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Dissertations / Theses on the topic 'Anaesthesia'
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1
Gormley, William Paul. "Local anaesthetic adjuvants in regional anaesthesia." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318771.
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Cowley, Nicholas John. "Point of care intravenous anaesthetic measurement in anaesthesia and critical care." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5127/.
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Maintenance of anaesthesia using the intravenous agent propofol has increased following development of pharmacokinetic models. An analyser capable of determining propofol concentrations at the point of care may lead to an improved accuracy of drug delivery. Validation work on a novel analyser measuring propofol concentration in near real time demonstrate a high level of precision for samples in the clinical range. Further work in the clinical setting was carried out using the novel propofol analyser to further research its potential use in a diverse patient cohort. Studies were performed in intensive care correlating blood propofol concentrations with depth of sedation, demonstrating a correlation with organ failure. The Marsh model of Target Controlled Anaesthesia was poorer at predicting propofol concentration in patients with significant organ dysfunction than in those without organ failure (correlation coefficient 0.36 vs. 0.73 respectively). Studies in the operating room were performed in which measured propofol concentrations were compared with those predicted using the Marsh model. Results demonstrated significant inaccuracies of the model (bias 32%, precision -8.7 to 72.6%). A method of Marsh model bias correction using a single blood propofol measurement was tested. Results demonstrated insufficient predictability to allow a single point calibration.
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Alibhai, Hatim Inayatali Kamruddin. "Caprine anaesthesia : aspects of inhalational anaesthesia in the goat." Thesis, Royal Veterinary College (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367525.
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Robinson, Frances P. "Total intravenous anaesthesia." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317032.
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Gohil, Bhupendra. "Diagnostic alarms in anaesthesia." AUT University, 2007. http://hdl.handle.net/10292/956.
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Smart computer algorithms and signal processing techniques have led to rapid development in the field of patient monitoring. Accelerated growth in the field of medical science has made data analysis more demanding and thus the complexity of decision-making procedures. Anaesthetists working in the operating theatre are responsible for carrying out a multitude of tasks which requires constant vigilance and thus a need for a smart decision support system has arisen. It is anticipated that such an automated decision support tool, capable of detecting pathological events can enhance the anaesthetist’s performance by providing the diagnostic information to the anaesthetist in an interactive and ergonomic display format. The main goal of this research was to develop a clinically useful diagnostic alarm system prototype for monitoring pathological events during anaesthesia. Several intelligent techniques, fuzzy logic, artificial neural networks, a probabilistic alarms and logistic regression were explored for developing the optimum diagnostic modules in detecting these events. New real-time diagnostic algorithms were developed and implemented in the form of a prototype system called real time – smart alarms for anaesthesia monitoring (RT-SAAM). Three diagnostic modules based on, fuzzy logic (Fuzzy Module), probabilistic alarms (Probabilistic Module) and respiration induced systolic pressure variations (SPV Module) were developed using MATLABTM and LabVIEWTM. In addition, a new data collection protocol was developed for acquiring data from the existing S/5 Datex-Ohmeda anaesthesia monitor in the operating theatre without disturbing the original setup. The raw physiological patient data acquired from the S/5 monitor were filtered, pre-processed and analysed for detecting anaesthesia related events like absolute hypovolemia (AHV) and fall in cardiac output (FCO) using SAAM. The accuracy of diagnoses generated by SAAM was validated by comparing its diagnostic information with the one provided by the anaesthetist for each patient. Kappa-analysis was used for measuring the level of agreement between the anaesthetist’s and RT-SAAM’s diagnoses. In retrospective (offline) analysis, RT-SAAM that was tested with data from 18 patients gave an overall agreement level of 81% (which implies substantial agreement between SAAM and anaesthetist). RT-SAAM was further tested in real-time with 6-patients giving an agreement level of 71% (which implies fair level of agreement). More real-time tests are required to complete the real-time validation and development of RT-SAAM. This diagnostic alarm system prototype (RT-SAAM) has shown that evidence based expert diagnostic systems can accurately diagnose AHV and FCO events in anaesthetized patients and can be useful in providing decision support to the anaesthetists.
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Goldmann, L. E. "Awareness under general anaesthesia." Thesis, University of Cambridge, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373669.
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Kenwright, David A. "Nonlinear dynamics of anaesthesia." Thesis, Lancaster University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.538583.
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McCleane, Gary John. "Anaesthesia and preoperative investigations." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335318.
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Austin, Bruce. "Maxillary Nerve Block Anaesthesia." Thesis, Faculty of Dentistry, 1987. http://hdl.handle.net/2123/5103.
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Hashemi-Sakhtsari, Ahmad. "Neural mechanisms of anaesthesia /." Title page, contents and abstract only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09phh348.pdf.
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McClelland, A. M. "The use of novel local anaesthetic agents for regional anaesthesia in major orthopaedic surgery." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273058.
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Renfrew, C. W. "Studies in inhalation anaesthesia delivery." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273051.
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Dib, Kanaa Mohammad. "Efficacy of dental local anaesthesia." Thesis, University of Newcastle Upon Tyne, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.545772.
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Mantzaridis, Haralmbos. "Closed-loop control of anaesthesia." Thesis, University of Strathclyde, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338938.
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McGowan, Karen Elizabeth. "Percutaneous local anaesthesia wth amethocaine." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296790.
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McClelland, Kathryn Helen. "Studies on percutaneous local anaesthesia." Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357449.
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Ding, Qinghua. "Intelligent systems engineering in anaesthesia." Thesis, University of Sheffield, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310761.
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Dass, Deshandra. "Anaesthesia Preoperative Clinic (APOC) Audit." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22755.
