Southern African Journal of Anaesthesia and Analgesia

Optimal dose of phenylephrine infusion in the prevention of spinal anaesthesia-induced hypotension in elderly patients

A.B. Filani — 2024-02-01

Background: Phenylephrine is one of the drugs of choice in the prevention of spinal anaesthesia-induced hypotension in the elderly. The optimal dose is yet to be established in elderly patients, hence this study.

Methods: This was a randomised, double-blind study on patients aged ≥ 65 years undergoing elective lower limb and urological surgeries under subarachnoid block. A total of 57 patients were randomised into groups A, B, and C and each group contained 19 patients. Group A received 50 µg/min, group B received 75 µg/min, and group C received 100 µg/min of phenylephrine infusion immediately after the induction of spinal anaesthesia. Non-invasive blood pressure and pulse rate (PR) were recorded after the commencement of phenylephrine infusion. Onset of hypotension, episodes of hypotension, reactive hypertension, and bradycardia were recorded in each group and also compared across the groups.

Results: Hypotension was prevented without any side effects of phenylephrine in group A; one patient (5.3%) in group B had an episode of hypotension at the sixth minute. The difference in the incidence of hypotension across the groups was not statistically significant (p = 0.617). Four patients (21.1%) in group B and nine (47.3%) in group C had reactive hypertension. The difference in the incidence of reactive hypertension among groups was statistically significant (p = 0.002). Bradycardia occurred in one patient (5.3%) in group B and three (15.8%) in group C. There was no statistically significant difference (p = 0.152) in the incidence of bradycardia across the three groups.

Conclusion: The optimal dose of phenylephrine infusion that prevented spinal anaesthesia-induced hypotension without any side effects in elderly patients was 50 µg/min.

The profile of female anaesthesiologists in South Africa: past and present

L.M. Fombad — 2024-02-01

Background: A trend of feminisation of medicine has been observed over the years. Feminisation of medicine is important as it ensures that both male and female doctors have equal opportunity to deliver patient care. In South Africa, the female profile in anaesthesiology is not known. This study aims to describe the past and present profiles of female anaesthesiologists in South Africa from 1960–2019.

Methods: Part I of this study retrospectively determined the number of females who qualified as fellows from the College of Anaesthetists of the Colleges of Medicine of South Africa (CMSA), as well as leadership roles held by female anaesthesiologists in the CMSA and the South African Society of Anaesthesiologists (SASA) and the number of female anaesthesiologists head of departments during the study period. Part II was an online, anonymous cross-sectional survey sent to female anaesthesiologists who had full membership with SASA, determining their profile and the factors influencing career progression.

Results: Of the 593 female anaesthesiologists who qualified from the CMSA, 11.3% qualified with a Fellowship of the Faculty of Anaesthetists from 1960–1993 and 88.7% with a Fellowship of the College of Anaesthetists from 1994–2019. Between 2010 and 2019, 50.6% of registrars who qualified were female. From the inception of the CMSA, SASA and the university departments of anaesthesiology, female anaesthesiologists have held limited leadership positions. Only 34.1% of female anaesthesiologists had research publications. The majority (84.3%) of female anaesthesiologists were satisfied with their career choice. A dichotomy in the factors influencing career progression was reported. In this study, commonly described factors such as family responsibilities and motherhood, were seen as a positive rather than a negative influence on career progression.

Conclusion: This study describes the past and present profile of female anaesthesiologists in South Africa. There is a notable increase in female anaesthesiologists qualifying from 1960–2019, in keeping with the feminisation of medicine. However, career progression among female anaesthesiologists, especially in leadership, remains limited.

Quality of anaesthesia care in elective surgery at a Western Cape academic hospital in South Africa: a perioperative patient satisfaction survey

C. Mathews — 2024-02-01

Background: At a Western Cape academic hospital in South Africa, patients’ experiences after elective surgery were surveyed to primarily determine the level of patient satisfaction with anaesthesia care and secondly, to identify aspects of anaesthesia care that could be improved to ensure the best and safest care possible during the perioperative period.
Methods: A total of 200 participants were interviewed within 24 hours postoperatively after elective surgery in a variety of surgical disciplines. They completed a Perception of Quality in Anaesthesia (PQA) questionnaire with the help of an independent nonanaesthetist research assistant. Overall satisfaction was inferred by the percentage response to each variable in the questionnaire. Chi-square testing was used to find a correlation between different demographics, subgroups, and specific questions in the questionnaire. A p-value < 0.05 was considered statistically significant.
Results: The overall patient satisfaction rate with anaesthesia care was 88.13% (95% CI 82.8–91.8). More than a quarter (27%) of patients reported inadequate management of nausea and vomiting, and almost half (46.5%) reported that the anaesthetist did not address their concerns. This was a statistically significant finding in patients with a college certificate level of education, with 75.76% of this group reporting the failure of anaesthetists to address their concerns about their anaesthesia management (p = 0.003).
Conclusion: The overall satisfaction rate with anaesthesia care was high among the study participants. Potential aspects of anaesthesia care that could be improved were identified. The importance of communication, providing sufficient information about anaesthesia care, and addressing patient concerns was highlighted in this study.

When CO₂ goes wild – a tale of surgical emphysema, pneumothorax and a gas-filled adventure in laparoscopic hernia repair

F. Uys — 2024-02-01

This case report describes a 69-year-old male patient who underwent laparoscopic inguinal hernia repair using a total extraperitoneal approach. Complications during the procedure were hypercarbia, surgical emphysema, and pneumothorax. Immediate interventions were necessary to address the rising end-tidal CO₂ levels, hypercarbia, and acidosis. The incidence of these complications may be higher than previously reported, particularly in extraperitoneal laparoscopic procedures, underscoring the importance of increased awareness among anaesthesiologists. This case report emphasises the significance of monitoring CO₂inflation pressure, assessing subcutaneous CO₂ accumulation, and adjusting ventilation to enhance patient safety and promote the reporting of such complications in the future.

“Belt and braces”: prophylactic vasoconstrictors after spinal blocks in the elderly

A. Milner — 2024-02-01

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Leadership dynamics and gender transformation in anaesthesiology in South Africa

B. Mrara — 2024-02-01