Browsing by Author "Stuart-Clark, Hannah Elizabeth"

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    Retrospective case series of the anaesthetic management and outcomes of patients with Rasmussen’s aneurysms at an academic hospital
    (University of the Witwatersrand, Johannesburg, 2022) Stuart-Clark, Hannah Elizabeth; Mogane, Palesa; Padi, Josias
    Tuberculosis (TB) has a high burden of disease in South Africa and a Rasmussen’s aneurysm is a late complication of TB (1-5). Although rare, the risk for life- threatening complications is high (>50%) (6-9). Pulmonary artery embolization (PAE) is a highly specialised, minimally invasive technique used for the management of haemoptysis caused by a Rasmussen’s aneurysm which is not commonly performed in Lower Middle-Income Countries (10). There is a paucity of information regarding anaesthetic management guidelines for these patients undergoing PAE. The aim of this study was to describe the periprocedural anaesthetic management and outcomes of patients presenting with Rasmussen’s aneurysms treated with PAE in the interventional radiology suite at Chris Hani Baragwanath Academic Hospital. Methods This study was designed as a retrospective case series and arterial embolization (AE) records were collected over a 4.5-year period (January 2017 – June 2021) for evaluation. All patients identified with Rasmussen’s aneurysms were included in the study and the anaesthesia charts, patient hospital ward files, records from interventional radiology, the National Health Laboratory Service, and pulmonology patient records were then interrogated. Results The prevalence of Rasmussen’s aneurysms in patients presenting for PAE with haemoptysis at this institution was 9%. Of the sixteen patients included in the study, thirteen were male and three were female. Current or previous tuberculosis infection was noted in ten patients and five patients had a current or previous history of smoking. The median duration of the general anaesthesia procedures were 4 hours 5 minutes (interquartile range 03:03 - 05:33), with nine cases done electively andeight done as emergencies. A total of 15 patients were intubated using double lumen endotracheal tubes and 12 patients were done with both consultant and registrar anaesthesiology coverage. Median haemoglobin was 10.5g/dl and eleven patients did not receive periprocedural blood transfusions. All patients were embolised successfully using metallic coils and were sent to a high-dependency unit post- procedure. Conclusion Despite the limitations, this study provides several novel insights into the prevalence and anaesthetic management of Rasmussen’s aneurysms in patients presenting with haemoptysis for PAE in our setting and helped establish the need for protocolised guidelines for the management of these patients. This data also allowed for the development of a novel set of guide recommendations for the management of this unique subset of patients, which include the following: guidelines for pre-operative optimisation, invasive monitoring, anaesthesia technique and postoperative care