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- Volume 22, Issue 2, 2016
Southern African Journal of Anaesthesia and Analgesia - Volume 22, Issue 2, 2016
Volume 22, Issue 2, 2016
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 38 –45 (2016) http://dx.doi.org/10.1080/22201181.2016.1154290More Less
The Royal College of Anaesthetists' National Audit Project (NAP) programme has been running in its current form since 2006. Since NAP3 was commissioned the NAPs have examined rare but important complications of anaesthesia and related subspecialties. The topics covered include major complications of central neuraxial block (NAP3), major complications of airway management in hospitals (NAP4) and accidental awareness during general anaesthesia (NAP5). NAP6 is currently studying severe perioperative anaphylaxis. The NAPs have shed new light on the major complications of anaesthesia, providing both quantitative (frequencies, prevalence, incidence, risk factors) and qualitative (themes, patient stories, human factors) knowledge that has led to new learning, recommendations and changes in practice. This article describes the background, nature and processes of the NAPs.
Author A.R. VisramSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 46 –51 (2016) http://dx.doi.org/10.1080/22201181.2016.1140705More Less
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 52 –56 (2016) http://dx.doi.org/10.1080/22201181.2016.1159784More Less
Background: The TotalTrack® Video Laryngeal Mask (VLM) is a novel airway management device consisting of a disposable laryngeal mask paired with a reusable video display. Prior to the commencement of this study, there was no published literature on the performance of the TotalTrack®.
Methods: The device was evaluated in sixty patients without predictors for difficult airway under general anaesthesia with neuromuscular blockade. Primary outcomes were laryngeal mask seal pressures and success of tracheal intubation through the device.
Results: Insertion and ventilation was successful in 98.3% of cases. Median static leak and maximal inflation pressures of the laryngeal mask component were 32 and 40 cmH2O respectively. Tracheal intubation through the device was successful in 95% of cases, with a mean intubation time of 9 5 s. No gastric insufflation occurred. Haemodynamic variability was found to be clinically insignificant. No significant side-effects were reported.
Conclusions: In this initial study, the TotalTrack® VLM was found to be effective as a laryngeal mask airway, exhibiting good sealing pressures. It facilitated predictable, easy intubating conditions under video guidance, with minimal interruption of ventilation.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 57 –59 (2016) http://dx.doi.org/10.1080/22201181.2016.1154310More Less
In the mid-1960s Dr Anthony Cohen, an anaesthetist in private practice in Johannesburg, developed the Minivent respirator in response to the lack of ventilators that existed at that time in operating theatres in both private and state hospitals. The remarkable, rugged, miniature ventilator had only four components, could fit into an anaesthetist's pocket and required no electrical power source. The pressure generated by the distension of a reservoir bag by the flow of anaesthetic gases to the patient triggered inspiration and the switch from inspiration to expiration was controlled by a pressure-sensitive magnetically operated bobbin. The device operated as a minute volume divider. Respiratory rate was obtained by counting the clicking noise from the bobbin and, provided there was no leak, tidal volume was easily calculated by dividing the gas flow by the respiratory rate. The device was widely used in numerous countries including South Africa, the United Kingdom, Australia and Canada.
The informed consent process for anaesthesia : perspectives of elective surgical patients at Inkosi Albert Luthuli Central Hospital, Durban, South Africa : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 60 –64 (2016) http://dx.doi.org/10.1080/22201181.2016.1157963More Less
Background: Amongst state hospitals in the eThekwini municipality, obtaining informed consent for anaesthesia is often an informal interaction between the patient and anaesthetist, lacking structure and standardisation.
Objectives: To evaluate the informed consent process from the patients' perspective in an attempt to modify current practice.
Methods: Competent adult patients presenting for elective surgery were presented pre- and postoperatively with structured questionnaires addressing various aspects of the consent process.
