Routine postoperative chest radiography after cardiac surgery is a common practice, although studies, both prospective and retrospective, conducted in their majority outside Africa, have shown that these chest radiographs are of low clinical value, mainly due to limited impact on patient management. Following cardiac surgery and admission to ICU, chest radiographs are obtained in order to ensure proper position of all invasive devices such as endotracheal tubes, invasive catheters as well as nasograstric tubes, and to exclude possibility of a pneumothorax, atelectasis, infiltrates, and other potential respiratory complications associated with ventilatory support. Following cardiac surgery, there are other elements that require assessment: mediastinum (for widening due to bleeding), pleural space (for presence of fluid or air) and cardiovascular system (for presence of signs of failure). Specific to cardiac surgery is the post-operative pulmonary dysfunction (PPD), where systemic inflammatory response due to cardiopulmonary bypass is the main culprit [Milot J et al, 2001] - leading to acute lung injury. Over and above the usual cardiovascular diseases that require surgical intervention, in Sub-Saharan Africa, inflammatory and infective conditions such as pulmonary tuberculosis, pulmonary hydatid disease, and pulmonary complications of HIV infection, are very prevalent. These pre-existing lung pathologies predispose patients to postoperative pulmonary complications after cardiac surgery. This audit investigates the role and importance of bedside chest X-rays in post operative care of cardiac surgery patients that come from a population group where lung pathology is quite prevalent.

Background: Anaemia is a widespread public health problem associated with increased mortality and morbidity. In a surgical population, the prevalence of preoperative anaemia often exceeds that of the general population. Elective colorectal patients often have multiple risk factors for preoperative anaemia. The fourth updated ERAS Society guidelines for optimal perioperative care in colorectal surgery include specific recommendations for screening and treatment of preoperative anaemia as well as utilising restrictive blood transfusion practice. Assessing the prevalence and predictors of anaemia and outcomes in this population may allow for improved preoperative assessment and treatment of colorectal patients in a resource limited setting. Objectives: The primary objective of this retrospective study was to determine the prevalence of anaemia in the colorectal surgical population who were part of the enhanced recovery after surgery (ERAS) programme at a tertiary level hospital in the Western Cape, South Africa. Secondary objectives were to determine independent risk factors of preoperative anaemia, and the effect of anaemia on post-operative complications and length of stay after elective colorectal surgery. Methods: We performed a secondary analysis of data collected for the colorectal surgical ERAS programme. Data of 260 patients was reviewed from the initiation of the database 01 September 2016 to 30 September 2019. Three regression analyses were performed as part of the secondary objective to determine the risk factors for preoperative anaemia and predictors for postoperative complications and length of hospital stay. Patients were defined as anaemic if their haemoglobin was less than 13.0 g/dL. Results: The prevalence of preoperative anaemia was 157/260 (60.3%). Female sex (odds ratio (OR) 2.44, 95% confidence interval (CI) 1.43 – 4.18; p=0.001) and the presence of malignancy (OR 2.42, CI 1.26- 4.67; p=0.008) showed a significant association with anaemia. Anaemia was not associated with increased risk of post-operative complications or length of hospital stay. Conclusion: South African colorectal surgical patients in an enhanced recovery after surgery programme have a higher prevalence of preoperative anaemia compared to the general surgical population. Predictors of preoperative anaemia in this population included female sex and the presence of malignancy. Long waiting lists for patients awaiting elective colorectal surgery allow time for evaluation and optimisation of patients at risk for anaemia preoperatively

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In 1973, Winnie and co-workers stated that no technique could truly be called simple, safe and consistent until the anatomy has been closely examined. This is evident when looking at the literature where many anatomically based studies regarding regional techniques in adults have resulted in the improvement of known techniques, as well as the creation of safer and more efficient methods. Anaesthesiologists performing these procedures should have a clear understanding of the anatomy, the influence of age and size, and the potential complications and hazards of each procedure to achieve good results and avoid morbidity. A thorough knowledge of the anatomy of paediatric patients is also essential for successful nerve blocks, which cannot be substituted by probing the patient with a needle attached to a nerve stimulator. The anatomy described in adults is also not always applicable to children, as anatomical landmarks in children vary with growth. Bony landmarks are poorly developed in infants prior to weight bearing, and muscular and tendinous landmarks, commonly used in adults, tend to lack definition in young children. The aim of this research was therefore to study a sample of neonatal cadavers, as well as magnetic resonance images in order to describe the relevant anatomy associated with essential regional nerve blocks, commonly performed by anaesthesiologists in South African hospitals. This research has brought to light the differences between neonatal and adult anatomy, which is relevant since the majority of paediatric regional anaesthetic techniques were developed from studies originally conducted on adult patients. Current techniques were also analysed and where necessary new improvements, using easily identifiable and constant bony landmarks, are described for the safe and successful performance of these regional nerve blocks in paediatric patients. In conclusion a sound knowledge and understanding of anatomy is important for the success of any nerve blocks. This study showed that extrapolation of anatomical findings from adult studies and simply downscaling these findings in order to apply them to infants and children is inappropriate and could lead to failed blocks or severe complications. It would therefore be more beneficial to use the data obtained from dissection of neonatal cadavers. / Thesis (PhD)--University of Pretoria, 2010. / Anatomy / unrestricted

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