The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus.

BACKGROUND: Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy. OBJECTIVE: To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations. METHODS: A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses' screening tool for preoperative assessment. RESULTS: Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery. CONCLUSION: A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.

Nutrient evaluation and ruminal degradation of dry matter and protein from amarula (Sclerocarya birrea), macadamia (integrifolia) and baobab (Adansonia digitata L.) oilcakes as dietary supplements for ruminants.

Inadequate availability of feed ingredients significantly contributes to reduced animal production. Nutritional evaluation of feed ingredients for potential use in feed ration is key. Triplicate samples of oil extraction by-products viz.: amarula (Sclerocarya birrea), macadamia (integrifolia) and baobab (Adansonia digitata L.) oilcakes were analysed for proximate, mineral and amino acids content. To determine the in situ rumen degradability of dry matter (DM) and crude protein (CP) from the oilcakes, polyester bags were used to incubate triplicate subsamples of each oilcake in the ventral rumen of each of the three cannulated mid-lactating Holstein cows for 2, 4, 8, 16, 24, or 48 h. Amarula oilcake (AOC) had higher (P < 0.05) CP, ether extract and essential amino acid content than macadamia (MOC) and baobab (BOC) oilcakes. Fibre fractions were higher (P < 0.05) in MOC and BOC than in AOC. While calcium (Ca) and potassium (K) concentrations were high (P < 0.05) in MOC and BOC, phosphorus (P) concentration was high (P < 0.05) in AOC. The effective degradability of DM and water-soluble, rapidly degradable fractions of DM and CP were high (P < 0.05) in AOC. Insoluble but degradable fraction of CP was high (P < 0.00) in BOC and effective degradation of CP was high (P < 0.05) in AOC and BOC. The AOC with its high CP, EE and essential AA can be used as both protein and energy source for ruminants. Seemingly, MOC and BOC can be used as supplements for fibre as well as Ca and K in ruminant diets. Hence, these non-conventional oilcakes have the potential to partially replace conventional oilcakes in ruminant diets. Evaluation of growth performance, nitrogen digestion and carcass characteristics in ruminants fed diets containing the AOC, BOC and MOC are recommended.

Intraocular pressure changes in patients undergoing cataract extraction and lens implantation: laryngeal mask airway versus endotracheal tube

Objectives: To investigate the influence on intraocular pressure (IOP) of airway management with a laryngeal mask airway (LMA) or tracheal tube (ETT); and secondly to compare the devices with regard to their impact on IOP. Design: Prospective; randomized observational study over a four-month period (August - November 2002) Setting: University-affiliated tertiary level hospital in Pretoria; South Africa Subjects: Forty ASA I and II adult patients undergoing unilateral cataract extraction and lens implantation under general anaesthesia Outcome measures: Changes in intraocular pressure after placement of airway device Methods: Following a standard anaesthestic induction with propofol and atracurium; airway management was randomized to LMA or ETT. IOP was measured pre-induction; 3 min post induction but before airway manipulation; 20 sec post LMA or ETT insertion and finally 2 min post airway instrumentation. Results: There was a small increase in mean IOP in the LMA group; which was statistically insignificant. However there was a significant rise in mean IOP in the ETT group (p = 0.0001) which returned to almost pre-insertion levels at 2 minutes. Conclusions: The LMA causes minimal changes in intraocular pressure when used to secure the airway during cataract surgery. The rise in IOP following tracheal intubation is significant; yet transient and probably clinically insignificant