AJOL - African Journals Online
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Implementation and initial validation of a multicentre obstetric airway management registry
Full text linkBackground: In Africa, maternal mortality after caesarean delivery is 50 times greater than in high-income countries. In South Africa, more than 50% of anaesthesia-related maternal mortality is attributed to failure to protect the airway. We implemented an obstetric airway management registry, to facilitate future improvements in management and outcomes.Methods: A prospective electronic registry was established at three obstetric sites in Cape Town, recording airway management for all general anaesthetics from 20 weeks gestation to seven days post-partum. Perioperative descriptive data are entered using a web-based smartphone-enabled platform. To quantify the reliability of capture, we compared the first 200 records in the registry to theatre logbooks. We used summary statistics to describe our obstetric anaesthesia population, and details relevant to airway management.Results: The first 200 cases were recorded from September 2018 to January 2019. According to theatre logbooks, this represented 80% of cases performed. Major indications for general anaesthesia included severe fetal distress/bradycardia (21%), failed neuraxial technique (19%), coagulopathy (19%), and abnormal placentation (12%). A third of patients had hypertensive disorders of pregnancy, and 6% had imminent/confirmed eclampsia. Forty per cent were in active labour. On airway assessment, Mallampati grade was 3 or 4 in 29% of patients, and mouth opening, thyromental distance and mandibular protrusion limited in 10%, 8% and 8% respectively. Cormack-Lehane grade IIb and III views were encountered in 6% and 2% respectively, with no grade IV views. Desaturation below 90% occurred in 12% of patients. There were two cases (1%) of failed intubation with supraglottic airway rescue, and no emergency surgical airways performed.Conclusion: An obstetric airway management registry was successfully implemented. Clinically significant hypoxaemia occurred commonly during general anaesthesia, with a high incidence of difficult intubation predictors and desaturation. The registry will guide research aimed at improving safety during general anaesthesia in obstetrics
The effect of cold-chain re-introduction on the molecular integrity of rocuronium bromide
Full text linkIntroduction: This study aimed to examine the effect of breakages and re-introduction into cold chain on the rocuronium bromide compound. Rocuronium bromide is frequently used in routine theatre lists and plays a vital role in modified rapid sequence induction and intubation for emergency patients who have contraindications to the primarily used muscle relaxant, succinylcholine. With the current practice of removing the drug from, and then reintroducing it into the cold chain, unpredictable clinical effects, including delayed onset of action and shortened duration of action have been observed. This may pose significant risks to the patient.Methods: Rocuronium bromide was subjected to different clinically applicable storage and temperature scenarios, after which the compound was analysed for integrity and quantities of the active compound, including detection of possible degradation products, by mass spectrometry, and compared to cold chain control samples.Results: There were no significant differences between any of the temperature exposure groups (18 °C or 24 °C) or between single or double exposures at these temperatures. No statistically significant difference could be demonstrated between the two control groups (cold chain preserved and room temperature controlled) with testing done at weeks one and six. However, week twelve analysis revealed a statistically significant result which translates to a 26 μg/ml difference, which clinically would have no effect. Substantial results were obtained with a secondary exposure to air; which lead to a 20% decrease in rocuronium concentration (p = 0.02).Conclusion: Practice should be adapted by keeping careful documentation as to when cold-chain was broken, and when the recommended 12 week period will lapse. Vial sharing as a standard is not recommended. If small quantities are repeatedly withdrawn from the vial during a prolonged case, the unused contents should be discarded after eight hours
Stability of BIS with Schnider or modified Marsh effect-site targeted infusions: As you like it, or much ado about nothing?
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Career choice of anaesthetists in a department of anaesthesiology at a tertiary institution in South Africa
Full text linkBackground: Choosing a career in anaesthesiology depends on factors that are inherent to the profession as well as factors related to the individual. Awareness of these factors is necessary for recruitment based on the needs of the specialty and the expectations of the individual.
Methods: A prospective, contextual, descriptive study design was conducted using convenience sampling. A self-administered questionnaire was used to describe the factors associated with choosing anaesthesiology as a career. This questionnaire was obtained from the USA and was modified for the South African context. It was used with permission from the original authors. The questionnaire was completed by anaesthetists at the University of the Witwatersrand, South Africa. The results of the questionnaire were described as categorical data and chi-squared tests were used for comparisons. A p-value < 0.05 was considered statistically significant.
Results: Anaesthesiology was chosen as a career by 38.5% of participants while working as a medical officer. The main factor that influenced this choice was dealing with one patient at a time, which was chosen by more than half of the participants. Of the 130 participants, 94.6% were satisfied with their career choice and 89.2% would choose anaesthesiology as a career again.
Conclusion: The three-to-five-year period after medical school is crucial for doctors to develop an interest in anaesthesiology. The main factor that influenced them to choose anaesthesiology as a career, was dealing with one patient at a time and most participants were satisfied with their career choice of anaesthesiology. This information can guide recruitment into anaesthesiology, especially among medical students. This study provides a foundation for further research to investigate these factors, as well as possible reasons for gender differences (which were not explored in this study)
How knowledgeable is the recovery room nurse you entrust your patient to about postoperative airway emergencies?
