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Southern African Journal of Anaesthesia and Analgesia最新文献

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Comparison of point-of-care device DiaSpect against the HemoCue and laboratory analyser in an ICU population ICU人群中即时护理设备DiaSpect与HemoCue和实验室分析仪的比较
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-04-01 DOI: 10.36303/sajaa.2021.27.2.2379
B. Salmond, Z. Farina, R. von Rahden, R. Rodseth
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引用次数: 0
Smartphone and app usage amongst South African anaesthetic service providers 南非麻醉服务提供商的智能手机和应用程序使用情况
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-04-01 DOI: 10.36303/sajaa.2021.27.2.2461
D. Shead, S. Chetty
Background: Mobile medical applications have evolved rapidly in the 21st century, making it easier for anaesthetic service providers to utilise these for work-related queries. However, there is no South African data available to determine if this technology is being utilised. The usage patterns of mobile medical health applications and the accessibility of this technology to a resource-limited environment, along with a focus on what apps South African anaesthetic service providers are using was assessed and quantified. Secondly, the favourability of a South African-based app and any possible barriers to entry were examined. Methods: A prospective, contextual, descriptive study was conducted amongst anaesthetic service providers attending the 2018 South African Society of Anaesthesiologists National Congress in Cape Town. Two hundred and thirty-two (116 specialists and 116 registrars) surveys were completed voluntarily between 4 to 8 April 2018, and analysed. Results: 100% of participants utilise smartphones for work-related queries. 169/232 (72%) participants favoured a South African-based app. Drug referencing and calculator functionality were the most frequently used mobile applications. Specialists were more likely to admit to nonprofessional use of smartphones in theatre. High data costs contribute to decreased usage amongst respondents. Conclusions: A South African-based pharmacology app would be welcomed and utilised by the South African anaesthetic community. Smartphone and app usage patterns, as well as limitations to this technology usage in South Africa appear to reflect those seen worldwide. Poor internet connectivity and high data costs were limiting factors to technology utilisation.
背景:移动医疗应用在21世纪发展迅速,使麻醉服务提供商更容易利用这些应用进行与工作相关的查询。然而,南非没有可用的数据来确定是否正在使用这项技术。对移动医疗健康应用程序的使用模式和这项技术在资源有限的环境中的可访问性,以及对南非麻醉服务提供商正在使用的应用程序的关注进行了评估和量化。其次,研究了南非应用程序的受欢迎程度以及任何可能的进入障碍。方法:在开普敦参加2018年南非麻醉师协会全国代表大会的麻醉服务提供者中进行了一项前瞻性、情境性、描述性研究。在2018年4月4日至8日期间,自愿完成了232项调查(116名专家和116名登记员),并进行了分析。结果:100%的参与者使用智能手机进行与工作相关的查询。169/232名(72%)参与者喜欢南非的应用程序。药物参考和计算器功能是最常用的移动应用程序。专家们更可能承认在剧院里非专业使用智能手机。高数据成本导致受访者使用率下降。结论:基于南非的药理学应用程序将受到南非麻醉界的欢迎和使用。智能手机和应用程序的使用模式,以及南非对这项技术使用的限制,似乎反映了世界各地的情况。糟糕的互联网连接和高昂的数据成本是限制技术利用的因素。
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引用次数: 1
Assessment of the clinical validity of an adjusted Marsh pharmacokinetic model using an effect-site rate constant (ke0) of 1.21 min-1 使用效应位点率常数(ke0) 1.21 min-1评估调整后的Marsh药代动力学模型的临床有效性
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-04-01 DOI: 10.36303/sajaa.2021.27.2.2583
J. Coetzee, A. Links, A. Levin
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引用次数: 5
Career choice of anaesthetists in a department of anaesthesiology at a tertiary institution in South Africa 南非一所高等院校麻醉师的职业选择
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-04-01 DOI: 10.36303/sajaa.2021.27.2.2492
G. Manjooran, J. Scribante, H. Perrie, C. Redelinghuys
