Browsing by Author "Dyer, R A"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Open Access
    Anaesthesia for lung volume reduction surgery
    (MedPharm Publications, 2005) James, M F M; Dyer, R A
    Chronic obstructive pulmonary disease (COPD) is a common condition with high morbidity and mortality rates.1 The condition, which is primarily a complication of smoking, is a chronic, slowly progressive disorder characterised by airway obstruction.2 The definition includes chronic bronchitis and emphysema with permanent destructive enlargement of distal pulmonary airspaces. Consequently, there is loss of normal lung architecture resulting in loss of elastic recoil of lung tissue leading to collapse of small airways, expiratory airflow limitation, air trapping, hyperinflation of the lungs and progressive enlargement of the thoracic cage. Expansion of the thorax leads to flattening of the diaphragm, in-drawing of the lower ribs and compromised chest wall mechanics. The ribs are lifted and flattened leading to increased total lung capacity and residual volume, with reduced FEV1 and increased work of breathing. As the disease progresses, patients must breathe at a higher lung volume to achieve the flows necessary to meet ventilatory requirements. At end-stage disease, the patient is dyspnoeic and has a severely restricted exercise capacity.3 Once the patient has reached a stage where the FEV1 < 0.75 L, the 1-year mortality is in the region of 30%4 and the patient will require frequent hospital admission for treatment of exacerbations of the condition.
  • Thumbnail Image
    Item
    Open Access
    Knowledge and expectations of labour among primigravid women in the public health sector
    (2007) Dyer, R A; Dyer, S; Fawcus, S; Ibach, F
    Objectives. We analysed knowledge and expectations of the process and pain of labour in primigravidas attending a local midwifery obstetric unit (MOU). It was anticipated that the results of this study could inform the development of interventions aimed at improving the analgesic care of women delivering at primary health care obstetric units. Design. Qualitative analysis of data obtained from in-depth semi-structured interviews. Setting. A Cape Town MOU. Subjects. 30 black African, Xhosa-speaking primigravidas. Outcome measures. An open-ended interview guide was developed. The themes explored included previous painful experiences, knowledge of labour, expectations of and attitudes towards labour pain, and knowledge of biomedical analgesia. Results. Patients were poorly informed about the process and pain of labour. Most women appeared highly motivated concerning their ability to cope with labour. Most expected pain, but had no concept of the severity or duration of the pain, and knew very little concerning methods available for pain relief in labour. Conclusion. Women at this MOU were poorly prepared for the experience of delivery. Antenatal programmes should incorporate sensitive education concerning the process and pain of labour and the methods available to alleviate pain.
  • Thumbnail Image
    Item
    Open Access
    An observational audit of pain scores post orthopaedic surgery at a level two state hospital in Cape Town
    (2015) Hauser, Neil David; Rolfe, D A; Dyer, R A
    An audit cycle of post-operative pain scores and patient satisfaction of pain control in orthopaedic patients at a Level Two State Hospital in Cape Town. In addition as part of the information collected during the research process we will audit the following: Intraoperative anaesthetic techniques, post-operative analgesia consumption and analgesic methods as well as any side effects to analgesic medication used in orthopaedic patients peri-operatively at Victoria Hospital Wynberg (VHW) will also be noted. Postoperative pain control is an essential, yet often inadequately managed part of peri-operative patient care. Adequate analgesia is important not only for patient comfort but also for maintaining stable physiology, facilitating recovery from surgery, enabling rehabilitation and to potentially decrease length of hospital stay post-operatively. International audits have previously shown that pain is poorly managed post-operatively in surgical patients. At facilities in the Western Cape, pilot student audits have shown that management of post-operative pain is also potentially inadequate. This means that surgical patients potentially experience severe pain in the first 48 hours following surgery, increasing the risk of chronic pain development as well as post-operative complications thereby placing a greater burden on already limited health care resources. These proposed observational audits will look at a population of orthopaedic patients at a Level Two Hospital in Cape Town. The study will be performed at Victoria Hospital Wynberg (VHW). VHW performs a large number of orthopaedic cases each week, giving us access to a potentially large number of patients. The choice of orthopaedic patients is due to the fact that orthopaedic surgery has been shown in some studies to be associated with a greater degree of post-operative pain as rated by patients when compared to other surgical disciplines. The high levels of pain associated with orthopaedic surgery are thought to be due to the degree of tissue trauma and the nature of tissue involved in the surgery itself.
  • Thumbnail Image
    Item
    Open Access
    Prevention and treatment of cardiovascular instability during spinal anaesthesia for Caesarean section
    (2004) Dyer, R A; Rout, C C; Kruger, A M; Van der Vyver, M; Lamacraft, G; James, M F
    Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability.
  • Thumbnail Image
    Item
    Restricted
    Spinal anaesthesia for caesarean section: How can we make it safer?
    (2004) Dyer, R A
    With the development of atraumatic spinal needles and the associated reduction in the incidence of post-spinal headache, spinal anaesthesia has become the favoured method of anaesthesia for caesarean section. In the UK in 2002, regional anaesthesia was employed for 95% of elective caesarean sections. Spinal anaesthesia was employed in 87% of these cases. Not only does this method avoid the problem of failed intubation, which occurs 8 times more frequently in the obstetric than the general surgical population, but other benefits include a lower morbidity, less blood loss and earlier bonding between mother and baby.