Research has a critical role to play in the advancement of anaesthetics and saving lives, says UKZN’s Dr Kim de Vasconcellos.

De Vasconcellos is a Specialist Anaesthetist at King Edward VIII Hospital and one of 10 UKZN academics who presented at the 5th All Africa Anaesthesia Congress held in Cairo, Egypt.

Recommended as a speaker by Dr Dean Gopalan, Head of UKZN’s Anaesthetics Department and sponsored by College of Health Sciences’ Mary Weston Fund to attend the Conference, de Vasconcellos delivered three oral presentations which highlighted recent research on Intensive Care Unit-related (ICU) topics.

One of de Vasconcellos’ talks was on the affects of hyperchloraemia – the electrolyte imbalance indicated by abnormally high levels of chloride in the blood – on the body at ICU level. He said patients who come into the ICU after bleeding or losing a lot of fluids to other causes often needed fluid resuscitation. According to de Vasconcellos, some resuscitation fluids such as “normal” saline contained high levels of chloride. 

He said evidence, specifically looking at the kidney, supported the finding that normal saline causes hyperchloraemia which can result in organ dysfunction such as renal failure. He said normal saline was commonly used in Africa and although it had a fairly subtle effect, alternative fluids should be considered when resuscitating patients.

De Vasconcellos also presented research which confirmed that doctors could possibly reduce the mortality of high risk surgical patients if they aimed for supranormal targets in perioperative haemodynamic optimization.

He said there was a school of thought which proposed that in high risk patients admitted for major surgery, the standard haemodynamic parameters, such as a cardiac output of “five litres-per-minute”, were not adequate to meet the needs of the surgical patient.

‘What some researchers have done is to identify these kinds of patients and put them on various medications which enhanced their cardiac output and potentially drove their circulation to higher than normal targets. They found that they could reduce mortality by aiming at the supranormal targets.

‘It’s a controversial field but recently we’ve had new cardiac output monitors that allow us to do it a lot less invasively.’

De Vasconcellos said there was a new interest in the field. ‘I know that resources are constrained but this is a possible future trend that anaesthetists around the world need to watch. There is even a potential cost-saving in it if you can reduce complications; which it appears to do in the right setting.’

De Vasconcellos’ final presentation was titled: “The Role of Neuromuscular Blockade in Modern Intensive Care”. He said muscular relaxants were previously overused in the ICU and this had risks and side-effects associated with it, hence most academics banned their long-term use in the ICU.

‘What is new is that in very specific patients with severe lung injury, using muscle relaxants for 48 hours, early in their admission,  has effectively reduced inflammation and improved outcomes.’

De Vasconcellos said it was essential to continue research in various topics within anaesthesia and critical care. The Conference had provided an invaluable opportunity for the country’s professionals to share ideas and network with delegates from the African continent.

De Vasconcellos is currently super-specialising in Critical Care and will write his final exams with the Colleges of Medicine later this year. His passion for anaesthetics and various medical and surgical disciplines is fulfilled working in the ICU where he manages to strike a balance.

He said his proposed PhD research would examine the use of B-type natriuretic peptide (BNP) in preoperative risk stratification and risk reduction.

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