Background: Peripartum pain management in patients with mechanical prosthetic heart valves (MHV) receiving lifelong anticoagulation poses unique challenges for an anaesthesiologists. Aim: To describe and evaluate factors influencing peripartum anaesthetic and analgesic practices and associated complications in pregnant women with mechanical heart valves. Setting: Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Methods: A descriptive, retrospective study of the in-hospital patient records of all pregnant women on anticoagulation for mechanical heart valves at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. The available modes of analgesia and anaesthesia offered during their labour and delivery were evaluated. The options included general anaesthesia (GA), neuraxial anaesthesia for caesarean delivery (CD) and neuraxial analgesia, intravenous or intramuscular opioids and nitrous oxide inhalants for vaginal delivery. Results: Neuraxial techniques were feasible in 83 out of 149 (55.7%) of parturients, mainly among women who had elective caesarean delivery (ELCD = 78%) compared to normal vaginal deliveries (NVD = 10.8%) or emergency caesarean delivery (EMCD = 67.1%), p < 0.001. The factor most strongly associated with the use of regional techniques for anaesthesia or labour epidural analgesia was the length of the anticoagulation-free window. This was longer in women who had an ELCD (8 h) compared to EMCD and NVD (6 h and 7 h, respectively), p = 0.001. The ELCD group had lower activated partial thromboplastin time (aPTT) prior to delivery than other modes of delivery, p = 0.001. Conclusion: The study found that neuraxial techniques were achievable in 55.7% of parturients. Contribution: In this cohort, neuraxial labour anaesthesia or analgesia was observed when anticoagulation had been withheld for approximately 6 h – 8 h, reflecting institutional practice rather than a prescriptive safety threshold.
Background: Labour epidural analgesia is the gold standard for intrapartum pain relief, yet documentation practices remain inconsistent, particularly in resource-constrained settings. Inadequate documentation creates patient-safety risk and limits audit and governance. No formally validated labour epidural documentation instrument has been described in the published literature. Aim: This study aimed to develop and content-validate a standardised labour epidural analgesia documentation instrument for the South African health sector. Setting: Study was conducted in the South African health sector. Methods: A two-phase instrument development and content validation study were conducted. In the development phase, a concept instrument was generated from a literature review and refined through expert consensus. In the quantification phase, national anaesthesiology experts independently rated items for relevance and importance using a four-point Likert scale. Item-level and scale-level content validity indices and inter-rater agreement values were calculated using predefined thresholds. Results: The initial 68-item concept instrument was refined to 56 items. Quantitative content validation resulted in a final instrument comprising four domains: pre-procedural assessment, intra-procedural documentation, post-procedural follow-up and chart layout. Most retained items demonstrated high item-level content validity (I-CVI ≥ 0.78), with inter-rater agreement values from 0.80 to 1.00. The layout domain had a borderline scale-level content validity index (S-CVI = 0.79), with all retained items meeting item-level validity criteria. Conclusion: This study presents a content-validated labour epidural analgesia documentation instrument, defining a consensus-based minimum dataset for clinical practice. Contribution: The findings of this research provide a foundation for patient-safety initiatives, audit, training and future electronic anaesthesia record development.
Background: Postoperative handover involves multidisciplinary collaboration among anaesthesia providers, surgeons and nurses, and the absence of standardised protocols can lead to communication errors that compromise patient safety. The Red Cross War Memorial Children’s Hospital (RCWMCH) lacks a standardised protocol for handover between anaesthesia providers and recovery nurses in the post-anaesthetic care unit (PACU), underscoring the need to evaluate current practices. Aim: To evaluate the quality of postoperative handover between anaesthetists and recovery nurses in the PACU using a standardised checklist. Setting: The PACU of the RCWMCH, a quaternary academic children’s hospital in Cape Town, South Africa. Methods: This was a cross-sectional observational study conducted in the PACU at the RCWMCH. A Paediatric Anaesthesia Handover Checklist was used to evaluate current handover practices. The checklist consisted of 26 mandatory items requiring verbal handover. Based on each item handed over, a score was calculated out of 26, and this was expressed as a percentage. Results: Fifty-five handovers were observed, involving 20 anaesthetists. The average duration of handover was 54.23 s. Handovers were frequently incomplete, with scores ranging from 0 out of 26 to 17 out of 26 (65.38%), and an average score of 5.54 out of 26 (21.31%). The most commonly handed-over item was intraoperative analgesia 42 out of 55 (76.36%). Despite routine administration, use of sedative premedication was reported in only 26 out of 55 (47.27%) of cases. Conclusion: The quality of handover in the PACU at the RCWMCH was low. Critical patient safety information was frequently omitted, highlighting the need for intervention. The use of checklists may improve the quality of communication and prevent potential adverse events. Contribution: This audit demonstrates significant gaps in paediatric PACU handover in a resource-limited setting and supports the introduction of a structured handover checklist as a low-cost intervention to improve communication and patient safety.
