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- Volume 9, Issue 1, 2003
Southern African Journal of Anaesthesia and Analgesia - Volume 9, Issue 1, 2003
Volumes & issues
Volume 9, Issue 1, 2003
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... EDITORIAL 1 Editorial Our first issue of SAJAA for 2003 coincides with the SASA Congress, and we are privileged to be able to publish all the entries for the Registrar Communication Prize. As you will see, there have been a record number of entries this year. The papers submitted cover a variety of subjects, all of which are relevant to the science and practice of anaesthesia. It is wonderful to see almost all of our medical schools represented. The order of publication is alphabetical, in terms of the authors' surnames, and as these are all prize entries, they have ..
Author P. FosterSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 6 –8 (2003)More Less
Extracted from text ... GUEST EDITORIAL Southern African Journal of Anaesthesia & Analgesia - February 2002 6 How deep is the sleep? Looking into anesthesia depths esthesia came from John Snow in London (1847) who also introduced the idea of monitoring his unconscious patients. The best-known description of Anesthesia Depth is in the (four) stages of anesthesia offered by Guedel in the USA, that was used first during WWI (1917 - 1918). The banning of nurse anesthetists in the US Army from active duty in France was the stimulus for this: Guedel had to train men only, mostly without nursing background, to take ..
Author J.C. BrandSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 10 –13 (2003)More Less
Extracted from text ... 10 Preoperative diagnosis of malignant hyperthermia As is now known, MH is an autosomal dominant disorder of skeletal muscle calcium dysregulation.8 It is a myopathy, usually subclinical, but after triggering by anesthetic vapours or succinylcholine, an acute loss of intracellular calcium control causes hypermetabolism, rhabdomyolysis, multi-organ failure and death unless immediately treated with dantrolene.9 Although it is only anesthetics that can trigger an acute MH reaction they are inconsistent in their ability to trigger. Thus, a MH susceptible patient can trigger on first exposure or only after the fifth or sixth GA unlike the PORCINE STRESS SYNDROME in pigs ..
Author J. DayaSource: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 15 Distribution of resources for paediatric cardiac surgery 1. Providing high quality tertiary service 2. Triage and optimal use of resources 3. Maintaining academic excellence References 1. Jenkins KJ, Gauvreau K, New burger JW, Spray T, Moller JH, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002; 123:110-8. 2. Dept. of Health; Policy on Organ Transplantation and Chronic Renal Dialysis; 1 Nov 2001. 3. Vanderdonk K, Annual Statistics 2002; Dept Of Cardio thoracic Surgery; Johannesburg General Hospital; University of the Witwatersrand. 4. World Health Report (1997). Fighting disease, ..
Author S.J.B. JohnstonSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 16 –17 (2003)More Less
Garlic (Allium sativum) has been investigated for its antihypertensive effects, although these are short-lived (<2hrs in animal studies) and is not recommended for routine use. The main interest with garlic is its anticholesterol activity. Allicin, a thiosulphate is formed when the garlic bulb is crushed and it inhibits HMG - CoA, an enzyme important in the synthesis of cholesterol. RCTs suggest possible short-term beneficial effects in lowering lipid and cholesterol levels.
Author J.S. MeyerSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 19 –22 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 19 The role of the anaesthestist during biological, chemical or nuclear incidents Mustard gas Mustard gas causes no initial eye irritation and smells faintly of mustard, garlic 1, 6 or onion. Acute effect starts within 4-12 hours post-exposure, and diffuse erythema occurs in exposed skin with oedema and 1st degree chemical burns. Eighty five percent of patients have reported eye problems recovering over weeks after sloughing of the cornea. Tracheobronchitis follows several hours after exposure in 70% of victims. Bronchospasm is common. Airway collapse and pulmonary haemorrhage, and oedema with secondary infection are factors that mandate intensive ..
Author F.J. MattheyseSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 25 –30 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 25 Molecular biology and anaesthesia FJ Mattheyse University of Stellenbosch Introduction The field of physiological research is experiencing a shift in emphasis towards explaining physiological processes in molecular terms. This has been brought about by the need for such explanation, but also because it has been made possible by development in the field of Molecular Biology. This can roughly be defined as describing cellular events in terms of molecular events. All kinds of biological molecules are important, but proteins and nucleic acids receive most of the attention. Proteins Proteins perform a large variety of functions, both intracellular ..
