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Health Sciences
Department of Anaesthesia
Head of Department: Professor Justiaan
LC Swanevelder
Departmental Profile
Clinical research
The arrival of the new Professor and Head of Department
of Anaesthesia, Justiaan LC Swanevelder, signalled a
new era of cardiovascular research in the Department.
Professor Swanevelder is an international expert in the
field of Transoesophageal (TOE) and Transthoracic (TTE)
Echocardiography, and has played a central role in the
development of this field, and formal guidelines for practice
and accreditation in the United Kingdom. He is a prominent
member of the European Association of Cardio-thoracic
Anaesthesia (EACTA). His initial contribution has involved
a paper on a suggested time course for accreditation in
South Africa, as well as several case reports and an editorial
on the subject. Several important collaborations have been
established during 2012, involving teaching and research
on TTE and TOE by visiting experts (Professors E Sloth,
Denmark, A Dennis, Australia and J Ender, Leipzig), with
a view to training and studies in both intraoperative and
point of care echocardiography. Professor Swanevelder has
also established a new laboratory research post. The first
incumbent will collaborate with Professor Karen Sliwa in the
Hatter Institute of Cardiovascular Research.
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 several MMed
dissertations. These include including a completed
pharmacokinetic study of the antimicrobial agent
cefazolin during cardiopulmonary bypass. The
Department of Pharmacology has developed an
assay for cefazolin, which should facilitate several
further important clinical trials. Important projects in
thromboelastography (TEG) are ongoing, and Dr Owen
Hodges is in the process of writing up his PhD on the
use of TEG during burns surgery. Valuable guidelines
have been published for pain management and
sedation in children. A further study on the noninvasive
measurement of haemoglobin in paediatrics, is nearly
complete.
Obstetric Anaesthesia remains an important area of
investigation. Ongoing projects involve spinal
anaesthesia in preeclamptic parturients. One study has
been completed on the effects of vasopressor therapy
pre-delivery on neonatal acid-base status in patients
with a non-reassuring fetal heart trace. A second study
examines 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 has been 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. An abstract
will be presented on stroke volume responsiveness in
preeclampsia at the Obstetric Anaesthetists’ Association
Annual Meeting in Bournemouth in May 2013. One of
the investigators represented the Department at the
Obstetric Anaesthetists’ Association annual 3 day course
in London in November 2012. The leader of this research
group, Professor RA Dyer, has received a B2 NRF rating
on the basis of completed research in the period of review
from 2004-2011.
Fluid therapy has continued to be a major area of
interest within the Department. Studies on the anion
composition of various intravenous fluids are ongoing,
in collaboration with University College London. 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 has been
published by Professor James, Professor Mythen (UCL),
Professor van der Linden (Belgium) and Dr Richard
Weiskopf (UCL) on the role of intravenous hydroxyethyl
starch in the perioperative period. The conclusions
of this review, together with the findings of the FIRST
Trial, should inform the policy on use of the hyroxyethyl
starches in the various settings of clinical practice at
Groote Schuur Hospital. Professor James remains a
very important contributor to research strategy and new
protocol design in this and other areas.
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 Professor B Biccard,