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- Southern African Journal of Anaesthesia and Analgesia
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- Volume 22, Issue 1, 2016
Southern African Journal of Anaesthesia and Analgesia - Volume 22, Issue 1, 2016
Volumes & issues
Volume 22, Issue 1, 2016
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 4 –6 (2016) http://dx.doi.org/10.1080/22201181.2016.1141566More Less
The continued use of "percent" in the labelling and description of many drugs used in the field of anaesthesia is an ongoing source of errors. As part of the modern drive towards safety in medicine it is proposed that the standard of labelling according to mass of the drug per millilitre be universally adopted.
The Obstetric Anaesthesia Special Interest Society : renewed commitment to improving obstetric anaesthesia in South Africa : guest editorialSource: Southern African Journal of Anaesthesia and Analgesia 22 (2016)More Less
Following the example of the UK and the USA, a group of interested practitioners has initiated a special interest group for obstetric anaesthesia in South Africa. This organisation will operate under the auspices of the South African Society of Anaesthesiologists (SASA), with its own constitution and elected executive committee. Its goal is to reduce anaesthesia-related maternal and fetal morbidity and mortality, as well as improve the overall birth and bonding experience of mothers in this country.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 10 –18 (2016) http://dx.doi.org/10.1080/22201181.2015.1126980More Less
The long-term cerebral effects of general anaesthesia at the extremes of age are currently enjoying attention. In children, the concern is that exposure to anaesthesia when less than 4 years of age may cause subsequent learning disabilities and behavioural changes. However, clinical equipoise exists as the available human studies are imperfect and the results of the large-scale multinational trials are not yet available. This structured narrative review summarises the overwhelming amount of information available.
Acute postoperative pain in 1 231 patients at a developing country referral hospital : incidence and risk factors : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 15 –22 (2016) http://dx.doi.org/10.1080/22201181.2015.1115608More Less
Background: Postoperative pain is poorly studied in developing countries. At a Western Cape referral hospital, it was aimed to determine the incidence of acute postoperative pain, to identify populations associated with a higher risk thereof (in order to guide resource allocation) and to investigate whether inexpensive analgesic modalities are currently utilised maximally.
Methods: Patients completed visual analogue scales 24 h after surgery for pain immediately after surgery, maximum pain since surgery and current pain. The incidence of moderate or severe pain and median pain scores were calculated for each scale and for different patient populations. Post hoc logistic regression was performed. Morphine prescriptions were compared with the actual administration thereof.
Results: Of 1 231 patients, 62% indicated their maximum pain as moderate or severe. Procedures with the highest incidences were caesarean section and lower limb orthopaedic surgery (> 80%). Younger age, female gender, emergency surgery, and surgery to the abdomen and lower limbs were associated with higher incidences. Patients experiencing moderate or severe pain received 46% of their prescribed morphine.
Conclusion: In this institution, the incidence of postoperative pain is high as expected. Associations with postoperative pain are identified, which may guide resource allocation. At least one low-cost analgesic modality is currently underutilised.
A prospective, randomised, controlled clinical trial to evaluate the effect of nitrous oxide on propofol requirement in elective craniotomy in which entropy was used to measure depth of anaesthesia : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 16 –22 (2016) http://dx.doi.org/10.1080/22201181.2015.1122708More Less
Background: Propofol is known to have a favourable effect on cerebral haemodynamics. The role of nitrous oxide (N2O) in neurosurgical anaesthesia is still being debated. The primary aim of this study was to assess the dose-sparing effect of N2O on propofol infusion maintenance dosing.
Method: Fifty American Society of Anesthesiology (ASA) grade I and II adults scheduled for elective craniotomies for supratentorial tumours were enrolled in the study. The patients received a standard anaesthetic comprising a fentanyl 2 μg/kg bolus prior to propofol induction. Anaesthesia was maintained with an infusion of fentanyl (2 μg/kg/hour), atracurium and propofol. The patients were randomised into two groups. Group A received 67% N2O. Group B did not receive N2O concomitantly with the propofol infusion. Entropy was used to guide the titration of the propofol infusion in both groups.
Results: The propofol maintenance dose requirements were 47% lower in Group A (54.30 ± 11.47 μg/kg/minute) vs. Group B (102.30 ± 14.00 μg/kg/minute), (p < 0.001).
Conclusion: The use of supplemental N2O significantly decreased propofol infusion rate requirements, compared with the propofol infusion alone, in ASA I and II patients undergoing elective supratentorial tumour excision.
A randomised trial to compare the effect of addition of clonidine or fentanyl to hyperbaric ropivacaine for spinal anaesthesia for knee arthroscopy : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 20 –24 (2016) http://dx.doi.org/10.1080/22201181.2015.1089667More Less
Objectives: To evaluate the clinical effects of hyperbaric ropivacaine alone and with clonidine or fentanyl for spinal anaesthesia for knee arthroscopy.
Methods: Sixty ASA I/II patients were randomised to receive spinal anaesthesia with hyperbaric ropivacaine alone (Group R), or with clonidine 15 μg (Group RC) or fentanyl 30 μg (Group RF). The sensory and motor block, time to micturition and side effects were assessed.
Results: The three groups were similar in mean time to onset of sensory block at T10, height of block and time to maximum block. Sensory regression to S2 took longer in Groups RF and RC compared with Group R (p = 0.001 and p < 0.01, respectively). Time to requirement of rescue analgesia was longer in Groups RF and RC compared with Group R (p = 0.023 and 0.002, respectively). Time for complete regression of motor block and time to voiding were longer in group RC compared with group R (p = 0.022 and p = 0.013, respectively).
Conclusion: The addition of fentanyl 30 μg to hyperbaric ropivacaine may be superior to the addition of clonidine 15 μg for knee arthroscopy as it provides a similar prolongation of sensory block and analgesia without prolonging motor block and time to micturition.
Author C. CurranSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 38 –40 (2016) http://dx.doi.org/10.1080/22201181.2015.1110403More Less
The GlideScope® is a widely used video laryngoscope that is especially beneficial in the setting of the anticipated difficult airway. However, its design introduces blind spots and necessitates the need for a curved stylet, most commonly the accompanying GlideRite® Rigid Stylet. A combination of these features and incorrect technique has resulted in cases of oropharyngeal injury, especially to the tonsillar pillars. Two cases of oropharyngeal injury are presented that were sustained during the use of the GlideScope® in the East London Hospital Complex. Both patients were obese. The recommendations presented in the literature to avoid such injuries are also summarised.
Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome : a case study : case reportSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 41 –44 (2016) http://dx.doi.org/10.1080/22201181.2015.1111676More Less
Pregnancy with underlying heart disease is a unique challenge both to the obstetrician and the anesthesiologist. Asymptomatic women with mild to moderate single lesions can successfully carry a pregnancy to term and undergo vaginal delivery. However, pregnancy can result in rapid clinical deterioration, which may lead to maternal and/or foetal mortality in symptomatic patients with complex heart diseases, like Shone's syndrome. A thorough understanding of the impact of pregnancy on the haemodynamic response to the patient's cardiac lesion is required for the management of labour and delivery. A meticulous approach is needed when planning anaesthesia for Caesarean section in such a case as the associated haemodynamic effects of both regional and general anaesthesia can have a serious deleterious effect on both the mother and infant.
We report on the successful management of a parturient known to have Shone's syndrome undergoing Caesarean section under graded epidural anaesthesia.