Khaya-warmer: blood warming in a resource-constrained setting
Blood warming in a resource-constrained setting poses a challenge for healthcare workers. Financial limitations, expensive devices and single-use consumables make fluid warmers a scarce commodity in these settings. The Western Cape Blood Service stores packed red blood cells (PRBC) and whole blood at 4–6°C. Transfusing 1 unit of PRBC at 4°C or 1 L of a crystalloid solution at room temperature, causes a decrease in core temperature of 0.25°C. This can contribute to the rapid development of hypothermia, which is defined as a core temperature below 35°C. Preventing hypothermia is important not only for patient comfort, but also for preventing morbidity and mortality. Important issues in the perioperative setting include impaired wound healing, coagulopathy with an increase in allogeneic transfusion requirements, arrhythmias and death.
Knowledge and practice of surgical antimicrobial prophylaxis at a tertiary academic hospital in a low-middle income country
Despite modern advances in disinfection techniques, equipment and environmental control measures, surgical site infections (SSI) remain one of the most preventable yet frequent hospitalacquired infections (HAI). HAI have significant implications for both the patients and the health sector. SSI are associated with a two- to elevenfold increase in mortality, prolonged hospital stay, repeated procedures, prolonged recovery period, increased intensive care admissions and loss of earnings during period of illness. It is estimated that HAI can double hospital costs, owing to longer hospital stays, more diagnostic testing and increased treatment costs.
The South African procedural times glossary
In South Africa, surgical and procedural services are provided by the parallel state and private healthcare systems. Challenges faced in the perioperative environment may differ greatly between these two systems, and even within each system. However, many of the obstacles are shared including suboptimal operating room utilisation, long turnaround times, maintenance of clinical quality and staffing challenges. The escalating complexity and cost of modern healthcare is increasing the financial pressure on funding mechanisms, both in the state and the private systems. It is also dictated that surgical services are provided in a safe, efficient and cost-effective manner. The ability to compare and contrast these systems requires metrics and benchmarks.
Anaesthetic management for orthotopic liver transplantation in a patient with glycogen storage disease type IIIa
Glycogen storage disease (GSD) type III, also known as Cory- Forbes, is an autosomal recessive metabolic disorder caused by a deficiency in amylo-1,6-glucosidase enzyme, which is responsible for the breakdown of the glycogen molecule. GSD III is divided into four types: IIIa, IIIb, IIIc and IIId. GSD types IIIa and IIIc mainly affect the liver and muscles, while GSD types IIIb and IIId typically affect only the liver. Mutations in the amylo-alpha- 1,6-glucosidase, 4-alpha-glucanotransferase (AGL) gene, which provides instructions for making the glycogen debranching enzyme, cause GSD type IIIa. As a result, this abnormal glycogen accumulates in hepatocytes, myocytes and cardiomyocytes. Hepatomegaly, low blood glucose with ketosis on fasting, and elevated serum concentrations of transaminases and creatine kinase (CK) are some evidence of the disease. From the anaesthetist’s point of view, hypoglycaemia, muscle weakness, liver dysfunction, delayed anaesthetic recovery, excessive surgical bleeding, cardiomyopathy, reduced response to epinephrine and end-organ dysfunction are some of the complications that may occur during the perioperative period. In this case report, we present a child with GSD type IIIa who underwent orthotopic liver transplantation (OLT) with her mother as donor.
Southern African Journal of Anaesthesia and Analgesia - September/October 2023 Vol 29 No 5