The incidence of perioperative critical events in paediatric patients at a Johannesburg academic hospital
Critical events in anaesthesia are defined as events requiring immediate intervention to prevent major disability or death. Critical events in anaesthesia are not uncommon, and care should be taken to avoid critical events in the vulnerable paediatric population to avoid morbidity and mortality.
Comparison between intra-arterial and two non-invasive blood pressure measuring systems: a cross-sectional analytic study employing Bland–Altman and error grid analyses
Arterial blood pressure is a critical physiological variable clinicians use for clinical decision-making and as a guide to therapy. Direct intra-arterial blood pressure (invasive blood pressure, invasive-BP) measurements provide continuous, beat-to-beat monitoring and are regarded as a “gold standard”, provided there are no artefacts. Many intra-arterial measuring systems have low natural frequencies and inadequate damping, resulting in inaccurate measurements, especially systolic arterial pressures (SAP). Resonance artefacts are also greater at faster heart rates. Inaccuracies also result from overdamping due to constrictions in the fluid line, for example, by fibrin deposits. Recommendations include regularly performing the “fast flush” test to determine the system’s dynamic responses. In clinical practice, measuring natural frequencies and damping ratios are seldom feasible because few monitors are equipped with strip chart recorders, and it is inconvenient and time-consuming in a busy clinical setting. Visual inspection of the response to a fast flush, although widely practised, is unreliable, except for identifying attenuation by a severely overdamped system or “ringing” in a recognisably underdamped system.
Disease spectrum and short-term outcomes of obstetric patients with cardiac disease admitted to an obstetric critical care unit in South Africa
Cardiac disease in the obstetric population differs between high-income countries (HICs), upper middle-income countries (UMICs), and low- to middle-income countries (LMICs). Whereas congenital heart disease predominates in HICs, rheumatic heart disease tends to predominate in LMICs and some UMICs, such as Brazil. The relative prevalence of congenital and rheumatic heart disease is quite variable in UMICs. The aforementioned prevalence is relatively similar in the Philippines, whereas limited information from a single tertiary hospital in South Africa (SA) suggests that congenital heart disease is predominant. Although SA is classified as an UMIC, there are many resource-limited environments outside the tertiary referral centres.
Anaesthetists’ knowledge and practice of environmentally sustainable anaesthesia in an academic department of anaesthesiology
Climate change is one of the leading threats to humanity’s long-term sustainability. Although not often considered a significant contributor to emissions, the healthcare sector is one of the largest producers of greenhouse gas (GHG) emissions, one of the leading drivers of climate change. Anaesthesia, through its use of inhalational anaesthetic gases (IAGs), intravenous agents, disposable equipment, consumables, and cleaning and sterilisation of reusable equipment, contributes heavily to the impact of the overall healthcare sector on the environment.
Southern African Journal of Anaesthesia and Analgesia - September/October 2024 Vol 30 No 5