Results: Of 143 included patients, only 57% of patients were given information about their anaesthetic preoperatively. With regard to complications experienced during anaesthesia, 36% of patients preferred not to be informed of any possible sequelae, while 17% wanted to be informed of all possible complications. In total, 83% of patients who had signed the surgical consent form with the surgeon thought that they had signed an anaesthetic form with the anaesthetist. Some 56% of patients felt that written consent on a specific standardised anaesthetic consent form should be introduced.
Conclusion: Even though the majority of patients are being seen preoperatively by the anaesthetist, the quality of this assessment is concerning, in terms of the amount and depth of information imparted and the lack of standardisation of information given.
Caesarean section in Eisenmenger's syndrome : anaesthetic management with titrated epidural and nebulised alprostadil : case reportSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 65 –67 (2016) http://dx.doi.org/10.1080/22201181.2016.1145432More Less
Pregnancy in patients with Eisenmenger's syndrome is associated with a high mortality. This article reports two cases of women with Eisenmenger's syndrome (secondary to two different primary cardiac defects) who presented with near-term pregnancies. Both the patients underwent successful elective Caesarean section with slowly titrated epidural anaesthesia. Nebulised prostaglandin E1(PGE1) analogue, alprostadil, administered immediately post-delivery resulted in a significant drop in systolic pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger's syndrome. Nebulised alprostadil intraoperatively or postoperatively in the intensive care unit (ICU) is readily available and a relatively cheap option as a selective pulmonary vasodilator in developing countries.
Frontline patient safety, currency training and continuing professional development linked to the workflow process for anaesthesia : letter to the editorSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 68 –69 (2016) http://dx.doi.org/10.1080/22201181.2016.1154311More Less
Over the last three decades, beginning with the NASA aviation safety initiative, massive strides have been made in many complex and high-risk industries in terms of enhancing human performance and the application of a systems-based approach to the workflow process. The result, for many of these industries, has been safer working environments, better outcomes and improved satisfaction for all users of the system. Large reductions in aviation-related incidents and deaths, the attainment of greater than sigma-6 level safety in certain environments such as aircraft carriers, and many more, are examples of how the application of relevant and effective frontline techniques have changed the working environment in these complex and stressful work environments.
Heparin flush vs. saline flush for use in the maintenance of adult central venous and intra-arterial catheters : potential harm, too little gain? : letter to the editorSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 70 –71 (2016) http://dx.doi.org/10.1080/22201181.2016.1151172More Less
Heparin saline use for the maintenance of invasive arterial and central lines may be associated with significant risks and has not been conclusively shown to confer additional benefits over saline flushing alone. The routine use of heparin saline flush instead of saline alone for arterial and central venous catheter maintenance should be thoughtfully considered.
Author Petrus FourieSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 72 –80 (2016) http://dx.doi.org/10.1080/22201181.2016.1154309More Less
Inflammatory mediators released from activated mast cells and basophils during hypersensitivity reactions have direct pathological effects on the myocardium and coronary vasculature. It was traditionally thought that cardiovascular signs and symptoms in anaphylaxis are largely due to peripheral vasodilation and increased vascular permeability. However, there is extensive evidence of primary cardiac involvement during hypersensitivity reactions, most notably coronary vasoconstriction as well as atherosclerotic plaque erosion and rupture, leading to angina pectoris and acute coronary syndromes. Furthermore, mast cells are well established as effector cells in atherosclerosis, through their effects on atherosclerotic plaque progression and destabilisation. It was noted over 30 years ago that cardiac patients have a markedly higher concentration of biologic amines (especially histamine) in their coronary vasculature, and, additionally, are hyper-reactive to the effects thereof. This is borne out by the disproportionate mortality rate of those with cardiac disease that suffer a hypersensitivity reaction. Kounis syndrome refers to angina pectoris or an acute coronary syndrome secondary to a hypersensitivity reaction, with the subtypes dependent on the underlying state of the coronaries and presence of a drug-eluting stent or not. This review will focus mainly on the aetiology, pathophysiology, diagnoses and treatment of this important syndrome.