Hypoxaemia during induction of general anaesthesia in pregnant women – a surrogate for overall airway difficulty?
Obstetric general anaesthesia continues to present unique challenges as a result of factors that may include: anatomical and physiological changes of pregnancy; indications for surgery based on the wellbeing of the fetus; clinical urgency; and remote locations of obstetric operating rooms. It is clear that the incidence of failed intubation is greater in obstetric than non-obstetric practice, even if the definition of this outcome is surprisingly variable. Difficult intubation is also defined variably and potentially open to even more subjectivity. Is there an objective marker that can indicate a change in a woman’s physical status resulting from a failure to speedily position a tracheal tube and commence lung ventilation? One answer, when we consider the usual sequence of general anaesthetic induction–muscle paralysis–apnoea, is that of hypoxaemia at induction measured by pulse oximetry.
Upper airway obstruction and sepsis following endotracheal intubation in paediatric cardiac surgical patients in South Africa
Endotracheal intubation and mechanical ventilation are associated with numerous potential complications, including upper airway obstruction or stridor, tracheal stricture formation, and ventilator-associated pneumonia (VAP). Subglottic stenosis, a complication following intubation, has harmful effects, particularly within the paediatric population, thus warranting all possible steps to minimise this risk. The incidence of stridor in cardiac intensive care units (ICU) varies from 3.5–30.2%. The incidence of postintubation stridor among paediatric patients in KwaZulu-Natal, South Africa, is unknown.
Predictors of difficult tracheal intubation during general anaesthesia: an analysis of an obstetric airway management registry
The airway of the pregnant patient presents unique challenges regarding pre-anaesthetic assessment, as well as safe, expeditious and definitive management. Management priorities include prevention of hypoxaemia and pulmonary aspiration during the induction of general anaesthesia (GA). Difficulties with airway management have been reported to be eight times more common in obstetric patients than in the general surgical population, with the incidence of difficult or failed tracheal intubation approximately 1 in 390 for obstetric GA. Maternal mortality remains at one death per 90 failed intubations, and results from hypoxaemia secondary to airway obstruction or oesophageal intubation, and/or pulmonary aspiration. This has resulted in a significant reduction in the use of GA for caesarean delivery, and a corresponding increased application of neuraxial techniques, thus avoiding airway management by the anaesthesia provider in a large proportion of patients.
Evaluation of serum troponin I following the use of a modified-cardioplegia chemical composition for myocardial protection: a case series
All patients who underwent open-heart surgery between 2018 and 2022 were retrospectively reviewed. A total of 27 patients who received a continuous solution of modified del Nido antegrade cardioplegia, including atrio-septal, ventriculo-septal and heart valve defects, were identified. Patient characteristics included age, gender, body surface area and preoperative comorbidities (Table I). Approximately 500–750 ml modified del Nido antegrade cardioplegia solution was administered using mild systemic hypothermia (32–34 °C) after the aorta was crossclamped (500–1 000 ml). The modified del Nido cardioplegia was the only cardioplegic solution used in this study and was administered at 4 °C. For the initial antegrade dose, the solution was administered as a blood to crystalloid ratio of 1:4 that consisted of 13 mEq Na+, 26 mEq K+, 10 ml MgSO4 20%, 6.0 ml lidocaine 2%, and 17 ml mannitol 20% (Table II). When ventricular fibrillation was achieved (usually about 1 L), cardioplegia was switched to continuous antegrade using a blood to crystalloid ratio of 4:1 to prevent haemodilution. Ventricular fibrillation is an abnormal rhythm that occurs a few seconds before asystole and leads to cardiac arrest. This sequence occurred after the administration of cardioplegia. After the heart stopped beating, open-heart surgery was performed.
Waste not, want not: the anaesthesiologist and the environment
Global climate change is a significant problem facing the modern world. The Royal Society and US National Academy of Sciences, in their recent publication, describe climate change as “one of the defining issues of our time”. Since the beginning of the 20th century, temperatures have increased on average by 1 °C throughout the world. This means that society is enduring the hottest period in the modern age. International consensus states that human activity is the leading cause of rising global temperatures. The most notable human activity leading to global warming and climate change is the release of greenhouse gas (GHG) such as carbon dioxide (CO2), methane (CH4), halocarbons and nitrous oxide (N2O).
The vagus nerve: current concepts in anaesthesia and ICU management
The vagus nerve (XN) is a major component of the autonomic nervous system (ANS) and plays an important role both in the regulation of metabolic homeostasis and in the neuroendocrine-immune axis. The sympathetic and parasympathetic components of the ANS control and regulate the function of various organs, glands and involuntary muscles throughout the body, including vocalisation, swallowing, heart rate, respiration, gastric secretion and intestinal motility. Through efferent and afferent fibres, the XN plays a role in maintaining cardiovascular homeostasis and in modulating inflammation.
Inpatient pain management of cancer patients
Pain is a major concern in up to 70% of cancer patients. Pain may be the presenting feature, as an exacerbation during medical or surgical therapy or at the end-of-life during palliative care.1 It is important to recognise that medications only form part of a multidisciplinary approach to the bio-psycho-social approach to pain management in all forms of pain, including cancer pain. Particularly in South Africa, where so many races and cultures are represented, these differences are often not considered in the management of cancer pain.
Southern African Journal of Anaesthesia and Analgesia - September/October 2022 Vol 28 No 5