A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology. Johannesburg, 2017 / Anaesthesia is an important aspect of clinical medicine. The quality, safety, education and training in anaesthesia have an impact on the outcome of patient care. The overall aim of the study was to evaluate anaesthetic services in selected Gauteng hospitals. This study was done in two parts. Part 1 evaluated the level of training of doctors administering anaesthesia, the range of procedures performed and the perception of training adequacy for the anaesthesia they administered. Part 2 of the study reviewed a total number of 585 procedures performed over a two week period in August 2015. Procedures performed and type of anaesthesia employed as well as the length of stay post the procedure were analysed. The majority of doctors, 72.4%, administering anaesthesia had neither an anaesthetic postgraduate qualification nor any recognised resuscitation certificate such as ACLS or ATLS. Although 58.6 % of doctors felt that the training they had received was adequate for the type of surgical cases they were expected to anaesthetise, some junior doctors highlighted inadequate supervision. The majority of procedures, 47.4%, were obstetrics caesarean sections, of which 96.0% were performed under spinal anaesthesia. There was no statistically significant difference in length of stay between obstetric patients who had either a general or spinal anaesthesia. Anaesthetic records were retrieved in 97.8% of the cases. Post-operative observations were recorded prior to discharge from the recovery room in 97.2% of patients. There were no anaesthetic related complications reported or noted during the two week study period. The majority of doctors were not trained in anaesthesia, however no complications occurred during the study period. Furthermore, the majority of procedures done were obstetrics using spinal anaesthesia. This is in contrast to the Green-Thompson (1) study that found that the majority of obstetric cases were done under general anaesthesia. There was also a substantial improvement in record keeping. / MT2017

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Lipophilic dialkylated-a-, β- and γ-cyclodextrin derivatives were used as selective ionophores for a series of clinically relevant ammonium ions, and as enantioselective ionophores for both a- and β-aryl ammonium ions. Sensitive and selective potentiometric detection of the local anaesthetics lidocaine and bupivacaine was achieved by using 2,3,6 trioctyl-β-cyclodextrin as the ionophore, leading to micromolar detection limits. Interference studies showed that the simulated clinical electrolyte background caused minimal interference whereas organic interferents of similar size and charge caused some perturbation of the electrode response at a concentration of 10 mmol dm(^-3). An electrode comprising a plasticized biocompatible membrane matrix, TECOFLEX, with 2,6 didodecyl-β-cyclodextrin was incorporated in a flow injection analysis system and the response to lidocaine studied in the presence of human serum. Human serum caused no adverse effects to the electrochemical response of the electrode. These electrodes are, therefore, very suitable for on-line detection of local anaesthetics. Potentiometric detection of tricyclic antidepressants using didodecyl-a-, β- and γ- cyclodextrins as the ionophore, gave micromolar detection limits. Interference from simulated clinical electiolyte background and selected organic interferents gave similar results to those discussed above. In order to lower the detection limit to sub-nanomolar levels modified amperometric electrodes were assembled by depositing a membrane comprising plasticised TECOFLEX, 2,3,6 triethyl-β-cyclodextrin and TKB on the working electrode of a screen printed electrode. Lipophilic 2,6 didodecyl-a- and β-cyclodextrins exhibited enantiomeric discrimination in the binding of propranolol, ephedrine, amphetamine and methamphetamine. These results were confirmed using potentiometric and NMR techniques.