Displaying publications 1 - 20 of 57 in total

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  1. Wong HM, Woo XL, Goh CH, Chee PHC, Adenan AH, Tan PCS, et al.
    World Neurosurg, 2022 01;157:e276-e285.
    PMID: 34648987 DOI: 10.1016/j.wneu.2021.10.074
    BACKGROUND: Burr hole drainage is the criterion standard treatment for chronic subdural hematoma (CSDH), a common neurosurgical condition. However, apart from the surgical technique, the method of anesthesia also has a significant impact on postoperative patient outcome. Currently, there are limited studies comparing the use of local anesthesia with sedation (LA sedation) versus general anesthesia (GA) in the drainage of CSDH. The objective of this study was to compare the morbidity and mortality outcomes of using LA sedation versus GA in CSDH burr hole drainage.

    METHODS: This retrospective study presents a total of 257 operations in 243 patients from 2 hospitals. A total of 130 cases were operated under LA sedation in hospital 1 and 127 cases under GA in hospital 2. Patient demographics and presenting features were similar at baseline.

    RESULTS: Values are shown as LA sedation versus GA. Postoperatively, most patients recovered well in both groups with Glasgow Outcome Scale scores of 4-5 (96.2% vs. 88.2%, respectively). The postoperative morbidity was significantly increased by an odds ratio of 5.44 in the GA group compared with the LA sedation group (P = 0.005). The mortality was also significantly higher in the GA group (n = 5, 3.9%) than the LA sedation group (n = 0, 0.0%; P = 0.028). The CSDH recurrence rate was 4.6% in the LA sedation group versus 6.3% in the GA group. No intraoperative conversion from LA sedation to GA was reported.

    CONCLUSIONS: This study demonstrates that CSDH drainage under LA sedation is safe and efficacious, with a significantly lower risk of postoperative mortality and morbidity when compared with GA.

    Matched MeSH terms: Anesthesia, Local/adverse effects; Anesthesia, Local/trends*
  2. Kuppusamy S, Faizal N, Quek KF, Razack AH, Dublin N
    World J Urol, 2010 Dec;28(6):673-6.
    PMID: 20623289 DOI: 10.1007/s00345-010-0578-7
    It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score.
    Matched MeSH terms: Anesthesia, Local/methods*
  3. Ahmad AA, Ikram MA
    Trauma Case Rep, 2017 Dec;12:40-44.
    PMID: 29644283 DOI: 10.1016/j.tcr.2017.10.016
    Isolated fractures of shaft of ulna are common. Plate fixation with anatomic reduction is thought to produce the best functional results in closed or open fractures. Surgery can be done under general and various types of regional anaesthesia. We report a case of fracture shaft of ulna treated by plating under a combination of WALANT (wide awake, local anaesthesia, no tourniquet) using tumescent anaesthesia and periosteal nerve block as a day care procedure.
    Matched MeSH terms: Anesthesia, Local
  4. Tang ML, Ching LS, Brito-Mutunayagam S, Revadi G
    Med J Malaysia, 2013 Dec;68(6):469-70.
    PMID: 24632915 MyJurnal
    A 19 year-old man was presented to us in a state of respiratory distress with history of alleged accidentally swallowed the live fish. Flexible nasopharyngolaryngoscope showed a big live fish impacted in the laryngopharynx. Attempts to remove the fish orally were futile as the fish was impacted. We resorted to tracheostomy under local anaesthesia, followed by direct laryngoscopy and removal of the fish under general anaesthesia. The literature review of such rare incidence and approach to such case are discussed.
    Matched MeSH terms: Anesthesia, Local
  5. Syed A, Zainal AA, Hanif H, Naresh G
    Med J Malaysia, 2012 Dec;67(6):610-2.
    PMID: 23770955 MyJurnal
    This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysm undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All four patients were males with a mean age of 66.7 years. Only one required ICU stay of two days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).
    Matched MeSH terms: Anesthesia, Local*
  6. Syed Alwi SA, Zainal Ariffin A, Hanif H, Naresh G
    Med J Malaysia, 2012 Oct;67(5):503-5.
    PMID: 23770868
    This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysms undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All 4 patients were males with a mean age of 66.7 years. Only one (1) required ICU stay of 2 days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).
    Matched MeSH terms: Anesthesia, Local*
  7. Tay JWT, Leong YP
    Med J Malaysia, 2012 Feb;67(1):111-2.
    PMID: 22582560 MyJurnal
    A 68 year old man with significant cardiorespiratory risks factors presented with a ruptured thoracic aortic aneurysm (TAA). This was treated by emergency thoracic endovascular aneurysm repair (TEVAR) under general anaesthesia (GA). An incidental abdominal aortic aneurysm (AAA) was not treated. Eight months later, he presented with ruptured AAA. Due to the patient's compromised respiratory system, he underwent endovascular aneurysm repair (EVAR) under local anaesthesia (LA). He had a smoother post-operation recovery compared to the first repair under GA.
    Matched MeSH terms: Anesthesia, Local*
  8. Ramanathan R
    Med J Malaysia, 1998 Sep;53 Suppl A:99-101.
    PMID: 10968190
    We studied 95 patients who underwent knee Arthroscopy under local anaesthesia between JANUARY 1995 till 1997. Materials used were 1% Xylocaine and 0.25% Bupivacaine of 20 mls each combined with midazolam 2 mg and IV pethidine 30 mgm for sedation. The patients were attached to monitors (pulse Oxymeter, ECG and BP and pulse recorders) and blood less field was created using a tornquet. The procedures lasted about 45 minutes. 90 out of 95 patients completed the procedures successfully without any complications. 2 developed respiratory embarrassments and were intubated and ventilated. 3 procedures abandoned and converted to general anaesthesia. The range of procedures done include meniscectomy, meniscal repair, synovial biopsy, debridement for osteoarthrosis, shaving of osteophytes, drilling of cartilage and bones and removal of loose bodies. This study is to show that knee arthroscopy under LA is a safe alternative in hospitals where GA time is limited.
    Matched MeSH terms: Anesthesia, Local*
  9. Yaacob HB, M Nor G, Malek SN, Mahfuz MA
    Med J Malaysia, 1983 Mar;38(1):59-61.
    PMID: 6633339
    The efficacy of xylocaine topical anaesthetic and a placebo in reducing intraoral injection pain were tested in 72 patients. The topical agent was found to be very effective in reducing such pain and the authors recommend its use prior to intraoral injections for the benefit of the patient.
    Matched MeSH terms: Anesthesia, Local*
  10. Peng WW, Hing NG, Fuvan IS
    Med J Malaysia, 1975 Jun;29(4):293-8.
    PMID: 1196177
    Matched MeSH terms: Anesthesia, Local*
  11. Goh CH, Lau BL, Teong SY, Law WC, Tan CS, Vasu R, et al.
    Med J Malaysia, 2019 12;74(6):499-503.
    PMID: 31929475
    INTRODUCTION: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy of the hand, up to 90% of all nerve compression syndromes. The disease is often treated with conservative measures or surgery. The senior author initially intended to treat his own neurosurgical patients concurrently diagnosed with carpal tunnel syndrome in 2014, subsequently, he began to pick up more referrals from the primary healthcare group over the years. This has led to the setup of a peripheral and spine clinic to act as a hub of referrals.

