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- Volume 15, Issue 2, 2009
Southern African Journal of Anaesthesia and Analgesia - Volume 15, Issue 2, 2009
Volume 15, Issue 2, 2009
Author Christina LundgrenSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 5 –6 (2009)More Less
The measure of a good anaesthetic may well differ, depending on whether you are the patient, the surgeon, the anaesthesiologist, or the postoperative nursing staff. Ultimately, however, the patient should be the judge of whether his or her anaesthetic was a good experience. An essential part of this experience is the recovery process which is continual, and may last for up to a few days. The less serious, non-life-threatening adverse events such as postoperative pain, nausea and vomiting, drowsiness and dizziness have been shown to be predictors for patient satisfaction and level of postoperative functioning.
Source: Southern African Journal of Anaesthesia and Analgesia 15 (2009)More Less
The requirement for anaesthesia services in the MRI suite are increasing, and require that the anaesthetic equipment is adequate to ensure patient safety, is MRI compatible, and has a negligible effect on image quality. The pilot balloon valve of a conventional endotracheal tube (ETT), and the pilot balloon springs of oral RAE tubes and some laryngeal mask airways have been implicated in MRI degradation. A twenty-five-year old male patient was operated on for haemoperitoneum. Intra-operatively, the surgeons were unable to locate and control the bleeding. They therefore closed the abdomen after packing the abdominal cavity.
Should patients be anaesthetised in a dedicated anaesthetic room? A survey of attitude of anaesthetists and patients in a district general hospital : scientific letterAuthor A. ObideySource: Southern African Journal of Anaesthesia and Analgesia 15, pp 8 –9 (2009)More Less
Ninety four percent of hospitals in the United Kingdom (UK) have anaesthetic rooms. However, they do not exist in hospitals in most Scandinavian countries, North America and Australia. Lately, the usefulness of the anaesthetic room has aroused debates among UK anaesthetists prompting several studies and publications. A survey of anaesthetists' attitudes to the use of an anaesthetic room in a district general hospital in the UK showed that 84% of them used the anaesthetic room for induction of anaesthesia for elective cases. Almost half the number would use the anaesthetic room for anaesthetic induction of high risk patients. This survey also showed sixty percent of patients preferred their induction of anaesthesia take place in the anaesthetic room. Previous anaesthetic experience did not influence this choice. Although anaesthetic rooms have been in use in the UK for decades, a robust argument for their continuous use is largely lacking from the literature. Issues relating to patient safety, medico legal liabilities and economic sense may lead to their disappearance in future. Adequate pre-operative preparation and education of the surgical patients may alter their preferential site for induction of anaesthesia.
Intracuff buffered lidocaine versus saline or air - a comparative study for smooth extubation in patients with hyperactive airways undergoing eye surgery : original researchSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 11 –14 (2009)More Less
Background : Increased cough and restlessness during emergence from general anaesthesia in patients undergoing ophthalmologic surgical procedures might result in increased intraocular pressure, ruptured sutures and suprachoroidal haemorrhage, which can be detrimental to the outcome of surgery. In hyperactive airway patients, as the cough receptors are in the hypersensitised stage, the patients tend to cough more frequently and violently during extubation. Hence, in such patients, we sought to determine the benefits of filling the endotracheal tube cuff with either buffered lidocaine, saline or air, so as to prevent endotracheal tube-induced coughing during emergence from general anaesthesia.
Methods: Seventy five patients either with a history of chronic smoking or recently treated upper respiratory tract infections were randomly assigned into three groups (n = 25), based on the type of endotracheal tube cuff inflation, as follows: Group A (air), Group B (6 ml normal saline) and Group C (6 ml 2% lidocaine + 0.5 ml 7.5% sodium bicarbonate). A second, blinded anaesthetist, graded the extubation as: Grade 0 (no cough), Grade 1 (cough < 15s) and Grade 2 (cough > 15s).
Results: Extubation was smooth in Group C compared with Groups B and A (p < 0.0001). Further, the incidence of sore throat was found to be lower in both liquid groups, B and C, compared with Group A at 1 h (p < 0.0001) and 24 h (p < 0.01) postoperatively.