Source: Southern African Journal of Anaesthesia and Analgesia 9, pp 33 –38 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 33 Physics of invasive blood pressure monitoring sine wave and is equal to the pulse rate, thus the first harmonic. The second harmonic is a sinusoidal waveform with a frequency twice that of the fundamental harmonic. The waves are in phase, moving in the same direction and passing through zero amplitude together.5 The ideal measurement system should deal with all the harmonics of the input waveform in the same way. The amplitudes of the output harmonics will bear a constant ratio to the corresponding amplitudes of the input harmonics and there will be no phase difference between ..
Source: Southern African Journal of Anaesthesia and Analgesia 9, pp 40 –42 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 40 Understanding arterial pressure waveforms their relation to the cardiac cycle the difference in waveforms recorded from different body sites The arterial pulse is the result of a wave of vascular distention, initiated by the impact of the stroke volume ejected into a closed system with every heartbeat. The forward-propagating pressure wave has both a fast-moving (10m/sec) and slower (0, 5m/sec) component.5 The wave is reflected back mostly by the arteriole, which provides the majority of peripheral vascular resistance.6 Peak aortic blood flow acceleration produces the initial rise of the pressure pulse, whereas the ejection ..
Author S. RobertsonSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 45 –46 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 45 Endothelium derived factors and pulmonary hypertension level. Several genetic factors clearly play a role in this disease. It has recently been discovered that primary pulmonary hypertensives lack a receptor for Transforming Growth Factor-??which may allow clonal expansion of endothelial cells.4 Nitric Oxide Previously known as Endothelin Derived Relaxant Factor, Nitric Oxide (NO) is a potent vasodilator of pulmonary and systemic blood vessels. Pulmonary selectivity relies on inhaled NO being delivered directly to ventilated pulmonary vasculature with rapid plasma inactivation before reaching the systemic circulation. Inhaled NO has been used for persistent pulmonary hypertension of the newborn, ..
Source: Southern African Journal of Anaesthesia and Analgesia 9, pp 48 –52 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 48 Factors affecting casuality rate Deployment factors Agent factors Population factors Source Climate Site Susceptibility Density Specific protection Point Line Air Ground Vaccination Evacuation Individual Mass incident Policy Antibiotics CBW Suites Single Multiple Open Space Enclosed Space Amount Physical nature Persistance Aerosol Liquid Gas Bioterrorism : a new challenge for the medical discipline 100kg of sarin gas released from an airplane would kill 8000 people. 100kg of the anthrax bacillus would kill 3 million people if optimally dispersed. Methods of chemical and biological weapon dispersal 1. release into water supplies 2. release into food chains 3. ..
Author J. SkownoSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 53 –55 (2003)More Less
Extracted from text ... Vasopressin Receptors and Other mechanisms The V1 receptor is present in the vasculature of most organ systems, and, via Gq mediated signalling, causes a rise in Ca++ leading to vasoconstriction. V1 receptor activation also inhibits IL-1 formation, reducing NO production. J Skowno University of Cape Town REGISTRAR PRIZE 54 Left Atrial, Carotid and Aortic Arch baroreceptors sense arterial pressure, and a reduction in MAP triggers the release of Vasopressin. The release is exponential in nature, and AVP levels, normally 3pg/ml can rise to 50-100pg/ml during severe hypotension. Of particular importance is Vasopressin's modulatory effect on the arterial baroreflex itself. ..
Author S. Van ZylSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 56 –58 (2003)More Less
Extracted from text ... REGISTRAR PRIZE 56 Capillary pressure-induced lung injury : fact or fiction? we see that an increase in vascular pressure may be transmitted to the lung capillaries from either the pulmonary arterial, or the pulmonary venous compartment. By far the most common cause of pulmonary capillary hypertension is pulmonary congestion due to left heart disease. It is important to keep in mind that even in healthy subjects, pulmonary arterial wedge pressure may rise above 20mmHg during severe exercise, thus causing significant capillary hypertension. Pulmonary capillary hypertension can also result from severe pulmonary arterial hypertension or pulmonary venoconstriction. This may be ..
Source: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... CPD QUESTIONNAIRE 60 Subscribe to the SAJAA and earn 15 CPD points per year CPD reference number A008/016/03/2003 Continuing Professional Development Point Questionnaire Accredited by the Wits CPD Office 1. Guedel's stages of anaesthesia applies mainly to ether anaesthesia. ................... 2. Malignant hyperthermia is a recessive dominant disorder of skeletal muscle calcium dysregulation. ........................... 3. Malignant hyperthermia is the most common cause of death from general anaesthesia in otherwise healthy patients. 4. The mortality from surgical procedures in patients with complex congenital heart disease is as much as 40%. .................... 5. Herbal medication may have profound physiological effects. ............................. 6. ..