Climate change – “How did it get so late so soon?”
“Suddenly” man-made climate change is impacting our world, and the understanding that everyone’s carbon footprint needs to drastically decrease, is a constant topic. In 1989, nitrous oxide (N2O) was the first anaesthetic gas implicated in the “greenhouse gas (GHG) effect and ozone depletion”. Halogenated hydrocarbon vapours (halothane, enflurane and isoflurane) were also mentioned at that time, but thought to be too shortacting to be significant. However, in 2010 a landmark article by cosmologist Sulbaek Anderson et al. published in the British Journal of Anaesthesia (BJA), equated anaesthetic vapours to Global Warming Potentials (GWP). GWPs are a measure of carbon dioxide’s (CO2) 100-year radiative forcing (climate forcing) effect in the troposphere, which contributes to its GHG warming effect (see Table I). Table I is a composite of two recent, back-to-back and very conflicting articles written by leading cosmologists and published in Anaesthesia.
Rethinking undergraduate anaesthesia: an African perspective on a missed opportunity to grow specialist anaesthesia training
Africa’s fast-growing population has a correspondingly large need for surgical care, which is largely inaccessible to many and may be unsafe when it is. Safe anaesthesia, a critical part of the surgical service, requires the active participation of a skilled workforce in sufficient numbers to influence positive clinical outcomes effectively.
Sustainability in anaesthesia: are South African anaesthesia providers doing their part?
Climate change is one of the global scientific community’s most pressing concerns. The prevailing scientific theory states that the leading cause of climate change is global warming through greenhouse gas (GHG) emissions, most of which are derived from human enterprise. Climate change appears to be intensifying, with the highest recorded average yearly global temperatures from November 2022 to October 2023. The repercussions of uncontrolled climate change are far-reaching and destructive. Curtailing GHG emissions is a priority.
Virtual reality for perioperative anxiety treatment in a resource-variable setting: an observational trial
Perioperative anxiety affects 40–60% of paediatric patients undergoing surgery, resulting in increased morbidity. Children who experience anxiety have a higher incidence of emergence delirium, greater postoperative pain, and increased analgesic medicine use. Traditional preoperative paediatric anxiety reduction techniques include parental presence, preoperative education programmes, and anxiolytic medications such as midazolam. However, none of these are optimal. Parental presence can have a detrimental effect on the child’s experience and may increase anxiety during induction. Preoperative education programmes are laborious to implement and have variable efficacy. Midazolam, which is the most reliable and effective anxiolytic, can lead to paradoxical delirium and delayed emergence.
Audiovisual distraction for preoperative anxiety in paediatric patients at a regional hospital
Preoperative anxiety is described as “an unpleasant state of uneasiness or tension, which may be associated with abnormal haemodynamics as a consequence of sympathetic, parasympathetic, and neuroendocrine stimulation.” Preoperative anxiety in children peaks at induction, but its harmful effects transcend the procedural experience. Concerns with preoperative anxiety include delayed induction, spontaneous urination, and flailing, which may require restraint that could lead to further trauma. Postoperative maladaptive behavioural changes, higher analgesic requirements, and more incidences of emergence delirium are also seen with increased preoperative anxiety. There are many subjective and objective measures for anxiety, but the modified Yale Preoperative Anxiety Scale (mYPAS) is the most widely used and has been validated in the paediatric population.
Southern African Journal of Anaesthesia and Analgesia - November/December 2024 Vol 30 No 6