on this experience and the findings of several studies on this topic, this approach could be a viable alternative to airway management.
A comparison of magnesium induced recurarization between neuromuscular block reversal agent in an in vivo rat model. : congress prize abstractsSource: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
SSEM Mthembu Medical Research Award
Magnesium recurarization is the sudden reinstatement of neuromuscular impairment upon administration of magnesium sulphate after recovery from neuromuscular block. Magnesium reduces acetylcholine release from the nerve terminal, thus allowing any residual neuromuscular blocking agent to rebind the receptor. Sugammadex is a reversal agent able to bind rocuronium in the plasma, thus promoting the removal of rocuronium from the neuromuscular junction. On the basis of sugammadex's mechanism of action it could prevent or reduce the effect of magnesium recurarization, since a decreased concentration of rocuronium would in effect be available for rebinding the cholinergic receptor. In this study, the magnesium recurarization effect was compared between neuromuscular block reversal with neostigmine, sugammadex and omission of neuromuscular block reversal.
Microorganisms cultured from laryngoscope blades in an academic hospital following implementation of a new decontamination technique : congress prize abstractsSource: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
The Gaisford Harrison Registrar Research Prize
Background: Laryngoscopy is a commonly performed invasive procedure in hospitals, especially in theatre. Lack of formal guidelines and variation of utilised decontamination techniques have resulted in a breach of ensuring patient safety in hospitals. Multiple international and local studieshave found microorganism contamination of laryngoscope blades.
Aim: The aim of this study was to describe the effectiveness of a newly implemented decontamination protocol for reusable laryngoscope bladesat Helen Joseph Hospital.
Method: A prospective, contextual, comparative, descriptive study design was used. A single area on the size 4 blades in the two emergency theatres was swabbed in an aseptic manner. After transport to the laboratory, the samples were inoculated onto petri film and blood agar plates. Following 48 hours of aerobic incubation, plates were examined for colonies with subsequent enumeration and identification of microorganisms. The samples were collected over a two month period.
Results: Five control samples were collected, all of which had no microorganism growth. Of the 73 samples collected, four samples were misplacedby the laboratory with no results recovered. Positive quantitative counts were reported on eight (11.6%) samples, with only two (2.9%) samples having positive microorganism growth and identification and 67 (97.1%) samples reporting no microorganism growth. The two microorganisms isolated were Chryseobacterium indologenes and Streptococcus salivarius. This shows the effectiveness of the new decontamination technique, with a p-value < 0.0001.
Conclusion: The reduction in positive microorganism contamination by high-level disinfection with Cidex® OPA will improve patient safety and decrease the potential risk of cross infection. Formal decontamination protocols using a high-level disinfectant should be implemented at all hospitals.
Author M. NiemandtSource: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
SASA Registrar Communication Prize
"How wonderful is Death, Death, and his brother Sleep!" Percy Bysshe Shelley
Everyday our patients walk the fine line between sleep, anaesthesia and death. According to the WHO webpage avoidable surgical complications still account for a large proportion of preventable deaths globally. Despite dramatic improvements in surgical safety knowledge, studies in developing countries suggest a death rate of 5-10% associated with major surgery. The rate of mortality during general anaesthesia is reported to be as high as 1 in 150 in parts of sub-Saharan Africa. The history of our profession reads like a great morbidity and mortality review. To this day, surgery is still not safe. This presentation remembers four stories of lethal anaesthesia from different periods in the history.
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 33 –34 (2015) http://dx.doi.org/10.1080/22201181.2015.1028221More Less
Continuous epidural anaesthesia through a catheter certainly offers the advantage of titrated, safe and prolonged anaesthesia along with a good quality of postoperative analgesia. Epidural catheters can cause some complications and one such rare complication is knotting in the epidural space. Epidural anaesthesia was planned for the arthroscopic repair of a torn anterior cruciate ligament. Intra operative and early postoperative periods were uneventful. However, the epidural catheter was found to be stuck when removal was attempted on the 4th postoperative day. Several attempts were made to retrieve the catheter by applying steady traction under maximal flexion of the back but failed. Finally, under spinal anaesthesia, the catheter was tracked, surgically, along its course up to the epidural space. A knot was observed at the tip of the retrieved catheter. There is a lot of debate in the literature favouring and contradicting the surgical removal of broken fragments of an epidural catheter. However, since the catheter was intact, we attempted removal by surgical dissection of the tract. Broken and lost fragments are better left untouched unless they pose problems and the patients reassured.
William's syndrome : was intubation rather than anaesthetic drug choice a cause of cardiac arrest? : letter to the editorAuthor Tim CookSource: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
Source: Southern African Journal of Anaesthesia and Analgesia 21 (2015)More Less
Providing one lung ventilation (OLV) for thoracic surgery is a challenge when patients are post laryngectomy or have a tracheostomy tube in situ. We anesthetised a patient with carcinoma of pyriform fossa having tracheostomy for video-assisted thoracoscopic (VATS) oesophageal mobilisation as a part of a major surgery using Arndt endobronchial blocker.