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Background: Preoperative assessment clinics have been employed in many institutions to manage perioperative risks1. These clinics provide an opportunity to stratify patients on the basis of risk prior to surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence resulting, in fewer last-minute cancellations for medical reasons2 and a shorter inpatient pre-operative stay3. The Anaesthetic Pre-Operative Clinic (APOC-GSH) was introduced to Groote Schuur Hospital in 2009 with the aim of assessing and optimising high risk patients undergoing intermediate or high risk surgery. The vision of the clinic is to decrease perioperative morbidity and mortality, rationally and costconsciously investigate patients, as well as to reduce theatre cancellations of inappropriately assessed and managed patients. The clinic, together with relevant role players, attempts to risk stratify patients in making an informed decision whether the intended perioperative risks are acceptable. Patients referred to the clinic fall into two categories. Either the surgical date has been scheduled and patients are referred to APOC-GSH for optimization, or the referral is for assessment of suitability to undergo an anaesthetic and thus the treatment modality hinges on the fitness for surgery. Objective The intention of the audit is to create a database of the patients seen at APOC-GSH during 2014. Primary objectives are: 1 Referral pattern: - What proportion of patients are referred for improvement of medical condition? - What proportion of patients are referred for an assessment of operability? 2 What interventions were recommended? - What was the influence of interventions on operability and timing of surgery? - Does the clinic improve theatre efficiency by reducing cancellations of patients who required further interdisciplinary discussion and investigations? Methods: Data collection will be based on the review of APOC-GSH clerking notes and hospital patient records. The following information will be collected and entered into an Excel spread sheet: the surgical discipline referring the patient, the proposed surgery, patient co-morbidities, the lead-time from the first APOC-GSH assessment to surgery, number of visits to APOC-GSH by each patient, the investigations and additional interventions instituted at APOC-GSH. We shall also calculate the proportion of patients that would have likely been cancelled had they not attended APOC-GSH but rather been assessed by an anaesthetist the day before surgery. The record of the APOC-GSH consultation will be documented on a clerking sheet established for use within the clinic (Addendum A). The original form will be included in the patients' file and a duplicate will be stored within the access controlled Department Of Anaesthesia offices at GSH. The duplicate records will be used to obtain the information for the audit. Ethical approval will be sought from the UCT Human Research Ethics Committee for the establishment of the database and retrospective review of the APOC-GSH records on the understanding that patient records would be kept confidential and that the data obtained would be stored in a password protected spreadsheet. Access to the spreadsheet will be limited to the investigators involved and no identifiable patient details will be included. Patients will be counselled as to the nature of the study and will be expected to submit signed consent forms allowing their records to be reviewed. Patients will be informed that they will not be disadvantaged by refusal to sign the consent form and that the appropriate standard of care will still be applied. No remuneration will be provided for partaking either. Consent will be documented on the consent form specifically designed for use in the APOC-GSH. (Addendum B) Statistical analysis will be performed using an Excel® spreadsheet. Means, medians, rates and percentages will be used to describe the discrete categorical data. Output and future work The audit will provide an objective assessment of the population profile referred to APOC-GSH. It may guide future implementation of APOC-GSH protocol changes and assist with resource allocation depending on the surgical discipline requirements. Patient and surgeon satisfaction ratings may be embarked at a later stage juxtaposed against an adequate assessment in a cost and time conscious manner.
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Achola, Kohath Jenge. "Measurements of catecholamines during anaesthesia." Thesis, University of Leicester, 1988. http://hdl.handle.net/2381/33571.
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Factors affecting catecholamine levels in vitro were studied using the modified high pressure liquid chromatography method with electrochemical detection. Differential centrifugation showed that platelet-rich plasma contained significantly higher catecholamine levels than platelet-poor plasma. Serum samples had significantly higher catecholamine levels than plasma. Plasma or serum samples clotted with glass beads had significantly higher catecholamine levels than those without. Therefore, consistent results can only be obtained when catecholamine samples are spun at the same speed, either plasma or serum can be used, but not both in a single study. Post-dated blood for transfusion was used to study stability of catecholamines, and showed that catecholamines are stable. Hence, the collection of blood samples for catecholamine measurements was modified. Blood samples were collected in Vacutainer tubes containing lithium heparin without antioxidants and not pre-cooled, samples were spun at the convenient time. This was welcomed by the clinicians who did not have to interrupt clinical assessment to care for blood samples as with the former method. The three clinical studies showed no significant differences in catecholamine levels in patients undergoing laryngoscopy with and without tracheal intubation, whether or not the patients were beta blocked or had received topical tracheal analgesia. The mean catecholamine levels were within the normal range. No relationships between baseline catecholamine levels and the baseline blood pressures or heart rate nor between the changes in catecholamine levels from the baseline and the corresponding changes in blood pressures or heart rate. The Injury Severity Score in minor injured patients had no relationship with plasma catecholamine levels, and no significant rise in noradrenaline levels when the ISS<30 and adrenaline levels when the ISS<17. The studies suggest that catecholamine levels are of no value in assessing the severity of minor injuries, or changes in blood pressures or heart rate during anaesthesia.
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White, Hermien Ilse. "Anaesthesia in abalone, Haliotis midae." Thesis, Rhodes University, 1996. http://hdl.handle.net/10962/d1005059.
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The principle aim of this study was to isolate a chemical for the "safe anaesthesia" of abalone under commercial farming conditions. "Safe anaesthesia" implied that the anaesthetic had no immediate detrimental or long term sublethal effect on the abalone, that it was safe for the farmer, the consumer and the environment. Four chemicals, magnesium sulphate (MgS0₄), ethylenediamine tetra-acetic acid (EDTA), 2-phenoxyethanol and procaine hydrochloride were shown to effectively inhibit the in vitro contraction of isolated tarsal muscle of Haliotis midae. This identified them as potential anaesthetics for abalone. Since abalone, like any other aquaculture species, would be subject to frequent size-sorting during the grow-out period, size related dosage tables were developed for the four chemicals at a temperature of 18⁰C. Dosage tables were also developed for benzocaine and carbon dioxide (C0₂), Three size classes (5-15, 20-50 and 60-90 mm shell length (SL)) of abalone were considered. Only three of the six chemicals, viz. MgS0₄, 2-phenoxyethanol and CO₂, met the criteria of an effective abalone anaesthetic in that they effected rapid and mortality-free anaesthesia. The other three chemicals caused mortalities and were considered to be unsuitable for commercial scale anaesthesia. Temperature related dosage tables were then developed for MgS0₄ and CO₂, MgS0₄ concentrations and CO₂ flow rates for effective anaesthesia in abalone were found to be inversely related to temperature. The three size classes of H. midae were intermittently exposed to MgS0₄ and 2-phenoxyethanol anaesthesia for an eight month period to determine the effect of the anaesthetics on growth rate. Because of an increased resistance to the efficacy of 2-phenoxyethanol and high monthly mortalities it was concluded that this chemical was unsafe and unsuitable for commercial use. MgS0₄, on the other hand, had no effect on growth of abalone and no significant effect on the rate of mortality. MgS0₄ also had no measurable effect on H. midae muscle ultrastructure and, by implication had no effect on flesh texture. The use of MgS0₄ as an anaesthetic would, therefore, not affect marketability. Moreover, no magnesium residues were found in H. midae muscle tissue after short term or intermittent long term exposure to MgS0₄ anaesthesia. It was found that the three size classes of H. midae used in this study could be safely exposed to the recommended MgS0₄ concentrations for up to 40 minutes without any mortalities. This is more than adequate for routine farming procedures. Medium size abalone (20-50 mm SL) were also safely exposed to 14 g.100 ml⁻¹ MgS0₄ for up to 6 hours without any mortalities. The results have shown that MgS0₄ was undoubtedly the best chemical that was evaluated for anaesthesia of H. midae in this study. It fulfils the requirements set forth by the U.S.A. Food and Drug Administration (FDA) in that it is safe for the abalone, the farmer, the consumer and the environment.
