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This paper reviews the history of the College of Anaesthetists of South Africa (CASA), starting with the establishment of the College of Physicians and Surgeons of South Africa (CPSSA), the subsequent formation of the Faculty of Anaesthetists as part of the College of Surgeons of South Africa (FFACSSA), to its present form as the CASA. This review includes major milestones achieved over the years, including international recognition, key role players involved, development of examinations, medals and awards given as well as individuals honoured by the CASA. [ABSTRACT FROM AUTHOR]

The informal poultry and pig sector in the Eastern Cape Province (ECP) of South Africa is of significant socio-economic importance as it sustains livelihoods and ensures food security; yet little is known about the distribution and prevalence of infectious and zoonotic diseases in this region. This paper reviews data published for pig and poultry diseases in the province during the last 20 years (2000–2020). The review included relevant published papers identified by a computerised literature search from Web of Science; provincial animal health reports; the national database from the Department of Agriculture, Land Reform and Rural Development (DALRRD); animal health reports submitted by DALRRD to the World Organisation for Animal Health (OIE) via the World Animal Health Information Database (WAHID) interface and laboratory records. A publication was considered eligible if it included qualitative or quantitative information on any disease affecting pigs and poultry including zoonosis. The search retrieved 174 publications, of which 26 were relevant. The review found that Newcastle disease (ND), coccidiosis and fowl pox (FP) were the most reported avian diseases in the national database, whereas avian infectious bronchitis (AIB), ND and highly pathogenic avian influenza (HPAI) were the most reported diseases in the OIE database. Classical swine fever (CSF) was the most reported pig disease in both databases. The retrieved literature on pig and poultry diseases was scarce and no longer up to date, providing decision makers with little information. The review identified important zoonotic diseases that require further studies yet failed to find information on important neglected diseases like leptospirosis. [ABSTRACT FROM AUTHOR]

Historically, feline infectious peritonitis (FIP) has been considered almost invariably fatal. The recent COVID-19 pandemic has fuelled research in coronavirus pathophysiology and treatment. An unintended consequence is that we now have an effective treatment accessible for FIP. This paper reports on the successful resolution of immunohistochemistry-confirmed effusive FIP in an adolescent cat in South Africa following monotherapy with remdesivir at 4.9–5.6 mg/kg daily for 80 days. [ABSTRACT FROM AUTHOR]

Background: In South Africa, the doctrine of informed consent (introduced by the South African courts, Cape Provincial Division) dictates that all reasonable patients be told of material risks and alternative options before consenting to medical treatment or procedural interventions. The reasonable patient standard requires that a patient be told of all material risks that would influence a reasonable person in determining whether or not to consent to the treatment. Regional anaesthesia, including peripheral nerve blocks (PNBs), provides a plethora of benefits to patients undergoing surgery but, due to potential risks involved, also requires informed consent. Studies have shown that South African anaesthetists do not regularly obtain adequate informed consent for these procedures. We implemented a quality improvement project to facilitate and enhance documented informed consent in our setting. Methods: A prospective quality improvement project was established at Groote Schuur Hospital, Cape Town, including all PNBs performed in two-week blocks before and after the introduction of a standardised regional anaesthesia informed consent form. The primary outcome, comparing the incidence of documented informed consent between the two groups, was assessed with the McNemar's test for differences in proportions. Regression analysis was used to explore the effect of prespecified confounders (such as documented consent taken, benefits discussed, alternatives discussed, complications discussed and whether autonomy was documented). Results: In total, 39 and 43 patients were included in the pre- and post-intervention groups, respectively. In our setting, anaesthetists were 4.16 times (95% confidence interval (CI) -6.67 to -2.98, p < 0.001) more likely to take documented informed consent when provided with a standardised form. The incidence of documented informed consent improved from 7.7% to 60.5%. Regression analysis showed that these confounders influenced the recall of the PNB consent and discussed benefits and complications. Overall, recall was mostly influenced when benefits were discussed with patients (95%CI -20.023 to -14.64, p < 0.001). Conclusion: Documentation of informed consent for PNBs in our setting is poor. A standardised consent form can facilitate the documentation of consent significantly. Patient recollection of the consent process also improved, specifically when benefits were discussed. [ABSTRACT FROM AUTHOR]

