Introducing a patient-controlled analgesia-based acute pain relief service into southern Africa - the first 10 months

The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) route. The efficacy, safety and resource implications were assessed. The results showed that pain control was good, with the majority of patients (66%) experiencing mild pain during the first 24 hours. The pump was used by each patient for an average of 4,32 days. The mean total dose of morphine used was 105,2 mg via the IV route and 114,6 mg via the SC route. Over the 10 months, the 25 PCA pumps worked 80 000 pump-hours; only 3 pumps malfunctioned. A total of 86 861 mg morphine was used during this period with rare morbidity and no mortality. Only 1 patient experienced sedation and respiratory depression. The benefits of an APRS with PCA to patients and medical staff alike are discussed

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The credo - reaffirming our professionalismThe quest for ethics in medicineThe public service labour relations shamblesSensitisation, pre-emptive and total analgesiaThe resurrection ofprimary percutaneous transluminal coronary angioplasty for the treatment of acute myocardial infarctionPrimary health care depends on the district health syste

Digestibilidade aparente de dietas práticas com diferentes relações energia:proteína em juvenis de pirarucu

The objective of this work was to determine the apparent digestibility of nutrients and energy of diets for pirarucu (Arapaima gigas) juveniles. Eight experimental diets containing four energy:protein ratios (11, 10.1, 9, 8 kcal digestible energy per gram of crude protein) and two non-protein energy sources (soybean oil and poultry fat) were tested in a 4x2 factorial scheme, in triplicates. Two hundred and forty pirarucu juveniles weighting 96.8±2.3 g were distributed in 24 cylindrical-conical fiberglass tanks, adapted for feces collection (modified Guelph system). Fish were fed twice a day to apparent satiation, with experimental diets containing 0.5% of chromium oxide as inert marker in order to determine the apparent digestibility coefficients. Diets containing an energy:protein ratio of 9 kcal digestible energy per gram of crude protein resulted in significantly lower apparent digestibility coefficient for dry matter, crude protein and non-nitrogenous extract. The highest apparent digestibility coefficients for crude fat was obtained with soybean oil. The dietary energy:protein ratio influences the nutrient and energy apparent digestibility coefficients to pirarucu juveniles

A comparison of labetalol, acebutolol, and lidocaine for controlling the cardiovascular responses tool endotracheal intubation for oral surgical procedures

Arterial blood pressure and pulse rate changes following tracheal intubation were studied in 80 patients undergoing oral surgical procedures who received an etomidate/suxamethonium anesthetic induction sequence. Three treatment groups and a control group were used. Intravenous labetalol (1 mg/kg), acebutolol (0.25 mg/kg), lidocaine (2 mg/kg), and saline (1 ml), injected prior to anesthesia, were compared with respect to their effects on the hemodynamic consequences of direct laryngoscopy followed by the passage of an endotracheal tube. A pre-induction dose of labetalol was found to be more effective than acebutolol and lidocaine in attenuating the pressor response to instrumentation and intubation. Labetalol should prove most useful for those patients at risk from the transient hypertension and tachycardia following instrumentation and intubation.Articl

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The measles epidemicThe recruitment of blood donors from the black population of South AfricaReporting occupational diseaseTechnological advances in regional anaesthesiaQuality in health car