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Reid, Alan. "Current Concepts in Local Anaesthesia." Thesis, The University of Sydney, 2010. http://hdl.handle.net/2123/7091.
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Cumin, David. "Simulation in anaesthesia: standards and models." Thesis, University of Auckland, 2010. http://hdl.handle.net/2292/7163.
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Harm from medical errors costs tens of billions of dollars and causes tens of thousands of deaths each year in the United States alone. This is not so surprising considering the lack of opportunity for medical students and consultants alike to practice rare events, to be systematically exposed to common scenarios, or to be objectively assessed. Similarly, there are limited opportunities to test new medical devices or procedures without putting patients at harm. Simulation has provided the airline industry, in particular, with such opportunities and is a contributing factor to the safety of air travel. Simulation in medicine has the same potential but there are few, if any, concrete standards to adhere to. My objectives were to provide a structure for such standards to be set, to develop methods for evaluating the modelled physiology of simulators, and to further the mathematical modelling needed for autonomous, realistic, and extendable simulators. To these ends, I have analysed the key components of simulation and reviewed existing simulators and the modelling which underpins their responses to interventions. A framework for standards was developed with a focus on the physiological modelling of anaesthetic simulators. Methods for evaluating the repeatability and concordance of simulators were explored using simple interventions. I created an extendable database of accurate, complete physiological and interventional time series data from anaesthetic cases. Some of these cases were used to confirm the repeatability and concordance results, and then used to develop more advanced methods for evaluating fidelity. Finally, I used a novel modelling approach to create an integrated model of the human cardio respiratory system encompassing cellular through to systemic physiological processes which produced promising results. It is my hope that the work in this thesis may pave the way for more realistic simulators and a more standardised approach to simulation so that medical errors are reduced.
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Brzezinska, Selldén Eva. "Amino acid-induced thermogenesis during anaesthesia /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3212-3/.
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Sheffy, Jacob. "Recording of diaphragm activity during anaesthesia." Thesis, Oxford Brookes University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261673.
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Moss, Gary Patrick Joseph. "Bioadhesive systems for percutaneous local anaesthesia." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.394471.
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Montgomery, F. J. "Identification and control in inhalation anaesthesia." Thesis, University of Salford, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385014.
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Nsoedo, Chidozie. "Technological responses to violations in anaesthesia." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517463.
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Steinberg, Eleonora. "Neural mechanisms of sleep and anaesthesia." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/31601.
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The daily transition we take in and out of sleep is ancient and occurs in all known mammals. Ancient also is human manipulation of this transition - across cultures there have been herbal remedies to prolong wake, shorten latency to sleep and induce a state of reversible unconsciousness known as anaesthesia. While we have discovered specific brain structures necessary for maintenance of sleep and wake and protein channels targeted by anaesthetics, much still remains unknown. This study aimed to elucidate which neuronal pathways are recruited in sleep, wake and anaesthesia by studying the EEG and behaviour of genetically manipulated mice. Study of TASK-3 potassium channel knockout mice, which are less sensitive to anaesthetics, revealed increased wakefulness, resistance to stress and normal sensitivity to wake-promoting compounds. These mice also unexpectedly revealed an inability to return to normal temperature after drug-induced hypothermia. Meanwhile, study of mice in which the wake-active locus coeruleus (LC) was selectively manipulated using adeno-associated viral vectors revealed that LC suppression increases rapid-eye-movement sleep. Conversely, selective activation of the LC via designer drug receptors maintained wake but paradoxically produced behavioural arrest. Both studies reveal that the neuronal mechanisms that control sleep and anaesthesia are complex. Manipulation of crucial channels (TASK-3) and crucial regions (LC) change sensitivity to specific anaesthetics and produce distinct changes in sleep-wake that cannot be generalized to all anaesthetics or all aspects of sleep architecture. Nevertheless, these findings contribute novel insights into individual components of the ancient and complex neural circuits that orchestrate sleep, wake and anaesthesia.
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Gent, Thomas Clifford. "Thalamocortical oscillations in sleep and anaesthesia." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9104.
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The last 20 years have seen a substantial advancement in the understanding of the molecular targets of general anaesthetics however the neural mechanisms involved in causing loss of consciousness remain poorly understood. Thalamocortical oscillations are present in natural sleep and are induced by many general anaesthetics suggesting that modulation of this reciprocal system may be involved in the regulation of consciousness. Dynamic changes of thalamocortical oscillations in natural sleep and anaesthesia were investigated in rats chronically implanted with skull screw and depth electrodes in the cortex and thalamus. The hypothesis that discrete areas within the thalamus are responsible for regulation of arousal was tested. The anaesthetics propofol and dexmedetomidine but not midazolam produced switches in delta frequency at loss of righting reflex (LORR). This switch in frequency mirrored that seen within non-rapid eye movement sleep (NREM), whereas the onset of NREM was characterized by a switch from theta to delta in the EEG. Depth recordings during NREM indicated that the switch into a NREM state occurred in the central medial thalamus (CMT) significantly before the cingulate, barrel cortex and ventrobasal nucleus (VB), and that the CMT switch corresponded to the switch seen in the global EEG. Dexmedetomidine hypnosis showed a delta frequency shift that occurred simultaneously within the thalamus and cortex, and furthermore that the thalamus exhibited phase advancement over the cortex at the point of LORR. In conclusion, globalised changes within the thalamocortical system occur for propofol and dexmedetomidine LORR in the rat. This change represents a transition within drug free NREM and may implicate a common pathway responsible for a decrease in arousal. Furthermore, the phase advancement of the intralaminar thalamus over the cortex at LORR suggests a crucial role for this part of the thalamocortical system for regulating consciousness.
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Absalom, Anthony Ray. "Feedback control of sedation and general anaesthesia." Doctoral thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/8625.
