Browsing by Subject "Perioperative Medicine"

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    Anaesthesia providers accessibility and usage of video
    (2023) Young, Matthew; Hofmeyr, Michael
    Introduction Approaches to airway management have undergone a dramatic transformation since the advent of video laryngoscopy (VL). Access to VLs for anaesthesia providers (AP) in operating theatres in South Africa has not previously been described, and the current usage is unknown. Methods We designed a cross-sectional survey investigating AP access and type of VL, as well as AP usage of VL in general, in obstetric anaesthesia, and in patients infected with SARS CoV-2. By using a combination of survey and direct contact audit we atempted to contact all medical facilities with an operating theatre in South Africa. Results 98% (661/676) of hospitals provided responses to the survey or were contacted directly via telephone. Of the total 559 hospitals with operating theatres, 65% (362/559) had access to a VL. 84% (1983/2357) of theatres are found in hospitals which have access to a VL. Larger hospitals are more likely to have video laryngoscopes. The C-MAC® and GlideScope® VL account for 85% of devices found in South Africa. 71% (395/559) of hospitals reported providing obstetric theatre services, while 58% (229/395) of these reported having access to a VL. 54% (301/559) of hospitals reported performing intubatons on patients infected with SARS-CoV-2, of these 79% (238/301) reported having access to a VL. Discussion Our data quantified the expected inequality in the distributon of VLs. There are large discrepancies between the different provinces, as well as between state and privately funded hospitals in South Africa. Despite having become a common device, VL is underutilized, even in high-risk populations.
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    Global Airway Management of the Unstable Cervical Spine Survey
    (2021) Stegmann, George Frederik; Hofmeyr, Ross; Llewellyn, Richard
    Background Rapid growth in optical and video devices for indirect visualisation of the airway has expanded the options for emergency and elective endotracheal intubation in patients with unstable fractures of the cervical spine. Aiming to ascertain whether video laryngoscopy (VL) has replaced awake flexible intubation (AFI) as the preferred technique for airway management, we conducted a global survey to evaluate current clinical practice. Methods After ethics approval, we created a questionnaire featuring one emergency and one urgent elective hypothetical patient with unstable injuries of the cervical spine. Target sample sizes per country were estimated using data from the World Federation of Societies of Anaesthesiologists' (WFSA) Global Anaesthesia Workforce Survey. Respondents were asked about their training, experience, airway skills, current clinical setting, and availability of airway equipment, as well as their preferred airway strategy in each case. The questionnaire was actively distributed for one year through the WFSA member societies and via social networks to physician anaesthesia providers (PAPs). Global and regional trends were assessed using descriptive statistics. Results Of a total of 1904 responses, 1153 (101 countries) were included in the final analysis. In the emergency case, 46.9% (95% confidence interval [CI]: 44.0–49.8%) of participants preferred VL and 39.8% (95% CI: 38.0-42.6%) chose AFI. In the urgent elective case, 51.3% (95% CI: 48.3-54.3%) selected VL as their preferred method, while 37.3% (95% CI: 34.4-40.2%) indicated AFI. Significant regional variations in preference were found. Conclusion The results suggest that practice in airway management of unstable cervical spine fractures is changing, and currently tends to favour VL over AFI. There is a statistically significant preference for VL in elective cases, traditionally considered to be a stronghold of AFI.
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    Innovation in low-cost video-laryngoscopy: Intubator V1-Indirect compared with Storz C-MAC in a simulated difficult airway
    (2021) De Villiers, Christiaan Tertius; Hofmeyr, Ross
    Background: Video laryngoscopy has directly impacted airway management, with numerous studies demonstrating its utility in clinical management of anatomically difficult airways. However, availability of video laryngoscopes in all clinical areas has been limited by cost. We used smartphone technology, miniature cameras and three-dimensional printing to design and create an innovative low-cost hyperangulated video laryngoscope. This has the potential to make the technique more widely available. Objectives: The aim of this study was to determine if time to intubation with the novel device was clinically equivalent to an existing gold-standard video laryngoscope (Storz CMAC with Dörges blade). Methods: We conducted a randomised, controlled, cross-over equivalence study with 100 skilled practitioners who had previous video laryngoscopy experience. Participants received instruction on the new device, and adequate opportunity to practice. Intubations were then performed in a randomised order on a mannikin simulating a difficult airway. Video recordings of each intubation were analysed by two independent investigators to determine time to intubation. A mean difference in intubation time of less than 10 seconds was determined a priori to denote clinical equivalence. Results: Mean difference in intubation time between the devices was 4.92 seconds, (two one-sided test 95%CI: 2.34 – 7.49 seconds). The innovative low-cost VL was thus clinically equivalent to the industry standard in a simulated difficult airway. Further testing in vivo in a clinical environment is needed. Conclusion: The results of this study show that a low-cost disposable hyperangulated video laryngoscope is clinically equivalent to the industry standard in a simulated difficult airway. In the context of the current global pandemic, video laryngoscopy has been advised in nearly all airway guidelines. Access to a low-cost VL which does not require reprocessing may be of great value.
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    Overcoming language barriers using an information video on spinal anesthesia for cesarean section: implementation and impact on maternal anxiety
    (2021) Purcell-Jones, Jessica M A; Duys, Rowan; Dyer, Robert
    Background It is unknown whether the implementation of an information video on spinal anesthesia for caesarean section, narrated in a patient's first language, reduces anxiety, increases satisfaction, and improves doctor-patient communication if there is a language barrier. In South Africa most doctors speak English, and patients Xhosa, with educational and cultural disparities existing in many doctor-patient interactions. Methods One hundred and seventy-five Xhosa patients scheduled for elective cesarean section were enrolled in the study. The first 92 patients received “usual care” verbal explanations of the spinal anesthesia procedure (control group); the next 83 patients watched a spinal anesthesia information video (intervention group), narrated in Xhosa. Videos were displayed using smartphones. Maternal anxiety was assessed before and after spinal explanation, using a Numerical Visual Analog Anxiety Scale (NVAAS). A difference in post-explanation NVAAS score of 1.5 points between intervention and control groups was regarded as clinically significant. Patient satisfaction was assessed using the Maternal Satisfaction Scale for Cesarean Section (MSSCS). Results The mean (SD) age (31.5 (5.2) and 32.1 (5.4) years) and pre-explanation NVAAS score (4.2 (3.2) and 4.0 (3.0)) of the intervention and control groups respectively, showed no difference at baseline. The mean (SD) post-explanation decrease in NVAAS score was greater in the intervention- than in the control group (1.6 (3.5) versus .7 (2.3), P = .046, unadjusted mean difference .9 points (95% CI .02 to 1.8)). A linear regression model for the post-explanation NVAAS score showed that the intervention effect was significantly associated with the pre-explanation score (P = .002), adjusted for age and English fluency. Patients with pre-explanation NVAAS scores ³ 5 showed a statistically significant intervention effect. There was no significant difference in patient satisfaction between the intervention and control groups. The smartphone was an accessible and convenient display medium for the video. Ninety nine percent of patients exposed to the intervention would recommend watching the video prior to the procedure. Conclusion In this pilot study, lower NVAAS scores were observed in anxious patients, when a Xhosa information video was used to ameliorate challenges posed by a doctor-patient language barrier. It is easily implemented and demonstrates a novel use of mobile health technology. The study provides baseline data to inform sample size calculations for future studies. A high level of patient recommendation for the video suggests that this is an agreeable practice.