Faculty of Health Sciences (ETDs)

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    A survey of the perceptions and knowledge of anaesthesia and anaesthetists possessed by Grade 12 learners in four Johannesburg districts
    (University of the Witwatersrand, Johannesburg, 2022) Talane, Pulane Adelice
    Background William J.G Morton (1816-1868) introduced the world to modern anaesthesia when he successfully anaesthetised a patient using Ether at Massachusetts General Hospital in Boston in October 1846. (1) Since then, advances in pharmacology have resulted in the safer use of anaesthetic drugs and technological advances have improved monitoring of patients under anaesthesia. Anaesthetists around the world are now involved in the fields of critical care, trauma and pain management. (2)This has brought a sense professional esprit de corps to the anaesthetic fraternity. Despite this radical growth and development of the speciality, there is still a lack of public knowledge regarding the discipline of anaesthesia, anaesthetists’ expertise, or the role played by the anaesthetist in the chain of health care delivery. (3) Methods A cross sectional study was carried out between June and September 2021 on Grade 12 learners in four Johannesburg districts. A questionnaire consisting of three sections and 26 questions was handed out at pre-selected schools. The first part of the questionnaire acquired demographic data, the second contained questions pertaining to anaesthetists and anaesthesia as a speciality, and the third part pertained to interest in the field of anaesthesia. Results Of the 595 learners that participated in this study, 335 (56.3%) were aware that an anaesthetist administers anaesthesia in the operating room. A considerable number of learners n=344 (57,8%) believed that a nurse monitored and recorded the patient’s vital signs during surgery. Only 95 learners (16%) correctly identified all the duties of the anaesthetist outside of the theatre environment. Overall, learners fared poorly, achieving an average score of 14% for the questionnaire. However, there was a statistically significant correlation between being from a high socioeconomic background and awareness that the anaesthetist administers anaesthesia. A high socioeconomic background was defined as having a suburban residence, a household income comprising a salary instead of social grants and care givers that possessed a university degree. Knowledge regarding the intraoperative duties of the anaesthetist was still poor, regardless of the socioeconomic background of the learner. Previous exposure to anaesthesia did not improve awareness about anaesthesia among the learners. Conclusion This study has shown that awareness regarding anaesthesia and anaesthetists is still lacking despite the radical growth in the field. This lack of awareness cannot be ignored; education of the general public should be intensified in order to empower people to ask the right questions as well as make informed decisions about their perioperative care in the future. More than half of the learners in the study (58.5%) believed that good medical education can reduce the burden of health care costs and medicolegal consequences; and 70% of them would request an anaesthetist to provide them with detailed information about their anaesthetic before the start of surgery. Therefore, despite lack of awareness, the majority of the learners displayed interest and willingness to know more about anaesthesia, and grade 12 learners would be a formidable target group to direct anaesthetic education campaigns
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    Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic
    (University of the Witwatersrand, Johannesburg, 2022) Mpemnyama, Lerato Nomonde
    Background The COVID-19 pandemic brought about unprecedented times that resulted in measures of social distancing that had to be put in place. The Department of Anaesthesiology at the University of Witwatersrand had to comply with these regulations and switched the teaching of registrars from in-person format to a virtual platform. The study aimed to look at the perceptions registrars had towards virtual teaching during the COVID-19 pandemic. Methods This cross-sectional quantitative study was conducted in the Department of Anaesthesiology at the University of Witwatersrand via an online self-administered questionnaire that was distributed to the registrars registered in the department. The validated questionnaire that was used was developed following a literature search and an adaptation from two validated questionnaires. The study was conducted from December 2021 to February 2022. Results The department has a total of 100 registrars, and the response rate was 90%. The study highlighted that virtual teaching did have a positive impact in teaching in the academic department, with 91% (n=81) finding virtual teaching to be effective and 63.9% (n=53) of respondents preferring virtual teaching over in-person teaching. Conclusion The COVID-19 pandemic brought about a disruption to the academic programme in the Department of Anaesthesiology at the University of Witwatersrand, resulting in virtual teaching being implemented. This move has been met with a positive response among the registrars in the department.
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    A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology
    (2024) Watermeyer, Benjamin David
    South Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.
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    Analysis of the thickness of the cortices along the course of the inferior alveolar nerve
    (University of the Witwatersrand, Johannesburg, 2023) Seleke, Kgothatso Morake; Mabongo, Mzubanzi; Kotsane, Daisy Fidelis
    Introduction Surgical procedures performed around the course of the inferior alveolar nerve (IAN) accounts for 63% of neuropathy reported2 . These surgical procedures include dental implant placement, surgical extractions around the lower molar area, internal fixation, mandibular ramus graft and bilateral sagittal split osteotomy. Failure to pay attention to detail while performing these surgical procedures may result in inferior alveolar nerve injuries, developing in neurological deficit which are characterized by either paraesthesia or anaesthesia. Aim -The aim of this study was to analyse the buccal and lingual cortical bone thickness along the course of the inferior alveolar nerve. Objectives To analyse the thickness of the buccal-lingual cortical bone along the inferior alveolar canal (IAC). To determine whether there is association between position of the IAC and thickness of the cortices. To determine the factors (age and gender) associated with buccal-lingual position of the nerve. Materials and Methods This was a retrospective study based on analysing radiographic records of patients who took CBCT at Wits Oral Health Centre (W.O.H.C) from January 2015 up to December 2018. The estimated sample size was 132 quadrants of CBCT images which was determined with 95% confidence level, 5% margin of error, 50% population proportion and 200 population size. CBCT images were taken using SIDEXIS next Generation software. The IAN was identified and highlighted along its course to the mental foramen. Results- The male and female buccal-lingual cortical measurements at all points were approximately the same. The lingual right cortical thickness increased with an increase in age, and the buccal right cortical thickness decreased with an increase in age. There was no association between gender and IAC position. The width of the buccal cortex was greater on the left than the right side and the lingual cortical thickness was also greater than the right. In the present study it was found that the males had a thicker buccal cortex posteriorly and a thinner cortex anteriorly compared to females. Females had thicker buccal cortex on the right side at point posteriorly whereas anteriorly it was thicker on the left. The left and right buccal cortices show the median increase in all age groups. The IAC was close to the lingual cortex at the molar region and buccal cortex at the premolar region. The position of the IAC whether buccal, lingual or inferior can be attributed to the type of the IAC as; straight projection, catenary-like projection and progressive descent. It was also determined by the type and depth of impaction, position of the roots of the third molar and the width or thickness of the buccal-lingual cortices. Conclusion- CBCT play an integral role in diagnostic imaging due to details of the images. The position of the IAC that houses IAN is influenced by various factors including but not limited to gender and age as well as the surrounding anatomy. By understanding the surrounding anatomical influences on the position of the IAN, any surgery to the area would minimize complications associated with the IAN especially with the use of detailed imaging such as CBCT.