Research Articles (Anaesthesiology and Critical Care)

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Anaesthesia and the diabetic patient
(HMPG, 1985) Roelofse, J. A.; Erasmus, F. R.
Since it is estimated that 1 out of every 2 diabetic patients will require surgery at some point in his lifetime, it is imperative that the anaesthetist should understand the disease process as well as the anaesthetic problems associated with it. This article emphasizes the medical, surgical and anaesthetic aspects of the treatment of patients with diabetes mellitus.
Anaesthesia for abdominal hysterectomy in Charcot-Marie-Tooth disease : a case report
(Health & Medical Publishing Group, 1985) Roelofse, J. A.; Shipton, E. A.
A 44-year-old white woman with Charcot-Marie-Tooth disease underwent an abdominal hysterectomy. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.
Anaesthesia for congenital lobar emphysema resection : a case report
(Health and Medical Publishing Group -- HMPG, 1984-09) Payne, K.; Van Zyl, W.; Richardson, M.
[No abstract available]
Anaesthesia in connective tissue disorders
(Health and Medical Publishing Group -- HMPG, 1985-03) Roelofse, J. A.; Shipton, E. A.
Patients with the more common connective tissue disorders require surgical operations more frequently than has been realized. They may present the anaesthetist with many potential problems. A few minutes of careful questioning and examination pre-operatively may prevent a tragic situation. A history of drug therapy is essential pre-operative information, particularly since many of these patients will need augmentation or coverage with steroid drugs. The anaesthetist must be aware of the patient's general state of health and must search for evidence of pulmonary, cardiac or haematological abnormalities.
Anaesthetic management of cerebral artery aneurysms at Tygerberg Hospital, 1980-1982
(Health and Medical Publishing Group -- HMPG, 1984-05) Erasmus, F. R.; Du Toit, H. J.; Rose-Innes, A. P.
Forty-seven patients were operated on for intracranial artery aneurysms at Tygerberg Hospital, Parowvallei, CP, between January 1980 and December 1982. Problems related to anaesthesia which are peculiar to this condition and the solution thereof are outlined. The importance of meticulous anaesthetic management in the successful recovery of these patients, the majority of whom are young and in the productive phase of their lives, is stressed. A plea is made for increased awareness, early diagnosis and surgical intervention to decrease the high mortality rate associated with this lethal condition.
'Closed circuit' anaesthesia
(Health & Medical Publishing Group, 1974) Foster, P. A.
[No abstract available]
Effect of 1% and 2% propofol on blood lipids during long-term sedation
(Health & Medical Publishing Group, 2002) Coetzee, A.; Blaine, E. M.; Labadarios, D.; Schall, R.; Haus, M.
Objectives. To compare the effects of 1% and 2% propofol on the maximum and average lipid levels, the relative frequency of hyperlipidaemia, the propofol dose required to achieve an equivalent degree of sedation, the pharmacodynamie effects at the required infusion rates, and the effect on respiratory function. Design. Open, randomised, parallel group, multicentre comparison study. Setting. Intensive care units (ICUs) at the Faculty of Medicine, University of Stellenbosch and at Vergelen Medicity, Somerset West. Subjects. Patients who were artificially ventilated for at least 72 hours in the ICUs and who required sedation or analgesia. Outcome measures. Continuous intravenous infusion of 1% or 2% propofol to provide an administration rate in the range of 1 - 4 mg/kg/h. The initial infusion rate was about 2 mg/kg/h, adjusted to achieve the appropriate level of sedation. Results and conclusions. Seventy-five patients were enrolled in the study, of which 72 were evaluable for safety analysis and 58 were evaluable for efficacy analysis. The total daily dose of propofol (ml/day) in the 2% propofol group was about 60% of that in the 1% propofol group, indicating that the lipid load in the 2% propofol group had only slightly more than half the lipid load in the 1% propofol group. Thirteen of 27 patients (48%) int 2% propofol group had abnormally high triglyceride levels compared with 19 of 31 patients (61%) in the 1% propofol group. Similarly, 1 of 22 patients (4%) in the 2% propofol group had lipaemia compared with 4 of 30 patients (13%) in the 1% propofol group. Abnormal cholesterollevels, alveolar-arterial oxygen tension gradient and daily percentage of time with desired sedation were comparable between the two groups. The observed incidence of raised plasma triglyceride concentrations, and of lipaemia, was lower in the 2% propofol group than in the 1% propofol group, although the differences were not statistically significant. The 2% formulation of propofol appears to be as effective and at least as safe as 1% propofol.
Filling pressures of the heart during anaesthesia
(Health & Medical Publishing Group, 1985) Coetzee, A.; Stewart, R. I.; Hattingh, P.
The validity of extrapolating central venous pressure (CVP) to left ventricular (LV) filling pressure as gauged from the pulmonary artery wedge pressure (PAWP) was investigated in 9 subjects undergoing lung resection. Correlations existed between CVP and PAWP before, during and after surgery, and between changes in CVP and PAWP during surgery. There was, however, a wide scattering of the data around the regression lines, and an inability of the CVP and changes therein to predict the actual and directional change in PAWP in specific individuals. Caution is therefore advised in assessing the LV filling pressure from the CVP in patients undergoing lung resection during any phase of the peri-operative period.
The 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.
Methylprednisolone and the adult respiratory distress syndrome
(Open access journal, 1984-06) Du Toit, H. J.; Erasmus, F. R.; MacFarlane, C. M.; Taljaard, J. J. F.; King, J. B.; De Klerk, A. J.; Elk, E.