Conclusions: Injecting buffered lidocaine into the endotracheal tube cuff, produces smooth extubation even in patients with hyperactive airways as the cough receptors in the tracheal mucosa gets blocked by the increased diffusion of uncharged base form of the drug across the hydrophobic polyvinyl chloride wall of the cuff.
Thoracic epidural for post-thoracotomy pain: a comparison of three concentrations of sufentanil in bupivacaine : original researchSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 16 –21 (2009)More Less
Background: The aim of this prospective, double blind, randomised trial was to compare the analgesic and adverse effects of three concentrations of the thoracic epidural sufentanil with bupivacaine in patients undergoing thoracotomy.
Methods: We studied 60 (randomised) patients who were to receive a 10 ml bolus dose of sufentanil, 1?g/ml, 2 µg/ml and 3 µg/ml, in bupivacaine 0.125%, via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation was assessed using a visual analogue scale (VAS) and observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Adverse effects were simultaneously assessed.
Results: There was no significant difference in the baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain, i.e. a VAS scores ≥ 40 and OVRS ≥ 2, at each of the four assessments postoperatively, was significantly higher with sufentanil 1 g/ml than with sufentanil 2 µg/ml or µ3 g/ml (p < 0.05). In the 3 µg/ml sufentanil group, four patients (20%) had a sedation score ≥ 3 compared with one (5%) and no (0%) patients in the 2 µg/ml and 1 µg/ml sufentanil groups, respectively (p < 0.05). In addition, 30% patients experienced pruritus in the 3 µg/ml sufentanil group compared with 10% and 5%, respectively, in the 2 µg/ml and 1 µg/ml sufentanil groups. In the sufentanil 3 µg/ml, 2 µg/ml and 1 µg/ml groups, 30%, 20% and 5% patients, respectively, had emetics symptoms (p < 0.05).
Conclusions: We conclude that a thoracic epidural bolus of 10 ml sufentanil 2 µg/ml with bupivacaine 0.125% provides the optimal balance between pain relief and side-effects following thoracotomy.
Intraocular pressure changes in patients undergoing cataract extraction and lens implantation : laryngeal mask airway versus endotracheal tube : original researchSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 23 –27 (2009)More Less
Objectives: To investigate the influence on intraocular pressure (IOP) of airway management with a laryngeal mask airway (LMA) or tracheal tube (ETT), and secondly to compare the devices with regard to their impact on IOP.
Design: Prospective, randomized observational study over a four-month period (August - November 2002)
Setting: University-affiliated tertiary level hospital in Pretoria, South Africa
Subjects: Forty ASA I and II adult patients undergoing unilateral cataract extraction and lens implantation under general anaesthesia
Outcome measures: Changes in intraocular pressure after placement of airway device
Methods: Following a standard anaesthestic induction with propofol and atracurium, airway management was randomized to LMA or ETT.
IOP was measured pre-induction, 3 min post induction but before airway manipulation, 20 sec post LMA or ETT insertion and finally 2 min post airway instrumentation.
Results: There was a small increase in mean IOP in the LMA group, which was statistically insignificant. However there was a significant rise in mean IOP in the ETT group (p = 0.0001) which returned to almost pre-insertion levels at 2 minutes.
Conclusions: The LMA causes minimal changes in intraocular pressure when used to secure the airway during cataract surgery. The rise in IOP following tracheal intubation is significant, yet transient and probably clinically insignificant.
A case of Lowe syndrome (oculocerebrorenal syndrome) : clinical implications and anaesthetic management : syndromic vignettes in anaesthesiaSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 29 –31 (2009)More Less
In 1952 Lowe and his colleagues described a syndrome with organic aciduria, decreased renal ammonia production, hydrophthalmos and mental retardation. In 1954, a renal Fanconi syndrome was recognised as being associated with the syndrome, and in 1965 an X-linked pattern of inheritance was determined.
Source: Southern African Journal of Anaesthesia and Analgesia 15, pp 33 –34 (2009)More Less
A 50-year-old male presented with signs and symptoms of oesophageal perforation after a biopsy. Suggestive symptoms and signs were pain in the neck radiating to the back, a rise in temperature and pulse, emphysema in the neck and widening of the mediastinum or a pneumothorax revealed by a chest X-ray. He survived with medical management.