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Southern African Journal of Anaesthesia and Analgesia
Journal Prestige (SJR): 0.182

Number of Followers: 7

This is an Open Access Journal

Open Access journal
ISSN (Print) 2220-1181 - ISSN (Online) 2220-1173
Published by African Journals Online

[261 journals]

POCUS as part of the medical curriculum – is this the year'
- Authors: EW Turton, M Gibbs, E Neethling, J Swanevelder
  Pages: 4 - 8
  Abstract: No .
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
The transthoracic echocardiographic skills of registrars in a department
of anaesthesiology
- Authors: N Coetzee, H Perrie, J Scribante, T Kleyenstuber
  Pages: 10 - 16
  Abstract: Background: Research has shown the value of integrating point-of-care ultrasonography (POCUS) into daily practice and has highlighted the lack of competency in transthoracic echocardiographic (TTE) skill among anaesthesiology registrars. The aim of this study was to determine the level of TTE skill of anaesthesiology registrars at the University of the Witwatersrand (Wits) using an objective structured clinical examination (OSCE).
  Methods: This research study employed a cross-sectional research design. Convenience sampling was used and 27 registrars were enrolled in this study. The OSCE consisted of two practical stations (Stations 1 and 2) and two clinical pathology stations (Stations 3 and 4). Adequate TTE skill was defined as competency in both the practical and clinical stations and an overall pass score of 70% was used.
  Results: The overall mean (SD) score obtained for the OSCE was 45.2% (23%). In comparing the TTE skill of registrars who have completed a cardiac rotation and have completed an accredited course with those who have not, no significant differences were found in the pass scores. Registrars who had completed an accredited TTE course performed significantly better in Stations 3 and 4 (p = 0.014). Of the registrars, 37% obtained a pass score for practical stations and 14.8% for the clinical stations with only 11.1% achieving an overall pass score indicating TTE competency. No significant difference in pass scores was found with the different categories of registrars. There was a strong positive significant correlation between completing more TTEs and the scores obtained (r = 0.540, p = 0.004). Completing more TTEs was associated with a higher score.
  Conclusion: Findings from this study suggest that the current skill level of registrars performing TTEs at our department is not sufficient to achieve clinical competency and that the training may not be initiated early enough in the registrar programme.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
Comparing paediatric caudal injection simulation on a 3D-printed,
gelatine-cast part-task trainer and the Life/form® Pediatric Caudal
Injection Simulator, to real anatomy, by specialist opinion
- Authors: H Janse van Rensburg, DJ van der Merwe
  Pages: 18 - 22
  Abstract: Background: Paediatric caudal anaesthesia is an established technique. Commercially, only one paediatric caudal part-task trainer (PTT) exists. In the South African context, access to caudal block simulation training is lacking. A reusable paediatric caudal anaesthesia trainer was produced through three-dimensional (3D) printing, silicone moulding and gelatine casting. This study compared the local and commercial trainers to patient-based anatomy, by specialist opinion. This was done to validate the locally manufactured PTT for potential anaesthesia training.
  Methods: Specialist anaesthesiologists (n = 30) randomly performed a caudal block on each trainer. Visual analogue scales were completed for each PTT, comparing four variables to real patient anatomy (i.e. palpation of bony landmarks and sacral hiatus;
  simulation of soft tissue; loss of resistance to needle insertion into the epidural space; overall similarity of the experience to caudal injection on a real patient). As a secondary outcome, correct needle placement was confirmed using ultrasound on the 3D-printed trainer.
  Results: Bony landmark and sacral hiatus palpation rated a median of 36.50% for the 3D-printed trainer and a mean of 36.58% for the Life/form® trainer (p = 0.28). Soft tissue simulation rated a median of 56.75% for the 3D-printed trainer and a mean of 43.23% for the Life/form® trainer (p = 0.11). Loss of resistance rated a median of 56% and 48.50% for the 3D-printed and Life/form® trainers, respectively (p = 0.44). Overall similarity of the experience to real anatomy rated a median of 52% for the 3D-printed trainer and a mean of 41.97% for the Life/form® trainer (p = 0.23). Simultaneous comparison of all four variables between the two trainers showed no statistically significant difference (p = 0.64). Ultrasound confirmed correct needle placement for 86.67% of participants on the 3D-printed trainer.
  Conclusion: The two caudal anaesthesia PTTs demonstrated no significant difference in performance, as judged by specialist opinion. Both models need improvement in terms of fidelity, compared to real anatomy. Using 3D printing to produce PTTs may
  improve local availability.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
A survey of the perceptions and knowledge of anaesthesia and anaesthetists
among Grade 12 learners in four Johannesburg districts
- Authors: PA Talane, A Mamoojee, N Madima
  Pages: 24 - 30
  Abstract: Background: William Morton conducted the first anaesthetic in 1846 using ether. Since then, advances in pharmacology and technology have radically improved modern anaesthesia and have allowed for advancements in surgery as well. Despite the radical growth of this speciality, public knowledge about anaesthetists’ expertise and their role in healthcare delivery remains poor.
  Methods: A cross-sectional study was carried out between June and September 2021 among Grade 12 learners in four Johannesburg districts. A questionnaire consisting of 26 questions was used to assess the learners’ knowledge of the role of anaesthetists, their insight into anaesthesia as a speciality, and their interest in the field.
