Double balloon enteroscopy examinations in general anesthesia

AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of anesthesia.RESULTS:We compiled data for 108 cases of general anesthesia with intubation.We did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P < 0.001) and apnea(7.7% vs 53.8%,P = 0.001)],however,their incidence was not proportional to the quantity of medication used or the duration of anesthesia.CONCLUSION:General anesthesia with intubation is definitely a viable option among DBE methods.It is highly recommended in patients with multiple additional diseases.

Ethical Decision-Making in Clinical Nutritional Practice

Ethics requires a critical evaluation of assumptions and arguments about norms and values;what should be done and what should not. Practitioners should practice ethically, and the professions should be at the forefront of applied ethics. There are four principles, patient autonomy, beneficence, non-maleficence and justice, which are guides to ethical day-to-day practice. Patient autonomy: Autonomy means self-rule by persons of their thoughts and actions. Patient autonomy requires the practitioner to realise that patients have the right to be involved in decision-making on their own behalf. Beneficence refers to the duty of the practitioner to do the best for the patient. The benefits of breast-feeding are many, and the eventual outcome on health enormous. Nevertheless, health-care workers are diffident in promoting breast-feeding, and readily accept excuses for not breast-feeding, contrary to the principle of beneficence. Non-maleficence refers to the duty of the practitioner not to do harm;it requires the practitioner to withhold harmful therapies;Vitamin E, for example, has been proven to be ineffective as an antioxidant in humans, and large doses have been proven to increase mortality. Yet these are the doses available in supermarkets and “Health shops”. Nutritionists should actively advise against harmful “dietary supplementation”. Distributive justice requires every patient to have an equal opportunity to obtain appropriate therapy. There are relatively few nutritionists and dieticians in South Africa, and indeed in the entire African continent, but proportionately even fewer in the areas of greatest need. A case illustrates the application of these ethical principles to show how they can be applied to our daily practice. Using these four principles is a practical approach to solving ethical dilemmas.