Anaesthesia for lung volume reduction surgery

No Abstract Available. Southern African Journal of Anaesthesia & Analgesia Vol. 11 (3) 2005: 103-10

An observational audit of pain scores post-orthopaedic surgery at a level two state hospital in Cape Town

Objectives: The aim was to determine whether postoperative pain is satisfactorily controlled in patients undergoing orthopaedic surgery at a level two state hospital in Cape Town.Design: Two observational audits were performed 12 months apart as part of a full audit cycle.Setting and subjects: In view of perceived poor postoperative pain control, an audit was performed of acute postoperative pain scores, anaesthesia techniques, and patient satisfaction with pain control. Orthopaedic patients undergoing surgical procedures at a level two state hospital in Cape Town were enrolled in the two audits. Patient groups included both patientsadmitted to the hospital and day-cases.Outcome measures: Patients admitted to hospital following major surgery, rated their perceived pain over 48 hours, using a visual analogue scale (VAS). Day-case patients scored their pain in hospital, and were then contacted telephonically after 24 hours, and if required, after 48 hours. A VAS score . 4 was regarded as unacceptable. The interventions employed after the first audit were: pain rounds, staff education and training,  increased postoperative epidural time, patient-controlled analgesia pumps and indwelling femoral catheters following total knee replacement.Results: Data were analysed from 71 patients in each audit. Mean VAS scores were unacceptable 12 and 24 hours after major surgery (range 4 - 5.1 in audit 1). Following the introduction of the aforementioned  interventions, the mean pain scores were < 4 at every time point  measurement, and significantly lower than in audit 1 at most assessment times (p < 0.05). Patient satisfaction with pain control improved from 32.4% in audit 1 to 54.9% in audit 2.Conclusion: Acute postoperative pain is an important clinical problem in orthopaedic surgery. Following the demonstration of unacceptable  postoperative pain scores in the first audit, specific interventions were shown to significantly improve pain control in the follow-up audit

A modern look at hypertension and anaesthesia

Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressure control must be allowed, and there is no place for sudden “cosmetic” correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management.Keywords: hypertension, anaesthesia, ris

A modern look at hypertension and anaesthesia

Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a  hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish  antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressurecontrol must be allowed, and there is no place for sudden “cosmetic” correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management

The use of ultrasound-guided transversus abdominis plane blocks for total abdominal hysterectomy: A double-blind, controlled trial

Objectives: This study investigated the postoperative analgesic efficacy of bilateral ultrasound-guided transversus abdominis plane (TAP) blocks, in patients undergoing total abdominal hysterectomy.Design, setting and subjects: This was a prospective, randomised, double-blind, controlled study. Thirty patients were allocated to two groups; a TAP block group (n = 15) and a placebo group (n = 15). The TAP blocks were performed with 0.25% bupivacaine. The placebo group received sham blocks with normal saline, post induction of anaesthesia. Postoperatively,patients received patient-controlled intravenous morphine for analgesia.Outcome measures: The primary outcome was morphine consumption during the first 24 hours postoperatively. Secondary outcomes were  adequacy of pain relief, as assessed by pain scores at 0, 6 and 24 hours postoperatively, and side-effects.Results: Our study showed a significant between-group difference in morphine requirements (5.2 ± 3.9 vs. 9.7 ± 4.3 mg, p = 0.007, and 12.9 ± 8.9 mg vs. 25 ± 12.1 mg, p = 0.006) for the TAP group, compared with the placebo group at six and 24 hours, respectively. There were no significant between-group differences in pain scores. There were no complicationswith any of the blocks.Conclusion: Bilateral ultrasound-guided TAP blocks significantly reduced postoperative morphine consumption in a multimodal postoperative analgesia regimen for abdominal hysterectomy

Guest Editorial: The Obstetric Anaesthesia Special Interest Society: renewed commitment to improving obstetric anaesthesia in South Africa

No Abstrac

Prevention and treatment of cardiovascular instability during spinal anaesthesia for caesarean section

Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability. S Afr Med J 2004; 94: 367-372

Symmetry-preserving matchings

In the literature, the matchings between spacetimes have been most of the times implicitly assumed to preserve some of the symmetries of the problem involved. But no definition for this kind of matching was given until recently. Loosely speaking, the matching hypersurface is restricted to be tangent to the orbits of a desired local group of symmetries admitted at both sides of the matching and thus admitted by the whole matched spacetime. This general definition is shown to lead to conditions on the properties of the preserved groups. First, the algebraic type of the preserved group must be kept at both sides of the matching hypersurface. Secondly, the orthogonal transivity of two-dimensional conformal (in particular isometry) groups is shown to be preserved (in a way made precise below) on the matching hypersurface. This result has in particular direct implications on the studies of axially symmetric isolated bodies in equilibrium in General Relativity, by making up the first condition that determines the suitability of convective interiors to be matched to vacuum exteriors. The definition and most of the results presented in this paper do not depend on the dimension of the manifolds involved nor the signature of the metric, and their applicability to other situations and other higher dimensional theories is manifest.Comment: LaTeX, 19 page

Paternal obesity is associated with IGF2 hypomethylation in newborns: results from a Newborn Epigenetics Study (NEST) cohort

Data from epidemiological and animal model studies suggest that nutrition during pregnancy may affect the health status of subsequent generations. These transgenerational effects are now being explained by disruptions at the level of the epigenetic machinery. Besides in vitro environmental exposures, the possible impact on the reprogramming of methylation profiles at imprinted genes at a much earlier time point, such as during spermatogenesis or oogenesis, has not previously been considered. In this study, our aim was to determine associations between preconceptional obesity and DNA methylation profiles in the offspring, particularly at the differentially methylated regions (DMRs) of the imprinted Insulin-like Growth Factor 2 (IGF2) gene

A flexible component-based robot control architecture for hormonal modulation of behaviour and affect

This document is the Accepted Manuscritpt of a paper published in Proceedings of 18th Annual Conference, TAROS 2017, Guildford, UK, July 19–21, 2017. Under embargo. Embargo end date: 20 July 2018. The final publication is available at Springer via https://link.springer.com/chapter/10.1007%2F978-3-319-64107-2_36. © 2017 Springer, Cham.In this paper we present the foundations of an architecture that will support the wider context of our work, which is to explore the link between affect, perception and behaviour from an embodied perspective and assess their relevance to Human Robot Interaction (HRI). Our approach builds upon existing affect-based architectures by combining artificial hormones with discrete abstract components that are designed with the explicit consideration of influencing, and being receptive to, the wider affective state of the robot