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- Volume 15, Issue 4, 2009
Southern African Journal of Anaesthesia and Analgesia - Volume 15, Issue 4, 2009
Volume 15, Issue 4, 2009
Living longer as an anaesthetist : the 'magic' lifestyle or the 'lifestyle polypill' : guest editorialSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 5 –10 (2009)More Less
The central premise of this paper is that interventions that result in prolongation of human life are good for the individual. We examine three broad lifestyle activities (anaesthetic health and health risks, common health misconceptions, accepted lifestyle modifications to improve longevity) identifying interventions that have been reported to result in reductions in all cause mortality. With regard to anaesthetic health and health risks, issues around life expectancy, anaesthetic mortality risks and suicide risks are examined. The negative effects of both acute and chronic sleep deprivation, as well as work and call stress on the health of the anaesthetist are identified and possible interventions to mitigate them are proposed. Common health misconceptions are addressed, with specific attention being given to the under-reported beneficial effects of coffee, alcohol and chocolate on longevity and health. Finally, accepted lifestyle modifications, including exercise, diet, aspirin and statins are discussed, and the possible utility and feasibility of the 'polypill' is considered.
Author R. SpiesSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 12 –19 (2009)More Less
Asthma is one of the most common coexisting diseases in children, and a major cause of mortality and morbidity in children. Morbidity is measured by school absences, emergency department visits and hospitalisations. Asthma continues to take the lives of children at an alarming rate and there is evidence that its mortality has increased over the last 20 years. Asthma severity has increased with urbanisation and exposure to cigarette smoke. Proper diagnosis, education, and appropriate management are essential to decrease morbidity and mortality.
This review article provides an understanding of the disease process, differences in physiology compared with adults and the use of a stepwise treatment of asthma according to level of control. Asthma can be controlled, partially controlled or uncontrolled. Control can be determined by assessment of daytime symptoms, limitation of activities, nocturnal symptoms, need for reliever, pulmonary function tests, and the frequency of exacerbations.
Discussion follows with the pre-operative assessment of a child with asthma, the timing of the anaesthetic, and management of the asthma patient in theatre. Intra-operative bronchospasm is one of the most difficult situations that an anaesthesiologist must handle and this article serves to provide tools in order to avoid this. It concludes with an approach to the management of intra-operative bronchospasm.
Source: Southern African Journal of Anaesthesia and Analgesia 15, pp 21 –23 (2009)More Less
An understanding of the physics, physiology and pathophysiology underpinning the use of the central venous pressure is essential in the effective use thereof. As for any hollow organ, the interaction between intracavity volume and pressure of the container is not linear. Because of this characteristic stress and strain relationship, the central venous pressure cannot be a simple and static indication of the volume inside the container and should neither be used as such nor should across the board comparisons between central venous pressure measurements and other markers of intravascular volume be attempted. Dynamic testing of the system stiffness (elastance) of the container is an effective but still indirect manner to gauge the particular intracavity volume.
Coping responses as predictors of psychosocial functioning amongst individuals suffering from chronic pain : original researchSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 25 –30 (2009)More Less
Background: Research on coping with chronic pain has focused on exploring the impact of different coping responses on various aspects of living with chronic pain. The aim of this study is to determine whether certain coping responses can be identified as predictors of the level of pain intensity reported by the chronic pain patient, as well as predictors of these individuals' psychosocial functioning.
Methods: One hundred and seventy-two individuals suffering from chronic pain completed both the West Haven-Yale Multidimensional Pain Inventory and the Coping Responses Inventory - Adult Form. The prevalence of the use of Avoidance and Approach Coping, and the relationship between these responses and psychosocial functioning (Pain Severity, Interference, Support, Life Control, and Affective Distress) were explored. Hierarchical regression analyses were performed in order to determine the amount of variance explained by the specific predictor variables.
Results: The findings of this research suggest that coping responses do impact upon the psychosocial functioning of individuals with chronic pain, and more specifically, on the level of interference, severity of pain, perceived amount of control over life and the amount of emotional distress experienced by these patients.
Conclusion: The outcomes of this study appear to contradict the general consensus in literature that regards Approach Coping responses as being associated with decreased pain severity and improved psychosocial functioning. The manner in which specific components of each type of coping response relates to specific aspects of psychosocial functioning was investigated; an aspect that was found to be lacking in most research regarding coping and chronic pain.
General anaesthesia with and without intubation for patients with Cornelia de Lange syndrome : case studiesSource: Southern African Journal of Anaesthesia and Analgesia 15, pp 32 –34 (2009)More Less
We present the use of different methods of general anaesthesia in two patients with Cornelia de Lange syndrome and its contribution to the patients' oral health.
Case 1: The patient was a 22-year-old woman with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. She exhibited the physical characteristics of Cornelia de Lange syndrome, including a small mouth, thin lips, short limbs, stiffness of joints and intellectual disability. General anaesthesia without intubation was performed safely eight times. No other complications except hypersensitivity to hypnotic agents were observed.
Case 2: The patient was a 10-year-old boy with Cornelia de Lange syndrome who underwent dental treatment under general anaesthesia. He had a history and symptoms of obstructive airway disorders in addition to showing physical characteristics of the syndrome similar to those seen in Case 1. General anaesthesia with nasal intubation was performed safely twice. Computed tomography (CT) of his head and neck produced unremarkable results.
These cases demonstrate that both general anaesthesia with and without nasal intubation can be safely used in managing individuals with Cornelia de Lange syndrome during dental treatment.