  Results: Of the 595 learners who participated, 56.3% were aware that the anaesthetist administers anaesthesia in the operating room. However, 57.8% believed that nurses monitored the patient’s vital signs during surgery. Only 16% could identify the duties of the anaesthetist outside of the theatre environment. Overall, participants fared poorly, achieving an average score of 14% for the questionnaire. There was a statistically significant correlation between participants from a high socioeconomic background and awareness that the anaesthetist administers anaesthesia. Knowledge regarding the intraoperative duties of the anaesthetist was still poor, regardless of the socioeconomic background of the participant. Previous exposure to anaesthesia did not improve awareness about anaesthesia among the participants.
  Conclusion: Awareness regarding anaesthesia and anaesthetists among participants is poor despite the radical growth in the field. Despite faring poorly, 58.5% of participants believed that good medical education could reduce the burden of healthcare costs and medicolegal consequences; while 70% of them would request an anaesthetist to provide information about their anaesthetic before surgery. Despite a lack of awareness, the participants displayed interest and willingness to learn about anaesthesia. Grade 12 learners would be a formidable target group for anaesthetic education campaigns, resulting in these learners becoming health savvy adults who can perpetuate this information in their communities.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
Total intravenous anaesthesia: a survey of practices and training at an
anaesthesiology department
- Authors: F Dadoo, J Scribante, H Perrie, E Welch
  Pages: 32 - 37
  Abstract: Background: Total intravenous anaesthesia (TIVA) provides an alternative to the classic volatile agent-based anaesthetic, with several clinical benefits. Volatile agent-based anaesthesia has dominated general anaesthesia practices, despite improvements in intravenous agents and drug delivery systems for TIVA. This study aimed to describe the practices and training of anaesthetists in TIVA at the Department of Anaesthesiology at the University of the Witwatersrand.
  Methods: A prospective, cross-sectional study was undertaken using a self-administered questionnaire.
  Results: In total, 153 questionnaires were completed, representing 73.6% of anaesthetists in the department. TIVA was infrequently used; 67.3% of participants reported using it < 10 times during the past year. Conversely, 88.9% of participants reported that they would like to use TIVA more often. Significantly more juniors than seniors performed ≥ 10 TIVAs during the past year (p < 0.0001). Of the participants, 56.9% experienced a situation where TIVA would have been ideal, but they lacked the confidence to use it. Anaesthetists who had performed ≥ 10 TIVAs were not significantly more confident in its use (p = 0.059). Seniors were significantly less deterred by a lack of understanding of the pharmacology of TIVA as an obstacle to TIVA use, compared to juniors (p < 0.0001). Target-controlled infusion (TCI) was preferred by 78.4% of participants for the administration of TIVA. TIVA was viewed as advantageous over volatile agent-based anaesthesia in malignant hyperthermia (98.7%), to reduce postoperative nausea and vomiting (86.9%) and to decrease environmental pollution (89.5%). The lack of availability of depth of anaesthesia monitors was the greatest obstacle to TIVA use, reported by 85% of participants. Only 24% of participants perceived their training in TIVA as adequate.
  Conclusion: TIVA usage was infrequent and participants lacked confidence in its administration. TIVA is an important skill in the armamentarium of an anaesthetist and, therefore, improved training should be prioritised.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
Visual estimation of blood loss on swabs by surgeons and anaesthetists in
KwaZulu-Natal: an online survey study
- Authors: SB Gangen, TC Hardcastle
  Pages: 38 - 42
  Abstract: Background: Human blood products are a scarce resource in South Africa. Doctors estimate blood loss from assessing swabs during surgical procedures to decide whether to transfuse blood or not. The objective of this study was to evaluate how accurate anaesthetists and surgeons in KwaZulu-Natal are at estimating the volume of blood in soaked swabs. Additionally, the study sought to determine whether choice of medical discipline, experience or medical rank had an influence on accuracy.
  Methods: An observational cross-sectional study was conducted whereby medical officers, registrars and specialists within the anaesthetic and surgical disciplines were sent an electronic survey. The survey consisted of closed-ended questions and images of swabs soaked in known volumes of blood. The survey required participants to visually estimate the blood volumes from the images. Data were analysed using Stata v17.1 (StataCorp, USA) with descriptive statistics determining the accuracy. Multilevel mixed effects logistic regression was used to estimate how medical rank, discipline or experience influenced the accuracy of the assessment. An accurate estimate was defined as within 25% either above or below the actual volume.
  Results: In total, 104 surveys were completed; 14 incomplete surveys were excluded. A general accuracy of 28.6% (within a deviation of 25%) was obtained for the 104 participants. No significant differences in accuracy were found based on medical discipline, medical rank, or years of experience in discipline, but accuracy improved with increased volumes.
  Conclusion: Anaesthetists and surgeons are poor at visually estimating blood loss from swabs, with marginal non-significant improvements in accuracy with rank and experience. Pictorial guides placed in theatre and further teaching are suggested as options to improve the rate of accuracy among staff, along with the use of quantitative measures of blood loss.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)
The management of postoperative pain after musculoskeletal surgery –
a narrative review
- Authors: JM Dippenaar
  Pages: 43 - 48
  Abstract: Cost-effective care amidst the rapidly rising cost of medical services necessitates the implementation of a standardised multimodal analgesia plan to aid patient care. This review aims to address the physiology and pharmacological management of postoperative pain following musculoskeletal surgery.
  PubDate: 2023-04-08
  Issue No: Vol. 29, No. 1 (2023)