Masters Degrees (Anaesthesiology and Critical Care)

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Browsing Masters Degrees (Anaesthesiology and Critical Care) by browse.metadata.advisor "Coetzee, Andre"

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    Central oxygen pipeline failure
    (Stellenbosch : Stellenbosch University, 2014-04) Mostert, Lelane; Coetzee, Andre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthesiology and Critical Care.
    ENGLISH ABSTRACT: Case Report - A case is described of central oxygen pipeline failure that occurred at a large academic hospital and its subsequent implications for managing the situation. Literature review - The literature review undertaken focused on the current state of affairs with regards to anaesthetic staff's knowledge of and preparedness for the management implications of central oxygen pipeline failure. The events I describe below demonstrate a significant deficiency in the staff’s understanding of and training for the crisis, which should be remedied to improve patient safety. Specific measures are suggested in the literature to prevent such incidents and guidelines are available to manage central oxygen pipeline failure. These are reviewed in this study. Recommendations - This study attempts to bring together the most critical aspects that need to be addressed to safely manage similar future incidents. Prevention should include measures to implement clearly stated disaster management plans and increased awareness with regards to the medical gas pipeline system (MGPS), simulation training, efficient alarm systems, personally conducted routine evaluations of equipment and emergency backup systems by anaesthesiologists and effective communication between hospital staff. Careful planning and successful coordination during maintenance and modification of the medical gas pipeline system, using piston-type or air-driven, rather than oxygen-driven, ventilators and optimal design of the hospital bulk oxygen system can contribute to reduce risks. In the event of central oxygen pipeline failure a specific sequence of actions should be taken by the anaesthesiologist and a clear institutional operational policy is described.
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    Die effek van lignokaien op segmentele miokardiale funksie in die oop borskas isgemiese varkhart onder algemene narkose
    (Stellenbosch : Stellenbosch University, 1991-12) Moolman, Johannes, Albertus; Coetzee, Andre; Stellenbosch University. Faculty of Medicine and Health Sciences. Department of Anaesthesiology and Critical Care.
    AFRIKAANSE OPSOMMING: Die effek van lae (1 mg/kg) en hoe (4mg/kg) bolusse intraveneuse lignokaYen op regionale funksie is ondersoek in 13 varkharte. Deur middel van 'n betekenisvolle vernouing van die linker afdalende koronere (LAD) arterie is 'n isgemiese segment in die LAD voorsienings gebied veroorsaak. Miokardiale funksie is bepaal in die isgemiese LAD-gebied en die normals voorsienings gebied van die sirkumfleks (Lx) koronere arterie. Konstriksie van die LAD het miokardiale isgemie in die LAD-segment veroorsaak sender om sistoliese disfunksie te induseer. lsgemie ge'lnduseerde diastoliese disfunksie blyk uit die toename in helling van styging in linker ventrikel druktoename · (df) (p<0.05), persentasie toename in postsistoliese verkorting (PSS) (p<0.02), afname in effektiewe verkortingsarea van die LAD-segment (p<0.05), afname in Pv02 van die dreinerende vene van die LAD-gebied (p<0.05) en toename in korone,re veneuse laktaat vanaf die isgemiese gebied. Die graad van isgemie wat veroorsaak is het nie sistoliese segmentele kontraktiele funksie be'lnvloed nie - geen verandering in die persentasie verkorting van die LAD-segment se spiervesels is aangetoon nie. Lignoka'!'en het geen beduidende invloed op miokardiale funksie gehad nie, hetsy globaal of regionaal. Die geringe afname in hartspoed en slagvolume het nie 'n betekenisvolle vermindering in die kardiale omset veroorsaak nie en geen betekenisvolle styging in eind-diastoliese druk het plaasgevind nie. Beide bg. bevindings is in teenstelling met bevindings van ander outeurs (Gee 1990, Klein 1968, Nath 1986). Regionale funksie het nie hipokinese by die terapeutiese plasma . konsentrasies van die middels soos bereik in die eksperiment getoon nie - Ees het nie paradoksaal toe geneem , en D0, die snypunt van Ees met die lengte-as, het