Masters Degrees (Anaesthesiology and Critical Care)

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    The self-reported prevalence of mehylphenidate use by Maste of Medicine (MMed) students registered at a South African university
    (Stellenbosch : Stellenbosch University, 2022-04) Louw, Willem Andries Nienaber; Davids, Ryan Alroy; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anesthesiology and Critical Care.
    ENGLISH ABSTRACT: Background. Methylphenidate is mainly used for the treatment of attention-deficit hyperactive-disorder (ADHD). Its effect of increased attentiveness leads to the potential of off-label use by students for academic enhancement - previously demonstrated in undergraduate students. No publication exists on postgraduate student use of methylphenidate. Objectives. To provide a summary of the self-reported prevalence and correlates of methylphenidate use in Masters of Medicine (MMed) students registered at the Faculty of Medical and Health Sciences of a South African university. Methods. A cross-sectional study was conducted. Data was collected via a self-administered anonymous online questionnaire distributed by email to 505 registered MMed students. Results. Of the 253 responses (response rate 50.1%) received 71 (28.1%) have used methylphenidate. Only 2.4% have been diagnosed with ADHD. The majority (73.2%) obtained it without a formal medical consultation. Self-prescription (26.8%) and prescription by a colleague without consultation (23.9%) contributed significantly. Academic performance enhancement was the primary motivation for use in 71.8% and 42.3% of users started using methylphenidate while registered as an MMed student. There was no statistically significant difference in terms of gender (p=0.151), age (p=0.288) or year of study (p=0.149). Conclusions. Off-label use of methylphenidate is prevalent in MMed students registered at this South African university. The prevalence is significantly higher than in undergraduate medical students. The non-conventional means of access is of great concern. Efforts should be made to discourage self-prescription, educate students on the dangers of methylphenidate use, promote better access regulation and enhance psychological support.
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    Effect of a carbohydrate lollipop on the gastric volume of fasted pediatric patients
    (Stellenbosch : Stellenbosch University, 2022-05) Odendaal, Pieter Schalk; Burke, Annemie; Coetzee, Johan; Burke, Annemie
    ENGLISH ABSTRACT: Background: Preoperative fasting is part of routine practice. Children subjected to prolonged preoperative fasting often suffer adverse effects. Consuming a preoperative lollipop may lessen their anxiety and have clinical benefits. Aims: To assess the effect of consuming a lollipop on gastric volume and the feasibility of administering a lollipop to a child preoperatively. Methods: In this prospective, repeated measures interventional study, we measured gastric antrum volume using ultrasound in children aged 2-18 years. We measured antrum volumes after participants had fasted for a minimum of six hours for solids and two hours for clear fluids. They then consumed a standard carbohydrate lollipop, and we repeated the antrum volume measurements after one hour. Results: Of the 38 patients enrolled, 32 completed the study; four had ingested additional food or liquid, and two were diagnosed with systemic disease the day after data collection. The gastric volume data were normally distributed. The mean volume change was 0.01 (95% CI -0.02 to 0.05; p = 0.460). The mean post-lollipop volume was 0.51 ml/kg (95% CI 0.43 to 0.58). Conclusions: Consuming a standard lollipop did not affect the gastric volume of fasted pediatric patients.
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    The Prevalence of Propofol Contamination in the Tygerberg Theatre Complex
    (Stellenbosch : Stellenbosch University, 2020-12) Drude, Carmen; Johnson, Marianne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthesiology and Critical Care.