Numerous factors that influence the choice of anaesthesiology as a career have been described. Previously, personality and intrinsic aspects of the job were marked as important influences in choosing anaesthesiology as a career.3,4 Recent literature, however, revealed a manageable lifestyle and better working conditions as more important.5,6 Other key influences noted were undergraduate and postgraduate exposure to the specialty, as well as role models within the specialty.3,6 Additional factors identified were related to the intrinsic nature of anaesthesiology: “hands-on”, practical, immediate gratification with the work (immediate results), and the applicability of physiology and pharmacology.4,6-8 Differences between gender have been identified, with females increasingly opting for specialties allowing for part-time work.3,9 Studies on choosing anaesthesiology as a career have been conducted in developing countries,10-13 including African countries such as Rwanda14 and Ghana,15 that have a severe shortage of anaesthetists. The findings of these studies are similar to those in developed countries.6-8,16 Studies have found that increased exposure to anaesthesiology at an undergraduate level as well as during an internship, improved the likelihood of someone choosing anaesthesiology as a career.13,14
已经描述了影响麻醉学职业选择的许多因素。以前,个性和工作的内在方面被认为是选择麻醉学作为职业的重要影响因素。3,4然而,最近的文献显示,可管理的生活方式和更好的工作条件更为重要。5,6注意到的其他关键影响因素是本科生和研究生对该专业的接触,以及专业内的榜样。3,6确定的其他因素与麻醉学的内在性质有关:“动手”、实践、对工作的即时满足(即时结果)以及生理学和药理学的适用性。4,6-8已经确定了性别之间的差异,随着女性越来越多地选择允许兼职工作的专业。3,9在发展中国家进行了关于选择麻醉师作为职业的研究,10-13包括卢旺达14和加纳15等麻醉师严重短缺的非洲国家。这些研究的结果与发达国家的研究结果相似。6-8,16研究发现,在本科生和实习期间接触麻醉学的人数增加,提高了人们选择麻醉学作为职业的可能性。13,14
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引用次数: 0
Airway management in COVID-19: Time to start thinking outside the box? 2019冠状病毒病的气道管理:是时候开始跳出思维定势了?
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2594
R. Hofmeyr, M. Sorbello
Faced with limited time, severely constrained resources and a lack of manpower in the face of the overwhelming numbers in Xerxes’ invading Persian Army, the Greeks strategised to halt their foe using two natural barriers which restricted movement: the Straits of Atremisium, and the narrow pass at Thermopylae. King Leonidas of Sparta led 7 000 mettlesome troops to engage at the Hot Gates, preparing to face a force today believed to have exceeded 150 000 fighters. When told that the Persians were so multitudinous that each volley of their arrows would block out the sun, Herodotus writes that the plucky Spartan soldier, Dienekes, replied laconically: “In the shade, then, we will fight!” The Battle of Thermopylae is history interwoven with legend, but speaks of the power of strategic interventions applied at the right place, at the right time, by the right people, even in the face of overwhelming odds.
由于时间有限,资源严重受限,人手不足,再加上薛西斯的波斯大军势不可挡,希腊人想出了一个策略,利用两个限制行动的天然屏障来阻止敌人:阿特米西姆海峡和塞莫皮莱的狭窄隘口。斯巴达国王列奥尼达率领7000名骁勇善战的士兵在热门交战,准备迎战一支今天估计超过15万的军队。希罗多德写道,当被告知波斯人人数众多,他们的每一箭都能挡住太阳时,勇敢的斯巴达士兵迪涅克斯(Dienekes)简洁地回答说:“那么,在阴暗处,我们将战斗!”塞莫皮雷战役是交织着传奇色彩的历史,但它讲述了在正确的地点,正确的时间,由正确的人进行战略干预的力量,即使面对压倒性的优势。
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引用次数: 4
A case report of the successful use of regional anaesthesia and mixed sedative techniques in an adolescent with Duchenne muscular dystrophy 成功使用区域麻醉和混合镇静技术治疗Duchenne肌营养不良青少年的病例报告
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2453
R. Tladi, R. Swart
In this case report, we present a 12-year-old male who presented with clubbed feet for Achilles tenotomy with comorbid Duchenne muscular dystrophy and obesity. Owing to his prior surgical history and requirement for a prolonged intensive care unit stay with mechanical ventilation, we opted for a regional anaesthetic technique with mixed pharmacological and non-pharmacological sedation. The patient tolerated the nerve blocks with minimal sedation with midazolam and local anaesthesia and the surgery was performed successfully with light sedation and the help of his favourite song.
