Browsing by Author "Alphonsus, Christella"

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    Anesthesia care task sharing a clinical audit for the anesthesia care provided by anesthesia technologists in Wad Medani,Central Sudan
    (2025) Mohamed, Alaa; Alphonsus, Christella; Mahjoub, Sami
    Introduction: The bachelor's degree in anaesthesia sciences program was implemented in Sudan in 1998 to alleviate the shortage of anaesthesiologists while minimizing the anaesthesia related complications of anaesthesia technicians' practice. In the absence of a defined scope of practice and a lack of financial and legal protection, practitioners are leaving their anaesthesia technology careers in Sudan in search of more secure careers, which has resulted in a noticeable gap in anaesthesia practice in Wad Medani, Gezira State. This study was conducted to determine the proportion of anaesthesia care tasks that were carried out by the anaesthesia technologists at four public referral hospitals in Wad Medani, Sudan. Methods: The study was a three-month cross-sectional observational clinical audit of anaesthetic services at four Gezira State Ministry of Health tertiary referral hospitals and included a number of 1559 patients. Data was gathered to describe the perioperative anaesthetic care tasks provided to surgical patients undergoing emergency or elective procedures through a questionnaire that was designed based on the definition of the American Society of Anaesthesiologists of the anaesthesia care tasks. The study began on November 3rd, 2022, and lasted three months, ending on February 2nd, 2023. Results: The analysed data showed an average of 18 cases per day. Out of the total 1559 surgical anaesthesia cases in Wad Medani, 718 (46%) of cases were carried out by anaesthesia technologists without the presence of supervising anaesthesiologists. A percentage of 65.2 of these cases were spinal anaesthesia while general anaesthesia and sedation comprised 25.6% and 9.2% respectively. In the presence of supervising anaesthesiologist, anaesthesia technologists performed over 80% of the anaesthesia care tasks. Conclusions: Anaesthesia technologists make a substantial contribution to Anaesthesia services in Wad Medani. Our results demonstrated that a considerable proportion of Anaesthesia procedures are carried out without any kind of anaesthesiologists supervision. Guidelines and protocols should be developed and implemented to govern anaesthesia practice given the resource constraints in this setting. Regular training on safe anaesthesia practice should be applied. Further research is needed on to assess the provision of anaesthesia care and the extent of surgical delay in regions of displacement.
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    Preoperative testing and medical therapy intervention to improve perioperative outcomes in noncardiac surgical patients.
    (2023) Alphonsus, Christella; Biccard, Bruce; Rodseth Reitze
    Introduction: Cardiovascular disease is the leading cause of death worldwide and a growing concern in low-and-middle income countries, including those in Africa. Patients with cardiovascular disease often have poorly managed chronic conditions in the African setting, which impacts their outcome when they present for non-cardiac surgery. This cohort has an increased risk of perioperative cardiovascular complications. This series of studies explored evidence-based perioperative cardiovascular management strategies in patients with high-risk cardiac comorbidities presenting for non-cardiac surgery. Methods: This was achieved through five objectives which formed five separate but interconnected research studies. The first objective was to study the approach of natriuretic peptide-directed medical therapy in non-surgical patients to inform development of a preoperative protocol in surgical patients through a systematic review. The second objective was to conduct systematic review on exercise therapy in nonsurgical patients to inform development of a preoperative protocol in surgical patients. The third objective was to define the population who would need optimisation before surgery in the Western Cape, South Africa through a prospective observational study of risk stratification. The fourth objective was to explore the broader applicability of perioperative cardiovascular management of high-risk patients by examining cardiovascular outcomes after surgery on the African continent (a sub-study of a larger African cohort study). The fifth objective was to produce national guidelines on cardiovascular risk stratification in a South African and African surgical population. Main results: The systematic reviews showed potential utility for exercise therapy in the optimisation of cardiac patients for non-cardiac surgery. Medical therapy optimisation guided by natriuretic peptide testing did not demonstrate a consistent reduction in natriuretic peptides, but did support a potential mortality benefit in non-surgical patients. The cohort of cardiac patients presenting for non-cardiac surgery in the Western Cape carries significant cardiac risk and needs perioperative cardiovascular management. This was confirmed by the rate of adverse cardiovascular outcomes reported on the African continent. These data supported the development of context-specific national cardiovascular risk stratification guidelines. Conclusion: The cardiovascular burden and risk for perioperative cardiovascular complications presents a challenge in low- and middle-income countries like South Africa, and more broadly Africa. This is a growing phenomenon which needs the collaborative effort of perioperative physicians and the implementation of evidence-based strategies in perioperative cardiovascular management.