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Includes bibliographical references.The man aim of my studies was to investigate the safety and efficacy of two modes of feedback control of sedation and anaesthesia. A secondary aim was to add to the body of knowledge on the Bispectral Index (BIS). I also wrote a computer program (BISCLAN) that was used in all the studies as a BIS data management tool, and in some studies for manual or automatic control of a propofol infusion. Two studies did not involve feedback control, but were performed to further our understanding of the BIS. For one, I recorded BIS values and the times at which clinical events occurred during 200 general anaesthetics. and studied memory of perioperative events. Broad variation in BIS values at similar levels of anaesthetic depth was found, although there was good separation between the majority of BIS values found during periods of consciousness and unconsciousness. BIS values on awakening were not predictive of memory for subsequent events. For the second study I investigated the effects of the stimuli used lo generate auditory evoked potentials on consciousness levels and the BIS, during sedation and anaesthesia. No effect was found. Three studies of BIS-guided computer control of anaesthesia and sedation were performed. Control performance was assessed in terms of clinical adequacy of anaesthesia and with recognised mathematical criteria. BISCLAN was able to control anaesthesia successfully. Cardiovascular parameters were stable in all patients. With two exceptions, operating conditions were also adequate. Control parameters during sedation and anaesthesia were acceptable and compare favourably with those found in other studies. Two studies of a second mode of feedback control of sedation (patient-maintained sedation) were performed. In both the goal was to determine if system safety was sufficient to prevent volunteers from purposefully inducing loss of consciousness. Sedation scores, propofol concentrations and physiological data were recorded. Secondary data included BIS values, and tests of memory for words. In one study a revised version of a previously developed blood concentration targeted infusion system was used, and in the other an effect-site targeted system. One subject in the second study became over-sedated, but no subjects lost consciousness. There was correlation among BIS values and propofol concentrations, and among BIS and propofol concentrations and the likelihood of memory for words. Several subjects remained conscious during periods when the BIS was < 60.
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van, Der Westhuizen Justine. "The prevalence of substance use in anaesthesia practitioners in South Africa." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33087.
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Introduction: Substance abuse has twice the mortality in United States anaesthesia- than non-anaesthesia residents. Since no data exist, the primary objective of this cross-sectional study was to establish the prevalence of substance use in South African anaesthesia practitioners. Secondary objectives were to compare the prevalence in male and female practitioners, and in private- and state practice anaesthetists. Years of experience and level of training were explored as possible risk factors for hazardous or harmful use. Method: Participants completed a self-administered, validated WHO questionnaire, run for ten days surrounding the 2018 South African Society of Anaesthesiologists (SASA) congress. All doctors practicing anaesthesia in South Africa were eligible. Recruitment was via an email link sent to all SASA members, as well as a web-based link at the congress. Results: A total of 1961 SASA members and 113 non-members (anaesthesiologists, registrars and non-specialists) were invited to participate (total 2074). There were 434 responses (response rate 20.9%, margin of error 4.18%); 364 were suitable for analysis. The most commonly lifetime-used substances were alcohol (92.8%), tobacco (42.3%), cannabis (34.7%), and sedatives (34.4%). Questionnaire scores defined low-, medium- and high-risk categories according to substance use during the previous 3 months. Sedative (12.6%) and alcohol (12.1%) users were deemed to be at moderate risk. The prevalence of opioid use was 1.9% (n=7). Prevalence of substance use was similar in male and female practitioners, as well as in those working in private practice or in state hospitals. Conclusion: The prevalence of current use of alcohol and sedatives is of major concern. A significant proportion of respondents were assessed to be at moderate risk of hazardous or harmful substance use. Gender and practice setting have little impact on substance use. Wellness efforts should be aimed at all anaesthesia practitioners in South Africa.
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Dresner, Alexandra. "Cefazolin plasma concentrations in children less than 25 kilograms undergoing elective cardiac surgery: an audit of current clinical practice at Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3025.
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Mhlanga, Gugulethu Tsakani Jenny. "A retrospective audit into the morbidity and mortality of open abdominal aortic aneurysm repair at Groote Schuur Hospital, Cape Town." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25442.
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Background: Open AAA repair is a major, high risk surgery and is associated with significant morbidity and mortality. Current literature quotes an overall mortality of ruptured AAA at 85-90%, including those who do not reach the operating theatre. Mortality of elective AAA repairs is 4-8%. Many patients presenting with abdominal aortic aneurysms are elderly and have pre-existing medical conditions, therefore putting them at high risk for numerous post-operative complications, such as acute kidney injury, pulmonary and cardiac complications. These complications lead to potentially increased ICU and hospital stays. Objectives: To the author's knowledge, an audit into the morbidity and mortality at Groote Schuur Hospital has not yet been formally performed. Such a retrospective audit will be useful in establishing where this hospital stands in terms of mortality, as compared with published data from international centres. In terms of morbidity, this research focused on the development of acute kidney injury following AAA repair. Methods: The study design was an observational retrospective file audit, of both emergency and elective open abdominal aortic aneurysm repairs. 90 case reports of operations performed between October 2006 and December 2014 were analysed. The primary outcome measure was the incidence and causes of perioperative (30-day) mortality. The secondary outcome measure was the incidence of acute kidney injury and renal replacement therapy (RRT). We further analysed whether cross-clamp time and anatomical classification of the aneurysm had any effect on the subsequent need for RRT, utilising the Mann-Whitney test. Results: Of the 90 patients, 76.7% were male (n=69). The study population had a mean age of 64.9 years. Overall perioperative (30-day) mortality of both emergency and elective cases was 15 out of 90 cases (16.6%); the mortality for emergency cases was 12 out 31 (38.7%), as compared to 3/59 (5.1%). Seventeen patients (18.9%) developed KDIGO stage 3 AKI, and RRT was instituted in 12 cases (13.3% of all patients); seven patients survived, and no patients were dialysis-dependent on hospital discharge. AKI was not significantly associated with abdominal aortic cross-clamp time (46 minutes vs. 38 minutes, p=0.9021), but was significantly associated with anatomical classification of the aneurysm (supra-/juxtarenal vs. infrarenal, p=0.037). Conclusions: In comparison with research from international centres, this study population was predominantly male, with a similar age profile to that quoted. The bulk of the perioperative mortality was from emergency AAA repairs, with the mortality associated with elective open AAA surgical repair being within the ranges quoted in international literature. Of the patients who received RRT, there was a mortality of 41.6%. There were many limitations in this study, as the population analysed was extremely heterogeneous, owing to the small sample size. There is great potential for further research, especially into the outcomes of open versus endovascular repairs of AAAs.