在本病例报告中,我们介绍了一名12岁的男性,他在跟腱切开术中出现了马蹄内翻,并伴有Duchenne肌营养不良和肥胖。由于他之前有手术史,需要在重症监护室长期使用机械通气,我们选择了混合药物和非药物镇静的区域麻醉技术。患者在咪达唑仑和局部麻醉的最低镇静下耐受了神经阻滞,在轻度镇静和他最喜欢的歌曲的帮助下,手术成功进行。
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引用次数: 0
The effect of cold-chain re-introduction on the molecular integrity of rocuronium bromide 冷链再引入对罗库溴铵分子完整性的影响
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2415
D. Vermeulen, M. Wooding, K. Outhoff, T. Dippenaar
Introduction: This study aimed to examine the effect of breakages and re-introduction into cold chain on the rocuronium bromide compound. Rocuronium bromide is frequently used in routine theatre lists and plays a vital role in modified rapid sequence induction and intubation for emergency patients who have contraindications to the primarily used muscle relaxant, succinylcholine. With the current practice of removing the drug from, and then reintroducing it into the cold chain, unpredictable clinical effects, including delayed onset of action and shortened duration of action have been observed. This may pose significant risks to the patient.Methods: Rocuronium bromide was subjected to different clinically applicable storage and temperature scenarios, after which the compound was analysed for integrity and quantities of the active compound, including detection of possible degradation products, by mass spectrometry, and compared to cold chain control samples.Results: There were no significant differences between any of the temperature exposure groups (18 °C or 24 °C) or between single or double exposures at these temperatures. No statistically significant difference could be demonstrated between the two control groups (cold chain preserved and room temperature controlled) with testing done at weeks one and six. However, week twelve analysis revealed a statistically significant result which translates to a 26 μg/ml difference, which clinically would have no effect. Substantial results were obtained with a secondary exposure to air; which lead to a 20% decrease in rocuronium concentration (p = 0.02).Conclusion: Practice should be adapted by keeping careful documentation as to when cold-chain was broken, and when the recommended 12 week period will lapse. Vial sharing as a standard is not recommended. If small quantities are repeatedly withdrawn from the vial during a prolonged case, the unused contents should be discarded after eight hours.
