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- Volume 21, Issue 6, 2015
Southern African Journal of Anaesthesia and Analgesia - Volume 21, Issue 6, 2015
Volumes & issues
Volume 21, Issue 6, 2015
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 3 –4 (2015)More Less
Children represent a significant proportion of the South African population, with 30% of the population aged ≤ 15 years. Globally, surgical volumes are large. An estimated 312.9 million operations took place in 2012. However, there are few data on perioperative morbidity and mortality in the paediatric surgical population in South Africa. Additionally, information is not known on the number of children undergoing surgery, who provides their anaesthesia (specialist anaesthesiologists versus non-specialist anaesthesiologists), and the quality outcomes of their perioperative care. These data are essential in order to understand current paediatric perioperative morbidity and mortality in order to develop evidence-based recommendations to improve patient outcomes. The World Health Organization (WHO) has initiated the second global patient safety challenge, "Safe surgery saveslives". This is a core set of safety standards to be applied universally. The measurement of surgical (anaesthesia) services is one of four areas that has been identified in which improvement can be made in terms of the safety of surgical care: "Routine surveillance to evaluate and measure surgical services must be established if public health systems are to ensure progress in improving the safety of surgical care". In a guest editorial in SAJAA in 2012, Prof Thomas asked the question: "What is the size of the problem of perioperative morbidity and mortality in children in South Africa?" She challenged us to address this problem. The time has come for us to accept this challenge and address these issues.
A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents : reviewAuthor L. CronjeSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 5 –11 (2015) http://dx.doi.org/10.1080/22201181.2015.1More Less
Anaesthetists increasingly face questions from parents on the long-term outcomes of anaesthesia, and yet more immediate anaesthetic risks are not understood, nor explained to families. This review focused on paediatric anaesthetic-related mortality, cardiac arrest and anaesthetic-related serious adverse events and critical incidents during general anaesthesia, and within 24 hours of anaesthesia ending. Anaesthetic-related mortality is rare in the developed world, and is approximately 1 per 10 000 anaesthetics, but increases in high-risk children. Serious anaesthetic-related adverse events occur in 1.4 per 1 000 anaesthetics in the developed world. Data are lacking from the developing world but anaesthetic mortality is 2-3 times higher in middle-income countries and may be up to 100-fold greater in low-income countries. A critical incident occurs in 3-8% of anaesthetics and this figure is double that in low-income countries. Anaesthetic-related events are predominantly preventable. Brief recommendations on preventative strategies are made and research goals outlined.
Comparison of dexmedetomidine versus midazolam for intranasal premedication in children posted for elective surgery : a double-blind, randomised study : researchSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 12 –15 (2015) http://dx.doi.org/10.1080/22201181.2015.107More Less
Objective: The aim of this study was to compare the effect of dexmedetomidine with midazolam for intranasal premedication in children posted for elective surgery. Trial design: This was a prospective, randomised, double-blinded clinical study.
Method: 60 children, 3 to 10 years of age, with American Society of Anaesthesiologists (ASA) physical status I, scheduled for elective surgery, were randomly divided into two groups, group D (dexmedetomidine) and group M (midazolam). Group D patients received intranasal dexmedetomidine 1 µg/kg and group M patients intranasal midazolam 0.2 mg/kg, approximately 30 minutes before induction of anaesthesia, in the form of a spray.
Outcome: Preoperative effects on heart rate, blood pressure, sedation and anxiety including parental separation and mask acceptance were assessed.
Results: Intranasal dexmedetomidine (1 µg/kg) premedication resulted in statistically significant but clinically unimportant lower heart rate and blood pressure at 10, 20, and 30 minutes following administration compared with intranasal midazolam (0.2 mg/kg). There were no episodes of hypotension or bradycardia. Children in group D achieved better parental separation and mask acceptance scores compared with group M.
Conclusion: Dexmedetomidine resulted in better parental separation and mask acceptance scores than intranasal midazolam. Thus it would seem to offer some advantage compared with midazolam.
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 16 –20 (2015) http://dx.doi.org/10.1080/22201181.2015.1More Less
Staphylococcus aureus remains one of the most common causes of bacteraemia in children. In order to evade and overcome the immune responses of its host and any antimicrobial therapies aimed at destroying it, this organism, through various mechanisms, continues to evolve. Staphylococcus aureus bacteraemia is a systemic disease; and, multiple organ involvement should be assessed and appropriately managed. This is especially important for the anaesthetist who will be administering general anaesthesia to children presenting for surgical source control.
