Brought to you by yours truly - the alleged prickly pear, Jeremy.

Dearest gentle readers — we’ve made it to December! 🥰
Whether you’re winding down, gearing up for the holiday shifts, or simply counting down to some well-earned rest, here’s your monthly dose of updates, exam-friendly summaries, and the usual sprinkle of chaos.
Open in browser to view the playlists:

An update regarding the scheduled recess (I stand corrected): 22nd December 2025 to January 2026

✈️ UP Updates

🧾 Administrative Notes

• Newsletter contributions are always welcome! If you want your work featured, please do not hesitate to message me directly. Both thoughts and prayers welcome. If you have any enlightening stories, please also feel free to share so that we can celebrate this with you!
• Leave: Please ensure TIMEOUS submission of sick leave and leave forms to, again we thank and appreciate our consultants for co-ordinating leave for the ENTIRE team which one can only imagine to be tedious and difficult: (Please feel free to click on the bottom button for a direct link to SBAH online leave roster:
  • Dr Morosi: [email protected]
  • Dr Voigt: [email protected]

🎓 Education & Exam Prep

• FCA1/2 Candidates (2026):
  • FS revision resources are being consolidated.
• January study groups will be announced soon (in-person + online options).
  • FCA 2 representative: Dr Mardé van Dyk and Dr Danielle Mouton
  • FCA 1 representative: Dr Anke van der Walt
  • DA Representative: Dr Rindze Yolanda Sithole

🌐 Website / Platform

• We strive to continuously see to this website being updated timeously
• Monthly advised readings distributed through newsletters when I publish

🏥 Clinical Highlight of the Month

Peri-operative Considerations: Atrial Fibrillation

• Of course there will be new guidelines when you are peri-exams (156 pages of it)
• Why it matters? This updates the three old pillars from 2014 to a new aspect where optimisation also features in the pillars
• Key intra-operative considerations
• Post-op issues
• Special features mentioning DOACs

📚 Research / Evidence Snapshot

Featured Paper: The TRAX Trial 
[Tranexamic Acid in Patients Undergoing Noncardiac Surgery] — The New England Journal of Medicine, 2022 

• 🧪 Design: Multicenter, randomized, placebo-controlled clinical trial
• 👥 Population: 9,535 adult patients undergoing noncardiac surgery who were at risk for bleeding and cardiovascular complications
• 💉 Intervention vs comparison: Tranexamic acid (TXA) given during surgery versus placebo
• 📊 Primary outcome: A composite of life-threatening bleeding, major bleeding, and bleeding that led to death
• 🫀 Take-home message: In patients undergoing noncardiac surgery, perioperative tranexamic acid administration significantly reduced major bleeding events without increasing the risk of major cardiovascular complications. 

Short Snippets
Links are clickable and will direct you towards the article

• [Ketamine or Etomidate for Tracheal Intubation in Critically Ill Patients] — Ketamine did not significantly lower in-hospital mortality compared to etomidate for induction of anaesthesia in critically ill patients.
• [Perioperative patient outcomes in the African Surgical Outcomes Study] — This study provided crucial observational data on perioperative patient outcomes across Africa, highlighting specific regional challenges in surgical care.
• [IMpact of PerioperAtive KeTamine on Enhanced Recovery After abdominal Surgery (IMPAKT ERAS): a pragmatic randomised single-cluster trial] — A pragmatic trial published in 2025 investigating if perioperative ketamine use improves outcomes in enhanced recovery after abdominal surgery protocols. Conclusion: ketamine did not provide additional benefit when included within a multimodal, low-opioid utilisation ERAS protocol for patients undergoing colorectal, ventral hernia, or surgical oncology procedures.

🧠 Academic Corner
Topic: Chronic pain of central origin
Key points:

• Chronic central neuropathic pain arises from lesions or diseases of the central somatosensory nervous system, including stroke, spinal cord injury, brain injury, and multiple sclerosis.
• Common symptoms include burning pain, allodynia, hyperalgesia, and dysesthesia, (±contralateral side of a central lesion)
• Diagnosis: It is often a diagnosis of exclusion, relying on patient history, somatosensory examinations, and neuroimaging (magnetic resonance imaging [MRI], computed tomography [CT], electroencephalogram [EEG], somatosensory evoked potential [SEP]).
• Treatment Approaches:
  • Pharmacological (tricyclic antidepressants, gabapentinoids, serotonin-norepinephrine reuptake inhibitors, opioids in refractory cases),
  • Interventional (spinal cord stimulation, neuroablation, nerve blocks)
  • Nonpharmacological (cognitive behavioral therapy (CBT), transcutaneous electrical nerve stimulation (TENS), physiotherapy).
• Challenges & Future Directions: Pain management is complex due to psychosocial factors, opioid misuse risks, and treatment resistance, requiring multidisciplinary approaches and ongoing research into neurophysiological mechanisms.

Pharmacological considerations:

📅 December Events & Reminders

• 🎉 UPAN End-of-Year Social: 6 December 2025

• 🗂️ New Class representatives for 2026:
  Dr Ruan Scheepers
  Dr Piruntha Naidoo
  Dr Llewellyn Davies
• December Birthdays
  4th December: Dr Lebo Mokwene
  5th December: Dr Anri Tempel
  7th December: Dr Dawie Smith
  24th December: Dr Justin Vieira
  29th December: Dr Llewellyn Davies
  31st December: Dr Tshidi Tsholo
  • From the department wishing you guys an amazing birthday month

😭💜 Jeremy’s Corner

In classic year-end spirit — please stay hydrated, sleep when you can, and touch some grass (real grass, not the devil's lettuce) before stepping into 2026.
If your list of December goals currently looks like:

• “Survive”
• “Submit leave request”
• “Buy one (1) gift to pretend I’m a functioning adult”
  …you’re not alone.
  Also please let me know if you are keen on Secret Santa 🧑‍🎄 (I mean Kalafong is doing it, maybe SBAH should also - in the spirit of team building)

🍽️ Air Fryer Recipe of the Month — Sesame Ginger Chicken Thighs

(High-protein, easy, and exam-season-friendly.)

Ingredients (2 servings):

• 500g boneless chicken thighs
• 1 tbsp soy sauce
• 1 tbsp oyster sauce
• 1 tbsp rice vinegar
• 1 tsp sesame oil
• 1 tbsp honey
• 1 tsp grated ginger
• 1 clove garlic, minced
• Sprinkle of sesame seeds
• Optional: sliced spring onions

Instructions:

1. Mix all marinade ingredients.
2. Coat chicken well and let sit 20–30 min.
3. Preheat air fryer to 190°C.
4. Air fry 10–12 min, flipping halfway, until golden and cooked.
5. Sprinkle sesame seeds + spring onions.

Macros (per serving):

• Calories: ~310
• Protein: 32g
• Carbs: 10g
• Fat: 16g

💌 Final Words

Thank you all for another year with UP Anaesthesia
Wishing you a safe festive season, restful leave, and minimal 2 am emergencies.

See you in January,
Jeremy
(Llewellyn will be publishing January's Newsletter 🫶🏻)