引言:本研究旨在检验断裂和重新引入冷链对罗库溴化合物的影响。罗库溴铵经常用于常规手术室名单,在对主要使用的肌肉松弛剂琥珀酰胆碱有禁忌症的急诊患者的改良快速序列诱导和插管中发挥着至关重要的作用。根据目前将药物从冷链中移除,然后将其重新引入冷链的做法,观察到了不可预测的临床效果,包括作用延迟和作用持续时间缩短。这可能会给患者带来重大风险。方法:将罗库溴化铵置于不同的临床适用储存和温度条件下,然后通过质谱法分析该化合物的完整性和活性化合物的数量,包括检测可能的降解产物,并与冷链对照样品进行比较。结果:在任何温度暴露组(18°C或24°C)之间,或在这些温度下的单次或两次暴露之间,都没有显著差异。在第一周和第六周进行的测试中,两个对照组(冷链保存组和室温控制组)之间没有统计学上的显著差异。然而,第12周的分析显示了一个具有统计学意义的结果,即26μg/ml的差异,这在临床上没有影响。二次暴露在空气中获得了实质性的结果;这导致罗库浓度下降20%(p=0.02)。结论:应通过仔细记录冷链何时断裂以及建议的12周期限何时到期来调整实践。不建议将小瓶共享作为标准。如果在长时间的情况下重复从小瓶中取出少量,则应在八小时后丢弃未使用的内容物。
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引用次数: 0
The influence of a Perspex intubation box on time to intubation: a simulation-based randomised crossover study 有机玻璃插管盒对插管时间的影响:一项基于模拟的随机交叉研究
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2452
R. Swart, Cmj Strydom, G. Joubert
Background: Standard personal protective equipment guidelines are insufficient to prevent contamination of healthcare workers with droplet spread during the COVID-19 crisis The added challenge of adequate aerosol protection has led to the development of an initial prototype intubation box The primary objective was to determine the impact of an intubation box on the mean time to completion of intubation in a simulated airway Secondary objectives included the best laryngoscopic view, the effect of intubator seniority and mode of laryngoscopy on intubation Methods: This was a randomised crossover study of the influence of an intubation box on mean time to completion of intubation of an airway management part-task trainer Senior anaesthesiology staff were assigned to two groups and recordings of their attempts at intubation were analysed by two independent observers Results: The intubation box led to a significantly longer mean time to completion of intubation of 7 6 seconds (95% CI 3 1;12 2;p = 0 001) with direct laryngoscopy and 9 2 seconds (95% CI 3 8;14 7;p = 0 001) with videolaryngoscopy It did not influence best glottic view Conclusion: We found that the use of an intubation box significantly prolonged the time to completion of intubation, but the clinical significance of the effect size is uncertain © 2021 The Author(s)
背景:在COVID-19危机期间,标准的个人防护设备指南不足以防止液滴传播对医护人员的污染。适当的气溶胶防护带来的额外挑战促使人们开发了最初的原型插管盒。主要目标是确定插管盒对模拟气道插管平均完成时间的影响。次要目标包括最佳喉镜视图。方法:这是一项随机交叉研究,研究了插管箱对气道管理部分任务培训师平均插管完成时间的影响。将高级麻醉人员分为两组,由两名独立观察员分析他们插管尝试的记录。结果:插管框导致大大延长平均完成时间插管7 6秒(95%可信区间3 1;12 2;p = 0 001)与直接喉镜检查和9 2秒(95% CI 3 8; 14 7; p = 0 001)与videolaryngoscopy最好不影响语言的观点结论:我们发现一个插管框的使用显著延长时间完成插管,但临床意义的效果是不确定©2021年作者(年代)
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引用次数: 3
Tracheal resection following prolonged intubation in a COVID-19 patient COVID-19患者长时间插管后气管切除
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2495
A. Milner
Only six months into the SARS-CoV-2 epidemic in South Africa, we present the first post-coronavirus disease (COVID-19) subglottic stenosis seen at Morningside Clinic. Ten weeks prior to the current admission, this 48-year old patient with diabetes, obesity and hypertension developed severe COVID-19 pneumonia. He was admitted to the intensive care unit (ICU) for 14 days of mechanical ventilation and intermitted prone positioning for optimal V/Q matching.
