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- Southern African Journal of Anaesthesia and Analgesia
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- Volume 17, Issue 1, 2011
Southern African Journal of Anaesthesia and Analgesia - Volume 17, Issue 1, 2011
Volume 17, Issue 1, 2011
Author J. GoosenSource: Southern African Journal of Anaesthesia and Analgesia 17 (2011)More Less
In South Africa, trauma is collectively the second greatest overall cause of mortality and haemorrhage, the major cause for mortality after injury. Major trauma, particularly hypoperfusion, is a potent stimulus for the systemic inflammatory response. Conceptually, damage-control resuscitation (DRS) is coupled with damage-control surgery.
Author J. VenturasSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 132 –135 (2011)More Less
UNAIDS estimated that, at the end of 2009, there were 33.4 million people worldwide who were living with HIV or AIDS, with an estimated 5.6 million of these people in South Africa. Although South Africa has the largest antiretroviral programme in the world, it also has the highest incidence of infected patients and access to treatment is low. At the end of 2009, only 37% of those infected with the virus in South Africa were receiving treatment for HIV according to the latest WHO guidelines.
Author M. VellerSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 136 –137 (2011)More Less
It is self-evident that the extent of a therapeutic intervention should be proportional to the risk of the disease being addressed. This concept implies that the factors influencing clinical outcome are considered prior to treatment and that treatment is then tailored to an individual's need.
Author S. ChettySource: Southern African Journal of Anaesthesia and Analgesia 17, pp 139 –140 (2011)More Less
Author S. RobertsonSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 141 –142 (2011)More Less
Author R.N. RodsethSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 143 –145 (2011)More Less
In 2010, the International Liaison Committee on Resuscitation (ILCOR) released its latest treatment recommendations on cardiopulmonary resuscitation (CPR). This was done as part of its five-yearly literature review cycle and was based on an examination and review of 277 resuscitation and emergency cardiovascular care topics. It is this consensus statement that is used as the basis for the creation of resuscitation guidelines by organisations such as the American Heart Association (AHA) and the European Resuscitation Council (ERC). These guidelines are then formalised into training courses such as the ERC's Basic Life Support (BLS), Advanced Life Support and European Paediatric Life Support; and the AHA's BLS, Advanced Cardiovascular Life Support and Paediatric Advanced Life Support courses.
Therapeutic hypothermia : the coolest part of the bundle of post-cardiac arrest care : refresher courseAuthor M. BothaSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 146 –147 (2011)More Less
Organised post-cardiac arrest care targeting cardiovascular and neurological outcomes can improve survival to hospital discharge among victims who achieve return of spontaneous circulation (ROSC) after cardiac arrest. A recent international resuscitation review and consensus process has searched the published evidence to determine the impact of therapeutic hypothermia on morbidity and mortality in the context of patients with ROSC after cardiac arrest. Therapeutic hypothermia forms an integral element of this "bundle of care" that has been shown independently to improve outcome after adult witnessed out-of-hospital ventricular fibrillation (VF) cardiac arrest, and after neonatal hypoxicischaemic insult. Furthermore, two recent nonrandomised studies have shown the possible benefit of hypothermia after cardiac arrest from other initial rhythms in hospital and out of hospital, with further studies with historic controls also showing benefit for therapeutic hypothermia after out-of-hospital, allrhythm adult cardiac arrests.
Author H. KluytsSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 148 –152 (2011)More Less
This discussion will focus on the perioperative anaesthetic considerations for patients undergoing bariatric surgery. The preoperative workup of these patients will be covered separately. However, one needs to emphasise that preoperative evaluation plays a huge role in risk stratification and will therefore be referred to again where it impacts on anaesthetic management.
Author D. LinesSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 153 –157 (2011)More Less
Bariatric surgery for the morbidly obese patient is no longer just indicated for weight reduction, but has also become an important co-morbid disease modifier in these patients. As the procedures are becoming safer to perform and better understood, more and more obese patients are turning to this therapeutic modality for a long-lasting solution to their weight and medical problems. The accreditation of "bariatric centres of excellence" throughout the country have ensured a safe environment for these procedures to take place in, and also the appropriate follow-up and support that these patients require in the years following bariatric surgery. In these centres, the mortality for bariatric surgery procedures is documented at less than 1%, and the overall morbidity at about 8%.
Author M. HeringlakeSource: Southern African Journal of Anaesthesia and Analgesia 17, pp 158 –160 (2011)More Less
The concept of goal-directed haemodynamic optimisation was developed in the late 70s and early 80s of the last century by the surgeon W C Shoemaker. Observational studies showed that high-risk surgical patients that did not survive after major non-cardiac surgery were characterised by the inability to adapt oxygen delivery to the perioperatively increased oxygen demand. He suggested improving patients' outcomes by optimising the cardiac index and oxygen delivery to the haemodynamic levels observed in survivors. Stimulated by Shoemaker's ideas, he and various other researchers performed prospective studies that clearly supported this concept.