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FACULTY OF health scienceS
Department of
Anaesthesia
Head of Department: Professor MFM James
Departmental Profile
Clinical research:
Fluid therapy has continued to be a major area of interest
within the Department. The FIRST (Fluids in resuscitation
of severe trauma) trial was published in a major journal
this year and a number of research projects have resulted
from that. In particular, studies on the anion composition
of various intravenous fluids have been commenced
in collaboration with University College London and
this project is now approximately halfway completed.
Further intravenous fluid therapy studies have included
the development of a semi-automated fluid administration
system for patients unable to maintain their own natural
fluid balance. This project known as the “Quench” project
is being developed jointly between the UCT and University
College London Department of anaesthesia and critical
care. A major systematic review is being undertaken jointly
between Prof James, Prof Mythen (UCL), Prof van der
Linden (Belgium) and Dr Richard Weiskopf (UCL) on the
role of intravenous hydroxyethyl starch in the perioperative
period.
A second important area of investigation is Obstetric
Anaesthesia. New projects were initiated in the study
of spinal anaesthesia in preeclamptic parturients. One
study will investigate the effects of vasopressor therapy
pre-delivery on neonatal acid-base status in patients
with a non-reassuring fetal heart trace. A second study
will examine three aspects of spinal anaesthesia, namely
stroke volume responsiveness prior to spinal anaesthesia,
the haemodynamic effects of the vasopressor therapy
prior to delivery, and the effects of various methods of
administering oxytocin, including the interaction with an
alpha-agonist. For this purpose, a non-invasive cardiac
output device will be employed, using an algorithm
based upon pulse wave form analysis. As part of
these investigations, a collaboration was initiated with
the Department of Anaesthesia of the University of
Washington. This aspect of the study will examine the
population characteristics of the adrenaline
β
2-haplotype
in preeclamptic women. At the same time data would be
collected on control healthy women. At least three MMed
mini-dissertations will arise from this work. One of the
investigators represented the Department at the Obstetric
Anaesthetists’ Association annual 3 day course in London.
A further study validating the use of a non-invasive
cardiac output device in patients with complicated severe
preeclampsia, was accepted by the British Journal of
Anaesthesia. In addition, a prospective audit of epidural
analgesia was completed and analysed. The leader of this
research group, Professor RA Dyer, has applied for NRF
rating on the basis of 22 publications and a PhD in this
area during the period of review from 2004-2011.
The refurbishment of the Red Cross Hospital operating
theatre complex continued to create an environment
conducive to research, and this was evidenced by the
publication of several instructive case reports, and an
important study of the pharmacokinetics of ketamine
in children, following oral administration, in the journal
Paediatric Anaesthesia. Several new projects are in
preparation, including a pharmacokinetic study of the
antimicrobial agent cefazolin during cardiopulmonary
bypass. Co-operation in these studies has been obtained
from the Department of Pharmacology, including the
development of an assay for cefazolin, which should
form the basis of several further important clinical trials.
Important projects in thromboelastography are ongoing.
Valuable guidelines have been published for pain
management and sedation in children.
The Department is an active research site for the
international, multicentre POISE-2 trial of aspirin and
clonidine for perioperative protection of high risk patients
against perioperative myocardial events, and has recruited
the second highest number of patients in South Africa.
The South African principal investigator is Dr B. Biccard,
from the Department of Anaesthesia, UKZN. The local
site was initially set up by Prof M. James. The lead author
is Dr A. Myburgh, with Drs O Porrill and A Emmanuel as
co-investigators.
Laboratory Research:
The Department was involved in 3 major areas of research
in 2011. Firstly, there are ongoing studies on coagulation,
both clinical, which resulted in a paper in Anaesthesia, and
an animal study of coagulation in a porcine model of acute
liver failure. Cardiac output measurements were also
obtained in the latter study. Secondly, transoesophageal
echocardiography is being performed in baboons
undergoing valve replacement.
Collaboration:
Once again, junior consultants and registrars were
encouraged to participate in research activities wherever
possible, and scientific writing skills were also improved
in this way. International collaboration continues, with the
University College London Hospitals, Stanford University,
the Rikshospitalet, Oslo, the University of Toronto, and the
University of Washington.