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Rous, Stephen Alexander. "The development of an in vivo nerve-muscle model in the rat : and an experiment "The interaction between rocuronium and thiopentone" to test the validity of the model." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/3029.
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Includes bibliographical references (leaves 55-59).Experimentation involving small animals has, over the years, been of major importance in the development of our current understanding of nerve - muscle physiology. This dissertation describes the development of an in vivo model of the rat nerve interface at the Faculty of Health Sciences at the University of Cape Town. Such a model was not previously available to the faculty. The development was the result of collaboration between the Departments of Anaesthesia and Human Biology.
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Delport, Kathleen Georgia. "The role of perioperative critical care support in a regional hospital: a prospective survey at new Somerset Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/31555.
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Background: Postoperative critical care support is required for emergency and elective cases having either major surgery, with poor physiological states or significant comorbidities, and for support following unexpected surgical or anaesthetic complications. Research suggests that as many as 48% of all critical care unit (CCU) admissions occur postoperatively, yet limited literature is available regarding the support role that onsite critical care availability provides for surgery. Research into this area is therefore necessary to understand the impact of accessible critical care support, especially in hospitals at regional and district level. Objectives: The objective of this research is to contribute to the literature on perioperative critical care by presenting data quantifying and describing the patients requiring postoperative critical care at New Somerset Hospital (NSH) - a regional hospital in Cape Town, in the Western Province of South Africa. Further to this, the research aims to identify cases that would not have proceeded here if the option of on-site postoperative critical care did not exist. Methods: Data was collected using a prospective survey spanning a six-month period from June 2015 to November 2015. The data represented two sets of patients: 1) every case done, documenting whether they would have proceeded at NSH without the presence of a critical care unit; 2) each admission to a critical care service directly from theatre, describing their indications for admission and their postoperative critical care pathway, interventions and outcomes. Results: A total of 3247 complete cases were included in the analysis. Of the total sample of cases assessed, 66 (2%) were supported by critical care at NSH, of which roughly half (31 cases) would not have proceeded at NSH without availability of a critical care bed. Of these patients, 7 did not have a bed reserved preoperatively, and were not admitted, highlighting an important subgroup of patients: those not admitted to a CCU, but yet received surgery at NSH solely due to the potential of postoperative critical care support there. New admissions amounted to 48 (1.5%) of all cases of which 43 were emergencies, and 14 were unplanned. 45% of admissions required monitoring or epidural care only, for which High Care would have been sufficient, while 55% received cardiorespiratory support. Conclusion: These results confirm that at NSH, an on-site CCU allows for cases to proceed that would otherwise have been transferred elsewhere. Of note, obstetrics accounted for 3 of the unplanned admissions, confirming that a level 2 obstetric service requires critical care support despite treating otherwise low risk patients. This data indicates that critical care plays a beneficial role in supporting a regional theatre service. 6 Further research is required in this field to determine whether these results can be generalised to other regional hospitals. This survey should help as baseline data, especially for studies to better assess quality and outcomes against national and international metrics.
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Dyer, Robert A. "Haemodynamic consequences of Spinal Anaesthesia for non-emergency Caesarean section." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3026.
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Single shot spinal anaesthesia for caesarean section is currently accepted as the favoured method in the absence of contraindications, for reasons of safety and comfort. Firstly, there is an increased risk of failed intubation associated with general anaesthesia. Secondly, spinal anaesthesia, if practiced correctly, allows for a superior experience of the delivery and improved bonding with the infant. Maternal haemodynamic stability is desirable both for maternal and neonatal safety, and to diminish maternal side-effects such as nausea and vomiting. Therefore, after an extensive literature review, clinically relevant aspects of spinal anaesthesia were studied, with a view to contributing to knowledge which could improve safety and outcome. The central themes explored in this thesis were fluid management during spinal anaesthesia for caesarean section in healthy parturients, the haemodynamic effects of the vasoactive agents ephedrine, phenylephrine and oxytocin during spinal anaesthesia for caesarean section in healthy patients and in patients with preeclampsia, and short term neonatal outcome after spinal anaesthesia in patients with severe preeclampsia. Research methodology included non-invasive measures as well as the use of a pulse wave form analysis monitor to measure maternal cardiac output. A validation study was performed comparing this method with thermodilution in patients with postpartum complications of preeclampsia. Abstract viii The results of these studies showed that: The pulse wave form monitor employed showed acceptable limits of agreement with the thermodilution method. Crystalloid coload was associated with lower vasopressor requirements than conventional preload. Spinal anaesthesia was associated with afterload reduction, which was more pronounced in healthy patients than in preeclamptics. Ephedrine maintained or increased, and phenylephrine reduced maternal cardiac output in healthy patients. Oxytocin was associated with transient haemodynamic instability in healthy and preeclamptic patients, which was obtunded by phenylephrine in the healthy population. Spinal anaesthesia for caesarean section was associated with a greater umbilical arterial base deficit than general anaesthesia in patients with preeclampsia. Overall, these studies should contribute to improved knowledge of haemodynamic responses during spinal anaesthesia for caesarean section, and ultimately to improved maternal morbidity and mortality.
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Ruttmann, Thomas Gotthard. "Haemodilution and coagulation." Doctoral thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/3030.
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Marais, Adri. "Efficacy of transversus abdominis plane blocks as part of a multimodal analgesia regime for total abdominal hysterectomies." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13314.
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Includes bibliographical references.Patients who undergo a total abdominal hysterectomy (TAH) experience a significant amount of pain postoperatively. Several multimodal pain regimes have been used in the past to manage these women’s pain. Neuraxial anaesthesia is usually not a feasible option in these cases, because of the risks involved. Limited resources with the lack of high care unit beds available when intrathecal opioids are given are also a problem. Effective analgesia includes both improved comfort and decreased opiate side-effects, if morphine requirements can be decreased. After approval from the University of Cape Town Human Research Ethics Committee, the trial was registered with the South African National Clinical Trial Register (DOH-27-0212-3945) and the South African National Human Research Ethics Council. All patients between the ages of 20-65 with an ASA score I-III were included in a prospective double-blind randomised controlled trial after obtaining written informed consent from them the day before their operation. Patients were excluded if they were allergic to any of the trial medication (morphine, bupivacaine), had a history of opioid addiction, coagulation disorders, infection at needle insertion site or were unable to give informed consent. If surgery did not for some reason proceed to a TAH, the patient was also excluded. The patients were visited in the ward the day before their operation to obtain informed consent. All the patients received a patient-controlled analgesia (PCA) pump and this as well as the visual analogue pain scale (VAS) were demonstrated and explained to them. This was done by the same person (principle investigator) for all the patients. Our aim with this double-blind randomised controlled trial was to study the efficacy of ultrasound-guided transversus abdominis plane blocks in patients undergoing total abdominal hysterectomy. We randomly allocated thirty patients to two groups, a transversus abdominis plane block group (n=15) and a placebo group (n=15). The transversus abdominis plane blocks were done with 0.25% bupivacaine. The placebo group received a sham block with normal saline post induction of anaesthesia. All patients received postoperative morphine patient-controlled analgesia. Pain scores and morphine consumption were assessed at 0, 6 and 24 hours postoperatively. Our trial showed a significant between-group difference in morphine requirements (5.2±3.9 vs. 9.7±4.3 mg [p=0.007], and 12.9±8.9 mg vs. 25±12.1 [p=0.006]) for the transversus abdominis plane- compared with placebo group at 6 and 24 hours respectively. There were no significant between-group differences in pain scores. There were no complications associated with any block. Ultrasound-guided transversus abdominis plane block is an effective addition to a multimodal postoperative analgesia regimen for abdominal hysterectomy.
