Can information technology improve my ambulatory practice?

eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the delivery of quality patient care to the patient. Improved multilevel communication and information exchange should not be to the detriment of patient confidentiality. There are various opportunities throughout the perioperative ambulatory care process for the individual anaesthesiologist to participate in eHealth. The most important contributions may manifest with improved preoperative communication, intraoperative  recordkeeping and postoperative tracking of outcomes data. However, it is crucial that development in the health IT field is coordinated to ensure interoperability.Keywords: eHealth, mHealth, health information technology, ambulatory anaesthesi

An evaluation of personality traits associated with job satisfaction among South African anaesthetists using the Big Five Inventory

Background: Job satisfaction is a vital contributor to occupational well-being and may be instrumental in mitigating stress and the adverse effects thereof. This is particularly pertinent in anaesthesiology, which is an inherently stressful field. There are myriad factors, including personality traits, shown to influence job satisfaction. Personality testing is conducted in many industries prior to recruitment; however, this is not the case in medicine. Currently the prevailing tool for the aforementioned purpose is the Big Five Inventory based on the well-described Five Factor Model of personality.Methods: A cross-sectional survey was utilised with electronic questionnaires distributed to all 1 509 members of the South African Society of Anaesthesiologists in 2016. Specialists, registrars, diploma-qualified and full-time general practitioner anaesthetists working in both the private and public sectors were included.Results: A response rate of 31% was achieved. Statistical analysis demonstrated that Neuroticism was the strongest and most consistent negative correlate of job satisfaction, while Agreeableness was positively associated with job satisfaction. Encouragingly, a mean of 65.6% was recorded for job satisfaction using a visual analogue scale. Socio-demographic variables positively associated with job satisfaction included increasing age, male gender, private practice and specialist/diploma qualification.Conclusions: Information gleaned from this study may prove useful in vocational counselling with the aim of improving occupational well-being, thereby reducing burnout and maladaptive behaviour among South African anaesthetists.Keywords: anaesthetists, big five inventory, five factor model, job satisfaction, personality trait

The African surgical outcomes-2 (Asos-2) pilot trial, a mixed-methods implementation study

Funding Information: The ASOS-2 Pilot Trial was supported by a grant (OPP#1161108) from the Bill & Melinda Gates Foundation.Peer reviewe

South African cardiovascular risk stratification guideline for non-cardiac surgery

The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa. The guidelines were developed by updating the Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts. The recommendations in these guidelines are: 1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5% (conditional recommendation: moderate-quality evidence). 2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence). 3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence). 4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence). Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.The Global Surgery Fellowship grant.http://www.samj.org.zadm2022Anaesthesiolog

South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

Anaesthesia for bariatric surgery

This discussion will focus on the perioperative anaesthetic considerations for patients undergoing bariatric surgery. The preoperative workup of these patients will be covered separately. However, one needs to emphasise that preoperative evaluation plays a huge role in risk stratification and will therefore be referred to again where it impacts on anaesthetic management