    OBJECTIVE: Department of Neurosurgery Sarawak aimed to evaluate the surgical outcome of carpal tunnel release done over five years.

    METHODS: The carpal tunnel surgeries were done under local anaesthesia (LA) given by neurosurgeons (Bupivacaine 0.5% or Lignocaine 2%). Monitored anaesthesia care (MAC) was later introduced by our hospital neuroanaesthetist in the beginning of 2018 (Target-controlled infusion propofol and boluses of fentanyl). We looked into our first 17 cases and compared these to the two anaesthesia techniques (LA versus MAC + LA) in terms of patient's pain score based on visual analogue scale (VAS).

    RESULTS: Result showed MAC provided excellent pain control during and immediately after the surgery. None experienced anaesthesia complications. There was no difference in pain control at post-operation one month. Both techniques had equal good clinical outcome during patients' clinic follow up.

    CONCLUSION: Neurosurgeons provide alternative route for CTS patients to receive surgical treatment. Being a designated pain free hospital, anaesthetist collaboration in carpal tunnel surgery is an added value and improves patients overall experience and satisfaction.

    Matched MeSH terms: Anesthesia, Local/methods*
  12. Ling NN
    Med J Malaya, 1972 Mar;26(3):198-200.
    PMID: 5031015
    Matched MeSH terms: Anesthesia, Local*
  13. Chandrasekaran B, Cugati N, Kumaresan R
    Malays J Med Sci, 2014 Nov-Dec;21(6):45-51.
    PMID: 25897282
    Student-to-student administration of local anesthesia (LA) has been widely used as the teaching modality to train preclinical dental students. However, studies assessing students' outlook towards their first injection were limited. Therefore, this study aims to evaluate students' perception and anxiety levels towards their first LA injection.
    Matched MeSH terms: Anesthesia, Local
  14. Prasetyono TOH, Adhistana P
    Malays J Med Sci, 2019 Mar;26(2):66-76.
    PMID: 31447610 DOI: 10.21315/mjms2019.26.2.8
    Background: This study aimed to measure the least initial and maintenance forces of syringe and needle combinations to provide a reference for local anesthetic injection.

    Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA.

    Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: -0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle.

    Conclusion: The 1 mL syringe with original 26G needle shows the best combination.

    Matched MeSH terms: Anesthesia, Local
  15. Ahmad AA, Yi LM, Ahmad AR
    J Hand Surg Am, 2018 Nov;43(11):1045.e1-1045.e5.
    PMID: 29866390 DOI: 10.1016/j.jhsa.2018.03.033
    Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures. Because distal radius fracture fixation is usually performed under general or regional anesthesia with the use of a tourniquet, this exposes patients, especially elderly people with extensive comorbidities, to adverse effects commonly associated with these forms of anesthesia. As such, many of these patients are unable to undergo surgery in a timely manner until they are deemed medically fit for surgery or anesthesia, and some may still be treated nonsurgically. Injecting local anesthetic of lidocaine and epinephrine into the surgical field and without using a tourniquet is known to be advantageous for various surgical procedures of the hand. However, this approach, also known as wide-awake local anesthesia no tourniquet (WALANT), has not been used in the fixation of fractures beyond the wrist. Using the WALANT approach as an alternative anesthetic for plating of distal radius fractures may enable patients who are normally denied surgery owing to their age or medical comorbidities to undergo plate fixation for the fractures. This article outlines the WALANT approach used for a single case of fixation of distal end radius fracture with a detailed description of the technique of administering local anesthesia.
    Matched MeSH terms: Anesthesia, Local*
  16. Thevi T, Godinho MA
    Br J Ophthalmol, 2016 Dec;100(12):1708-1713.
    PMID: 26994109 DOI: 10.1136/bjophthalmol-2015-307785
    BACKGROUND: Cataract surgery has progressed from large incision to smaller incisions, which do not require sutures. Anaesthesia too has progressed from general anaesthesia to local anaesthesia to topical anaesthesia. The ideal anaesthesia for cataract surgery would be one that is easy to administer, provides adequate pain relief during surgery and is associated with fewer complications.

    AIMS: This study was done to find out the most suitable anaesthesia for patients with fewer complications and also to look at the trend of anaesthesia being used.

    METHODS: A retrospective analysis was done of patients who underwent cataract surgery from 2007 to 2014 in Hospital Melaka. Data were obtained from the National Eye Database and analysed using SPSS. Trend of types of anaesthesia used and the associated complications with each were studied.

    RESULTS: The most frequently used anaesthesia was topical anaesthesia, which showed an upward trend followed by subtenon in turn showing a downward trend. Subtenon anaesthesia was associated with more intraoperative and postoperative complications while topical anaesthesia was associated with fewer complications.

    CONCLUSIONS: Topical anaesthesia has shown a steady increase in usage and is the ideal anaesthesia, which has been associated with fewer complications.

    Matched MeSH terms: Anesthesia, Local/methods*
  17. Cunningham IG, Lee YK
    Aust N Z J Surg, 1975 Aug;45(3):285-9.
    PMID: 1058690
    A group of patients with solitary nodules of the thyroid were treated at the University of Malaya by surgery under local anaesthesia. This was done in order to expedite exploration of a potentially malignant condition. This group comprised 43 patients, and four cancers were found. The standard technique used was satisfactory from the viewpoint of both the patient and the surgeon. The pattern of this condition in a Malaysian population is documented, the technique used is described, and thyroidectomy under local aneaesthesia is discussed.
    Matched MeSH terms: Anesthesia, Local*
  18. Zainudin BM, Rafia MH, Sufarlan AW
    Singapore Med J, 1993 Apr;34(2):148-9.
    PMID: 8266157
    Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.
    Matched MeSH terms: Anesthesia, Local/methods*
  19. Abdullah S, Ahmad AA, Lalonde D
    Plast Reconstr Surg Glob Open, 2020 Aug;8(8):e3023.
    PMID: 32983779 DOI: 10.1097/GOX.0000000000003023
    Tendon transfer for radial nerve palsy is a common procedure done under general anesthesia. We describe a surgical technique of triple tendon transfer with wide awake local anesthesia no tourniquet (WALANT). We transfer flexor carpi radialis to extensor digitorum communis, palmaris longus to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis. This is commonly known as the Brand transfer. Our anesthetic or WALANT solution consists of up to 200 mL of 1:400,000 epinephrine, 0.25% lidocaine buffered with sodium bicarbonate. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively extend their fingers, thumb, and wrist during the surgery and making adjustments before we close the wound. In our experience, there is no need of brain retraining because a patient is able to immediately use the flexor muscles to perform extension movements. WALANT is a safe and viable option for radial nerve tendon transfers.
    Matched MeSH terms: Anesthesia, Local
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