Southern African Journal of Anaesthesia and Analgesia - Volume 21, Issue 4, January 2015

It is a travesty to waste resources. In medicine, a persistence of futile research depletes the already limited resources available for research. Furthermore, ignoring clinical trial evidence of benefit is unethical and negatively impacts on public health.

Chloride is in many ways the forgotten electrolyte. Recent evidence suggests that hyperchloraemia results in metabolic acidosis, and is associated with renal dysfunction, increased mortality, coagulation disturbances, splanchnic ischaemia, and a pro-inflammatory state. The renal effects and the increased mortality are the best established and most concerning of these associations. The choice of intravenous fluids significantly influences the development of hyperchloraemia. Further studies are required to confirm or refute these associations. In the interim high-chloride fluids, most commonly 0.9% saline, should be avoided as resuscitation fluids.

Background: A plethora of studies have shown elevated preoperative natriuretic peptide measurements to predict postoperative mortality and adverse cardiac events.

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Objectives: The current study aimed to demonstrate this overwhelming association and to show that further studies of this nature are unwarranted.

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Methods: A cumulative meta-analysis of 28 studies was conducted where the primary outcomes of mortality and adverse cardiac events were associated with elevated preoperative natriuretic peptides.

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Results: Cumulative meta-analysis demonstrated an odds ratio trending to a constant of 5.66, with a marked narrowing in the 95% confidence interval.

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Conclusions: Further studies aiming only to demonstrate an association between a preoperative natriuretic peptide threshold and the risk of postoperative adverse cardiac events are not justified. Future investigation should focus on the clinical implications of these data and the application of these findings with regard to further investigation, optimisation and appropriate adaptation of perioperative management.

Background: The anaesthetic preoperative evaluation of a patient is the clinical foundation of perioperative patient management, and can potentially reduce operative morbidity and enhance patient outcomes. Generally, anaesthetists complete a standardised preoperative anaesthetic record (PAR) form to improve the quality of the information obtained during their pre-anaesthetic visit. Previous studies reported an unacceptable standard of preoperative assessment record keeping. The aim of the study was to audit the documented preoperative anaesthetic evaluations of surgery patients at Universitas Academic Hospital, Bloemfontein.

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Methods: For this retrospective study a sample of 81 patients, who underwent surgery during May 2013, was randomly selected. The information obtained from the standardised PAR form in each patient's file was audited using a self-generated checklist, based on the measures and criteria incorporated in the Global Quality Index.

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Results: Although 100% of files retrieved contained the PAR form, none of these forms were fully completed according to the study checklist used. Criteria where less than 50% were completed correctly included : 'per os' status (1.2%), current medication (37.0%), preoperative diagnosis (38.3%), preoperative vital signs (43.2%), American Society of Anesthesiologists Physical Classification(44.4%), airway assessment (45.7%), anaesthetic history and complications (48.2%) and special investigation results (49.4%).

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Conclusions: The documented preoperative evaluations were incomplete with regard to a number of criteria, as also found in studies conducted at two other national institutions. Training and evaluation regarding completion of preoperative assessment of patients by anaesthetists is needed at Universitas Academic Hospital.

Background: Patient satisfaction is multidimensional. The clinician's perspective of a good outcome and the patient's experience of a satisfactory service are often two different end-points. The primary aim of our study was to assess the perioperative experience of patients undergoing procedural sedation. A secondary aim was to create a postoperative questionnaire which could be used as a measurement tool. The questions could also be used as an audit to assist with adherence to quality assurance and clinical governance.

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Method: A questionnaire was compiled to attempt to assess the perioperative aspects of procedural sedation. Five hundred consecutive patients undergoing procedural sedation for dental-related outpatient procedures were asked to complete a questionnaire.Patients who didn't complete it were excluded. Ninety-eight per cent of the patients returned the questionnaire and489 questionnaires were evaluated.

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Results: A total of 489 patients were included. Ninety-three per cent of the patients expressed a good (7+/10) overall experience of procedural sedation, and 92.6% indicated that they would recommend it to others.

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Conclusion: Our study population showed a high level of satisfaction with their sedation experience. It is suggested that the devised questionnaire could be used successfully in future as an assessment tool or audit of patient satisfaction following procedural sedation for ambulatory surgery.

This case report focuses on a patient who presented with respiratory distress and with a background history of asthma. The underlying pathology is explored, as well as the diagnostic error that could have resulted in serious complications.

A case of difficulty was recently encountered in ventilating an anaesthetised infant after intubating the trachea with size 3.5 mm endotracheal tube. It was found that the problem had occurred due to a manufacturing defect in the endotracheal tube connector where the connector was abnormally tapered and had an extremely narrow opening. The case underlines the need for a thorough check of each connector before use, especially for paediatric endotracheal tubes.