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 21 –23 (2015) http://dx.doi.org/10.1080/22201181.2015.1More Less
Summary: Proteus syndrome is a rare genetic disorder first described in 1979 and named after Proteus, a Greek demigod who was capable of changing his form to avoid capture. The incidence is < 1:1 000 000, but can be expected to be slightly higher in the surgical population, as these patients often present for repeat procedures. The disorder is characterised by sporadic and progressive overgrowth of tissue of any origin. Normal anatomy usually becomes distorted and serious functional and cosmeticsequelae may ensue. Regular anaesthetic interventions are required for diagnostic and therapeutic procedures, often to correct deformities related to overgrowth, tumour excision and otolaryngological procedures. Literature relating to the anaesthetic management of patients with Proteus syndrome is limited to case reports describing instances of general anaesthesia. Complications of general anaesthesia secondary to respiratory tract abnormalities appear prevalent. Regional anaesthesia is often used when respiratory compromise is anticipated due to any cause. Despite this, current guidelines suggest that regional anaesthesia be avoided in patients with Proteus syndrome, due to the gross anatomical variance and the high incidence of vascular abnormalities in these patients. The use of ultrasound-guided neural block enables practitioners to distinguish nerves from vascular structures and other tissues. It helps avoid neural injury during needle placement and improves success rate. This case report is the first to demonstrate the successful use of an ultrasound-guided regional anaesthetic technique in a boyrequiring surgery to his right forearm.
Factors influencing the choice of anaesthesia as a field of specialty in Universityof Ghana School of Medicine and Dentistry, Korle-Bu Teaching Hospital : researchSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 24 –26 (2015) http://dx.doi.org/10.1080/22201181.2015.1089666More Less
Background: Specialisation is perceived as essential for success, and affects the availability and distribution of medical personnel and the quality of service the health system is able to deliver. In Ghana, some areas of medical specialties have a relatively good number of practitioners and are constantly attracting prospective doctors into these fields. Anaesthesia, which is an essential and integral part of the health care system, is one field with an inadequate workforce and has been attracting few doctors intothe specialty.
Method: A cross-sectional study was conducted among 183 undergraduate final-year students of the University of Ghana School of Medicine and Dentistry. A total of 183 self-reporting questionnaires were distributed among the students during tutorials for their final exams. Of these, 146 questionnaires were completed and returned.
Results: General surgery was the most desirable specialty 26 (17.8%), paediatrics was the second most desirable specialty 24 (16.4%), whilst anaesthesia 2 (1.4%) ranked seventh.
Conclusions: The results of this survey suggest that duration of exposure during clinical clerkship influences career decisionamong undergraduate medical students. Most of the students prioritise their choice of specialty based on interest and exposure during rotation through the specialty.
Source: Southern African Journal of Anaesthesia and Analgesia 21, pp 27 –30 (2015) http://dx.doi.org/10.1080/22201181.2015.110More Less
Background: Studies have been done to determine the level of burnout in anaesthesiology internationally, but not in South Africa.
Method: The Maslach Burnout Inventory-Human Services Survey was used to assess the level of burnout. The primary objectives were to estimate the level of burnout among doctors working in the Department of Anaesthesiology at the University ofthe Witwatersrand (Wits doctors) and to estimate the level of burnout among private anaesthetist attending an anaestheticsymposium (Private doctors).
Results: High levels of burnout were identified in 21.0% of Wits doctors. Higher burnout scores were noted in female doctors(p = 0.49), less years of anaesthetic experience (p = 0.37), doctors of younger age (p = 0.07), registrars (p = 0.22) and writingexaminations within three months of completing the survey (p = 0.15), but none where statistically significant. High levels of burnout were identified in 8.1% of Private doctors
Conclusion: High levels of burnout were identified, especially, among anaesthetists working in the academic hospitals affiliated to Wits.
Development and evaluation of an integrated electronic data management system in a South African metropolitan critical care service : researchSource: Southern African Journal of Anaesthesia and Analgesia 21, pp 31 –35 (2015) http://dx.doi.org/10.1080/22201181.2015.1More Less
Introduction: The importance of accurate healthcare data is vital when approaching current healthcare challenges, but is difficult to collect in busy, under-resourced environments. It was aimed to develop and implement an information system that is cost-effective, easy and practical for data collection. A clinically integrated data collection system that demonstrates how to achieve this in a resource-poor setting is described.
Methods: A database was developed using customisable software to provide a robust relational database and clinically practicalsolution to data collection. The system was examined for data completeness through a field audit of referral records for evaluation of the reviewed system.
Discussion: The database system has been incorporated into the daily flow of clinical work, thus reducing duplication of note keeping and avoiding the need for data capturers. After improving the design and user interface, better compliance was noted. This provided useful insight into critical care database development.
Conclusion: This project has demonstrated successful development and implementation of a hybrid electronic medical record and registry for a critical care metropolitan service. It has provided a practical information system allowing for the development of local critical care services with the ability for quality improvement, aggregate reporting for systems planning, and research.