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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]

Considerations for assessing optimal regional anaesthesia and analgesia in
paediatric surgical patients
- Authors: A Torborg
  Pages: 198 - 202
  Abstract: No abstract
  PubDate: 2023-03-26
  Issue No: Vol. 27, No. 5 (2023)
22q11.2 deletion syndrome: an anaesthetic perspective
- Authors: K Kemp
  Pages: 206 - 210
  Abstract: Owing to the increased sensitivity and availability of molecular testing, the last decade heralded a new understanding of 22q11.2 deletion syndrome. An awareness of the clinical significance of this syndrome is increasing across medical specialties.
  22q11.2 deletion syndrome is the most common microdeletion syndrome. It affects most organ systems but, due to poor phenotypical recognition, it is still vastly underdiagnosed. The incidence of confirmed cases is 1 in 3 000 live births, and it is estimated that the actual incidence among the general population might be much higher than recognised.
  Several syndromes previously classified according to phenotypical expression, such as DiGeorge syndrome, velocardiofacial syndrome, conotruncal anomaly face syndrome, Cayler cardiofacial syndrome, CATCH 22 and several psychiatric abnormalities due to a deletion on the long arm of chromosome 22, are now known to be part of a single syndrome.
  Pathological features of the syndrome extend beyond the better known conotruncal cardiac defects. Knowledge of the spectrum
  of the disease is paramount to delivering safe anaesthesia to this cohort of patients.
  Anaesthetists have the opportunity to improve recognition and diagnosis of 22q11.2 deletion syndrome and all its clinical manifestations which will allow for multidisciplinary intervention and improve patient outcome and quality of life.
  PubDate: 2023-03-26
  Issue No: Vol. 27, No. 5 (2023)
Development of a clinical prediction model for high hospital cost in
patients admitted for elective non-cardiac surgery to a private hospital
in South Africa
- Authors: HL Kluyts, PJ Becker
  Pages: 214 - 222
  Abstract: Introduction: Clinicians may find early identification of patients at risk for high cost of care during and after surgery useful, to prepare for focused management that results in optimal clinical outcome. The aim of the study was to develop a clinical prediction model to identify high and low hospital cost outcome after elective non-cardiac surgery using predictors identified from a preoperative self-assessment questionnaire.
  Methods: Data to develop a clinical prediction model were collected for this purpose at a private hospital in South Africa. Predictors were defined from a preoperative questionnaire. Cost of hospital admission data were received from hospital administration, which reflected the financial risk the hospital carries and which could be reasonably attributed to a patient’s individual clinical risk profile. The hospital cost excluded fees charged (by any healthcare provider), and cost of prosthesis and other consignment items that are related to the type of procedure. The cost outcome measure was described as cost per total Work Relative Value Units (Work RVUs) for the procedure, and dichotomised. Variables that were associated with the outcome during univariate analysis were subjected to a forward stepwise regression selection technique. The prediction model was evaluated for discrimination and calibration, and internally validated.
  Results: Data from 770 participants were used to develop the prediction model. The number of participants with the outcome of high cost were 142/770 (18.4%). The predictors included in the full prediction model were type of surgery, treatment for chronic pain with depression, and activity status. The area under the receiver operating curve (AUROC) for the prediction model was 0.83 (95% confidence interval [CI]: 0.79 to 0.86). The Hosmer–Lemeshow indicated goodness-of-fit (p = 0.967). The prediction model was internally validated using bootstrap resampling from the development cohort, with a resultant AUROC of 0.86 (95% CI: 0.82 to 0.89).
  Conclusion: The study describes a clinical risk prediction model developed using easily collected patient-reported variables and readily available administrative information. The prediction model should be validated and updated using a larger dataset, and used to identify patients in which cost-effective care pathways can add value.
  PubDate: 2023-03-26
  Issue No: Vol. 27, No. 5 (2023)
Comparative study between an ultrasound-guided transversus abdominis plane
block and an ultrasound-guided caudal block for postoperative analgesia in
children undergoing lower abdominal surgeries – a prospective randomised
study
- Authors: A Reddy, A Bhandary, SR Shetty, BG Harish
  Pages: 223 - 227
  Abstract: Background: Ultrasound imaging techniques have gained great popularity in anaesthesia during the last decade. We aimed t compare an ultrasound-guided transversus abdominis plane (TAP) block and an ultrasound-guided caudal block for postoperative analgesia in children undergoing lower abdominal surgeries.
  Methods: This study randomly allocated 62 children to two groups of 31 children each. One group received a caudal block with 0.25% bupivacaine 0.5 ml/kg with 1 μg/kg dexmedetomidine while the other group received a TAP block with 0.25% bupivacaine 0.5 ml/kg with 1 μg/kg dexmedetomidine. The parameters that were compared were the duration of postoperative analgesia, cumulative dose of rescue analgesic consumed, FLACC pain scores postoperatively, intraoperative and postoperative haemodynamic changes and incidence of side effects.
  Results: The duration of analgesia was comparable between the two groups, with 6.61 ± 0.76 hours for the caudal block group and 6.65 ± 0.915 hours for the TAP block group. However, the total amount of cumulative rescue analgesic consumed was significantly higher in the caudal block group (375.8 ± 120.5) compared to the TAP block group (314.5 ± 127.7). The pain scores in 0–6 hours postoperatively were higher in the TAP block group, whereas the caudal block group had higher pain scores 6–24 hours postoperatively with steady rescue analgesic consumption at 8, 12, 16 and 20 hours. Patient-parent satisfaction was better in the TAP block group (7.39 ± 0.76) compared to the caudal block group (6.48 ± 0.811).
