Background: Recovery from anaesthesia and surgery is an important marker of the quality of perioperative care. One extensively validated score in assessing this is the Quality of Recovery-15 items (QoR-15) score. This study aimed to translate the QoR-15 score into isiZulu and validate both the original and translated version on an isiZulu speaking population. Methodology: A randomised quantitative observational study was performed testing the original and the translated version of the QoR-15 score. In a crossover format, patients were asked to complete both questionnaires with 40 minutes allowed between each questionnaire. A 100 mm visual analogue score (VAS) was completed by each participant as a comparative tool for overall quality of recovery. Results: There was good correlation between the English and isiZulu score 0.91 (p < 0.001) and substantial agreement between the scores (mean weighted kappa: 0.69). There was a negative correlation between duration of surgery and total QoR-15 scores for both the English (-0.3; p < 0.001) and isiZulu (-0.29; p < 0.001) questionnaires, and a positive correlation between VAS scores and total QoR-15 scores for both the English (0.38; p < 0.001) and isiZulu (0.38; p < 0.001) questionnaires. Conclusion: This study demonstrates that the QoR-15 score is suitable to use in an isiZulu speaking patient population. The translated isiZulu version is comparable to the English QoR-15 score and should be used to assess the QoR to improve patient care.

Background: Osteogenesis imperfecta (OI) is an inherited genetic syndrome affecting connective tissue. Patients often undergo surgery due to an increased susceptibility to bone fractures. Anaesthesia is associated with many perioperative challenges. This study aimed to describe and evaluate the perioperative management of OI paediatric patients presenting for surgery at Inkosi Albert Luthuli Central Hospital (IALCH). Methods: A retrospective chart review of children under 18 years who had OI and underwent surgical procedures from 2000 to 2017 at a quaternary referral hospital was conducted. Patients were identified from the electronic patient database. The following variables were extracted: demographic data, preoperative history, examination, investigations, chronic medications, intra- and postoperative management and perioperative complications. Simple descriptive statistics were performed using a Microsoft® Excel spreadsheet. Results: Thirty-nine patients who underwent 93 surgeries were included. The majority (72.1%) had severe type III OI and had elective orthopaedic surgery. Anaemia was identified in 64.5% of patients; 40.8% had a spinal deformity and 37.6% had an abnormality on respiratory examination. A supraglottic airway device (SGAD) was used in 91.9% of patients, with only three airway complications. Eighty-seven per cent of cases had combined general (GA) and regional anaesthesia (RA). No children had documented signs suggestive of hypermetabolism or malignant hyperthermia. Conclusion: Despite most patients in our study having severe OI, few of the complications and difficulties described in the literature were identified. A combined GA and RA technique with a SGAD was shown to be a safe anaesthesia technique. Improved preoperative investigation, especially a full blood count due to the high incidence of anaemia, should be encouraged to improve overall care.

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This case report demonstrates the challenges of the paediatric airway, and useful, practical solutions in the management of tracheostomies in children. A six-year-old child underwent a tracheostomy, where an inappropriately large tracheostomy tube was inserted. The choice was guided by the internal diameter (ID) of the tracheostomy tube (TT) rather than the external diameter of the TT (which is much larger than the external diameter (ED) of an endotracheal tube (ETT)). The reduced diameter of the paediatric airway led to complications following the tracheostomy insertion. The TT needed to be exchanged to a smaller size to provide reliable access to the trachea. Access to the airway had to be maintained during the exchange process, as there was extensive head and neck swelling, which would have made re-intubation from above impossible. The conduit chosen for the tube exchange was a section of tubing from a high-capacity fluid administration set. Fixation of the tube was difficult, but finally achieved by a modified cable tie. Tracheostomy is a potentially hazardous procedure in children. The correct size TT needs to be selected with consideration of the ED rather than ID of the TT. This case report also demonstrates the utility of the tubing of a high-capacity fluid administration set for TT exchange and the use of a modified cable tie for fixation of the ETT.