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Van, Dyk Hanlie. "Dexmedetomidine : a phase I study to evaluate the pharmacokinetics and pharmacodynamics in paediatric patients." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/3024.
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Whitehead, Paul Neville. "Survival after local anaesthetic overdose : a comparison of the success of resuscitation after established cardiotoxicity caused by ropivacaine or bupivacaine." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26250.
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The purpose of this thesis is to review the pharmacology and toxicity of local anaesthetics, particularly highlighting the differences between bupivacaine and ropivacaine and to present an experiment attempting to establish whether ropivacaine is a safer drug, once cardiotoxicity has occurred.
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Chambers, Neil. "A dissertation and review of current knowledge on aspects relating to the use of Remifentanil to cover the tunnelling phase of Ventriculoperitoneal Shunt Insertion in paediatrics." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/26339.
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In this study, the administration of remifentanil to cover the tunnelling phase of shunt insertion in children caused good attenuation of haemodynamic and endocrine markers of stress, no delay in recovery and no additional post operative respiratory depression in all age groups, including xpremies and neonates.
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Nock, Mariasa. "Multidisciplinary management of Complex Regional Pain Syndrom Type 1 in children admitted to Red Cross War Memorial Hospital: A case series describing long-term effects on pain, function and quality of life." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27014.
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Background: Complex regional pain syndrome (CRPS) is characterised by neuropathic-type pain in a regional distribution with associated signs and symptoms including: swelling, change in temperature, change in skin colour and motor dysfunction. Although CRPS is not a common condition, the disease burden is high and can lead to long-term impairment and disability. Current guidelines for the management of paediatric CRPS are mostly extrapolated from adult data. Literature regarding treatment and long-term prognosis of paediatric CRPS is sparse and often lacks well-defined and reproducible outcome measures. Aim: This study aims to assess the efficacy of treatment of CRPS Type 1 in children admitted to Red Cross War Memorial Children's Hospital (RCWMCH) in eliminating pain and improving function. Methods A retrospective folder review and follow-up telephonic survey of all children admitted to RCWMCH over a 5 year period was performed. Long-term follow-up was defined as a minimum of 6 months after discharge from hospital. Follow-up questionnaires included the Faces Pain Scale, and the Paediatric Quality of Life Inventory Version 4 generic core scales (PedsQL 4.0) Results: Nine children with confirmed CRPS Type1 were included in the study, all of whom participated in long-term follow-up. Children received in-hospital treatment from a multidisciplinary team, including intensive physiotherapy and psychological therapy. Pharmacological treatment consisted of an intravenous ketamine infusion and varying combinations of gabapentin, clonidine and amytriptilline. One child received epidural local anaesthetic infusion. On average, pain scores improved by 67.8% by the time of discharge. At an average long-term follow-up interval of 10.3 months (ranging between 6 to 21 months), the pain score had worsened by 10.5% compared to discharge. Two children (22.2%) experienced complete recovery while the remainder experienced partial recovery. Three children (33.3%) suffered a relapse, of which one recovered completely. At long-term follow-up, children for whom PedsQL 4.0 data was available from admission all demonstrated clinically meaningful improvements in all four functional domains (physical, social, emotional and school). Children scored on average similar to healthy peers in terms of social, emotional and school function, but worse in terms of overall quality of life. The area most affected was that of physical function, in which children with CRPS scored worse than other children with chronic health conditions. Conclusion: Children with CRPS experience significant improvement in pain and function with an in-patient, multidisciplinary, non-invasive treatment approach. Most children return to a level of school functioning comparable to healthy peers. However, the rate of complete recovery is low, relapse is common, and most children have significant persistent impairment of physical function. We recommend a long-term support program for children with CRPS and their families, and standardisation of follow-up intervals and outcome measures to enable comparison between future studies.
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Roche, Anthony Michael. "Polypropylene and Polycarbonate containers have a varied effect on coagulation after haemodilution, as judged by TEG® in vitro." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/26320.
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The reasons for this study were multi-factorial, but mostly due to some interesting data obtained from a pilot study conducted at University College London (UCL). In that study, the coagulation effects in vitro of two hetastarch solutions were compared with two crystalloids by means of thrombelastography (TEG®). The fluids compared were: 1. Hespan® (HES), a high molecular weight hetastarch (450kDa/O.7 substitution ratio) in a 0.9% saline solution - Laevosan, Austria. 2. Hextend® (HEX), also a high molecular weight hetastarch (670/0.75 substitution ratio) in a balanced electrolyte, lactate and glucose solution - BioTime Inc, Berkeley, California, USA. 3. Saline 0.9% 4. Hartmann's Solution (Ringer's Lactate) The crystalloids revealed no surprising differences known from previous published data, but data obtained from the hetastarch solutions revealed contradictory results to known in vivo results found in a phase III trial. This previous Phase III in vivo trial showed that HEX haemodilution produced a superior coagulation profile to HES, along with a significantly shorter r-time than HES. There was also a significantly smaller transfused volume of blood than HES in the HEX-treated patients. This Phase III study prompted the initial UCL in vitro haemodilution study mentioned above. In the UCL study, there were significantly impaired TEG® results, indicating severe hypocoagulability with HEX, when compared with HES. This included prolonged r-and k-times, as well as reduced a-angles and maximum amplitudes in the HEX group, compared with HES and crystalloid groups. Many theories were discussed for these controversial UCL results, but the thought was that a container-effect could have been responsible, as the in vitro UCL study methodology included the use of a polycarbonate container for initial storage, as well as for haemodilution of the blood in vitro. In view of the known wettable surface, as well as a strong negative surface charge of polycarbonate, it was suggested that the container surface itself could have affected coagulation. When different ionic compositions of the various fluids and starches were taken into account, it seemed possible that some interaction between the fluids and the material of the containers could have induced or inhibited coagulation at the container surface. The suspicion was that the observed change in TEG® variables was likely due to a methodologic idiosyncrasy. Previous track record of haemodilution and TEG research at the University of Cape Town made it an obvious setting for exploration of this problem. Preparations were thus made to test container effects with haemodilution in vitro at Prof MFM James' anaesthesia laboratory at the University of Cape Town. The hypothesis was that the use of polypropylene and polycarbonate containers, with their different chemical and surface properties, would lead to a variability in TEG® results obtained from fresh whole blood, as well as blood diluted with various fluid solutions. Choosing TEG® as a monitor of coagulation was essential, as it has a well-established track record in monitoring coagulation effects in trials of haemodilution (in vitro and in vivo). TEG® produces reliable and quick results, giving a reflection of global coagulation function. It, along with the Sonoclot®, are the only two devices which can reliably diagnose a hypercoagulable state. More will be mentioned on the TEG® later.
