Department of anaessthesia

Faculty of Health Sciences

Research Report 2006

Department of Anaesthesia

Research Report 2006

Head of Department: Professor MFM James
Departmental Profile
The past year has been one of continued achievement for the Department, with a satisfactory, but not increasing record of publication. New researchers continue to emerge from among the consultant ranks as the previous research achievements attract further interested clinicians into the research arena. Presentation of new work at major international meetings such as the European Society of Anaesthesiologists Congress, international Paediatric Anaesthesia meetings and various fluid therapy conferences has been sustained. Expertise in studies in coagulation remains a major strength, and collaborative studies in this area have been maintained with Anaesthesia Departments at University College London Hospitals and the University of San Francisco. Substantial equipment grants have been obtained for new equipment for ongoing research in this field. The incidence of pre-eclampsia in our obstetric population makes this a fruitful and important area for anaesthesia research. Following the acquisition of sophisticated cardiovascular monitoring substantial research progress has been made in this field. The wealth of clinical material in paediatric anaesthesia has led to a blossoming of publications in this area, with a successful publication of a book on the management of Burns and ongoing research in regional anaesthesia in children. Collaborative studies with the University of Vienna into ultrasound-assisted regional blockade have been highly successful. Fluid therapy studies, particularly in trauma, are a major interest, and substantial funding has been obtained for a major research project into the use of colloid resuscitation in trauma. Studies into drug errors during anaesthesia have been successfully conducted in collaboration with the University of the Witwatersrand and the University of Auckland, New Zealand.

Departmental Statistics
PERMANENT AND LONG TERM CONTRACT STAFF

Professors	2
Associate Professor	4
Principal Specialists	3
Senior Specialists/Lecturers	7
Specialists/Lecturers	17
Registrars	47
Medical Officers	2
Administrative staff, Clerical Staff and laboratory staff	5
TOTAL	87

STUDENTS

Postgraduates	47
Undergraduates	350
TOTAL	397

Research Fields and Staff

Bösenberg, AT

Paediatric anaesthesia, with special interest in paediatric regional anaesthesia.
Dyer, RA

Obstetric anaesthesia and thoracic anaesthesia and pharmacology. Cardiac output studies during anaesthesia for preeclampsia.

Heijke, SAM

Transoesophageal echocardiography in cardiac anaesthesia.

Gordon, PC

Studies on drug errors in anaesthesia.

James, MFM (Head of Department)

The role of magnesium in the treatment of malignant arrhythmias and hypertension in association with anaesthesia, particularly phaeochromocytoma; blood transfusion and anesthesia, haemodilution and coagulation; crystalloid v. colloid in trauma resuscitation; saline v balanced salts in resuscitation; calcium and blood coagulation; blood coagulation in patients with chronic renal failure and thromboelastographic studies.

Reed, A

Intravenous regional anesthesia and the role of morphine; magnesium in the treatment of bupivacaine toxicity; the role of magnesium in anaesthesia for patients undergoing cerebral aneurysm surgery. Non-steroidal anti-inflammatory agents in their neurosurgical anaesthesia.
Ruttmann, TG

Interaction of various intravenous solutions and anaesthetic techniques on coagulation; the effects of intra-venous fluid management with either colloid or crystalloid on coagulation in patients undergoing peripheral vascular surgery; remifentanil and midazolam regimen versus a morphine and midazolam regimen in Intensive Care Unit patients; the effects of increasing haemodilution on coagulation. The effects of intravenous fluid management on coagulation in patients undergoing orthopaedic hip surgery using a colloid, either gelatine [heamacell] or hydroxy-ethyl starch [haes-steril] or a crystalloid [plasmalyte B/other], The effect on coagulation of reducing haematocrit by dilution with homeogenic plasma. The effect of magnesium on aemodilution-induced enhanced coagulation.

Llewellyn, R

The effect of low molecular weight heparin on the enhancement of coagulation by haemodilution.

Steffanutto, T

The use of magnesium in the management of cerebral ischaemia following interventional radiological procedures. Methylnaltrexone in colon surgery.

Thomas, J

Epidural infusion of ropivacaine; management of burns in children; pain management in children; anaesthesia for the separation of conjoined twins.

Contact Details

Postal Address: Department of Anaesthesia, Room 80, D23, New Groote Schuur Hospital, Main Road, Observatory, 7925, South Africa

UCT Telephone: [phone]

GSH Telephone: [phone]

Fax: [phone]

E-mail: [e-mail]

