Southern African Journal of Anaesthesia and Analgesia 2023-08-30T13:52:21+00:00 Robyn Marais Open Journal Systems <p>The Journal's primary aim is the publication of review and CME papers, aimed at both specialist professionals and general practitioners. Original research will be accepted for review; as will Case Reports and letters to the Editor. All material will be sent for peer review.&nbsp;</p> <p>Other websites related to this journal: <a title="" href="" target="_blank" rel="noopener"></a></p> Knowledge, attitudes, and practices of South African anaesthesiology registrars towards perioperative point-of-care viscoelastic testing 2023-08-30T13:32:13+00:00 M. Padayachee T. Louw <p><strong>Background</strong>: Perioperative bleeding contributes significantly to patient morbidity and mortality while the cost of blood products is&nbsp; substantial. Viscoelastic testing (VET) forms part of the armamentarium for perioperative patient blood management. To date, there is a&nbsp; lack of published literature on the knowledge, attitudes, and practices (KAP) of medical practitioners regarding VET. The objective of this&nbsp; study was to describe the KAP of South African anaesthesiology registrars concerning perioperative point-of-care (POC) VET.</p> <p><strong>Methods</strong>: A descriptive, cross-sectional study design was performed using a novel, electronic self-administered questionnaire as the data&nbsp; collection instrument. The study population consisted of South African anaesthesiology registrars who were part of the South&nbsp; African Society of Anaesthesiologists’ (SASA) electronic mailing list.</p> <p><strong>Results</strong>: A total of 71 completed questionnaires were received&nbsp; (response rate = 16.67%). Based on this, 69% of registrars were found to have adequate knowledge. Senior registrars were more likely to&nbsp; have adequate knowledge than junior registrars (p = 0.043). Of the registrars, 64.7% had a positive attitude score towards perioperative&nbsp; VET. All registrars felt they would benefit from a formal education platform on VET. The overall median self-rated confidence score for&nbsp; interpreting VET results was 6/10. Senior registrars had a higher median self-rated confidence score (6 vs 5) compared to junior registrars&nbsp; (p = 0.005). Registrars stated that a lack of VET consumables and trained technologists to administer the test was the greatest&nbsp; barrier to requesting VET for patients at their respective institutions.</p> <p><strong>Conclusion</strong>: Overall knowledge scores were encouraging, however,&nbsp; there is room for improvement, particularly at the junior registrar level. Targeted educational interventions should be implemented at&nbsp; both a local and national level. The lack of national guidelines should be addressed by a multidisciplinary team. Locally developed&nbsp; guidelines can serve as a tool for improving registrar knowledge on the subject of VET and can be used for improving uniformity in&nbsp; practices and standards across the various registrar training circuits in South Africa.&nbsp; </p> 2023-08-30T00:00:00+00:00 Copyright (c) 2023 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 K. Wakabayashi T. Leonard A. Oosthuizen <p><strong>Background</strong>: Extubation at the end of general anaesthesia (GA) should be performed in a way that ensures patient comfort and&nbsp; minimises cardiorespiratory changes to prevent harm. Several drugs have been shown to attenuate these changes during emergence.&nbsp; This study aimed to investigate if a sub-hypnotic dose of propofol can produce such favourable peri-extubation conditions.</p> <p><strong>Methods</strong>: A total of 50 American Society of Anesthesia (ASA) physical status I–II patients (aged 18–70) undergoing elective abdominal or&nbsp; 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&nbsp; of the surgery, once the minimal alveolar concentration reached 0.6, patients received either propofol 0.5 mg kg<sup>-1</sup> or an equivalent&nbsp; volume of 0.9% normal saline intravenously (IV). The primary outcome was the incidence and severity of bucking and coughing observed&nbsp; during emergence, with the assessment performed by a blinded anaesthetist. Haemodynamic parameters, airway responses, extubation&nbsp; complications, and time to extubation were evaluated during the emergence period at predetermined intervals.