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This paper outlines how individual collections of books and equipment donated to the University of Cape Town Department of Anaesthesia and Perioperative Medicine developed into the national asset that the Nagin Parbhoo History of Anaesthesia Museum now represents. From the humble beginnings of collections of donated books and early equipment, the article describes how the museum evolved into its present form. The contributions made by many individuals over the last hundred years to this remarkable display of historical artefacts is described.

This paper provides a brief history of the Nagin Parbhoo History of Anaesthesia Museum housed in the University of Cape Town Department of Anaesthesia and Perioperative Medicine and introduces readers to the contents of the museum. Artifacts are contextualised and demonstrate the vast changes that have taken place in the specialty from the early days of ‘rag and bottle’ anaesthesia in the 1840s to the present. The role of a medical museum in preserving the history of the specialty, encouraging research and in using artifacts to teach physical principles relating to anaesthetic equipment is discussed. A follow-up paper will document the history of the museum.

BACKGROUND: Trauma-induced coagulopathy (TIC) is a major contributing factor to worsening bleeding in trauma patients. The objective of this study is to describe the spectrum of coagulation profiles amongst severely injured patients METHODS: This is a retrospective study of all patients with complete baseline TEG coagulation parameters collected prior to randomisation in the FIRST (fluids in resuscitation of severe trauma) trial between January 2007 and December 2009. Parameters recorded for this study included patient demographics, mechanism of injury, admission vital signs, lactate, base excess, coagulation studies prothrombin time (PT), international normalised ratio (INR), thromboelastography (TEG) parameters, volume, and type of fluids administered, volume of blood products administered, length of intensive care unit (ICU) stay and major outcomes RESULTS: A total of 87 patients were included in this study, with a median injury severity score (ISS) of 20 and 57.5% had a penetrating injury mechanism. Coagulopathy was highly prevalent in this cohort, of which a majority (69%) was diagnosed with hypercoagulopathy and 24% had a hypocoagulopathy status on admission. There was no difference in age, gender and amount of pre-hospital fluids administered across the three groups. The median volume of blood products was higher in the hypocoagulopathy group, although not statistically significant. Overall, the 30-day mortality rate was 13%, with case fatalities occurring in only coagulopathic patients: hypercoagulopathy (15%) and hypocoagulopathy (10% CONCLUSION: TIC is not an infrequent diagnosis in severely injured patients resulting in increased morbidity and mortality. Determining the coagulation profile using TEG at presentation in this group of patients may inform appropriate management guidelines in order to improve outcome

Background Buffered intravenous fluid preparations contain substrates to maintain acid-base status. The objective of this systematic review was to compare the effects of buffered and non-buffered fluids administered during the perioperative period on clinical and biochemical outcomes. Methods We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library until May 2017 and included all randomised controlled trials that evaluated buffered versus non-buffered fluids, whether crystalloid or colloid, administered to surgical patients. We assessed the selected studies for risk of bias and graded the level of evidence in accordance with Cochrane recommendations. Results We identified 19 publications of 18 randomised controlled trials, totalling 1096 participants. Mean difference (MD) in postoperative pH was 0.05 units lower immediately following surgery in the non-buffered group (12 studies of 720 participants; 95% confidence interval (CI) 0.04 to 0.07; I 2 = 61%). This difference did not persist on postoperative day 1. Serum chloride concentration was higher in the non-buffered group at the end of surgery (10 trials of 530 participants; MD 6.77 mmol/L, 95% CI 3.38 to 10.17). This effect persisted until postoperative day 1 (5 trials of 258 participants; MD 8.48 mmol/L, 95% CI 1.08 to 15.88). Quality of this evidence was moderate. We identified variable protocols for fluid administration and total volumes of fluid administered to patients intraoperatively. Outcome data was variably reported at disparate time points and with heterogeneous patient groups. Consequently, the effect size and overall confidence interval was reduced, despite the relatively low inherent risk of bias. There was insufficient evidence on the effect of fluid composition on mortality and organ dysfunction. Confidence intervals of this outcome were wide and the quality of evidence was low (3 trials of 276 participants for mortality; odds ratio (OR) 1.85, 95% CI 0.37 to 9.33; I 2 = 0%). Conclusions Small effect sizes for biochemical outcomes and lack of correlated clinical follow-up data mean that robust conclusions on major morbidity and mortality associated with buffered versus non-buffered perioperative fluid choices are still lacking. Buffered fluid may have biochemical benefits, including a significant reduction in postoperative hyperchloraemia and metabolic acidosis.

