No abstract

Background: Studies have been done to determine the level of burnout in anaesthesiology internationally, but not in South Africa. Method: The Maslach Burnout Inventory-Human Services Survey was used to assess the level of burnout. The primary objectives were to estimate the level of burnout among doctors working in the Department of Anaesthesiology at the University of the Witwatersrand (Wits doctors) and to estimate the level of burnout among private anaesthetist attending an anaesthetic symposium (Private doctors). Results: High levels of burnout were identified in 21.0% of Wits doctors. Higher burnout scores were noted in female doctors (p = 0.49), less years of anaesthetic experience (p = 0.37), doctors of younger age (p = 0.07), registrars (p = 0.22) and writing examinations within three months of completing the survey (p = 0.15), but none where statistically significant. High levels of burnout were identified in 8.1% of Private doctors Conclusion: High levels of burnout were identified, especially, among anaesthetists working in the academic hospitals affiliated to Wits.

Background: Endotracheal tube (ETT) cuff pressure commonly exceeds the recommended range of 20-30 cm H₂O during anaesthesia. A set volume of air will not deliver the same cuff pressure in each patient and the pressure exerted by the ETT cuff can lead to complications, with either over-or under-inflated cuffs. These can include a sore throat and cough, aspiration, volume loss during positive pressure ventilation, nerve palsies, tracheomalacia and tracheal stenosis. No objective means of ETT cuff pressure monitoring is available in the operating theatres of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). The ETT cuff pressure of patients undergoing general anaesthesia is therefore unknown. Method: ETT cuff pressure of 96 adult patients undergoing general anaesthesia without nitrous oxide at CMJAH and CHBAH was measured by one researcher. A RUSCH Endotest™ manometer was used to measure ETT cuff pressure in size 7.0 -8.5 mm ETTs. The cuff inflation technique that was used by the anaesthetist was also documented. Results: The mean ETT cuff pressure recorded was 47.5 cm H₂O (range 10-120 cm H₂O). ETT cuff pressures exceeded 30 cm H₂O in 64.58% of patients. Only 18.75% of patients had ETT cuff pressures within the recommended range of 20-30 cm H₂O. There was no statistically significant difference between the ETT cuff pressures measured at the two hospitals. Minimal occlusive volume was the most frequent technique used to inflate the ETT cuff (37.5%); this was followed by inflating the ETT cuff with a predetermined volume of air in 31.25% of cases and palpation of the pilot balloon (27.08%). There was no statistically significant difference between the ETT cuff pressure measured and the inflation technique used by the anaesthetist. Conclusion: ETT cuff pressures of the majority of patients undergoing general anaesthesia at two academic hospitals were higher than the recommended range. ETT cuff pressure should routinely be measured using a manometer.

Background: Cognitive dysfunction after surgery includes delirium and postoperative cognitive dysfunction. Important risk factors for these include increased age and pre-existing cognitive dysfunction. This study describes preoperative cognitive dysfunction and its associated factors in patients aged !60 yr awaiting elective noncardiac surgery in a developing country. Methods: A prospective, contextual, descriptive study design with consecutive convenience sampling was used at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Assessment of cognition was subjective (through casual conversation, henceforth referred to as observer assessment) and objective (using the Mini-Cog test). Results: A total of 194 outpatients (median age: 65 yr) were assessed. A score 3 (indicating mild cognitive impairment) was obtained by 111 patients (57.2%). Subjective memory complaints were reported by 124 patients (63.9%). Univariate analyses demonstrated significant associations between low Mini-Cog scores and increasing age (r s ¼À0.1901; P¼0.0079), unskilled occupation (P¼0.0033), low functional status (r s ¼À0.1831; P¼0.0106), low level of education (P¼0.0005), and frailty (r s ¼À0.3010; P<0.0001). Logistic regression showed level of education and frailty to be significant. A score 3 is more likely in frail patients (odds ratio: 7.54; P¼0.003) and those with only primary school education (odds ratio: 3.54; P¼0.003). Conclusions: Undiagnosed pre-existing cognitive dysfunction was common in older patients awaiting surgery at a regional academic hospital in South Africa. Patients at risk for cognitive dysfunction should be identified through brief preoperative screening.

No abstract