Full text linkIntroduction: Respiratory complications remain an important cause of morbidity and mortality in the post-anaesthetic period. This study aimed to describe the knowledge of postoperative airway emergencies of recovery room nurses attending two separate anaesthetic symposia held in Cape Town and Johannesburg.
Methods: A cross-sectional research design was followed by means of an anonymous, self-administered, previously described questionnaire using a convenience sampling method.
Results: A total of 309 nurses took part in the study, 116 (37.5%) and 193 (62.5%) in Cape Town and Johannesburg, respectively. Of the nurses, 279 (90.3%) were female, had a mean (SD) age of 44.6 (10.4) years (n = 198) and had 11.5 (9.2) years of operating room experience (n = 304). One hundred and fifty (50.8%) were registered nurses and 196 (62.5%) worked in the private sector. The overall mean score obtained by the nurses was 40.4% (SD 17.9), with a range of 0–88%. This is 30% below the pre-determined competency score of ≥ 70%, which was achieved by only 24 (7.8%) nurses. The lowest median (IQR) scores, 16.7% (0–33.3) and 16.7% (0–50) were obtained in the clinical signs and treatment sections of the questionnaire, respectively.
Conclusion: This study showed that the nurses sampled had poor knowledge of postoperative airway emergencies in the recovery room. Legal action in the healthcare environment is a reality in South Africa. The anaesthetist remains accountable for ongoing patient care in the recovery room until discharge. Therefore, it is of the utmost importance that anaesthetists know how knowledgeable the recovery room nurses whom they entrust their patients to are regarding postoperative airway emergencies
Guidelines for infection control and prevention in anaesthesia in South Africa 2021
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Anaesthesia drugs preparation and administration in Libyan tertiary hospitals: a multicentre qualitative observational study
Full text linkBackground: Accidental administration of the wrong medication in anaesthesia can cause serious harm to the patient. To help prevent this issue, anaesthetists must be aware of their responsibility to implement a safe practice of drug preparation and administration. We aimed to assess the anaesthesia drug preparation and administration across Libyan tertiary hospitals.Method: Three hospitals took part in a pilot study for over two months. Fifteen cases were observed from the start until the end of the operation. We conducted 15 semi-structured interviews immediately after completing the observation with the anaesthetists involved. All the interviews and observations data were transcribed, qualitatively analysed using line-by-line coding and then the codes were synthesised into themes.Result: We found that there was no ‘standard’ practice for drug preparation and administration with a significant variation in the timing of medication preparation, the method of medication and syringe checking, and the separation of emergency medications.Conclusion: We have demonstrated an urgent need for drug preparation and administration practice improvement across the Libyan healthcare system. Further research is required into the existing practices for drug preparation and administration to minimise patient safety risks
Patient satisfaction at the Chronic Pain Management Clinic at Groote Schuur Hospital
Full text linkBackground: Chronic pain is a costly and debilitating ailment with an estimated global prevalence of 20%. The evaluation of patients’ satisfaction with pain management is crucial both to ensure that care provided remains fit for purpose and to identify opportunities for improvement. Groote Schuur Hospital (GSH) has one of the few functional interdisciplinary pain clinics in South Africa with more than 900 patients seen per year. To date, there had been no data informing us about patient satisfaction at the clinic. The aim of our study was to survey patients who are being treated at the Chronic Pain Management Clinic to determine their level of satisfaction with the service.Methods: A descriptive cross-sectional study was conducted with a sample of 67 patients who had been attending the Chronic Pain Management Clinic for more than three months. Data were collected telephonically using the patient demographics form and the internationally validated pain treatment satisfaction scale (PTSS). The data were then analysed using descriptive statistics.Results: The mean age of the 67 participants was 56.5 years (SD 12.9; age range: 18–83). In this sample, 81% of the participants are female while 70% of the participants had not completed 12 years of schooling. Most of the participants were referrals from orthopaedics (48%), followed by referrals from day clinics (13.5%). The median pain severity score was 7.5 (IQR 7–9) a week prior to data collection. The majority of participants (70%) reported that they could ask the staff questions and were provided with adequate support and care. Results indicate that six in every ten patients are satisfied with their pain management at the GSH Chronic Pain Management Clinic. One aspect of care which was less than satisfactory related to patients receiving information about their condition and the treatment thereof. In general, participants would have appreciated more information about their illness or injury (51%), causes and treatments of the pain, as well as side effects of the pain medication (60%).Conclusion: Most participants were either somewhat satisfied or very satisfied with all aspects of care they were asked about. It is clear that patient satisfaction is not only driven by pain relief but can also be enhanced by good patient-provider relationships and shared decision-making. It is, therefore, important to continually train healthcare providers to improve their communication skills
