Southern African Journal of Anaesthesia and Analgesia

One-lung ventilation in vascular surgery for a patient with significant lung pathology – a case report

2025-02-27T13:44:23+00:00

In South Africa, the prevalence of tuberculosis and human immunodeficiency virus (HIV) coinfection is one of the highest globally. This combination can have myriad clinical manifestations, posing a challenge to anaesthesiologists. This case report focuses on the anaesthetic management of an HIV-positive patient with previously treated pulmonary tuberculosis (PTB) complicated by fibrocavitary disease and subsequent right lung abscess. The patient presented to the theatre for an emergency right carotidaxillary bypass for multiple subclavian artery mycotic pseudoaneurysms.

Bronchospasm or not?

2025-03-10T08:46:43+00:00

Premature closure is one of a list of cognitive biases in decision-making during anaesthesia. Cognitive biases may delay the recognition and correct treatment of a life-threatening event. The authors describe a case of wrongly diagnosed bronchospasm following endotracheal intubation in a 53-year-old female patient who presented for elective peritoneal dialysis catheter reinsertion.

The effect of a preoperative patient information video on child and caregiver anxiety: a prospective, non-randomised, controlled study

2025-01-06T08:25:13+00:00

Background: Preoperative anxiety is common in paediatric patients and associated with significant adverse postoperative outcomes. Video techniques to alleviate preoperative anxiety are effective in adult patients, whilst there is variable evidence in children. In our setting, there is limited evidence demonstrating a similar impact on paediatric patients and their caregivers.

Methods: This was a prospective, non-randomised, controlled study to determine if exposure to a preoperative anaesthetic information video reduces anxiety levels in paediatric patients and their caregivers before surgery, compared to those who had routine preoperative counselling. A video was shown before the theatre, and a clip of the same video was shown pre-induction. Paediatric anxiety was assessed in the waiting area (T0) and at induction (T1) using the modified Yale Preoperative Anxiety Scale (mYPAS) for the child and the 6-point State-Trait Anxiety Inventory (STAI-6) for the caregiver.

Results: A total of 173 participants were included, 90 in the control group and 83 in the intervention group. The demographics of the groups were similar, except for the control group having younger patients (median [interquartile range, IQR], 6 [3–8] vs. intervention group 7 [5–9.75]; p = 0.03). Caregivers experienced a similar incidence of “high anxiety” in the control and intervention groups (59/90 [66%] vs. 61/83 [73%]; p = 0.52). There was no significant difference in median (IQR) STAI-6 scores between groups (control group 50.0 [43.4–53.5] and intervention group 50.0 [43.4–53.5]; p = 0.32). We also did not find a significant difference in the median (IQR) childhood anxiety measured by the mYPAS between groups at either T0 (39.6 [27.1–50.0] vs. 33.3 [22.9–45.8]; p = 0.107), or T1 (39.6 [33.3–53.6] vs. 39.6 [27.1–50.0]; p = 0.386).

Conclusion: A preoperative information video did not alter caregiver or child anxiety in our study. While we believe the video is an invaluable tool for education, consistent counselling, and information provision to patients in a familiar language, it does not demonstrably impact perioperative anxiety in our setting.

The practice of patient blood management among South African anaesthetic providers: a cross-sectional study

2025-02-14T07:40:59+00:00

Background: Patient blood management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment. Thus far, perioperative PBM practices of South African anaesthetic providers have not been described.

Methods: This study prospectively evaluated perioperative PBM practices in South Africa utilising an online survey. In addition, we described the extent to which practices align with the 2020 South African Society of Anaesthesiologists (SASA) and 2014 South African National Blood Service (SANBS) guidelines.