Background: Commercially available crystalloid solutions used for volume replacement do not exactly match the balance of electrolytes found in plasma. Large volume administration may lead to electrolyte imbalance and potential harm. We hypothesised that haemodilution using solutions containing different anions would result in diverse biochemical effects, particularly on acid-base status, and different outcomes.\ud \ud Methods: Anaesthetised, fluid-resuscitated, male Wistar rats underwent isovolaemic haemodilution by removal of 10% blood volume every 15 min, followed by replacement with one of three crystalloid solutions based on acetate, lactate, or chloride. Fluids were administered in a protocolised manner to achieve euvolaemia based on echocardiography-derived left ventrical volumetric measures. Removed blood was sampled for plasma ions, acid-base status, haemoglobin, and glucose. This cycle was repeated at 15-min intervals until death. The primary endpoint was change in plasma bicarbonate within each fluid group. Secondary endpoints included time to death and cardiac function.\ud \ud Results: During haemodilution, chloride-treated rats showed significantly greater decreases in plasma bicarbonate and strong ion difference levels compared with acetate- and lactate-treated rats. Time to death, total volume of fluid administered: chloride group 56 (3) ml, lactate group 62 (3) ml, and acetate group 65 (3) ml; haemodynamic and tissue oxygenation changes were, however, similar between groups.\ud \ud Conclusions: With progressive haemodilution, resuscitation with a chloride-based solution induced more acidosis compared with lactate- and acetate-based solutions, but outcomes were similar. No short-term impact was seen from hyperchloraemia in this model.

No Abstract. Keywords: context-sensitive fluid administration, fluid therapy, benefits, harm

No Abstract. Keywords: regional techniques, safety, drug toxicity, sharp trauma, blunt trauma, stretch injury, nerve ischaemia

Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressure control must be allowed, and there is no place for sudden “cosmetic” correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management.Keywords: hypertension, anaesthesia, risk

An audit of anaesthetic records was performed to determine the rate of completion and adequacy of such records. Less than one third of all records was complete and legible. In one quarter of all anaesthetics, no record of any kind was made. The remaining 45% were all incomplete or illegible in some or all respects. It is concluded that the standard of record-keeping in this random sample falls far short of the minimum acceptable standard.Keywords: Anaesthesia, Anaesthetic records, Medicolegal.

We compared heart rate and blood pressure changes to intubation produced by conventional laryngoscopic-guided intubation to thoseproduced by blind intubation through the intubating laryngeal mask (ILM) in normotensive adults with normal airways. Forty paralysed, anaesthetised adults undergoing elective surgery were randomly assigned to one of two groups : 1.Blind intubation through the ILM using a straight silicone tracheal tube manufactured for specific use with the ILM; 2. Intubation with a size 3 macintosh laryngoscope using a polyvinyl chloride tube. Intubation success rate, number of intubation attempts, time to intubation were recorded. Heart rate and non-invasive blood pressure preinduction, preintubation and at one minute intervals after intubation until ten minutes post intubation were recorded. The intubation success rate was 90%(68% first attempt)for the ILM group and 100%(all first attempt)for the laryngoscopic group. Time to successful intubation was longer (50 vs 22s) and more intubation attempts were required in the ILM group (p

No Abstract Available. Southern African Journal of Anaesthesia & Analgesia Vol. 11 (3) 2005: 103-106

No Abstract Available Southern African Journal of Anaesthesia & Analgesia Vol.11(2) 2005: 68-72