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- Volume 22, Issue 3, 2016
Southern African Journal of Anaesthesia and Analgesia - Volume 22, Issue 3, 2016
Volumes & issues
Volume 22, Issue 3, 2016
Efficacy of premixed versus sequential administration of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in lower limb surgery : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 81 –85 (2016) http://dx.doi.org/10.1080/22201181.2016.1179468More Less
Objective: To evaluate the efficacy of intrathecal hyperbaric bupivacaine premixed with dexmeditomidine compared with sequential administration in separate syringes on block characteristics, haemodynamic parameters, side effect profile and postoperative analgesic requirement.
Trial design: This was a prospective, randomised clinical study
Method: Sixty orthopaedic patients scheduled for elective lower limb surgery under spinal anaesthesia were divided into two groups to receive either intrathecal hyperbaric bupivacaine 12.5 mg premixed (Group P) with dexmeditomidine 10 µg (diluted to 0.5 ml with normal saline) or by sequential administration in separate syringes (Group S).
Outcome: Block characteristics, haemodynamic parameters, side effect profile and postoperative analgesic requirement were compared in both groups.
Results: Time to achieve T10 spinal level was significantly less in group S (4.467 + 0.973 min) compared with group P (5.5 + 1.167 min). Similarly, patients in group S achieved Modified Bromage III earlier (6.1 + 1.296 min) than group P (7.5 + 1.333 min), p-value 0.0001.
Conclusion: Dexmeditomidine given sequentially in a separate syringe as adjuvant to intrathecal hyperbaric bupivacaine can result in faster onset of both sensory and motor block and prolongs the duration of spinal anaesthesia, minimises clinically significant side effects and reduces the postoperative analgesic requirement.
Thoracic epidural anaesthesia for major abdominal surgeries : experience in private hospital setting in Uyo, South-South Nigeria : researchSource: Southern African Journal of Anaesthesia and Analgesia 22, pp 86 –88 (2016) http://dx.doi.org/10.1080/22201181.2016.1168612More Less
Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation.
Aims: To evaluate the feasibility of TEA for major abdominal surgeries in the private hospital setting.
Patients and methods: This was a retrospective study of all major abdominal surgeries performed under TEA in two private hospitals in Uyo, Akwa Ibom State, Nigeria over a two-year period. All thoracic epidural anaesthesia was performed under aseptic conditions at the T8/9, T9/10, or T10/11 interspinous space using a size 18G Tuohy epidural needle and catheter inserted as appropriate. A test dose of 3 ml of 1% lidocaine with adrenaline was used in all patients, after which a loading dose of 10-15 ml of 2% lidocaine with adrenaline was injected at 5 ml every 5 minutes till a block height of approximately T4-L1 was obtained. Anaesthesia was maintained with 5 ml of 2% lidocaine with adrenaline every 45 minutes till the end of surgery. The operative condition was assessed on the basis of sedation and analgesic requirement, as well as response to mesenteric traction. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the patients' folders and operation register. Information obtained included: age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed using SPSS®, version 16.
Results: Twelve patients underwent major abdominal surgeries under TEA. The mean age (range) was 49.58 (20-78) years, with a male to female ratio of 1:1.4. TEA was adequate in 10 (83.3%) patients, while two (16.7%) patients developed total spinal anaesthesia and were successfully resuscitated and their surgeries completed under general endotracheal anaesthesia.
Conclusion: TEA for major abdominal surgeries is feasible. However, careful patient selection, a meticulous approach and preparation for resuscitation is required to prevent and manage complications.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 89 –92 (2016) http://dx.doi.org/10.1080/22201181.2016.1187497More Less
Background: The use of traditional medicine (TM) in South Africa is reportedly high. TM use in a South African surgical population presenting for elective surgery is unknown.
Aim: The study aim was to survey the perioperative usage of TM in a South African population presenting for elective surgery at a tertiary hospital.
Methods: A prospective, contextual and descriptive study was carried out on adults presenting for elective surgery at a tertiary South African hospital.
Results: During a 2 month study period 495 patients were interviewed (97% response rate). The mean age was 46.6 years (SD 14.8) with 34% male and 66% female. Patients underwent orthopaedic (42%), general (32%) and gynaecological (26%) surgery. Fifty per cent of the participants were on chronic medication. Thirty-nine per cent of participants reported past TM use and 7% admitted to current TM use. The most common reason for TM was for cleansing purposes (41%) followed by pain (17%). Seven(4%) participants reported adverse events attributed to TM use with 46% unsure whether an adverse event occurred. Factors associated with current TM use were planned surgical procedure (p-value = 0.009), known positive HIV status (p-value = 0.04), and current arthritic medication use (p-value = 0.002).
Conclusion: Perioperative TM use is clinically relevant and should be considered in elective surgical patients. However, TM use in the current survey was found to be lower than that quoted in the literature.
Source: Southern African Journal of Anaesthesia and Analgesia 22, pp 93 –99 (2016) http://dx.doi.org/10.1080/22201181.2016.1168611More Less
Sickle cell disease (SCD) is the most common inherited haematological disorder, producing a mutation of the haemoglobin molecule known as haemoglobin S (HbS). The presence of HbS in the erythrocyte makes it prone to sickling - a process that may lead to vaso-occlusive injury, haemolysis and a hypercoagulable state. Sickling is precipitated by dehydration, hypoxia, hypothermia, acidosis and low flow situations. Over time, multi-organ damage develops with significant morbidity and mortality. Paediatric patients with SCD and congenital heart defects may require anaesthesia for corrective cardiac surgery oncardiopulmonary bypass (CPB). During the perioperative period these high-risk patients may suffer significant complications when exposed to the conditions that favour erythrocyte sickling. This case series details experience of four paediatric patients with SCD who underwent corrective cardiac surgery at Red Cross War Memorial Children's Hospital. The pathophysiology is discussed and the perioperative management of transfusion, cardiopulmonary bypass and temperature regulation is highlighted.
The impact of introducing drug labelling at Grey's Hospital Theatre over a six-month period : letter to the editorSource: Southern African Journal of Anaesthesia and Analgesia 22 (2016) http://dx.doi.org/10.1080/22201181.2016.1168613More Less