nie na regs geskuif nie. Diastoliese funksie van beide die isgemiese en normals miokardiale segments het geen disfunksie getoon na lignokaYen toediening nie. Die maksimale vesellengte by eind-diastolie, helling van diastoliese vulling en post-sistoliese verkorting het nie verander nie. Die invloed van lignoka'ien op die koronere vloei kan slegs by afleiding evalueer word, aangesien koronere vloei nie direk bepaal is nie. Die area onder die druk-lengte kurwe, wat 'n indirekte parameter van segmentele werk is, het nie verander met toenemende dosisse lignokai'en nie. Dit dui op 'n onveranderde miokardiale suurstof verbruik van die LAD- en Lx-segment. Die effektiewe verkortingsarea, wat meer sensitief as die totale area onder die • druk-lengte kurwe is vir veranderinge in koronere bloedvloei (Safwat 1991), het eweneens onveranderd gebly wat die feit ondersteun dat lignoka'ien nie die miokardiale suurstof verbruik verminder het nie. Laktaat metabolisme as indirekte parameter van miokardiale isgemie het geen betekenisvolle veranderinge na die toediening van lignoka'ien getoon nie, soos ook weerspieel word deur die afwesigheid van 'n korrelasie tu~sen koronere veneuse laktaat en serumvlakke van lignoka'ien (korrelasie koeffisient = -0.32). Die kliniese ekwivalent van die situasie wat hier ondersoek is, is die. pasient . met 'n betekenisvolle koronere stenose en meegaande miokardiale isgemie wat 'n disritmie ontwikkel wat behandel moet word. Die belang van hierdie studie is dat bewys is dat lignokaren geen betekenisvolle effek op isgemiese miokardium gehad het by terapeutiese serumvlakke lignokai'en nie. Die bekende hoe terapeutiese indeks van die middel in nie-isgemiese miokardium word weereens bevestig. Die resultate van hierdie studie sal in gedagte gehou moet word by die gebruik van nuwe anti-aritmiese middels, en die klinikus sal moet kan verantwoord of die nuwe middels hierdie bekende ou middel in veiligheid, effektiwiteit en koste-effektiwiteit oortref.
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    Intra-articular bupivacaine : a literature review including a pilot study investigating the safety of intra-articular bupivacaine to chondrocytes
    (2015-12) Van der Merwe, Willem Jacobus; Firfiray, L.; Coetzee, Andre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anesthesiology and Critical Care.
    ENGLISH ABSTRACT: Background: Today, intra-articular bupivacaine injections are common practice, with very good analgesic effects. This method of analgesia is utilized by general practitioners, orthopedic surgeons and anesthesiologists. Unfortunately, since 2004, more than 200 cases of chondrolysis were noted following intra-articular bupivacaine infusion. Numerous studies have investigated the safety of intra-articular bupivacaine. The aim of this thesis was to quantify the risk of chondrolysis with intra-articular bupivacaine and to guide medical practitioners in safe practice. Methods: A literature review was done of the most recently published original research, meta-analysis and review articles. Adverse outcomes were mostly associated with bupivacaine infusions, rather than with single intra-articular doses of bupivacaine. Limited data on the safety of a single dose of intra-articular bupivacaine was found. We conducted a pilot study to investigate the safety of a single dose of intra-articular bupivacaine. A paired, case-controlled, experiment was done using four merino sheep. The nul hypothesis was that a single dose of intra-articular bupivacaine did not cause chondrolysis when compared with a dose of intra-articular normal saline. Our results were added to the thesis to further quantify the risk. Results: Numerous in vitro and in vivo studies confirmed that bupivacaine is chondrotoxic. The chondrotoxic effect is time, dose and concentration dependent. Our pilot study revealed that single dose intra-articular bupivacaine may also be unsafe for chondrocytes. Conclusion: The administration of intra-articular bupivacaine is toxic to chondrocytes. The chondrotoxic effect of intra-articular bupivacaine is time, dose and concentration dependent. Infusions of intra-articular bupivacaine should be contra-indicated. From the limited data available on single dose intra-articular bupivacaine, it appears that it is also chondrotoxic. Magnesium, morphine and clonidine may be safer for intra-articular use, but this needs further investigation.