Browsing by Author "Coetzee, A. R."
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- ItemCommunity-acquired pneumonia - factors influencing intensive care admission(Health & Medical Publishing Group, 1988-01) Van Eeden, S. F.; Coetzee, A. R.; Joubert, J. R.The mortality rate in critically ill patients with pneumonia who receive invasive vital organ support, including mechanical ventilation, in an intensive care unit (ICU) remains above 50%. The contribution of these costly life support systems to the survival of patients with extensive pneumonia is a matter for debate. The high mortality rate in this group of patients can be attributed in part to the fact that they are frequently referred for ICU care when their condition has already deteriorated to the point of no return. A retrospective study over 18 months of 34 cases of community-acquired pneumonia (17 patients required ventilatory support in the respiratory ICU) was undertaken to identify criteria which would justify early admission to an ICU. These were first-line clinical and biochemical factors, three of which were present in all patients on admission to hospital: (i) bronchopneumonia or lobar pneumonia involving more than two lobes (P < 0.001); (ii) respiratory rate > 30/min (P < 0.001); and (iii) partial arterial oxygen pressure < 8 kPa (P < 0.001). Other systemic factors associated with a poor prognosis and admission to the ICU were clinical signs of septicaemia, abnormal liver function and low serum albumin value. A scoring system for severity of pneumonia based on these factors is proposed. The possibility of an improved prognosis in a potentially reversible disease can become a reality if this approach is employed prospectively.
- ItemDrukomsetters in die kliniese en navorsingspraktyk : 'n kort kritiese beskouing(Health & Medical Publishing Group, 1987) Fourie, P. R.; Badenhorst, E.; Coetzee, A. R.The correct measurement of various blood pressures in clinical practice is of obvious importance. A method by which the frequency response and damping of various transducers and catheters can be determined is discussed and reference is made to values obtained in the validation of certain catheters.
- ItemThe effect of acute haemodilution during cardiopulmonary bypass on blood calcium, pH, phosphorus and protein values(Health & Medical Publishing Group, 1983) Coetzee, A. R.; Van der Merwe, W. L.; Taljaard, J. J. F.; Els, D.The changes in total serum calcium, ionized calcium, total serum proteins, albumin and phosphate levels during cardiopulmonary bypass were measured. The possible causes of the changes in these parameters are discussed. The effect of the presence of heparin on serum ionized calcium is evaluated. The metabolic and clinical significance of the changes in blood components measured are discussed, special attention being paid to the use of calcium as an inotropic agent at the termination of cardiopulmonary bypass.
- ItemThe effect of halothane, enflurane and isoflurane on the circulation(Health & Medical Publishing Group, 1989) Coetzee, A. R.; Fourie, P. R.; Badenhorst, E.This study, in open-chest dogs, sought to explore the relationship between whole-body oxygen delivery and oxygen consumption during anaesthesia, using increasing concentrations of halothane, enflurane and isoflurane. Results indicate that the cardiac index and oxygen delivery became critical at less than 1 MAC (minimal alveolar concentration of anaesthetic) for the three commonly used vapours. Halothane caused the least depression of contractility, but the stroke volume was reduced by the well-maintained afterload at 1 MAC. Enflurane and isoflurane were associated with more depression of contractility, but the cardiac output was maintained by an increase in heart rate in the case of isoflurane and reduced mean arterial pressure during the use of enflurane.
- ItemThe load independence of the end-systolic pressure-length relationship of the heart(Health & Medical Publishing Group, 1989) Coetzee, A. R.; Fourie, P. R.; Badenhorst, E.The end-systolic pressure-volume relationship is the state of the art in the measurement of myocardial contractility. This index is load-independent and relatively independent of heart rate. In this study the load-independent character of the end-systolic pressure-length (ESPL) relationship was evaluated in dogs under general anaesthesia. The result indicated that the ESPL is pre- and afterload-independent, since the comparative values of ESPL from afterloaded and reduced preload contractions did not differ significantly (N = 75; P = 0.5993). The application of the ESPL relationship as a means of describing the function of the heart as a muscle as well as a pump is discussed.