Results: The information letter was opened 573 times, and 403 surveys were more than 50% complete (response rate 70.3%). Most respondents were specialists (54.6%) or specialist trainees (25.1%). Although most providers (89.3%) often or always record preoperative haemoglobin (Hb), only 1% would defer elective surgery (other than caesarean section) if the Hb were < 13 g/dl. Appropriate preoperative anaemia treatment was rarely or never seen by 65.5% of respondents. Only 25.6% of respondents had no access to any point-of-care (POC) test. Most respondents (63.9%) use a transfusion threshold of 7 g/dl for red cell concentrates (RCC) in non-cardiac patients. Few respondents often or always use cell salvage in non-obstetric surgery, where blood loss > 500 ml is anticipated (21.2%), or in major obstetric haemorrhage (21.2%). In major haemorrhage, most respondents often or always monitor for, treat, and prevent hypothermia (97.5%), acidosis (96.0%), hypocalcaemia (90.0%), and hyperkalaemia (91.6%). Tranexamic acid (TXA) is often or always used in severe trauma (70.7%) and major obstetric haemorrhage (72.1%).

Conclusion: Rational blood usage practices among respondents were reasonably good; however, PBM practices were poor and did not align with South African guidelines. Preoperative anaemia management requires improvement, including facilities to identify and treat anaemic patients preoperatively.

Management of endotracheal tube cuff pressures in the intensive care unit at a tertiary hospital: a review of the adequacy of current practices

2025-02-20T11:52:56+00:00

Background: The inappropriate management of endotracheal tube (ETT) cuff pressures in ventilated patients in the intensive care unit (ICU) is associated with myriad complications and increased morbidity and mortality.^1,2 International recommendations agree that ETT cuff pressure should be maintained in the 20–30 cmH₂O range to minimise potential harm to intubated patients.^3-8 Currently, the ICU at Dr George Mukhari Academic Hospital (DGMAH) has no formal protocol for ETT cuff pressure management, potentially exposing patients to risk and the hospital to increased healthcare costs and burdens. This study investigated whether ETT cuff pressure management practices in the ICU at DGMAH aligned with the recommended standard and allowed pressures to remain within the 20–30 cmH₂O range.

Methods: Over three months, 205 patients, within 24 hours of admission to the ICU, were recruited in a prospective, observational cross-sectional survey. The initial ETT cuff pressure was measured. If the pressure was outside the 20–30 cmH₂O range, the volume of adjustment needed to bring the measurement into range was documented. The minimal pressure at which a leak was occluded clinically by auscultation was recorded.

Results: In our study, 25% of patients (95% confidence interval [CI] 19.9% to 31.7%) surveyed had ETT cuff pressures within the recommended range, with 65% (95% CI 57.6% to 70.6%) falling over the upper threshold, and 21% (95% CI 6.8% to 15.2%) being underinflated according to the recommendations. Of the 205 participants, 153 (74.6%) required adjustment of their ETT cuff pressure at the time of data collection, with 121 (59%) achieving a clinical seal below the reference range.

Conclusion: We concluded that the current practice of measuring the ETT cuff pressure at the discretion of the treating clinician without a standardised protocol results in a significant percentage of patients with inappropriate cuff pressures going undetected.

Language, literacy and reassurance: do videos calm the anxious child or caregiver?

2025-07-28T07:42:37+00:00

Preoperative anxiety in children is a significant and well-recognised problem. It is associated with adverse behavioural outcomes, increased analgesic requirements, and prolonged recovery times, placing an additional burden on both the perioperative team and the child’s family.^1,2 This challenge has motivated anaesthetists and surgical teams to investigate various strategies to mitigate anxiety, ranging from sedative premedication to parental presence and child-friendly preoperative environments.^3-5 Among the more recent innovations is the use of audiovisual media as an educational and distraction tool, a concept particularly appealing in the era of smartphones and digital accessibility.

CPD Questionnaire (V31N04)

2025-07-28T07:47:01+00:00

CPD Questionnaire

SASA Congress Refresher Course Abstracts 2025

2025-08-07T05:47:06+00:00

Abstracts