Southern African Journal of Anaesthesia and Analgesia - Volume 9, Issue 5, November 2003

Extracted from text ... EDITORIAL Southern African Journal of Anaesthesia & Analgesia - November 2003 1 As 2003 draws to a close, our profession and specialty is faced with significant upheaval and change, ranging from the licensing of medical practices to new legislation on perverse incentives. In addition, the South African Medical Association is no longer permitted to publish a recommended tariff, in terms of the Competition Act. All of these changes affect all of us in some way, both in the private and public sectors. At times like these, it is easy to become so embroiled in the politics of these important ..

&lt;I&gt;Objective:&lt;/I&gt; To compare the quality of intravenous patient controlled analgesia (PCIA) of low dose morphine plus ketamine with morphine. &lt;br&gt;&lt;I&gt;Design:&lt;/I&gt; Double blind case control study. &lt;br&gt;&lt;I&gt;Setting:&lt;/I&gt; Academic hospital. &lt;br&gt;&lt;I&gt;Patients:&lt;/I&gt; Thirty-six patients scheduled for elective abdominal hysterectomy were randomly divided into two groups to receive patient controlled intravenous analgesia (PCIA). <br><I>Interventions:</I> Group M received morphine 21 µg/kg as a bolus, Group MK received morphine 7 µg/kg plus ketamine14 µg/kg as a bolus. The lockout period in both groups was 7 minutes. &lt;br&gt;&lt;I&gt;Measurements:&lt;/I&gt; Morphine consumption, visual analogue pain score (VAPS), pulse oximetry oxygen saturation (SpO₂), respiratory rate (RR), verbal descriptive sedation score (VDSS), nausea, pruritis, dreaming, and hallucinations were recorded at 1, 4, 24 and 48 hours. Equivalence of the two groups was assessed by comparing the 95% confidence interval (CI) for the effect with the equivalence delta (10%). &lt;br&gt;&lt;I&gt;Results:&lt;/I&gt; Morphine consumption was significantly lower in Group MK after 24 and after 48 hours (p < 0, 05). VAPS was significantly higher in Group MK at 4 hours (p < 0, 05), but VAPS was always clinically lower than in Group MK at all times (Equivalence delta > 10%). SpO&lt;sub&gt;2&lt;/sub&gt; at 4 hours was marginally higher in Group MK (p = 0, 0809). &lt;br&gt;&lt;I&gt;Conclusion:&lt;/I&gt; Morphineketamine PCIA, in doses used in this study, provided analgesia inferior to that of morphine PCIA, but may improve the respiratory side effect profile of morphine. The analgesia of morphine and ketamine are additive rather than synergistic.

&lt;I&gt;Objective:&lt;/I&gt; Thyroidectomy is traditionally performed under general anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital. &lt;br&gt;&lt;I&gt; Design:&lt;/I&gt; This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999. &lt;br&gt;&lt;I&gt; Setting:&lt;/I&gt; The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution. &lt;br&gt;&lt;I&gt;Subjects:&lt;/I&gt; The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. <br><I>Outcome Measures / Results:&lt;/I&gt; The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20-80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. &lt;br&gt;&lt;I&gt;Conclusion:&lt;/I&gt; Bilateral superficial cervical plexus block is a useful anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.

Extracted from text ... CASE REPORT Southern African Journal of Anaesthesia & Analgesia - November 2003 19 Early postpartum eclampsia complicated by subarachnoid haemorrhage, cerebral oedema and acute hydrocephalus made and treatment was commenced with magnesium sulphate. She received 5g intramuscularly (imi) in each buttock, 4g in 200ml of normal saline infused intravenously over 20 minutes, and a maintenance dose of 5g imi every four hours. Toxicity was excluded by patellar tendon reflex testing. Blood tests were ordered for urea and electrolytes, uric acid, full blood count, liver function and coagulation profile. The results were normal. The patient was admitted to the obstetric ..

We present the case of a 60-year old woman, who had an unusual complication of nasotracheal intubation, which was carried out to relieve post-thyroidectomy respiratory distress at the University of Ilorin Teaching Hospital (UITH). She presented with a huge malignant goitre complicated by severe respiratory distress due to pressure symptoms and left vocal cord palsy. An emergency neartotal thyroidectomy was done under endotracheal general anaesthesia. Respiratory distress persisted after thyroidectomy and tracheal extubation. A nasotracheal tube was subsequently passed. On the fourth postoperative day, she developed another episode of severe respiratory distress due to endotracheal tube blockage. Her trachea was extubated but attempts to re-introduce the tube through the nasal route were unsuccessful but instead resulted in submucous dissection of the nasopharynx. An emergency tracheostomy was subsequently performed.

Extracted from text ... CPD QUESTIONNAIRE Southern African Journal of Anaesthesia & Analgesia - November 2003 32 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. Eclampsia accounts for approximately 90 000 maternal deaths worldwide annually. 2. The management of an unconscious eclamptic patient excludes the following: 1. Ventilatory support 2. Seizure prophalaxis 3. The neurological complications due to hypertensive disorders of pregnancy are: 1. Eclamptic seizure 2. Visual disturbances 4. The following drugs were used to control blood pressure in this patient: 1. ..