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A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service
Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effect...
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| Format: | Thesis |
| Language: | English |
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Division of General Surgery
2022
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| _version_ | 1867613186885156864 |
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| access_status_str | Open Access |
| author | de Kock, Joalda Marthiné |
| author2 | Stassen, Willem |
| author_browse | Stassen, Willem de Kock, Joalda Marthiné |
| author_facet | Stassen, Willem de Kock, Joalda Marthiné |
| author_sort | de Kock, Joalda Marthiné |
| collection | Thesis |
| description | Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/35543 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:08.355Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/35543 A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service de Kock, Joalda Marthiné Stassen, Willem Buma, Chloe Ashton Endotracheal intubation Emergency Medical Services Post-intubation Sedation and Analgesia Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions. 2022-01-20T12:42:18Z 2022-01-20T12:42:18Z 2021 2022-01-20T09:30:00Z Master Thesis Masters MPhil http://hdl.handle.net/11427/35543 eng application/pdf Division of General Surgery Faculty of Health Sciences |
| spellingShingle | Endotracheal intubation Emergency Medical Services Post-intubation Sedation and Analgesia de Kock, Joalda Marthiné A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| thesis_degree_str | Master's |
| title | A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| title_full | A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| title_fullStr | A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| title_full_unstemmed | A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| title_short | A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service |
| title_sort | retrospective review of post intubation sedation and analgesia practices in a south african private ambulance service |
| topic | Endotracheal intubation Emergency Medical Services Post-intubation Sedation and Analgesia |
| url | http://hdl.handle.net/11427/35543 |
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