Towards improved theatre efficiency: a study of procedural times for common elective surgical procedures at Tygerberg Hospital

The operating theatre should provide a safe environment for the performance of a large variety of surgical procedures. To provide this service, multiple components are required to work together smoothly and efficiently. If theatre efficiency is compromised, it may have significant negative implications for the hospital, staff, and patients.

Implementation of the prospective PURE (Point of Care Ultrasound Registry)

Ultrasound has become an essential tool in clinical medicine due to its non-invasive nature and ability to provide high-quality information at the bedside. Point-of-care ultrasound (POCUS) is particularly effective in perioperative care, offering immediate answers to clinical questions and aiding in decision-making and monitoring. Cardiovascular and lung POCUS form part of the basic and essential skills of all anaesthetists, gaining widespread acknowledgment and adoption as essential diagnostic tools in anaesthetic and intensive care settings globally, including South Africa.

Postoperative pulmonary complications in adult surgical patients in low- to middle-income countries: a systematic review and meta-analysis

Postoperative pulmonary complications (PPCs) are common following surgery and include respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis. Depending on the definitions used to describe PPCs, the incidence of PPCs ranges from 1–23%. In 2015, the European Perioperative Clinical Outcome (EPCO) definitions for PPCs were published and subsequently used by some researchers. The Standardized Endpoints for Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) group performed a systematic review as part of their initiative. By means of a Delphi consensus method, definitions were created for pulmonary complications that are more precise and easier to apply. Exclusions were made for pulmonary embolism, pleural effusions, cardiogenic pulmonary oedema, pneumothorax and bronchospasm due to a lack of common biological pathophysiological mechanisms. The use of different definitions of PPCs in clinical trials makes it difficult to compare the results of different studies.

Informed consent for peripheral nerve blocks at a tertiary level hospital in South Africa: a quality improvement project

The Health Professions Council of South Africa (HPCSA) guidelines on informed consent reference Section 6(1)(b) & (c) of the National Health Act and state that “every healthcare provider must inform the user of the range of options generally available to the user; the benefits, risks, costs and consequences associated with each option”. Informed consent should provide patients with sufficient information, in a way that they can understand, to enable them to make an informed decision regarding their management and to comprehend the implications of acting on this information. The South African Society of Anaesthesiologists (SASA) recommends that the anaesthetist should advise the patient on the most appropriate treatment based on their personal experience and patient characteristics, including risks and benefits of the proposed technique as well as alternative options. The patient should be directed to additional information where possible and thorough documentation of the consultation should be done. The doctrine of informed consent was introduced into South African law in 1994 on appeal in the Cape Provincial Division in Castell v De Greef. This case was important as it imported and accepted the doctrine of informed consent into South African medical law, ousted medical paternalism in favour of patient autonomy, treated lack of informed consent as an issue of assault and not negligence, and established the yardstick of the “reasonable patient” as the test for informed consent and not that of the “reasonable doctor”. The “reasonable patient” standard requires that the patient be told of all the material risks (risks with grave consequences regardless of their statistical frequency)8 that would influence a reasonable person in determining whether or not to consent to the treatment. Further, available guidelines advise medical practitioners to rather give too much than too little information and that an uninformed patient cannot provide informed consent.

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Southern African Journal of Anaesthesia and Analgesia - Mar/Apr 2024 Vol 30 No 2