Browsing by Author "Gray, Rebecca"

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    Anaesthetic complications in gastroschisis
    (2025) Heald, Andrew; Gray, Rebecca; Meyer , Heidi
    Introduction: Patients with gastroschisis (GS) are a vulnerable population who present to the operating theatre for pathology or central venous access related indications. Little is known about anaesthesia-related adverse events (ARAEs) in children from low- and middle-income countries (LMICs). Methods: We performed a single-centre retrospective observational study at Red Cross War Memorial Children's Hospital (RCWMCH), in Cape Town, South Africa. Data was collected from patient folders from the hospital's GS database. Each general anaesthetic exposure (GAE) was treated as an independent event and a binary logistic regression analysis was performed to assess the association between indication for GAE and the odds of an ARAE. A mixed-effects logistic regression model was used to analyse the association between adverse complications and key predictor variables in paediatric anaesthesia. Results: Seventy folders were collected between 2012 and 2021. The median gestational age was 36 weeks and median birthweight 2270g. 56 (80%) patients survived to full enteral feeds and the median duration of TPN was 18 days (IQR 12-29). There were 196 GAEs, of which pathology-related indications comprised 59%. There was a total of 94 ARAEs. At least one ARAE occurred in 79 (40%) of the 196 GAEs. Cardiovascular instability was the most common ARAE, comprising 76% of the total ARAEs. Respiratory events comprised 18% of the ARAEs, with reintubation predominating. Patients presenting for pathology related indications were associated with an unadjusted 6-fold odds increase (95% CI = 3.10, 12.27) in the odds of ARAEs compared to patients with CVC-related indications (p<0.001), however at least one ARAE occurred in 18% of CVC related GAEs. No statistically significant association with ARAE was found for gestational age, birth weight or sex. Conclusion: At RCWMCH, many patients with GS experience a complicated clinical course, requiring multiple general anaesthetic exposures. They have a high prevalence of anaesthetic related adverse events, particularly instances of CVS instability and reintubation. Establishing a multidisciplinary management protocol for these patients may decrease intervention frequency and improve outcomes.
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    Paediatric out-of-theatre procedural sedation at a tertiary children's hospital: A prospective observational study
    (2021) Lapere, Cherese; Gray, Rebecca; Wilson, Graeme
    Background: This tertiary referral centre is one the largest paediatric hospitals in Africa. Despite an increasing number of surgical and diagnostic procedures being performed annually, a formal out-of-theatre sedation service does not exist. Procedural sedation and analgesia (PSA) is an important adjunct in behavioural management for invasive procedures in children. Objective: A prospective, observational study was performed at RCWMCH, aimed primarily at defining the number of cases of PSA performed outside the operating theatre. Methods: Data was collected from all procedural out-of-theatre sedations performed over a period of three months, including ward patients and out-patient departments. All children < 13 years of age were included. Results: A total of 639 sedations were performed. Of these sedations, 288 (45.0%) paper responses were captured and analysed. The reported incidence of desaturation was 4.2% (12/288), laryngospasm 0.3% (1/288) and nausea and vomiting 2.4% (6/288). Three cases required conversion to general anaesthetic, and three cases were abandoned due to inadequate sedation. In 16.3% (47/288) of cases the clinician was an operator sedationist (the same person performing the sedation and the procedure). In 90.6% of cases the intravenous route was utilized, with dexmedetomidine, ketamine and propofol being the three most commonly used agents. Conclusion: 639 PSA events were recorded in 3 months. The 288 events analysed were safely performed with minimal serious reported events. These results compare favourably with international studies and provide quantitative evidence as a prelude to setting up a dedicated sedation service at our facility.
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    Regional cerebral oxygenation monitoring - intraoperative management in a patient with severe left ventricular dysfunction
    (2006) Ing, Richard J; Fischer, Stephanie; Shipton, Steve; Gray, Rebecca; Thomas, Jenny; Hewitson, John
    Intraoperative near-infrared spectroscopy cerebral oxygenation monitoring assists intraoperative decision-making in environments without extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) or access to cardiac transplantation. We report a case of an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), undergoing cardiac surgery. A 4-month-old infant presented in extremis with cardiac failure. We discuss the pathophysiology and challenging intraoperative management of ALCAPA with extensive ischaemia and myocardial infarction.
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    Regionalcerebral oxygenation monitoring - intraoperative management in a patient withsevere left ventricular dysfunction
    (2006) Ing, Richard J; Fischer,Stephanie; Shipton, Steve; Gray, Rebecca; Thomas, Jenny; Hewitson, John
    Intraoperative near-infrared spectroscopy cerebral oxygenation monitoring assists intraoperative decision-making in environments without extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) or access to cardiac transplantation. We report a case of an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), undergoing cardiac surgery. A 4-month-old infant presented in extremis with cardiac failure. We discuss the pathophysiology and challenging intraoperative management of ALCAPA with extensive ischaemia and myocardial infarction.