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Nyoka-Mokgalong, Simangele Cecilia. "A retrospective audit of the clinical value of routine chest radiographs in the first 24 hours after cardiac surgery using medical records." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20682.
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Routine postoperative chest radiography after cardiac surgery is a common practice, although studies, both prospective and retrospective, conducted in their majority outside Africa, have shown that these chest radiographs are of low clinical value, mainly due to limited impact on patient management. Following cardiac surgery and admission to ICU, chest radiographs are obtained in order to ensure proper position of all invasive devices such as endotracheal tubes, invasive catheters as well as nasograstric tubes, and to exclude possibility of a pneumothorax, atelectasis, infiltrates, and other potential respiratory complications associated with ventilatory support. Following cardiac surgery, there are other elements that require assessment: mediastinum (for widening due to bleeding), pleural space (for presence of fluid or air) and cardiovascular system (for presence of signs of failure). Specific to cardiac surgery is the post-operative pulmonary dysfunction (PPD), where systemic inflammatory response due to cardiopulmonary bypass is the main culprit [Milot J et al, 2001] - leading to acute lung injury. Over and above the usual cardiovascular diseases that require surgical intervention, in Sub-Saharan Africa, inflammatory and infective conditions such as pulmonary tuberculosis, pulmonary hydatid disease, and pulmonary complications of HIV infection, are very prevalent. These pre-existing lung pathologies predispose patients to postoperative pulmonary complications after cardiac surgery. This audit investigates the role and importance of bedside chest X-rays in post operative care of cardiac surgery patients that come from a population group where lung pathology is quite prevalent.
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Golding, Tarryn. "An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27329.
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It is widely assumed in the literature that large thyroid goitres pose a significant risk to the airway perioperatively. They are of concern to anaesthetists because of anticipated difficulty relating to intubation, ventilation and post-thyroidectomy tracheomalacia. They are of concern to surgeons because of the anticipated risk of difficult dissection and increased risk of surgical complications including haemorrhage, laryngeal nerve injury and tracheomalacia. Objectives: To analyse the folders of patients who have undergone anaesthesia and surgery for large, nonmalignant goitre, to assess the impact of large goiters on perioperative and postoperative management. An attempt will also be made to identify possible predictive markers/ patient characteristics associated with difficult intubation. Design: A retrospective folder review Setting: Groote Schuur Hospital Participants: All patients who had thyroidectomies performed at Groote Schuur Hospital between Jan 2010 and June 2016 for large, non-malignant goitres. Measurements and main results: Of the patients who underwent a thyroidectomy procedure at Groote Schuur Hospital between Jan 2010 and June 2016, 196 were identified as having non-malignant goitre and size in one dimension of greater than fifty millimeters. There were seven documented difficult intubations and only one case of failed intubation. This case was subsequently put onto cardiopulmonary bypass and intubated successfully using a rigid fibreoptic bronchoscope. Of the one hundred and nighty-six cases, four were intubated using a fibreoptic bronchoscope, eight with a videolaryngoscope, and six cases, a bougie. All other patients underwent uneventful tracheal intubation via direct laryngoscopy. All glands were removed via a collar incision with no requirement to proceed to sternotomy. There was only one patient requiring blood intraoperatively and only four reported cases of postoperative haematomas. There were no instances of tracheomalacia. Two patients suffered long term recurrent laryngeal nerve injury with voice changes. Conclusion: The data shows that, in patients with large, benign goitre undergoing thyroidectomy, airway difficulties at intubation and surgical and anaesthetic complications postextubation are rare. Intravenous induction and direct laryngoscopy is a safe technique in appropriately experienced hands.
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Pretorius, Petrus Rohan. "The influence of delayed sample processing time on the PO₂ values in critically ill patients with sepsis-induced leukocytosis." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/26939.
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Background: The ability to correctly measure the partial pressure of Oxygen is one of the fundamental test that influence clinical decision making in a septic ICU patient. The study examined the extent of error over time, from collection to processing, when measuring blood gas samples for PO₂, PCO₂, pH, in critically-ill patients with sepsis and metabolically active leucocytosis > 12 000/mm³ and compares it with a control, where immersing it in ice has stopped metabolism. Methods: Thirty septic ICU patients with confirmed leucocytosis > 12 000/mm³, who had routine arterial blood analysed was included in the study. Blood form the standard PICO50 radiometer arterial blood sampler (2ml) syringe was decanted into two 1ml Glass syringes that was pre-heparinised with 1ml Heparin 1000U - all excess Heparin removed. One syringe was cooled with ice slurry and tested as a control at 60 minutes The other syringe was used to repeatedly analyse the sample at 0,10, 30 and 60 minutes. The syringes were sealed with plastecine and a glass capillary tube was use to decant the sample just prior to analysis to fit the analyser. Samples were processed using an ABL 800 blood gas analyser. Results: The mean absolute difference in PO₂ at 10 minutes was -0.94 kPa (95% CI: -1.48 to -0.4 kPa), at 30 minutes -2.42 kPa (95% CI: -3.10 to -1.75 kPa) and at 60 minutes -4.44 kPa (95% CI: -5.54 to -3.34 kPa). The relative difference in pO₂ at 10 minutes was -4.98% (95% CI: -8.12 to -1.84%), at 30 minutes -13.79% (95% CI: -17.40 to -10.17%) and 60 minutes -25.46% (95% CI: -30.97 to -19.95%). The absolute difference in PO₂ at 60 minutes on Ice was - 0.31 kPa. Conclusion: Delayed blood gas analysis in Septic ICU patients with a raised WCC > 12 000/mm³, results in statistical and possible clinical significant abnormality in the pO₂, that progressively worsens with time. After 10 minutes there was a 5% change, at 30 minutes a 14% change and there was a 25% change from baseline PO₂ at 60 minutes. The magnitude of change with statistical mixed linear models shows the rate of decline to be of the magnitude of 1% per minute. So at 60 minutes, the ratio change is 0.7313859 (0.9948 to the power of 60).This deviation may alter clinical decision making.
