Southern African Journal of Anaesthesia and Analgesia

Knowledge, attitudes, and practices of South African anaesthesiology registrars towards perioperative point-of-care viscoelastic testing

2023-08-30T13:32:13+00:00

Background: Perioperative bleeding contributes significantly to patient morbidity and mortality while the cost of blood products is substantial. Viscoelastic testing (VET) forms part of the armamentarium for perioperative patient blood management. To date, there is a lack of published literature on the knowledge, attitudes, and practices (KAP) of medical practitioners regarding VET. The objective of this study was to describe the KAP of South African anaesthesiology registrars concerning perioperative point-of-care (POC) VET.

Methods: A descriptive, cross-sectional study design was performed using a novel, electronic self-administered questionnaire as the data collection instrument. The study population consisted of South African anaesthesiology registrars who were part of the South African Society of Anaesthesiologists’ (SASA) electronic mailing list.

Results: A total of 71 completed questionnaires were received (response rate = 16.67%). Based on this, 69% of registrars were found to have adequate knowledge. Senior registrars were more likely to have adequate knowledge than junior registrars (p = 0.043). Of the registrars, 64.7% had a positive attitude score towards perioperative VET. All registrars felt they would benefit from a formal education platform on VET. The overall median self-rated confidence score for interpreting VET results was 6/10. Senior registrars had a higher median self-rated confidence score (6 vs 5) compared to junior registrars (p = 0.005). Registrars stated that a lack of VET consumables and trained technologists to administer the test was the greatest barrier to requesting VET for patients at their respective institutions.

Conclusion: Overall knowledge scores were encouraging, however, there is room for improvement, particularly at the junior registrar level. Targeted educational interventions should be implemented at both a local and national level. The lack of national guidelines should be addressed by a multidisciplinary team. Locally developed guidelines can serve as a tool for improving registrar knowledge on the subject of VET and can be used for improving uniformity in practices and standards across the various registrar training circuits in South Africa.

Evaluating the efficacy of propofol in attenuating the cardiorespiratory response to extubation: single-blinded randomised placebo-controlled tria

2023-08-30T13:36:55+00:00

Background: Extubation at the end of general anaesthesia (GA) should be performed in a way that ensures patient comfort and minimises cardiorespiratory changes to prevent harm. Several drugs have been shown to attenuate these changes during emergence. This study aimed to investigate if a sub-hypnotic dose of propofol can produce such favourable peri-extubation conditions.

Methods: A total of 50 American Society of Anesthesia (ASA) physical status I–II patients (aged 18–70) undergoing elective abdominal or pelvic surgery under GA with a volatile agent were randomly assigned to a propofol group (n = 28) or a control group (n = 22). At the end of the surgery, once the minimal alveolar concentration reached 0.6, patients received either propofol 0.5 mg kg^-1 or an equivalent volume of 0.9% normal saline intravenously (IV). The primary outcome was the incidence and severity of bucking and coughing observed during emergence, with the assessment performed by a blinded anaesthetist. Haemodynamic parameters, airway responses, extubation complications, and time to extubation were evaluated during the emergence period at predetermined intervals.

Results: The demographic and clinical characteristics of the two groups were comparable before surgery. Results indicated the incidence and severity of bucking at extubation were significantly lower in the propofol group (21.4%) compared to the control group (68.2%, p < 0.001). Similarly, patients in the propofol group had significantly fewer heart rate (HR) (p = 0.031) and systolic blood pressure (BP) (p = 0.031) changes at extubation.

Conclusion: The addition of propofol 0.5 mg kg-1 before extubation successfully attenuated cardiorespiratory responses following GA in ASA Grade I–II adult patients undergoing elective abdominal or pelvic surgery, but did not reduce the overall incidence of cough at extubation

The utilisation of the post-anaesthesia high-care unit at Tygerberg Hospital: a retrospective audit

2023-08-30T13:42:30+00:00

Background: The post-anaesthesia high-care unit (PAHCU) at Tygerberg Hospital is a short-stay high-care unit that provides continuous monitored care to patients identified preoperatively as having an elevated risk for postoperative complications. This study aims to describe the patient population, utilisation, and functionality of this unit and to investigate the correlation between patient comorbidities, surgery type, and risk of exceeding a 24-hour stay.

Methods: This is a retrospective, single-centre descriptive study of 1 020 patients’ data admitted to the PAHCU from 1 January 2019 to 31 December 2020. All patients admitted were included. The primary outcome was the utilisation and functionality of the unit. Secondary outcomes were the indication for admission, modes of analgesia used, and length of stay.

Results: Of the 1 020 patients, 69 (6.76%) patients exceeded the 24-hour stay. In total, 889 (87.2%) were pre- planned admissions and 130 (12.8%) unplanned, one (0.09%) patient demised, and 11 (1.07%) patients were transferred to the ICU for further management. Bed occupancy during weekdays was 86.8% in 2019 and 58.13% in 2020. Patients with aortic stenosis had 4.36 (95% CI 1.23–15.41, p = 0.022) times the odds of exceeding a 24-hour PAHCU stay. Additional significant factors included ages < 40 (p = 0.01) and > 61 (p = 0.006), admission for epidural care (p = 0.015), haemodynamic monitoring (p < 0.001), and patients who were admitted from the general surgery department (p = 0.014).

Conclusion: PAHCU admissions are considered appropriate due to the low mortality rate, ICU transfer rate, and the number of patients exceeding a 24-hour stay. With a bed occupancy of 86.80% in 2019, the management of the unit can be considered effective.

Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

2023-08-30T13:46:53+00:00

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD).

Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank.

Results: The majority of the participants were between ages 31–40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02–10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7–9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6–9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2–13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family.

Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

Towards perioperative point-of-care viscoelastic testing

2023-08-30T13:29:06+00:00

No Abstract