Research Output
Articles in peer-reviewed journals
Bösenberg, A.T. 2006. Anaesthesia and Hallermann-Streiff Syndrome. South African Journal Anaesthesia and Analgesia, 12(2): 55-56.
Bösenberg, A.T. and Larkin, K. 2006. Anaesthesia and Charcot-Marie-Tooth Disease. South African Journal Anaesthesia and Analgesia, 12(4): 131-133.
Bösenberg, A.T., Ing, R. and Thomas, J.M. 2006. Fifty years of paediatric anaesthesia - new approaches to an old technique. South African Medical Journal, 96(9): 880-888.
Gordon, P.C., Llewellyn, R.L. and James, M.F.M. 2006. Drug administration errors by South African anaesthetists - a survey. South African Medical Journal, 96(7): 630-632.
Ing, R., Fischer, S., Shipton, S., Gray, R., Thomas, J.M. and Hewitson, J.P. 2006. Regional cerebral oxygenation monitoring - intraoperative management in a patient with severe left ventricular dysfunction. South African Medical Journal, 96(12): 1266-68.
James, M.F.M., Bennett-Guerrero, E. and Mythen, M.G. 2006. A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesthesia and Analgesia, 2006(102): 1274-0.
Petroz, G.C., Sikich, N., James, M.F.M., Van Dyk, H., Shafer, S.L., Schilly, M. and Lerman, J. 2006. A Phase1, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology, 105(6): 1098-1110.
Roche, A.M., James, M.F.M., Grocott, M.P. and Mythen, M.G. 2006. Just scratching the surface: Varied coagulation effects of polymer containers on TEG variables. European Journal of Anaesthesiology, 23(1): 45-49.
Ruttmann, T.G. 2006. Coagulation for the clinician. South African Journal of Surgery, 44(1): 22-30.
Ruttmann, T.G., Lemmens, H.J.M., Malott, K.A. and Brock-Utne, J.G. 2006. The haemodilution enhanced onset of coagulation as measured by the thrombelastogram is transient. European Journal of Anaesthesiology, 23: 574-579.
Stefanutto, T.B. and Ruttmann, T.G. 2006. Conscious sedation v. monitored anaesthersia care - 20 years in the South African context. South African Medical Journal, 96(12): 1252-54.
Thomas, J.M., McCulloch, M., Spearman, W., Butt, A.D. and Numanoglu, A. 2006. A practical approach to anaesthesia for paediatric liver transplantation. Southern African Journal of Anaesthesia and Analgesia, 12(3): 11-15.
Willschke, H., Bösenberg, A.T., Marhofer, P., Johnston, S.J.B., Kettner, S., Wanzel, O. and Kapral, S. 2006. Ultrasonography-guided rectus sheath block in paediatric anaesthesia-a new approach to an old technique. British Journal of Anaesthesia, 97(2): 293-298.
Willschke, H., Bösenberg, A.T., Marhofer, P., Johnston, S.J.B., Kettner, S., Eichenberger, U. and Wanzel, O. 2006. Ultrasonographic-Guided Ilioinguinal/iliohypogastric Nerve Block in Pediatric Anesthesia: What is the Optimal Volume? Anesthesia and Analgesia, 102(6): 1680-84.
Willschke, H., Marhofer, P., Bösenberg, A.T., Johnston, S.J., Wanzel, O., Sitzwohl, c., Kettner, S. and Kapral, S. 2006. Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique. British Journal of Anaesthesia, 97(2): 285-292.

CHAPTERS IN BOOKS
Bösenberg, A.T. 2006. Regional anaesthesia. In J.M. Thomas and H. Rode (eds), A practical guide to paediatric burns: 114-122. Cape Town: SAMA Health and Medical Publishing.
Bösenberg, A.T. 2006. Regional anesthesia for pediatric orthopaedic surgery. In A.P. Boezaart (ed.), Anesthesia and orthopaedic surgery: 137-155. Iowa, USA: McGraw-Hill.
Bösenberg, A.T. 2006. The dysmorphic child and other pediatric issues. In A.P. Boezaart (ed.), Anesthesia and orthopaedic surgery: 61-81. Iowa, USA: McGraw-Hill.
Dent, D. and James, M.F.M. 2005. Perioperative care of patients with endocrine neoplasms. In A.D. Shaw, B.J. Riedel, A.W. Burton and T.W. Feeley (eds), Acute care of the cancer patient: 407-31. USA: Taylor and Francis Group.
James, M.F.M. 2006. Complications of adrenal surgery. In J.L. Atlee (ed.), Complications in anesthesia: 822-826. USA: Elsevier.
Joubert, I. and James, M.F.M. 2006. Rational fluid management. In C.Y. Kuen and N.K. Peng (eds), Management aspects of acute care: 189-99. Malaysia: University of Malaya Press.
Ruttmann, T.G. 2006. Fluids and coagulation. In R.G. Hahn, D.S. Prough and C.H. Svensen (eds), Perioperative fluid therapy: 517-524. Texas, UCA: Informa Healthcare USA.

PUBLISHED CONFERENCE ABSTRACTS
Bösenberg, A.T. 2006. Neonatal caudal block revisited: Can safety be improved? Southern African Journal of Anaesthesia & Analgesia 12 (1) : 36.
Bösenberg, A.T. 2006. Pain issues in children of the developing world. Pain Research and Management 11:76 (B).
De Liefde, I., Van Dijk, M., Tibboel, D. and Bösenberg, A.T. 2006. Eipdural analgesia in major neonatal surgery:worthwhile alternative? Pain Research & Management 11:31 (B).
Ibach, F. and Bösenberg, A.T. 2006. Parental presence at induction of anaesthesia: who benefits? Southern African Journal of Anaesthesia and Analgesia 12 (1) : 26.
Jeebhay, M., Robins, T., Malo, J.L., Lin, X., Seixas, N., Lehrer, S., Bateman, E.D., Baatjies, R., Miller, M., George, D., Russford, E., Smuts, M. and Lopata, A.L. 2006. Risk factors for occupational allergy and asthma among fish processing workers in South Africa. Conference on Research on workplace health and safety: from the core to the margins - mini symposium on occupational allergy and asthma among seafood processing workers.Memorial University, St Johns, Newfoundland / Labrador, Canada, June 2006. Abstract and invited speaker.
Willschke, H., Johnston, S.J.B., Bösenberg, A.T., Marhofer, P. and Kapral, S. 2006. Ilio inguinal block: do we know the correct dose? Southern African Journal of Anaesthesia & Analgesia 12 (1) : 37.