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Ultrasound-guided erector spinae plane block for acute pain management in patients undergoing posterior lumbar interbody fusion under general anaesthesia
Get PDFBackground: The article dealt with evaluating the efficacy of bilateral single shot ultrasound-guided (US-guided) lumbar erector spinae plane block (ESPB) in patients scheduled for L3-L5 posterior lumbar interbody fusion (PLIF) under general anaesthesia (GA). The primary goal of the article was to determine total morphine consumption 24 hours postoperative. Secondary goals included determining total intraoperative and postoperative opioid consumption, length of post-anaesthesia care unit (PACU) stay, and complications.Methods: Sixty patients, American Society of Anesthesiologists (ASA) I and II, aged 18–60 years, undergoing PLIF under GA were enrolled in this prospective, randomised, double-blinded study. Patients were randomised to 2 groups (30 patients each). Group I (control group) received GA only and group II received preoperative bilateral ESPB with 20 ml 0.25% bupivacaine. The primary outcome was postoperative morphine consumption. Secondary measurements were intraoperative fentanyl consumption, time to first analgesic request, static and dynamic visual analogue score (VAS), haemodynamic changes, PACU stay, and complications.Results: Patients who received ESPB showed a significant decrease in intraoperative and postoperative opioid consumption, shortened PACU stay, and haemodynamic stability compared to those who received GA only. Significant increase of VAS was observed in group I compared with group II up to 8 and 12 hours postoperative (static and dynamic VAS respectively). Conclusion: Preoperative bilateral single shot US-guided ESPB provided safe and effective postoperative analgesia for PLIF with reduced opioid consumption and short PACU stay
The Nagin Parbhoo History of Anaesthesia Museum Part 2
Get PDFThis paper outlines how individual collections of books and equipment donated to the University of Cape Town Department of Anaesthesia and Perioperative Medicine developed into the national asset that the Nagin Parbhoo History of Anaesthesia Museum now represents. From the humble beginnings of collections of donated books and early equipment, the article describes how the museum evolved into its present form. The contributions made by many individuals over the last hundred years to this remarkable display of historical artefacts is described
Anaesthesia for the child with a univentricular heart: a practical approach
Get PDFCongenital heart disease (CHD) represents a major challenge for anaesthetists. This is due to the complexities in pathophysiology and the impact of surgery and anaesthesia, which predisposes to significant perioperative morbidity and mortality.1 Univentricular heart (UH) consists of a large variety of rare and complex congenital cardiac malformations. There are rare cases of children having only a single functional ventricle from birth. More commonly, children may receive surgical palliation for complex cardiac defects by creating a univentricular heart when biventricular repair is not feasible. About 30% of patients with univentricular physiology have complications when undergoing non-cardiac surgery.2 During this review, we aim to provide a practical understanding of the pathophysiology of UH and outline a systematic approach to the perioperative management of these patients presenting for non-cardiac surgery. We conclude with an evaluation of the use of near-infrared spectroscopy, transoesophageal echocardiography and ventricular assist devices, as technologies with increasing application in the management of this challenging patient population.
Supplementary video available online: http://www.sajaa.co.za/index.php/sajaa/article/view/257
22q11.2 deletion syndrome: an anaesthetic perspective
Get PDFOwing to the increased sensitivity and availability of molecular testing, the last decade heralded a new understanding of 22q11.2 deletion syndrome. An awareness of the clinical significance of this syndrome is increasing across medical specialties.22q11.2 deletion syndrome is the most common microdeletion syndrome. It affects most organ systems but, due to poor phenotypical recognition, it is still vastly underdiagnosed. The incidence of confirmed cases is 1 in 3 000 live births, and it is estimated that the actual incidence among the general population might be much higher than recognised.Several syndromes previously classified according to phenotypical expression, such as DiGeorge syndrome, velocardiofacial syndrome, conotruncal anomaly face syndrome, Cayler cardiofacial syndrome, CATCH 22 and several psychiatric abnormalities due to a deletion on the long arm of chromosome 22, are now known to be part of a single syndrome.Pathological features of the syndrome extend beyond the better known conotruncal cardiac defects. Knowledge of the spectrumof the disease is paramount to delivering safe anaesthesia to this cohort of patients.Anaesthetists have the opportunity to improve recognition and diagnosis of 22q11.2 deletion syndrome and all its clinical manifestations which will allow for multidisciplinary intervention and improve patient outcome and quality of life
Airway ultrasound predicts endotracheal tube size more accurately than Cole’s age-based formula in paediatric patients
Get PDFBackground: Age-based formulas (ABFs) are commonly used in paediatric anaesthesia to determine the correct size of an endotracheal tube (ETT). However, these formulas often predict an incorrect size. The aim of this study was to determine if the tracheal internal diameter as determined on axial ultrasound images better predicts paediatric ETT size than Cole’s ABF.Methods: This study is a prospective observational study that involved 106 paediatric patients aged 1–10 years classified as ASA I and ASA II according to the American Society of Anesthesiologists Classification of Physical Status. These paediatric patients were scheduled for elective surgery and required general anaesthesia. They were randomly allocated to one of two groups by blind balloting. There were 53 participants in each group: the ultrasound-predicted endotracheal tube size (UPE) group and the (agebased) formula-predicted endotracheal tube size (FPE) group. For both groups, the actual ETT size used for intubation was noted and compared to the predicted size.Results: The two groups (UPE and FPE) were comparable with respect to demographic and clinical variables. Airway ultrasound scans predicted the appropriate ETT size in 52 out of the 53 participants in the UPE group. This is a better prediction than the Cole’s ABF, which accurately predicted appropriate ETT size in 35 out of the 53 participants in the FPE group (p < 0.001).Conclusion: Data from this study shows that an airway ultrasound scan predicted the ETT size more accurately than Cole’s ABF in paediatric patients
Strychnos spinosa Lam: comprehensive review on its medicinal and nutritional uses.
Get PDFBackground: Most of the people living in developing countries rely on local remedies from traditional medicines to take care of their healthcare needs. In recent years, the use of medicinal plants increased considerably. Consequently, studies on medicinal plants are necessary to produce more effective drugs with fewer side-effects. This work aims to compile the dispersal data on Strychnos spinosa Lam., a medicinal plant with great therapeutic potential in traditional medicine, on its ethnobotanical uses, chemical compounds, as well as its pharmacological and nutritional effects.Material and Methods: To achieve the aforementioned aim, electronic databases such as Pubmed, Science Direct, Google scholar, Scopus and SciFinder were scanned.Results: Literature survey revealed that S. spinosa is used in the treatment of microbial infections, malaria, trypanosomiasis, intestinal worms, tuberculosis, infertility, gastrointestinal disorders, snake bite, hypertension, and diabetes mellitus among other ailments. The plant is also used as food material. S. spinosa contains many chemical compounds, such as alkaloids, terpenes, sterols, fatty acids, flavonoids, saponin, and others. The fruits are a source of important nutrients such as carbohydrates, sugars, proteins, vitamins and fibres. Experimental studies have shown numerous pharmacological properties, including antimicrobial, antiplasmodial, anti-trypanosomal, anti-leishmanial, anti-nematicidal, anti-inflammatory, anti-oxidant, antidiabetic and other activities.Conclusion: This review article provides comprehensive information on S. spinosa and its various extracts. Due to the promising effects of the plant extracts on various diseases and its nutritional values, there is a need for toxicity studies and clinical trials to assess the effects of its identified bioactive compounds