- ItemOral midazolam in paediatric premedication(Health & Medical Publishing Group, 1991) Payne, K. A.; Coetzee, A. R.; Mattheyse, F. J.; Dawes, T.In a premedication study involving 135 children, aged 1-10 years, four regimens were investigated: (i) no premedication; (ii) oral trimeprazine tartrate 2 mg/kg, methadone 0.1 mg/kg, droperidol 0.15 mg/kg (TMD); (iii) intramuscular midazolam (Dormicum; Roche) 0.15 mg/kg; and (iv) oral midazolam 0.45 mg/kg. All premedications were given 60 minutes before a standard halothane anaesthetic. No impairment of cardiovascular stability occurred but after premedication the mean oxygen saturation decreased by 1.6% and 1.1%, respectively, in the intramuscular midazolam and TMD groups. Overall, children under 5 years of age behaved less satisfactorily in the holding room and at induction, than those over 5 years (P<0.01). Midazolam, intramuscularly and orally, produced more satisfactory behaviour than the other two regimens (P<0.05) and, combined with a 70% more rapid recovery than the TMD regimen (P<0.05), suggests that oral midazolam is a more effective paediatric premedication agent than placebo or TMD.
- ItemPancreatic transplantation in a patient with severe insulin resistance : a case report(Health & Medical Publishing Group, 1988) Du Toit, D. F.; Heydenrych, J. J.; Coetzee, A. R.; Weight, M.A 22-year-old white woman with insulin-dependent diabetes mellitus of 20 years' duration and advanced secondary complications underwent pancreatic transplantation for severe insulin resistance and rapidly progressive nephropathy. Resistance to all forms and strengths of subcutaneously administered insulin had necessitated almost permanent hospitalisation for the previous 10 years. Short-term improvement of the endocrine and metabolic status was achieved by initial segmental and subsequent whole pancreatic transplantation.
- ItemPre-operative assessment of cardiac patients for non-cardiac surgery(Health & Medical Publishing Group, 1984) Ford, B. M.; Weich, H. F. H.; Coetzee, A. R.Non-cardiac surgery presents significant risks to patients with cardiac diseases. With the improvement in anaesthetic techniques and intensive care facilities, many cardiac patients who in the past would have been considered as being at too great a risk are now being considered for non-cardiac surgery. Smaller centres must still practice strict selection of patients if they do not possess an intensive care unit with facilities for full haemodynamic monitoring. We present a review of the recent literature and current practice at our hospital to assist clinicians in assessing these patients for anaesthesia. However, the final decision whether the patients is fit for anaesthesia still rests with the anaesthetist.
- ItemRural anaesthetic practices in the Western Cape(Health & Medical Publishing Group, 1991) Payne, K. A.; Muller, C. J. B.; Coetzee, A. R.The findings of specialist anaesthetists on visits to rural towns in the western Cape over 6 years are reported. The importance of academic units communicating with general practitioners, nursing staff and hospital authorities in their own working environment is emphasised. Hospital anaesthetic facilities and general practice anaesthetic methods are discussed and recommendations made and, in addition, common problems that could improve anaesthesia in general practice are summarised.
- ItemDie suurstofbalans in die normale hondmiokardium gedurende toenemende konsentrasies van inhalasienarkosemiddels(Health & Medical Publishing Group, 1988) Coetzee, A. R.; Fourie, P. R.; Badenhorst, E.; Els, D.Myocardial oxygen supply and demand in the normal dog were evaluated as the concentration of halothane, enflurane or isoflurane was increased. Although coronary blood flow decreased as the anaesthetic gas concentration increased, the O2 supply-to-demand ratio remained stable owing to a decrease in the myocardial O2 consumption.