Browsing by Author "Bosenberg, A T"
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- ItemOpen AccessFifty years of paediatric anaesthesia - newapproaches to an old technique(2006) Bosenberg, A T; Ing, R J; Thomas, J MThe safety of paediatric anaesthesia has improved since Red Cross Children’s Hospital opened its doors 50 years ago. At that time routine surgical procedures were considered lifethreatening. To avoid the dangers of general anaesthesia some surgery was performed under local infiltration. However significant advances in virtually all aspects of paediatric anaesthesia have occurred over the past five decades. The perioperative well-being of all children has become an expectation. Economic pressures may have modified practice so that children after minor and some major surgical procedures can be discharged the same day. Peri-operative well-being is paramount. Improved outcome in children of all ages has become the focus of the modern paediatric anaesthesiologist. This has taken place in the face of improved surgical techniques and advances in neonatal care. More and more complex surgery, even in premature babies, who were not previously expected to survive, is being performed with good outcomes. Without the advances in anaesthesia, many of the surgical procedures performed at Red Cross Children’s Hospital could not be done. Computers and information technology have become an integral part of our lives. Evolution of this technology has influenced the way we conduct modern anaesthesia. Anaesthetic machines are self-calibrating with built-in safety checks to ensure safe delivery, fluid therapy and the infusion of intravenous agents can be tightly controlled and fine tuned, and ventilators and monitoring equipment have become highly sophisticated computer-controlled apparatus. Even anaesthetic record keeping can be automated. Some of the more important advances considered to have had the greatest impact on the safety of anaesthesia and the well-being of children undergoing surgery are highlighted.
- ItemOpen AccessMeningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome(Health and Medical Publishing Group, 2007) Bickler, SW; Bosenberg, A T; Numanoglu, A; Rode, HObjective: To describe surgical experience with purpura fulminans related to meningococcaemia in a single institution, and to suggest a management protocol. Methods: A retrospective review was done of patients admitted to the intensive care unit at Red Cross War Memorial Children's Hospital in Cape Town with the clinical diagnosis of purpura fulminans. Results: During a 28-year period (1977 - 2005) 112 children (average age 3.4 years) were treated for meningococcaemia with purpura fulminans. Overall mortality was 10.7%. Local treatment consisted of measures to improve circulation, infection control and healing of necrotic tissue. Demarcation of necrotic areas was evident at 5.5 days and the average area of skin necrosis was 14% total body surface area (range 2 - 85%). The lower limbs were predominantly affected. Purpura fulminans resolved in 35 children (31.2%) without skin necrosis. Skin grafting was required in 77 children (68.8%). Factors associated with a poor outcome for peripheral extremity salvage were progressive irreversible skin changes, early disappearance of distal pulses, tense cold swollen extremities and intense pain on passive movement of the affected extremity. Amputations were performed proximal to the area of necrosis, on average 27 days after injury. Conclusions: Meningococcaemia is a disease with potentially devastating consequences. Early surgical consultation is essential. Skin- and soft-tissue-releasing incisions should be considered early to reduce the incidence of extremity necrosis. Small necrotic areas usually separate spontaneously with secondary healing or can be excised and sutured. Larger necrotic areas should be excised only after demarcation has been established, and can be covered with delayed skin grafting. Amputation should be conservative but may require revision.