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Reed, Anthony Raddon. "Magnesium sulphate reversal of established bupivacaine electrophysiological cardiotoxicity." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/26985.
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The results of this study show that in intact rats magnesium produces a more rapid resolution of bupivacaine induced electrophysiological changes than placebo. The improvements are in rhythm and electrical conduction, although this is often at the expense of potentiating the bradycardic effects of bupivacaine toxicity. Whilst the bradycardia remains a problem it is potentially more amenable to therapy than the changes in rhythm and conduction which magnesium sulphate reversed. The opportunity therefore exists to explore the possibility of combining magnesium with a positive chronotrophic agent such as dobutamine.
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Lawrie, Ruchi. "Coagulopathy in severe, isolated traumatic brain injury: A prevalence study." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29668.
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Introduction: Traumatic brain injury (TBI) is an important cause of morbidity and mortality in the developing world, and remains the leading cause of death and long-term disability in young adults. Hypocoagulopathy is a well described sequela of severe TBI and is associated with prolonged intensive care unit stays and poor outcomes. This study was conducted to determine the prevalence of coagulopathies in patients with severe, isolated TBI. The secondary outcome was to note any difference in the prevalence of detected coagulopathy between blunt and penetrating TBI. Methods: This is a prospective observational study of fifty patients with severe, isolated TBI (AIS head >3, AIS body <3), presenting to, or were referred to Groote Schuur Hospital. We drew blood for International Normalised Ratio (INR), activated partial thromboplastin time (aPTT), platelets count, sodium, potassium, urea and thromboelastography (TEG) on all patients at 12 hours (±3 hours), 36 hours (±3 hours) and eligible patients at 60 hours (±3 hours) post injury. Coagulopathy was defined as any one of the following: platelet count<120 x 109/L, INR>1.2, PTT>37 seconds, R time<4 minutes or >8 minutes, K time>4 minutes, α angle<47˚ or >74˚, maximum amplitude<54 mm or >72mm, EPL>15%, LY30>8 %, coagulation index<-3 or >3. Results: The patients were mostly male (n=47), with a mean age of 31 years. Median AIS head and body were 5 and 1, respectively. Thirty-six patients sustained blunt, and the remaining 14 penetrating trauma. Sixteen of the fifty patients demised during the course of the study. The cumulative prevalence of coagulopathy, as diagnosed by TEG, was 84% as diagnosed by TEG. Of the total 109 TEGs, 59 samples were hypercoagulable, 10 were hypocoagulable and the remaining 40 normal. There was poor correlation between laboratory-based coagulation assessments and TEG. Conclusions: Contrary to what is reported in the literature, we found little evidence of a hypocoagulable state as defined by TEG (10 of the 109 samples). Many patients were significantly hypercoagulable (59 of the 109 samples) according to criteria specified by the TEG manufacturer. When considering the CBT results, we had a much higher number of hypocoagulable samples (72 of the 109 samples), with none showing a hypercoagulable state. Moreover, there was poor correlation between coagulation status as measured by TEG described and that found on conventional blood testing. No significant differences in the prevalences of coagulopathy amongst blunt and penetrating mechanisms of injury were noted. Some differences in fluid balance and presenting vitals in the hypocoagulable group when compared to the normal and hypercoagulable groups were noticed, but this does not attain any statistical significance due to the small numbers of hypocoagulable patients in our study.
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Roos, John. "Prehospital endotracheal intubation practices by paramedics in the provincial ambulance service of the Western Cape province of South Africa." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/3028.
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Includes bibliographical references (leaves 76-79).It is well-established that endotracheal intubation in the field is associated with a considerably greater degree of difficulty, and a much higher complication and failure rate than intubation undertaken in the operating-theatre environment. The reasons for this are many-fold, have been quantified and discussed in detail. This study assesses the difficulties encounteed by paramedics in the field, by identifying factors contributing to difficult and failed intubation, by quantifying the incidence of difficult and failed intubations, by assessing and describing the incidence of complications and adverse outcomes, and by assessing the impact of the procedure on patient care. This dissertation includes a comprehensive international literature review of studies related to prehospital endotracheal intubation, and discusses and compares these published findings to the results obtained from this study. Furthermore, this study provides feedback to paramedics, paramedic-educators and managers, by offering a comprehensive strategy for improvement in the procedure of field intubation, with a view to increased safety, ease of execution, and improved patient outcome.
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Duys, Rowan Alexander. "Validation of the use of short message service (SMS) as a training tool for anaesthetic nurses." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15510.
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Background: Anaesthetic nurses form a critical part of the team providing peri-operative care to patients, but no accredited training exists for them in South Africa. In this setting, without a formal training programme, short in-service training interventions are a pragmatic attempt at improving nurse performance and patient outcomes. Traditional didactic teaching formats have limitations, and mLearning (the use of mobile telephones to facilitate education) has proven equivalent or superior to traditional teaching methods in several settings. Despite very high levels of mobile phone ownership amongst healthcare workers in Africa, this form of educational delivery has not been tested in the hospital-based nursing population. Methods: A telephonic True/False Pre-Test was performed with 12 nurses of varying levels of training, to assess their pre-existing knowledge of anaesthesia. A pre-learning package was then delivered to them in the form of daily SMS’s for a month covering relevant anaesthesia content. A telephonic post-intervention test was performed to assess if anaesthesia theory knowledge had improved. Results: Median test scores were compared using a Wilcoxon Signed Rank test and were statistically higher in the post-intervention test: 83,3% (IQR 66,7-86,7) vs. 70% (IQR 66,7-71,7) (p=0,018). Conclusions: The results show that knowledge scores of hospital-based anaesthetic nurses can be improved using training by SMS, thus validating the use of the mobile phone as a cheap, widely accessible and effective educational vehicle.