    ENGLISH ABSTRACT: Propofol is a widely used intravenous anaesthetic agent. Soon after its introduction into the market, propofol-related postoperative infections were reported. It was determined that the emulsion supports growth and manufacturers provided strict aseptic guidelines with regards to propofol usage, but it has been shown that clinicians in South Africa do not adhere to these guidelines. The primary objective of our observational study was to determine the prevalence of contamination of syringes containing propofol (Fresenius’ Propoven® 1%, Fresenius Kabi, Sweden) in the Tygerberg Hospital Theatre Complex. Samples of syringes containing propofol were collected from various randomised operating theatres over a period of 15 days and specimens cultured and tested for growth of organisms. The secondary objective was to differentiate between contamination occurring in e mergency and elective surgery operating theatres and investigate the difference in propofol contamination when used by junior versus more senior anaesthetists. We demonstrated an unacceptably high propofol contamination prevalence of 41.8% (95% CI: 32.5%, 51.6%). Coagulase negative staphylococcus (CONS) was the most prevalent organism. Overall, 58.18% of samples demonstrated no growth after 2 days. Regarding our secondary objective, there was no statistically significant difference regarding the prevalence of propofol contamination of samples taken from the emergency and elective operating theatres (p = 0.95; risk ratio 1.02; 95% CI: 0.55; 1.89). Propofol syringes handled by senior versus junior anaesthetists revealed a similar result (p = 0.65; risk ratio 0.90; 95% CI: 0.58; 1.41). CONS are often contaminants and the bulk of organisms we cultured are non-pathogenic in healthyhosts but can be lethal in immunocompromised patients. Presence of commensals is also a warning that any other pathogens (including viruses) that may be present on the anaesthetist’s hands or in the environment may also contaminate the propofol. The presence of human commensals as well as environmental organisms in the propofol syringes are avoidable and a zero-contamination rate should be aspired to in all interactions with patients.
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    Reassessment of acute postoperative pain in a resource limited burns unit after the implementation of an analgesic management plan
    (Stellenbosch : Stellenbosch University, 2017-12) Greyling, Adriaan Johann; Senekal, A. C.; Murray, A. A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthesiology and Critical Care.
    ENGLISH ABSTRACT: Background Tygerberg Academic Hospital is the referral centre for all major burn wounds in adult patients in the Western Cape. Patients who underwent surgery for burns related injuries at Tygerberg Academic Hospital were identified as having a high incidence of moderate to severe postoperative pain in an audit done in 2012 when there was no fixed protocol for postoperative analgesia.1 In an attempt to reduce the incidence of moderate to severe postoperative pain, the Department of Anaesthesiology and Critical Care at Tygerberg Academic Hospital introduced a new postoperative analgesia protocol in the burns unit in November 2016. This is, according to our knowledge, the first unit in Tygerberg Academic Hospital where pain scores were introduced as part of routine vitals. Methods A five month interval after the introduction of the new protocol was allowed before an audit of patients’ pain experience was commenced. A sample of 64 patients that underwent burns related surgery was evaluated. Patients were asked to indicate on a printed visual analogue scale (VAS) the worst pain experienced in the first 24 hours postoperatively, as well as the amount of pain experienced at the time of the interview at 24 hours postoperatively. These values were compared to the data collected during the audit of 2012 to establish whether any improvement had been made. We considered a reduction in median VAS score of at least 18mm to be significant. Results In this study we could not prove a statistically significant difference between the control group of Murray and Retief from 2012 and the post-intervention group of 2017 in terms of pain outcome.
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    Postoperative pain assessment : a review of nursing practices at Tygerberg Academic Hospital
    (Stellenbosch : Stellenbosch University, 2018) Dippenaar, Petrus Johannes; Naidoo, R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthesiology and Critical Care.
    ENGLISH ABSTRACT: Pain is a complex, subjective, physical and emotional experience with large individual variation. Murray et al has estimated a prevalence of 62% of severe postoperative pain in Tygerberg Academic Hospital Surgical Wards (TAHSW). Efficient pain management stems from accurate pain assessment. Cultural influences and level of education determines patients’ willingness and ability to disclose the pain experience, as well as the health care provider’s ability to accurately assess it. Nurses with a greater level of training and experience tend to acknowledge self-report of pain to establish the existence of pain, but use objective parameters to determine intensity. Pain rating scales should be used to grade intensity of pain, as this is the easiest dimension to delineate. Acute pain has recently been regarded as the “fifth vital sign”, and routine assessment has created greater awareness of pain. Unfortunately, the lack of proper management protocols, has resulted in an increase in the inappropriate administration of opioid analgesics with an increased incidence of postoperative respiratory depression. Level of sedation secondary to opioid administration correlates with the risk of apnoea. Respiratory depression mostly occurs at night during the first 24 hours, due to lack of proper monitoring. Nurses need to be trained to recognise the danger signs of opioid induced respiratory depression.