Knowledge, attitudes, and practices of South African anaesthesiology registrars towards perioperative point-of-care viscoelastic testing
Anaesthetists regularly encounter coagulopathic patients in a perioperative setting and are expected to make decisions on whether to administer a blood product or not to the patient. point-of-care (POC) viscoelastic testing (VET) has become an increasingly important modality in a perioperative setting for the management of clinically coagulopathic patients by elucidating the nature of coagulopathy and directing the administration of blood products.
Evaluating the efficacy of propofol in attenuating the cardiorespiratory response to extubation: single-blinded randomised placebo-controlled trial
Tracheal extubation represents a critical point at the end of general anaesthesia (GA). The process is associated with transient physiological changes that trigger a range of cardiovascular and respiratory responses. While the physiological changes are well tolerated by most patients, they can be harmful. Adverse cardiovascular outcomes include cardiac arrhythmias, tachycardia, hypertensive as well as hypotensive periods, myocardial ischaemia, and a prolonged increase in myocardial oxygen consumption. Adverse respiratory sequelae include coughing, bucking, laryngospasm, bronchospasm, apnoea, and desaturation. Avoiding adverse cardiorespiratory responses at extubation is a key concern for anaesthetists. Furthermore, procedures involving microsurgery require a smooth emergence without coughing or straining. Antitussive strategies at extubation have become particularly relevant in the era of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) due to its aerosol generation and the associated risk to healthcare professionals.
The utilisation of the post-anaesthesia high-care unit at Tygerberg Hospital: a retrospective audit
The post-anaesthesia high-care unit (PAHCU) is a high-care unit linked to a theatre complex and is equipped to provide level 1 and 2 care, ideally for less than 24 hours. Care is provided by trained nursing staff and anaesthesiologists, with preferably a nurse-to-patient ratio. This care can include continuous cardiac and haemodynamic monitoring, non-invasive ventilation, inotropic or vasopressor support as needed, and optimising postoperative analgesia with intravenous opioids, analgesic infusions and epidural catheters. Additionally, this unit aids the implementation of enhanced recovery programmes.
Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa
The coronavirus disease of 2019 (COVID-19) has brought about many challenges internationally with far-reaching economic and health consequences. There is a high probability of mental and behavioural disorders as a result of pandemics. Data recorded from earlier pandemics dating back to the era of the Spanish flu, and more recently the severe acute respiratory syndrome (SARS) pandemic, provides invaluable insight into potential psychological consequences and the impact on healthcare workers (HCWs). The psychological impact reported by staff during a recent epidemic included exhaustion, sleeping difficulties, change in appetite, and irritability during the outbreak.
Infection control and prevention in anaesthesia – safe injection and medicine administration practices
In South Africa, approximately one in seven patients entering hospitals is at high risk of significant morbidity and mortality due to a hospital-acquired infection (HAI). Importantly, appropriate anaesthesia practices can decrease the incidence of HAIs. To improve safe practice and lower the risk of anaesthesia-associated HAI, the South African Society of Anaesthesiologists (SASA) have, in 2021, published guidelines for infection control and prevention in anaesthesia.
Management of hypotension with vasopressors during caesarean section under spinal anaesthesi
The National Institute for Health and Care Excellence (NICE), in 2021, issued an international consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Clinically significant hypotension, defined as systolic blood pressure of 90–100 mmHg or a relative 20% fall from baseline, is common in the setting of spinal anaesthesia for caesarean section, with an incidence as high as 70–80% in the absence of pharmacological prophylaxis. The NICE guidelines recommend that an intravenous infusion of phenylephrine be started immediately after spinal injection. For prophylaxis, the rate of phenylephrine infusion should be adjusted to keep maternal blood pressure at ≥ 90% of baseline value and to avoid decreases to < 80% of baseline. In circumstances where the heart rate is low and blood pressure is < 90% of baseline value, guidelines recommend giving intravenous ephedrine boluses to manage the hypotension.
Cholstyq – simpler, safer reversal of neuromuscular block
Post-operative residual neuromuscular block (PRNB) following the administration of neuromuscular blocking agents (NMBAs) remains a common problem with general anaesthesia. Associated with an increased risk of post-operative pneumonia, coma and mortality, PRNB is a preventable complication; incidence can be reduced by 20%–40% through the routine use of broad-spectrum anticholinesterase reversal agents, most commonly neostigmine, in all patients who receive intraoperative non-depolarising neuromuscular muscle relaxants. Anticholinergic medicines such as glycopyrronium bromide or atropine are co-administered to compensate for the cholinergic action of neostigmine.