Introduction

Perioperative outcomes – more than sevoflurane and scalpels

It is well understood that access to safe surgery is a major challenge in low- and middle-income countries (LMICs), where over five billion people do not have reliable access to surgical care, resulting in an estimated 17 million avoidable deaths per annum. Bickler et al. have predicted that up to 90% of children in LMICs will manifest a surgically treatable condition before the age of 15. If these conditions are not managed effectively, they result in severe morbidity or mortality. Butler et al. have echoed this sentiment, noting that up to 20% of children in Rwanda, Sierra Leone, Nepal, and Uganda needed surgery but that 62% of that cohort had an unmet surgical need. Despite paediatric surgical services in South Africa being positioned to offer a wide range of safe paediatric surgical interventions, the paucity of surgeons results in limited access to centralised centres and much of the population remains unserved.

A retrospective review of the perioperative management of patients with congenital oesophageal atresia and tracheo-oesophageal fistula at a South African third level hospital

Congenital tracheo-oesophageal fistula (TOF) is the anomalous connection between the mucosal surface of the oesophagus and that of the trachea, and is one of the most common errors of development encountered in children with an estimated incidence of 1:3 000–4 500 live births. In 1929, Vogt described an anatomical classification which was adapted by Ladd in 1944 and then by Gross in 1953. The Gross classification is referenced to most commonly in the modern literature. Types A through E are described, with the Type C being the most encountered variant in international data (Figure 1). Types B, C and D often require urgent surgery – within the first two days of life – to avoid aspiration and respiratory compromise. Factors affecting morbidity and mortality in these patients are: low birth weight, prematurity, intercurrent chest infections, and congenital abnormalities such as VACTERL association, CHARGE syndrome, Trisomy 13, 18 or 21 and Chromosome 22q11.2 deletion syndrome.

Airway ultrasound predicts endotracheal tube size more accurately than Cole’s age-based formula in paediatric patients

The choice of an appropriately sized endotracheal tube (ETT) has been a challenge in paediatric anaesthesia. Different methods have been used to determine ETT size, including the width of the little finger, use of Broselow tape, weight-based formula (WBF), age-based formula (ABF), neck x-ray and magnetic resonance imaging (MRI). Each of these methods, however, has demonstrated differing degrees of inaccuracy.

Anaesthetists’ knowledge and frequency of use of neuromuscular monitoring at the University of the Witwatersrand

Neuromuscular blocking agents (NMBA) cause muscle relaxation and are often used during general anaesthesia (GA) to improve endotracheal intubation as well as the surgical condition. The introduction of these agents in the early 1950s initially resulted in a higher mortality rate due to their inadequate reversal. In 1965, Churchill-Davidson demonstrated that a peripheral nerve stimulator (PNS) was the only method to assess the degree of neuromuscular blockade after NMBA were used.

Development of the anaesthesia workforce and organisation of the speciality in Uganda: a mixed-methods case study

In Africa, as in other parts of the world, there is anecdotal evidence that medicine was practised before the arrival of the Europeans and ‘modern medicine’ as we know it. The same is valid for surgery and anaesthesia in Uganda (Figure 1). Detailed descriptions of surgery under anaesthesia in Uganda are available through Robert W. Felkin’s elaborate accounts of caesarean sections done in the Bunyoro-Kitara Kingdom. In Felkin’s publication, ‘Notes on labour in central Africa’, he describes in detail a successful caesarean section performed entirely by African ‘traditional surgeons’ under intoxication with alcohol from banana wine. Antisepsis, heat rods for haemostasis and wound closure were also used. Felkin witnessed this event in 1879, only 32 years after W.T.G. Morton’s public demonstration of ether in the United States of America, and J.N.P. Davies supports these findings in his report on the existence of organised medical practices, including surgery and anaesthesia in a kingdom far separated from outside influence at the time.

Accreditation

Health Professions Council of South Africa

MDB015/134/01/2022

3 Clinical 

Certification

Attempts allowed: 2

70% pass rate





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Southern African Journal of Anaesthesia and Analgesia - May/June 2022 Vol 28 No 3

3.0 CPD Points


Level 2