Background: Preoperative anxiety potentially results in perioperative anaesthetic complications. This study aimed to determine the prevalence of preoperative anxiety in adult patients scheduled to undergo elective orthopaedic surgery at an academic hospital in South Africa and identify contributory factors. Methods: This cross-sectional study included all patients scheduled for elective orthopaedic surgery the following day from 25 July to 3 November 2021. An adapted version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. Four questions determined the patients' anxiety and two questions their desire for more information about their forthcoming anaesthesia and surgery. A 5-point Likert scale was used to capture the patients' responses to the APAIS questions. Data on other possible contributory factors to preoperative anxiety were collected using a questionnaire. Results: Of the 88 patients, 82 (93.2%) were included in the study. A total of 40 (48.8%) patients had an APAIS score of = 11, indicating anxiety. A high need-for-information score (= 8) was found in 31 (37.8%) patients. A significant association between patients with a higher anxiety score and a higher need-for-information score (p = 0.0063) was identified. Other non-significant factors associated with a higher anxiety score included a lower level of education and no postoperative home support. Conclusion: Patients with a high need for information tended to be more anxious on the day before surgery. The APAIS could be introduced in preoperative ward admissions to identify these patients and provide an appropriate level of counselling about their planned procedure. Counselling might reduce their preoperative anxiety, but further research needs to confirm this assertion. Larger studies are recommended to determine the influence of other factors contributing to preoperative anxiety. [ABSTRACT FROM AUTHOR]

Background: Perioperative bleeding contributes significantly to patient morbidity and mortality while the cost of blood products is substantial. Viscoelastic testing (VET) forms part of the armamentarium for perioperative patient blood management. To date, there is a lack of published literature on the knowledge, attitudes, and practices (KAP) of medical practitioners regarding VET. The objective of this study was to describe the KAP of South African anaesthesiology registrars concerning perioperative point-of-care (POC) VET. Methods: A descriptive, cross-sectional study design was performed using a novel, electronic self-administered questionnaire as the data collection instrument. The study population consisted of South African anaesthesiology registrars who were part of the South African Society of Anaesthesiologists' (SASA) electronic mailing list. Results: A total of 71 completed questionnaires were received (response rate = 16.67%). Based on this, 69% of registrars were found to have adequate knowledge. Senior registrars were more likely to have adequate knowledge than junior registrars (p = 0.043). Of the registrars, 64.7% had a positive attitude score towards perioperative VET. All registrars felt they would benefit from a formal education platform on VET. The overall median self-rated confidence score for interpreting VET results was 6/10. Senior registrars had a higher median self-rated confidence score (6 vs 5) compared to junior registrars (p = 0.005). Registrars stated that a lack of VET consumables and trained technologists to administer the test was the greatest barrier to requesting VET for patients at their respective institutions. Conclusion: Overall knowledge scores were encouraging, however, there is room for improvement, particularly at the junior registrar level. Targeted educational interventions should be implemented at both a local and national level. The lack of national guidelines should be addressed by a multidisciplinary team. Locally developed guidelines can serve as a tool for improving registrar knowledge on the subject of VET and can be used for improving uniformity in practices and standards across the various registrar training circuits in South Africa. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is becoming part of the standard skill set of the modern-day anaesthetist. There is limited knowledge regarding the availability of ultrasound (US) and POCUS skills in South Africa. There may be barriers to adopting US in many institutions. Methods: An observational cohort questionnaire was distributed via an online REDCap survey. All doctors practising anaesthesia in South Africa were eligible. Recruitment was done via an email link that was sent to South African Society of Anaesthesiologists (SASA) members. Non-SASA members were recruited via departmental mailing lists or social media. Results: Of the 580 respondents, 478 were SASA members (response rate 22.9%, confidence interval 3.94) and 102 were non- SASA members. In total, 571 surveys were suitable for analysis, 397 (69.5%) respondents had more than five years anaesthesia experience, 558 (97.7%) of respondents worked in hospitals that have US machines available, and 76.7% had US readily available after hours. Respondents used US mostly for central venous catheter (CVC) insertions (77.9%), regional anaesthesia (82.3%), and cardiac and lung assessments (26.4% and 17.7%, respectively). It is used much less frequently for neuraxial anaesthesia (1.4%). Of the respondents, 382 (66.9%) had received US training, only 198 (34.7%) felt confident in their US skills, and 482 (84.4%) wish to have further US training. The two most significant barriers to US were lack of equipment and lack of training at postgraduate level. Conclusion: South African anaesthetists work at institutions where US equipment is generally available, and most practitioners want to incorporate US in their practice. However, anaesthetists feel insecure with respect to their skills and indicated that they wish to receive further training. Efforts should be made to formalise POCUS training in the Fellowship of the College of Anaesthetists (FCA) curriculum and make US training more accessible. [ABSTRACT FROM AUTHOR]

The article presents a study which found that anaesthetists have suboptimal knowledge of the law, with specific reference to informed consent for surgery, which is pivotal to their work.