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DAY 1 - Monday
WELCOME:
After registration and morning coffee and rusks delegates were welcomed to
the first day of the first ARASA by the course convenor, Dr Russell Raath, He
thanked the delegates for being willing to attend the first course and told them
how important their feedback would be in “fine tuning” the course and its
content for future courses, as there is very big interest in ARASA courses for
2008. He also told them that the idea for such a course came from a very similar
course held every year in December in Sweden at which Dr Raath presents the pig
workshop part every year. He also explained the dream of ARASA which is that
this course should become a centre of excellence for regional anaesthesia
teaching for the southern hemisphere and Africa. Courses like the one in Sweden
are simply too expensive for people in the southern hemisphere and Africa when
the cost of the air ticket (long distance), the course fee and accommodation
(both in euros) are added up. ARASA would be much cheaper and convenient for
people in the southern hemisphere and Africa to attend. Now that the first ARASA
is done and all logistics for the course have been successfully tested much
bigger courses will be held in 2008.
NEURAXIAL BLOCKS
After the welcome the course kicked off with ‘neuraxial blocks’ – epidurals and
spinals. Firstly dermatomes and the importance of knowing and understanding them
were discussed. Then the basics of anatomy, techniques, indications and
complications were dealt with. After that, topics around neuraxial blocks were
dealt with nl.
- Epidural haematomas. This devastating complication was dealt with and what to
do to prevent it and how to recognise it and what to do about it. Protocols for
managing the condition were given as well as protocols for monitoring the
patient for it and protocols for catheter removal in patients on
anti-coagulation.
- Protocols for the monitoring and care of patients on continuous epidurals
were discussed. Delegates were given the protocols from the consensus statement
of anaesthesiologist in Johannesburg and Pretoria of 2005. The importance of
proper monitoring was emphasised.
- Accidental dural puncture – incidence, causes, prevention and handling and
treatment were discussed
- Neuraxial blocks and anti-coagulation was also touched on and discussed.
- Difficult epidurals, or epidurals in patients with difficult spines.
Techniques for overcoming problems in performing epidurals and spinals in
patients with bad backs were presented and discussed.
Delegates then had the opportunity to try their hand at and to practice the
techniques for difficult epidurals on cadaver specimens.
NERVE STIMULATORS
Principles of nerve stimulation and location were presented as well as effective
use of the nerve stimulator. Basic operation and settings on nerve stimulators
were discussed and the importance of the ‘disconnect warning or alarm’ was
emphasised and explained. The new technique of using the mapping probe along
with the stimulating needle at the same time using the new Xavant Stimpod nerve
stimulator was demonstrated and delegates had the opportunity of trying the
technique on a live model.
BASIC PHARMACOLOGY
Basic working of local anaesthetics at receptor and channel level were
discussed. Then isomers were explained and the difference between dextro- and
levo-isomeres explained. Local anaesthetic toxicity was presented as well as the
handling thereof and available treatments. A protocol for using Intralipid for
the resuscitation of cardiovascular collapse due to local anaesthetic toxicity
was presented and discussed, as well as the use of magnesium in treating local
anaesthetic toxicity.
REGIONAL ANAESTHETIC OPTIONS FOR ABDOMINAL SURGERY OTHER THAN EPIDURAL OR
SPINAL.
Discussing and demonstrating regional anaesthesia options for abdominal surgery
other than epidurals or spinals took up the last session of the day. Blocks
discussed were ilio-inguinal blocks, thoracic paravertebral blocks, rectus
sheath block and transversus abdominus block as well as celiac plexus blocks.
Intra-abdominal local anaesthetics were also discussed and various regimes with
various additives discussed including magnesium and ketamine.
The day ended at 17h00 and the delegates left tired but satisfied suffering from
information overload, but they were back the next morning at 8h00 for another
day.
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