Total hip replacement was carried out on 22 patients under general anaesthesia. Of these, 10 were pretreated with methylprednisolone (30 mg/kg); 1 of these developed the adult respiratory distress syndrome (ARDS) and had high levels of thromboxane B2 (TXB2) 5 minutes after fixation of the femoral prosthesis and at the end of the operation. The other 12 patients served as controls; 5 of them developed ARDS and had statistically significant higher TXB2 levels than the other 7 control patients who remained well. All patients who did not develop ARDS had low TXB2 levels. TXB2 and β-thromboglobulin levels followed the same trend and there was good correlation (r = 0.6806; P < 0.01) at the end of the operation in the control group patients who developed ARDS. There was no statistical difference in 6-keto-PGF(1α) levels between the patients who developed ARDS and those in the control group who remained well. Steroids reduce arachidonic acid metabolism by inhibiting the release of substrate for cyclo-oxygenase and lipoxygenase activity. Patients prone to ARDS thus benefit from methylprednisolone administration.
Midazolam premedication in paediatric anaesthesia
(Health & Medical Publishing Group, 1986) Payne, K. A.; Heydenrych, J. J.; Kruger, T. C.; Samuels, G.
To investigate the efficacy of midazolam (Dormicum; Roche) as a paediatric premedication, 150 children, aged 6 months - 5 years, were divided into three groups. All three groups spent time with the anaesthetist to allow rapport to be established. Group A received midazolam premedication, group B received oral trimeprazine, droperidol and methadone (TDM) and group C received no sedative medication. Midazolam gave the best behaviour patterns in the holding room. Behaviour at induction was the same in all three groups. The recovery times were similar in the midazolam and unsedated groups, but in the TDM group recovery was significantly delayed. Temperatures remained stable in the unsedated and midazolam groups, but decreased in the TDM group. It is concluded that midazolam is a satisfactory paediatric premedication agent.
Obstruction of a breathing circuit : a case report
(Health & Medical Publishing Group, 1984) Roelofse, J. A.; Shipton, E. A.
Preventable mishaps resulting from human error contribute to anaesthetic risk, as demonstrated in the case report presented. The incidence of anaesthetic-associated deaths has fallen steadily since 1935, and general anaesthesia is now a very safe procedure, provided the anaesthetist takes the requisite precautions.
Peri-operative mortality in the anaesthetic service at Tygerberg Hospital
(Health & Medical Publishing Group, 1992) Coetzee, A.; Du Toit, H.
This study reports on the process of peer review of peri-operative mortality at Tygerberg Hospital. The peri-operative mortality rate for the past 3,5 years was 11,9/10000. The departmental evaluation committee thought that 3,4/10000 of these deaths were anaesthetic-related. In 2,3/10000, the anaesthetic contributed to the death of the patient and in 10 cases (total case load = 94945; i.e. 1,1/10000) anaesthesia was responsible for the death of the patient. The majority of the peri-operative deaths (8,5/10 000) were caused by a combination of trauma and haemorrhagic shock.
Potassium maldistribution revisited
(MedPharm, 2014-11) Pietersen, Justine Mari; Levin, Andrew I.
Background: This study investigated maldistribution of concentrated 15% potassium chloride after injection into one-liter, flexible, Ringer’s lactate bags. Methods: Twenty milliliters of concentrated 15% potassium chloride was injected into suspended, flexible, liter bags of Ringer’s lactate. The potassium was injected by hand, over either four (“fast”) or twenty (“slow”) second periods. The effect of two successive bag inversions on maldistribution was also investigated. A simulated infusion at 600 ml per hour was controlled using a volumetric pump. Sampling occurred at 5-minute intervals for the first 20 minutes and at 10-minute intervals thereafter until 90 minutes. Potassium concentrations were measured using an accurate, calibrated wide range analyzer not requiring specimen dilution. This experiment was repeated once. A duplicate set of experiments was performed with Bonney’s blue dye added to the potassium concentrate. Bonney’s blue distribution was evaluated visually. Results: Significant maldistribution occurred. Maldistribution was not dependent on the injection rate. After 20 to 30 minutes of commencing the infusion, maldistribution resulted in delivery of up to 64 to 85% respectively of the available potassium. Two bag inversions effectively homogenised the solution. The distribution of Bonney’s blue stained concentrated potassium was inconsistent with measured potassium concentrations. Conclusions: In cardiac and other surgery, point of care potassium supplementation is frequently required. Anaesthetists should be cognisant of eliminating not only errors of substitution, but also maldistribution of concentrated potassium. Potassium infusion rates should be controlled, preferably using an electronic infusion controller. Keywords: potassium, hyperkalemia, anaesthesia related death, drug error, maldistribution, layering, complication, preventable, mixing, homogenization, mortality, magnesium, dye, indicator, mistake
Should we pre-oxygenate?
(Health & Medical Publishing Group, 1981) Erasmus, F. R.; Murray, W. B.
The importance of routine pre-oxygenation before induction of anesthesia was demonstrated in animals. The onset of dangerous levels of hypoxia after the administration of suxamethonium can be delayed considerably by the administration of pure oxygen for 5 minutes before induction. This allows time for an atraumatic and panic-free intubation before controlled ventilation. After pre-oxygenation the volume of oxygen in the functional residual capacity of the lungs shows a sixfold increase. This is the principal oxygen stored during apnea.
Die 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.

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