Browsing by Author "Gray, Rebecca"

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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.