在南非发生严重急性呼吸系统综合征冠状病毒2型疫情仅六个月后,我们在晨兴诊所发现了第一例冠状病毒病后(新冠肺炎)声门下狭窄。在本次入院前10周,这名患有糖尿病、肥胖症和高血压的48岁患者患上了严重的新冠肺炎。他被送入重症监护室(ICU)接受了14天的机械通气和间歇性俯卧位,以实现最佳V/Q匹配。
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引用次数: 1
Anaesthetic nurse training in KwaZulu-Natal government hospitals: exploring strengths and deficiencies 夸祖鲁-纳塔尔省政府医院麻醉护士培训:探索优势和不足
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2021-02-24 DOI: 10.36303/SAJAA.2021.27.1.2481
A. Maharaj, L. Cronjé, S. Jithoo
Background: The anaesthetic nurse is a key assistant to the anaesthetist and integral to the provision of safe anaesthesia. Inadequate undergraduate training in South Africa necessitates anaesthetic nurses to acquire the requisite skills and knowledge in the workplace. Few studies explore the challenges faced by practising nurses to acquire such skills. This study sought to explore the experiences of working anaesthetic nurses to gain their perspectives on workplace-based learning, skills acquisition and how to improve anaesthetic nurse training.Methods: We used qualitative methodology comprising an English-medium, self-administered, anonymous questionnaire. A purposive sampling method was used, and 73 anaesthetic nurses working in five government hospitals in eThekwini, KwaZulu-Natal were recruited. Questionnaires were thematically analysed, and simple statistical analysis was used for quantitative data.Results: Most anaesthetic nurses received little or no undergraduate anaesthesia training and participants identified subsequent workplace-based training as inconsistent, and insufficient. Despite most participants’ arbitrary allocation to the position of anaesthetic nurse, the majority found their work stimulating and identified themselves as team-players, adaptable, and willing to learn. Further training and hands-on skills acquisition were keenly sought. Factors impacting positively on their learning and job satisfaction included a confident anaesthetist who was willing to teach and collaborate on learning, provide positive feedback, and include the anaesthetic nurse in case planning. Participants identified crucial areas for further development. In theatre teaching and practical group tutorials led by anaesthetists were suggested as preferred training modalities. Responses to hypothetical case scenarios demonstrated qualities in the participants that are valued in the anaesthetists’ non-technical skills framework.Conclusion: It is evident that there is insufficient formal training and inconsistent training methods of the current anaesthetic nurses in the five study hospitals. The workplace-based learning experiences of our study participants has given us a unique perspective from practising anaesthetic nurses and may be used to inform the formulation of appropriate training curricula and improve the learning partnership with anaesthetists. This should ultimately improve anaesthetic nurse job satisfaction and the theatre team experience.
背景:麻醉护士是麻醉师的重要助手,也是提供安全麻醉不可或缺的一部分。南非本科培训不足,麻醉护士必须在工作场所获得必要的技能和知识。很少有研究探讨执业护士在获得此类技能方面所面临的挑战。本研究试图探索麻醉护士的工作经验,以获得他们对基于工作场所的学习、技能获取以及如何改进麻醉护士培训的看法。方法:我们采用了定性方法,包括英语媒介,自填,匿名问卷。采用了有目的的抽样方法,招募了73名麻醉护士,他们在夸祖鲁-纳塔尔省eThekwini的五家政府医院工作。对问卷进行了主题分析,并对定量数据进行了简单的统计分析。结果:大多数麻醉护士很少或根本没有接受过本科麻醉培训,参与者认为随后的工作场所培训不一致,而且不够充分。尽管大多数参与者被随意分配到麻醉护士的职位上,但大多数人发现自己的工作很有刺激性,并认为自己是团队成员,适应性强,愿意学习。迫切需要进一步的培训和实践技能的获取。对他们的学习和工作满意度产生积极影响的因素包括一位自信的麻醉师,他愿意教授和合作学习,提供积极的反馈,并将麻醉护士纳入病例规划。与会者确定了需要进一步发展的关键领域。建议将由麻醉师领导的剧场教学和实践小组辅导作为首选培训模式。对假设病例场景的反应表明了参与者的素质,这些素质在麻醉师的非技术技能框架中受到重视。结论:五家研究医院现有麻醉护士的正规培训不足,培训方法不一致。我们的研究参与者基于工作场所的学习经历为我们提供了一个从执业麻醉护士的独特视角,并可用于制定适当的培训课程和改善与麻醉师的学习伙伴关系。这将最终提高麻醉护士的工作满意度和手术室团队的经验。
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引用次数: 1
期刊
Southern African Journal of Anaesthesia and Analgesia
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