Browsing by Author "Thomas, Jenny"

Now showing 1 - 9 of 9
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    Audit of acute limb ischaemia in a paediatric intensive care unit
    (2016) Mumba, Jesse Musokota; Hodges, Owen; Thomas, Jenny
    Objective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population.
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    Clinical utility of B-type natriuretic peptide (NP) in paediatric cardiac surgery: a systematic review
    (2014) Afshani, Nura; Thomas, Jenny; Biccard, Bruce M
    B-type natruiretic peptide (NP) is a biomarker that has gained widespread use in several patient populations and clinical situations. It is a hormone secreted primarily by ventricular myocytes in response in myocyte stretch or ischaemia.
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    Leaving the party - withdrawal of South African essential medicines
    (2005) Wilmshurst, Jo M; Blockman, Marc; Argent, Andrew; Gordon-Graham, Eugenie; Thomas, Jenny; Whitelaw, Andrew; McCulloch, Mignon; Ramiah, Malitha; Dyeshana, H; Ireland, Joe
    In August 2004 pharmacies and drug depots were advised that the sole supplier of parenteral phenobarbitone in South Africa, essential for the management of status epilepticus in children, was stopping production at the end of the same year. Alternative protocols for the management of status epilepticus resulted in more children requiring intensive care intervention (N = 9) at the Red Cross Children’s Hospital, over a 2-month period, than had occurred in any 12-month period since 2000 (2000 N = 3, 2001 N = 1, 2002 N = 1, 2003 N = 2, 2004 N = 7). Other agents that have suffered or are at risk of the same fate are sodium nitroprusside, labetalol and esmolol. Sodium nitroprusside is used extensively in the peri-operative period in cardiac patients requiring after-load reduction. There are no other nitrates with equivalent efficacy. Supply was stopped in 2005 and only reinstated after the pharmaceutical company was contacted directly. Supply of labetalol and esmolol was stopped without warning. Without access to these products it is necessary to resort to agents that are not appropriate for paediatric use. Acetylcysteine (Parvolex), used in the management of acetaminophen overdose, also became unavailable and the supply was re-established only after direct communication with the pharmaceutical company.
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    Lumbar punctures in the paediatric emergency medicine department at Red Cross War Memorial Children's Hospital: An evaluation
    (2016) Procter, Claire; Buys, Heloise; Thomas, Jenny
    Background: Lumbar punctures (LPs) are frequently performed in the paediatric medical emergency unit (MEU) department to diagnose or exclude meningitis. Unsuccessful lumbar punctures (LPs) cause diagnostic uncertainty which may prolong hospital stay and result in unnecessary antibiotic treatment and increased costs to the hospital and patients. It is important to determine factors that may be effective in reducing unsuccessful LPs. There is a paucity of studies on this topic from sub-Saharan Africa. Previous studies have shown inconsistent results and the use of sedation has not previously been studied. Aims: To determine the prevalence of unsuccessful lumbar punctures(LPs) and the factors influencing this in the medical emergency unit (MEU) and short stay ward (SSW) at Red Cross War Memorial Children's Hospital, Cape Town.
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    The measurement of procedural burn pain and anxiety in paediatric burns : the new BOPAS method
    (2002) Albertyn, Rene; Rode, Heinz; Thomas, Jenny
    The assessment of pain and anxiety in South Africa is complicated by language barriers, cultural differences, socio-economic difficulties and delayed cognitive development. The high number of paediatric burn injuries (annually 2000) treated at the Red Cross War Memorial Children's Hospital, the need to accurately assess pain and drug efficacy and the current lack of specifically designed methods to do so, led to the development of the Burn Observational Pain and Anxiety Scale (BOPAS). This scale is believed to be the first of its kind and was designed to measure both pain and anxiety in burned children. The aim of this study was: - To develop an observational pain and anxiety scale that can overcome ianguage barriers by excluding patient involvement in the assessment process. - To develop a scale that can differentiate between pain and anxiety during wound care procedures. - To develop a method that facilitates the translation of nominai information into numerical data. - To develop a scale that can evaluate drug and dose efficacy. A total of 105 chiidren, (M = 65, F = 40) aged 2-12 (average age 6.8 years), admitted for minor to moderate burn injuries to the Burns Unit of the Red Cross War Memorial Children's Hospital, were included in the sample. Five different consecutive studies varying between explorative and quasi-experimental were conducted to determine different levels of validity and reliability.
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    Paediatric cardiac anaesthesia in sickle cell disease : a case series
    (2015) Janse van Rensburg, P J; Thomas, Jenny
    Sickle cell disease (SCD) is the most common inherited haematological disorder, producing a mutation of the haemoglobin molecule known as haemoglobin S (HbS). The presence of HbS in the erythrocyte makes it prone to sickling - a process which may lead to vaso-occlusive injury, haemolysis and a hypercoagulable state. Sickling is precipitated by dehydration, hypoxia, hypothermia, acidosis and low flow states. Over time, multi-organ damage develops with significant morbidity and mortality. Paediatric patients with SCD and congenital heart defects may require anaesthesia for corrective cardiac surgery on cardiopulmonary bypass (CPB). During the perioperative period these high-risk patients may suffer significant complications when exposed to the conditions that favour erythrocyte sickling. This case series details our experience of four paediatric patients with SCD patients who underwent corrective cardiac surgery at Red Cross War Memorial Children’s Hospital. The pathophysiology is discussed and the perioperative management of transfusion, cardiopulmonary bypass and temperature regulation is highlighted.
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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.
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    Temperature changes in paediatric patients undergoing Magnetic Resonance Imaging: A Red Cross War Memorial Children's Hospital experience
    (2017) Fullerton, Zahnne; Thomas, Jenny
    Background: Magnetic resonance imaging (MRI) scanning places paediatric patients at risk of both hypothermia and hyperthermia. The aim of this study is to determine primarily if paediatric patients gain or lose heat during MRI scanning, and secondarily to examine potential risk factors for any such change. Methods: A prospective audit was conducted from February 2015 until April 2015 involving 200 children aged five days to 12 years. Tympanic temperatures were recorded pre- and post- MRI scan. Variables including age, height, weight, head circumference, area scanned, length of time in the scanning room and duration of scan were recorded. The type of anaesthetic management was decided by the anaesthetist and recorded. Results: Tympanic temperature decreased in 111 patients, with a loss of greater than 0.5°C in 29% of patients (n=58) and a range of decrease from 0.1°C to 1.9°C. Hypothermia, defined as a core temperature of less than 36°C for this study, occurred in 13.5% (n=27) patients. A total of 23 patients had no change in pre- and post-scan temperature, and 66 recorded a higher temperature post-scan. The range of gain in temperature was 0.1°C to 1.5°C, with 14.5% (n=29) of patients' temperatures increasing by 0.5°C or more. The mean pre-scan temperature was 36.603 °C ± 0.512°C (range: 35.5 - 38.70 °C) and the mean post-scan temperature was 36.442°C ± 0.615 (34.80-40.0 °C). Overall, the mean post scan temperature was 0.16°C (P<0.001) less than the pre-scan temperature. Linear regression analysis identified sedation and general anaesthesia as signficant risk factors for heat loss. Conclusion: Overall paediatric patients tend to have a minor decrease in temperature during MRI scanning. Individually, each paediatric patient may have an increase or decrease in temperature, or no change. A significant proportion of paediatric patients are at risk of hypothermia post MRI scan, and almost half are at risk of an increase or decrease in temperature of a minimum of 0.5°C. These factors are clinically significant and may be associated with adverse outcomes. For these reasons, temperature monitoring and active temperature management should be implemented during MRI scanning in paediatric patients.