</p> <p><strong>Results</strong>: The&nbsp; demographic and clinical characteristics of the two groups were comparable before surgery. Results indicated the incidence and severity&nbsp; of bucking at extubation were significantly lower in the propofol group (21.4%) compared to the control group (68.2%, p &lt; 0.001).&nbsp; Similarly, patients in the propofol group had significantly fewer heart rate (HR) (p = 0.031) and systolic blood pressure (BP) (p = 0.031)&nbsp; changes at extubation.</p> <p><strong>Conclusion</strong>: The addition of propofol 0.5 mg kg-1 before extubation successfully attenuated cardiorespiratory&nbsp; responses following GA in ASA Grade I–II adult patients undergoing elective abdominal or pelvic surgery, but did not reduce the overall&nbsp; incidence of cough at extubation&nbsp; </p> 2023-08-30T00:00:00+00:00 Copyright (c) 2023 The utilisation of the post-anaesthesia high-care unit at Tygerberg Hospital: a retrospective audit 2023-08-30T13:42:30+00:00 L. Harmse N. Ahmed C. Cilliers <p><strong>Background</strong>: The post-anaesthesia high-care unit (PAHCU) at Tygerberg Hospital is a short-stay high-care unit that provides continuous&nbsp; monitored care to patients identified preoperatively as having an elevated risk for postoperative complications. This study aims to&nbsp; describe the patient population, utilisation, and functionality of this unit and to investigate the correlation between patient comorbidities,&nbsp; surgery type, and risk of exceeding a 24-hour stay.</p> <p><strong>Methods</strong>: This is a retrospective, single-centre descriptive study of 1&nbsp; 020 patients’ data admitted to the PAHCU from 1 January 2019 to 31 December 2020. All patients admitted were included. The primary&nbsp; outcome was the utilisation and functionality of the unit. Secondary outcomes were the indication for admission, modes of analgesia&nbsp; used, and length of stay.</p> <p><strong>Results</strong>: 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&nbsp; further management. Bed occupancy during weekdays was 86.8% in 2019 and 58.13% in 2020. Patients with aortic stenosis had 4.36 (95%&nbsp; CI 1.23–15.41, p = 0.022) times the odds of exceeding a 24-hour PAHCU stay. Additional significant factors included ages &lt; 40 (p = 0.01)&nbsp; and &gt; 61 (p = 0.006), admission for epidural care (p = 0.015), haemodynamic monitoring (p &lt; 0.001), and patients who were admitted from the general surgery department (p = 0.014).</p> <p><strong>Conclusion</strong>: PAHCU admissions are considered appropriate due to the low mortality rate,&nbsp; 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&nbsp; unit can be considered effective.</p> 2023-08-30T00:00:00+00:00 Copyright (c) 2023 Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa 2023-08-30T13:46:53+00:00 S. Kisten Z. Jooma T. Kallenbach P. Motshabi <p><strong>Background</strong>: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic&nbsp; required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on&nbsp; anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD).&nbsp;&nbsp;</p> <p><strong>Methods</strong>: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling&nbsp; and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress&nbsp; and organisational support was determined by calculating the median rank.</p> <p><strong>Results</strong>: The majority of the participants were between ages&nbsp; 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&nbsp; previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02–10.24], p &lt; 0.001),&nbsp; 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 &lt;&nbsp; 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at&nbsp; work, and taking the infection home to family.</p> <p><strong>Conclusion</strong>: Participants with a history of mental illness were predisposed to&nbsp; developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to&nbsp; appropriate personal protective equipment.</p> 2023-08-30T00:00:00+00:00 Copyright (c) 2023 Towards perioperative point-of-care viscoelastic testing 2023-08-30T13:29:06+00:00 P.F. Wessels <p>No Abstract</p> 2023-08-30T00:00:00+00:00 Copyright (c) 2023