Background: After internship, junior doctors complete a year of community service before independent practice. Community service doctors work in resource-constrained facilities with minimal supervision, and often deliver anaesthesia after only two months of practical exposure as an intern. Aim: This study aimed to evaluate interns’ knowledge before and after their anaesthetic rotation, and determine their self-perceived post-rotation preparedness for community service. Setting: A prospective cross-sectional study was conducted at the Universitas Academic Hospital in Bloemfontein (1 March 2023 to 29 February 2024). Methods: A departmental assessment tool and questionnaire were used. Four competency areas were assessed (anaesthetic pharmacology, emergencies and equipment, and obstetric anaesthesia). Competency pass marks were pre-determined by departmental consultants. We assessed the baseline knowledge of the interns entering the anaesthetic rotation, the change in their knowledge and their perceptions after the rotation, and preparedness to provide basic anaesthesia safely. Results: Fifty-five interns completed the questionnaire, with 54 included in the evaluation. Only 11.1% of participants achieved ≥ 80% for obstetric anaesthesia, and 9.3% achieved ≥ 80% for anaesthetic emergencies. A significant overall improvement was observed in all these domains. The anaesthetic emergencies domain had the lowest baseline knowledge score (mean 37.8%; standard deviation 20.56). Thirty-five (63.6%) participants believed that their undergraduate education not adequately prepared them for internship in anaesthesia. Most (96.4%) participants considered their intern anaesthesia rotation as sufficiently preparing them for community service. Conclusion: Interns’ knowledge improved from baseline assessment, but remained unsatisfactory. Contribution: Knowledge gaps and learning challenges were exposed, showing that improvement in medical interns’ undergraduate and internship anaesthetic training is needed.
Background: Obesity is a significant issue in South Africa, where 27% of the population is considered obese and this is estimated to increase. Bariatric surgery is currently offered at four public institutions in South Africa. There is limited literature on the anaesthetic practice in bariatric surgery in South Africa. Aim: To describe perioperative anaesthetic practices for bariatric surgery. Setting: Helen Joseph Hospital. Methods: This was a retrospective, descriptive study that included all bariatric cases performed from 01 January 2022 to 30 June 2024. The data collection sheet was designed in accordance with the perioperative recommendations of the Enhanced Recovery After Surgery (ERAS) Society for Bariatric Surgery. Pre-, intra- and postoperative variables were reviewed. Outcomes were descriptively described. Results: Forty-three patients met the inclusion criteria; 90% were female, with a median age of 45 years and a median body mass index of 59 kg/m2. Although all patients met the prerequisites for surgery, only 65% achieved the recommended preoperative weight loss. Opioid-sparing analgesia and multimodal postoperative nausea and vomiting (PONV) prophylaxis were administered to 55% and 78% of patients, respectively. Postoperative prophylactic oxygen was provided to 86% of patients. PONV was the most common complication (16.3%), and overall mortality was 7%. Conclusion: This was the first public-sector audit of bariatric surgery in South Africa analysing current anaesthetic practice. Intraoperative practices had higher compliance with ERAS guidance, and postoperative practices had the lowest compliance. Multidisciplinary involvement for context-specific guidance will ensure standardised care for these patients throughout the perioperative period. Contribution: The study provides insight into current anaesthesia practices for bariatric surgery at a single centre in South Africa. It highlights areas for improvement to align practice with international guidelines.
