An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide

Anaesthesia in connective tissue disorders

The original publication is available at http://www.samj.org.zaPatients with the more common connective tissue disorders require surgical operations more frequently than has been realized. They may present the anaesthetist with many potential problems. A few minutes of careful questioning and examination pre-operatively may prevent a tragic situation. A history of drug therapy is essential pre-operative information, particularly since many of these patients will need augmentation or coverage with steroid drugs. The anaesthetist must be aware of the patient's general state of health and must search for evidence of pulmonary, cardiac or haematological abnormalities.Publishers' versio

Anaesthesia for thymectomy in myasthenia gravis

The original publication is available at http://www.samj.org.zaAANHALING: Roelofse, J.A. 1981. Narkose vir timektonie in myasthenia gravis. S Afr Med Tyd, 60(10):619-620.ENGLISH ABSTRACT: This report emphasizes the medical, surgical and anaesthetic aspects of the treatment in cases of myasthenia gravis. Since many of the drugs used in anaesthesia affect the activity of the neuromuscular conduction mechanism, the anaesthetist should be aware of the pathophysiology of the disease and of the effect which these drugs have on it.Publisher’s versio

Anaesthesia for abdominal hysterectomy in Charcot-Marie-Tooth disease : a case report

CITATION: Roelofse, J. A. & Shipton, E. A. 1985. Anaesthesia for abdominal hysterectomy in Charcot-Marie-Tooth disease : a case report. South African Medical Journal, 67:605-606.The original publication is available at http://www.samj.org.zaA 44-year-old white woman with Charcot-Marie-Tooth disease underwent an abdominal hysterectomy. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.Publisher’s versio

Blood oxygen saturation levels during conscious sedation with midazolam. A report of 16 cases

CITATION: Roelofse, J. A. et al. 1986. Blood oxygen saturation levels during conscious sedation with midazolam. A report of 16 cases. South African Medical Journal, 70:801-802.The original publication is available at http://www.samj.org.zaIn a double-blind randomized study on 16 healthy individuals, two groups of subjects (8 in each group) received either midazolam (Dormicum; Roche) 0,1 mg/kg or placebo intravenously for conscious sedation during oral surgical procedures. Oxygen saturation of the blood was measured at different stages. Ten minutes after administration of the drug, the percentage oxygen saturation was significantly lower (P<0.05) in the midazolam group than in the placebo group.Publisher’s versio

Anaesthesia and the diabetic patient

ArticleThe original publication is available at: Roelofse, J.A. & Erasmus, F.R. 1985. Anaesthesia and the diabetic patient. SAMJ, 68:872-875, http://www.samj.org.zaSince it is estimated that 1 out of every 2 diabetic patients will require surgery at some point in his lifetime, it is imperative that the anaesthetist should understand the disease process as well as the anaesthetic problems associated with it. This article emphasizes the medical, surgical and anaesthetic aspects of the treatment of patients with diabetes mellitus.Publishers' versio

Obstruction of a breathing circuit : a case report

CITATION: Roelofse, J. A. & Shipton, E. A. 1984. Obstruction of a breathing circuit : a case report. South African Medical Journal, 66:501-502.The original publication is available at http://www.samj.org.zaPreventable mishaps resulting from human error contribute to anaesthetic risk, as demonstrated in the case report presented. The incidence of anaesthetic-associated deaths has fallen steadily since 1935, and general anaesthesia is now a very safe procedure, provided the anaesthetist takes the requisite precautions.Publisher’s versio