If it isn’t written down, then it didn’t happen: documentation in obstetric anaesthesia
Accurate documentation in clinical medicine is vital for delivering safe patient care and essential for medicolegal protection. Several international medical governing bodies place accurate record keeping as one of the fundamental requirements for good clinical care. This edition of SAJAA features an article directly relevant to clinical documentation, specifically within obstetric anaesthesia. The study by Du Toit et al. is timely within the context of the medicolegal climate in South Africa.
Technology or tradition? Transversus abdominis plane block versus wound infiltration for postoperative analgesia after lower abdominal surgeries
The transverse incision for lower abdominal surgeries transgresses a limited number of dermatomes providing a good chance for nerve blocks. The nerves supplying the anterior abdominal wall do not travel in a closed compartment or form a plexus, thus, entailing injection of large volumes of local anaesthetic (LA) in the fascial plane. Complications analogous with this fascial block such as bowel haematoma, organ laceration, etc., have led to the infrequent use of such techniques
Documentation of spinal anaesthesia technique and block level at caesarean section at a secondary-level obstetrics hospital in South Africa
The ease of administration and relative safety of spinal anaesthesia (SA) have made it the preferred technique for both elective and most emergency caesarean sections (CS). Complications include incomplete sensory block, resulting in intraoperative breakthrough pain, which is commonly associated with successful medicolegal claims. It has been stated by Russell that “if a block fails in mid-surgery, even with cold or pinprick level at or above T4, and there is no assessment indicating an adequate level of block to touch preoperatively, then difficulties for the anaesthetist lie ahead should litigation ensue”.
Haemodynamic monitoring in patients undergoing high-risk surgery: a survey of current practice among anaesthesiologists at the University of the Witwatersrand
Patients with complex comorbidities undergoing major surgery are at high-risk of perioperative complications and mortality. In high-income countries (HICs), high-risk surgery patients account for less than 15% of inpatient procedures, but these patients have a greater than 70% postoperative mortality rate. Perioperative mortality rate is one of the indicators of strength of a country’s surgical system.
Comparison of a ketamine-propofol combination and etomidate for anaesthesia induction on haemodynamic parameters in patients undergoing coronary artery bypass grafting
The most critical period in cardiac patients undergoing coronary artery bypass graft (CABG) surgery is the anaesthesia induction. Various factors that affect anaesthetic induction in cardiovascular surgery include haemodynamic stability, balance between myocardial oxygen demand and supply, and minimising the intubation stress response. A multitude of induction agents are used either alone or in different combinations, including thiopentone, etomidate, propofol, midazolam and ketamine. Etomidate is a cardio stable drug and is preferred as an induction agent for anaesthesia in patients undergoing CABG surgeries.
Cancer pain management in a hospital setting
The overall incidence of significant pain in cancer patients has been assessed at 40%. The World Health Organization (WHO) has published guidelines for the management of cancer pain and emphasised the need for providing treatment based upon the following aspects:
1. By mouth
2. By the clock
3. For the individual
The “knowing-doing gap” – preoperative assessments via telemedicine during COVID-19
The phrase “knowing-doing gap” was first coined by Pfeffer and Sutton in 2000. They postulated that while big businesses often knew correct management principles, implementation of appropriate change was not always possible. This phrase has also been used by ecologists, highlighting humanity’s failure to control environmental catastrophes regarding global warming.
Practice Guideline 2022
The South African Society of Anaesthesiologists’ (SASA) mission is “leading the science and practice of safe anaesthesia at the highest standard and ensuring the sustainability of anaesthesiology services. SASA is dedicated to further the discipline of anaesthesia at both academic and clinical levels”. While SASA members adhere to a code of conduct for anaesthesia professionals (Appendix A[i]), these guidelines provide practical guidance for the safe practice of anaesthesia within our diverse clinical settings.
Southern African Journal of Anaesthesia and Analgesia - July/August 2022 Vol 28 No 4