  Conclusion: The TAP block provided superior analgesia compared to the caudal block, as demonstrated by a statistically significant decrease in the required cumulative rescue analgesic and lower pain scores 6–24 hours postoperatively.
  PubDate: 2023-03-27
  Issue No: Vol. 27, No. 5 (2023)
Minimum alveolar concentration of sevoflurane required to prevent Bell’s
phenomenon during examination of the eye under anaesthesia
- Authors: G Lama, J de Beer, C van Rooyen
  Pages: 228 - 234
  Abstract: Background: Ophthalmological examination under anaesthesia (EUA eyes) in children is usually performed under sevoflurane anaesthesia. Adequate anaesthesia is required to immobilise the eye in a central position. Ocular stimuli at an insufficient depth of anaesthesia can result in Bell’s phenomenon, with eyes turning cephalic, delaying the procedure. The aim of this study was to determine the minimum alveolar concentration (MAC) of sevoflurane which inhibits Bell’s phenomenon (MACBell) in young children and the main stimuli eliciting this response.
  Methods: A sequential experimental study was conducted using the up-and-down procedure or method. Children between the ages of 1 month and 10 years, scheduled for EUA eyes were included. Each patient received sevoflurane (in 40% oxygen/air) at a preselected end-tidal sevoflurane concentration that differed by 0.1%, depending on the response evoked in the preceding patient. The stimulus that elicited this response was recorded.
  Results: Forty-three children were included in this study. The median age was 37.0 months (range 2–120 months). MACBell, determined by the average MAC at the midpoint of the 14 crossover pairs, was 1.74 (SD 0.19) and 1.81% by probit regression analysis (95% confidence interval 1.63–2.14). The main stimuli responsible for eliciting the reflex were forced traction on eye muscles (68% of responses) and lid speculum insertion (28%).
  Conclusion: MACBell was 1.74 MACs of sevoflurane. A high concentration of sevoflurane is required for EUA eyes to prevent ocular movement. The most powerful stimulus during EUA eyes in children was traction on the eye muscles, followed by the insertion of the lid speculum. Administering other anaesthetic agents prior to the stimuli causing Bell’s phenomenon should be considered to reduce sevoflurane requirements.
  PubDate: 2023-03-27
  Issue No: Vol. 27, No. 5 (2023)
Anaesthesia drugs preparation and administration in Libyan tertiary
hospitals: a multicentre qualitative observational study
- Authors: DS Almghairbi, KH Al Gormi, TC Marufu
  Pages: 235 - 240
  Abstract: Background: Accidental administration of the wrong medication in anaesthesia can cause serious harm to the patient. To help prevent this issue, anaesthetists must be aware of their responsibility to implement a safe practice of drug preparation and administration. We aimed to assess the anaesthesia drug preparation and administration across Libyan tertiary hospitals.
  Method: Three hospitals took part in a pilot study for over two months. Fifteen cases were observed from the start until the end of the operation. We conducted 15 semi-structured interviews immediately after completing the observation with the anaesthetists involved. All the interviews and observations data were transcribed, qualitatively analysed using line-by-line coding and then the codes were synthesised into themes.
  Result: We found that there was no ‘standard’ practice for drug preparation and administration with a significant variation in the timing of medication preparation, the method of medication and syringe checking, and the separation of emergency medications.
  Conclusion: We have demonstrated an urgent need for drug preparation and administration practice improvement across the Libyan healthcare system. Further research is required into the existing practices for drug preparation and administration to minimise patient safety risks.
  PubDate: 2023-03-27
  Issue No: Vol. 27, No. 5 (2023)
Patient satisfaction at the Chronic Pain Management Clinic at Groote
Schuur Hospital
- Authors: MBM Majangara, K Limakatso, R Parker
  Pages: 241 - 248
  Abstract: Background: Chronic pain is a costly and debilitating ailment with an estimated global prevalence of 20%. The evaluation of patients’ satisfaction with pain management is crucial both to ensure that care provided remains fit for purpose and to identify opportunities for improvement. Groote Schuur Hospital (GSH) has one of the few functional interdisciplinary pain clinics in South Africa with more than 900 patients seen per year. To date, there had been no data informing us about patient satisfaction at the clinic. The aim of our study was to survey patients who are being treated at the Chronic Pain Management Clinic to determine their level of satisfaction with the service.
  Methods: A descriptive cross-sectional study was conducted with a sample of 67 patients who had been attending the Chronic Pain Management Clinic for more than three months. Data were collected telephonically using the patient demographics form and the internationally validated pain treatment satisfaction scale (PTSS). The data were then analysed using descriptive statistics.
  Results: The mean age of the 67 participants was 56.5 years (SD 12.9; age range: 18–83). In this sample, 81% of the participants are female while 70% of the participants had not completed 12 years of schooling. Most of the participants were referrals from orthopaedics (48%), followed by referrals from day clinics (13.5%). The median pain severity score was 7.5 (IQR 7–9) a week prior to data collection. The majority of participants (70%) reported that they could ask the staff questions and were provided with adequate support and care. Results indicate that six in every ten patients are satisfied with their pain management at the GSH Chronic Pain Management Clinic. One aspect of care which was less than satisfactory related to patients receiving information about their condition and the treatment thereof. In general, participants would have appreciated more information about their illness or injury (51%), causes and treatments of the pain, as well as side effects of the pain medication (60%).
  Conclusion: Most participants were either somewhat satisfied or very satisfied with all aspects of care they were asked about. It is clear that patient satisfaction is not only driven by pain relief but can also be enhanced by good patient-provider relationships and shared decision-making. It is, therefore, important to continually train healthcare providers to improve their communication skills.
  PubDate: 2023-03-27
  Issue No: Vol. 27, No. 5 (2023)