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- Volume 9, Issue 4, 2003
Southern African Journal of Anaesthesia and Analgesia - Volume 9, Issue 4, 2003
Volume 9, Issue 4, 2003
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... EDITORIAL Southern African Journal of Anaesthesia & Analgesia - October 2003 1 It is estimated that at the end of 2002 approximately 70% of all surgical procedures in the United States were being performed on an ambulatory basis. This is nowhere near as high in South Africa, where home facilities and means of getting home are often the rate limiting steps for performing ambulatory anaesthesia. More and more cases, however, particularly in the private sector, are being performed on an outpatient basis. This requires us to look at many factors, the most important being: the decision on exclusion criteria ..
A quantification of discharge readiness after outpatient anaesthesia : patients' vs nurses' assesment : research articleSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 5 –9 (2003)More Less
<I>Objectives:</I> Criteria for discharge after outpatient surgery do not take into consideration the patients' assessment of discharge readiness. Our aim was to compare discharge readiness as determined by nurses with that determined by patients against the modified Aldrete score as a benchmark. <br><I>Design and setting:</I> In this prospective study, a single observer followed 194 outpatients in the PACU. A modified Aldrete score was assigned and further assessments were made at 15-min intervals in parallel with those made by nursing staff. Nurses and patients were blinded to each other's assessments . Discharge readiness was quantified according to three different approaches: 1) time to reach a modified Aldrete score of >9, 2) time to discharge readiness according to the patient's own evaluation and, 3) time to discharge readiness according to nursing assessments. <br><I>Results:</I> All three times were significantly different from each other. a) Time to achieve a modified Aldrete score >9 was 8.3+7.6 min, b) Time the patient felt discharge ready was 45.3+39.5 min, c) Time the patient was actually discharged by nurses was 86.8+45.8 min. <br><I>Conclusions:</I> Nursing staff tend to keep patients an additional 41.5 + 36.6 min in the PACU compared to the patients' own evaluation. Significant cost saving could be potentially realised if outpatients who achieve a modified Aldrete score >9 are allowed some freedom in the determination of their own discharge readiness.
Author L.N. NienaberSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 11 –15 (2003)More Less
<I>Introduction:</I> The practice of warming blood for transfusion by immersion into a waterbath has been investigated. <br><I>Objective:</I> To find the maximum waterbath temperature at which blood can be heated effectively without effecting the red blood cell functional and structural integrity. <br><I>Method:</I> Blood, three days after donation (fresh blood), with CPD anticoagulant, was warmed at 37°C, 43°C, 45°C, 47°C, 50°C and 55°C for 10, 20, 30 and 60 minutes and analysed for haemolysis. In addition, the biochemical markers were done on the blood after 34 days of storage at 4°C (old blood). Temperature increase within the blood unit being warmed by immersion in warm water is non-uniform, with the outer part showing the largest temperature increases. This was examined at waterbath temperatures of 45°C and 47°C and represented graphically. Temperature decrease in a stainless steel bucket filled with 10 liters of warm water (45°C and 47°C), commonly used in theatre to heat blood, was analyzed and is graphically displayed. Results and discussion: Only minor biochemical changes resulted from warming up to 47°C for 1 hour. The values of the free haemoglobin in old blood corresponded to the significant changes of fresh blood after being heated at 50°C for 30 minutes (p<0.001). The change of the haematocrit in old unheated blood was much higher than the significant changes caused by heating the fresh blood at 55°C. The value of potassium of old blood corresponded to the value after heating fresh blood at 55°C for 30 minutes, even though the potassium already increased significantly at 50°C after 60 minutes (p<0.01). The value of lactate hydrogenase in old blood corresponded to the significant increase after heating fresh blood at 55°C for 60 minutes, while this marker already increased significantly at 50°C after 20 minutes exposure (p<0.001). The results suggest that immersion warming of fresh blood for 1 hour at 47°C and below do not cause red cell damage. A limitation of immersion warming is that warming of the blood within the unit is not uniform, with a temperature gradient as big as 5°C to 10°C between the inner and outer parts of the unit. There is also a lag time of 30 to 40 minutes between the inner and outer parts to reach the same temperature in a thermostatically controlled waterbath. The temperature of the bucket of warm water in theatre decreased rapidly. <br><I>Conclusion:</I> It is safe to heat blood in a bucket of warmed water in theatre at a confirmed initial temperature of 47°C, as only the outer part of the unit is exposed to this temperature for a short while.
Author A. BosenbergSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 17 –19 (2003)More Less
Extracted from text ... SYNDROMIC VIGNETTES IN ANAESTHESIA Southern African Journal of Anaesthesia & Analgesia - October 2003 17 Anaesthesia and Freeman Sheldon Syndrome and a dimple on the chin were noted. The skin over his wrists was smooth and no veins were visible. His wrists, elbows and ankles were stiff. He had cryptorchidism. Chest was clear. Blood results were unremarkable and his haemoglobin was 10gm. Case 2 A 22 month old Mauritian girl, weighing 11.2kg, presented for correction of a craniofacial defect (brachycephaly). She showed similar facial features and her lips were puckered as if whistling. She also had limited mouth opening ..
Author K.M. KuczkowskiSource: Southern African Journal of Anaesthesia and Analgesia 9, pp 21 –23 (2003)More Less
Extracted from text ... REVIEW Southern African Journal of Anaesthesia & Analgesia - October 2003 21 Marijuana use in Pregnancy: Anaesthetic Implications ethanol, tobacco, caffeine, cocaine, amphetamines and opioids. Poly-substance abuse is common. 3, 14 The majority of parturients with a history of drug addiction deny it when interviewed preoperatively by anaesthesiologists.6, 15 Therefore a high index of suspicion for drug use in pregnancy is necessary. Risk factors suggesting drug use in pregnancy (including marijuana) include absence of prenatal care, cigarette smoking and history of preterm labour.16-18 MARIJUANA: Epidemiology and pathophysiology The use of marijuana for both medical and recreational indications dates back ..
Source: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... EDITORIAL Southern African Journal of Anaesthesia & Analgesia - October 2003 1 "New Indications for Ultiva" GlaxoSmithKline recently obtained registration for the dosages of Ultiva in Paediatric & Cardiac procedures, as well as the use of Ultiva in the ICU. To introduce the new indications to the profession, a number of regional launches were held recently. The presentations highlighted the benefits of Ultiva in these settings and were very well received. According to Jaco de Wet, outgoing brand manager for Ultiva, the recent approval of these indications proves that Ultiva has come of age, and the range of patients it ..
Source: Southern African Journal of Anaesthesia and Analgesia 9 (2003)More Less
Extracted from text ... CPD QUESTIONNAIRE Southern African Journal of Anaesthesia & Analgesia - October 2003 28 Subscribe to the SAJAA CPD programme and earn 20 CPD points per year CPD reference number A008/288/02/2003 Continuing Professional Development Point Questionnaire Accredited by the Wits CPD Office 1. Freeman Sheldon Syndrome is an inherited disorder 2. It can be diagnosed prenatally 3. The airway does not pose a problem during anaesthesia 4. Masseter muscle spasm may occur following exposure to halothane 5. Freeman Sheldon Syndrome is a myopathy 6. Warming blood in a water bath may be dangerous 7. Warming blood in a water bath does ..