Laryngospasm in anaesthesia

Laryngospasm is a common and serious respiratory complication in anaesthetic practice which can be fatal if not diagnosed and treated timeously. This review will look at the definition, epidemiology, mechanism, risk factors, clinical presentation, differential diagnosis, prevention, treatment and complications of laryngospasm.http://www.sajaa.co.za/index.php/sajaaam2018Anaesthesiolog

Anaesthesia for thoracoscopy in paediatric patients

Modern equipment and surgical techniques have enabled endoscopic procedures in smaller patients, making thoracoscopy a possibility for a variety of diagnostic and therapeutic procedures, even in very young patients.1,2 (Table I) To understand the perioperative anaesthetic requirements of paediatric patients for video-assisted thoracoscopic surgery (VATS), a review of the physiology of one-lung ventilation in the lateral decubitus position and techniques of lung isolation are imperative. A review of the general considerations of paediatric anaesthetic practice fall outside the scope of this review, but should be kept in mind during VATS procedures in children.http://www.sajaa.co.za/index.php/sajaaam2018Anaesthesiolog

Contributing factors for preoperative caregiver anxiety at Steve Biko Academic Hospital

https://drive.google.com/file/d/1Id5X8lK3VUN3s-p6LCJvXV8BLT5iiQ_P/view?usp=sharinghttps://drive.google.com/drive/folders/1nELDECp29zO-u72nACcqrdmRjUHqidUZ?usp=sharinghttps://drive.google.com/drive/folders/1qK5XOOdJhIu3ZjY0FakMISTYALx2W-_L?usp=sharin

Anaesthetic nurse training in South Africa and the role of the anaesthetist

One night during a polytrauma theatre case, I asked the anaesthetic nurse to run a blood gas analysis in a nearby intensive care unit. He returned with saline, glucose and insulin, announcing from the door that “we need to crank up the respiratory rate a bit and shift the potassium”. To me, that was the embodiment of the anaesthetic nurse. He referred to “we” because he saw himself as part of the team. In that one moment, he displayed not only his knowledge of physiology and pharmacology but every category of non-technical skill defined in the anaesthetists’ non-technical skills (ANTS) framework – teamwork, situational awareness, task management and decision-making.1 Of course it was not his first day on the job. He drew on years of experience, training and inquisitive self-learning.http://www.sajaa.co.za/index.php/sajaaAnaesthesiolog

Determining the effect of sleep deprivation on reaction time and mood in anaesthetists

https://drive.google.com/file/d/1o0H_u-FC9P44KSkni10k3DY1OUC-3LNA/view?usp=sharinghttps://drive.google.com/drive/folders/1xeWEZVXiBbelZ7cfeOp5g_kxcTFtqQTl?usp=sharinghttps://drive.google.com/drive/folders/1wD8VU2WAfFe853NhlEgFSqwPM34VnGZ1?usp=sharin

Prevalence and predisposing factors of post-traumatic stress symptoms in anaesthetists during the COVID-19 outbreak in South Africa: a cross-sectional survey

https://drive.google.com/file/d/1CtkzLkZA_AecE7a6MRf64Oz79UZ3uyOc/view?usp=sharinghttps://drive.google.com/drive/folders/1lrBzuKwkDv0YDd1J-XDC4ZgQYy4cqkRI?usp=sharinghttps://drive.google.com/drive/folders/1YPEEicEz2MaCFeq_81Z6d-lbZ2zWewlg?usp=sharin

Incidence and risk factors of exposure keratopathy in critically ill patients in an academic hospital complex - a cohort study

https://drive.google.com/file/d/11XauRd8_w4e_c8jgLxEPF4urCvPHclHW/view?usp=sharinghttps://drive.google.com/drive/folders/15cWFPxccGylThfsRch-tJaKg7fI7IFb1?usp=sharinghttps://drive.google.com/drive/folders/1NTHIc69Pd2HCKI1p1Lr2-1qLZ4GewJq7?usp=sharin

A cross-sectional observational study of endotracheal intubation and extubation practices among doctors treating adult COVID-19 and suspected COVID-19 patients in South Africa

BACKGROUND. Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. OBJECTIVES. To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). METHOD. A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. RESULTS. Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%; n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5; p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). CONCLUSIONS. The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.http://www.samj.org.zadm2022Anaesthesiolog

A four-domain approach of frailty explored in the Doetinchem Cohort Study.

Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty

Adapted full-face snorkel masks as an alternative for COVID-19 personal protection during aerosol generating procedures in South Africa

INTRODUCTION : SARS-CoV-2 has resulted in increased worldwide demand for personal protective equipment (PPE). With pressure from ongoing epidemic and endemic episodes, we assessed an adapted snorkel mask that provides full-face protection for healthcare workers (HCWs), particularly during aerosol-generating procedures. These masks have a custom-made adaptor which allows the fitment of standard medical respiratory filters. The aim of this study was to evaluate the fit, seal and clinical usability of these masks. METHODS : This multicentre, non-blinded in-situ simulation study recruited fifty-two HCWs to don and doff the adapted snorkel mask. Negative pressure seal checks and a qualitative fit test were performed. The HCWs completed intubation and extubation of a manikin in a university skills training laboratory, followed by a webbased questionnaire on the clinical usability of the masks. RESULTS : Whilst fit and usability data were generally satisfactory, two of the 52 participants (3.8%) felt that the mask did not span the correct distance from the nose to the chin, and 3 of 34 participants (8.8%) who underwent qualitative testing with a Bitrex test failed. The majority of users reported no fogging, humidity or irritation. It was reportedly easy to speak while wearing the mask, although some participants perceived that they were not always understood. Twenty-one participants (40%) experienced a subjective physiological effect from wearing the mask; most commonly a sensation of shortness of breath. DISCUSSION : A fit-tested modified full-face snorkel mask may offer benefit as a substitute for N95 respirators and face shields. It is, however, important to properly select the correct mask based on size, fit testing, quality of the three-dimensional (3D) printed parts and respiratory filter to be used. Additionally, HCWs should be trained in the use of the mask, and each mask should be used by a single HCW and not shared.APPENDIX A. SUPPLEMENTARY DATA. APPENDIX B. Fig. B1: A. The SEAC Libera full face snorkel mask, and B. The Mares Sea Vu Care full face snorkel masks, used in this study. Fig. B2: Adapter for A: SEAC Libera Med+ mask and B: Mares Sea Vu Care. Fig. B3: Clear-Guard 3 Breathing Filter used in this study. APPENDIX C. Intubation and extubation checklists. APPENDIX D. Comparison of the different snorkel masks. APPENDIX E. Google form to determine clinical usability of the full-face snorkel mask.The Faculty of Health Science, University of Pretoria who provided financial assistance through the Leeds University COVID-19 funds.https://www.elsevier.com/locate/afjemam2022AnaesthesiologyInternal Medicin