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Effects of sevoflurane increments on left ventricular systolic long-axis performance during sevoflurane-remifentanil anesthesia for cardiovascular surgery

Kwon WK, Sung TY, Yu GY, Sidik H, Kang WS, Lee Y, et al.

J Anesth, 2016 Apr;30(2):223-31.

PMID: 26577248 DOI: 10.1007/s00540-015-2094-9

BACKGROUND: The direct impact of sevoflurane on intraoperative left ventricular (LV) systolic performance during cardiac surgery has not been fully elucidated. Peak systolic tissue Doppler velocities of the lateral mitral annulus (S') have been used to evaluate LV systolic long-axis performance. We hypothesized that incremental sevoflurane concentration (1.0-3.0 inspired-vol%) would dose-dependently reduce S' in patients undergoing cardiac surgery due to mitral or aortic insufficiency.

METHODS: In 20 patients undergoing cardiac surgery in sevoflurane-remifentanil anesthesia, we analyzed intraoperative S' values which were determined after 10 min exposure to sevoflurane at 1.0, 2.0, and 3.0 inspired-vol% (T1, T2, and T3, respectively) with a fixed remifentanil dose (1.0 μg/kg/min) using transesophageal echocardiography.

RESULTS: Linear mixed-effect modeling demonstrated dose-dependent declines in S' according to the end-tidal sevoflurane concentration increments (C(ET)-sevoflurane, p < 0.001): the mean value of S' reduction for each 1.0 vol%-increment of C(ET)-sevoflurane was 1.7 cm/s (95 % confidence interval 1.4-2.1 cm/s). Medians of S' at T1, T2, and T3 (9.6, 8.9, and 7.5 cm/s, respectively) also exhibited significant declines (by 6.6, 15.6, and 21.2 % for T1 vs. T2, T2 vs. T3, and T1 vs. T3, p < 0.001, =0.002, and <0.001 in Friedman pairwise comparisons, respectively).

CONCLUSIONS: Administering sevoflurane as a part of a sevoflurane-remifentanil anesthesia regimen appears to dose-dependently reduce S', indicating LV systolic performance, in patients undergoing cardiac surgery. Further studies may be required to evaluate the clinical implications of these findings.

Matched MeSH terms: Anesthesia/methods*

Anesthetic management of a parturient with superior vena cava obstruction for cesarean section

Chan YK, Ng KP, Chiu CL, Rajan G, Tan KC, Lim YC

Anesthesiology, 2001 Jan;94(1):167-9.

PMID: 11135739

Matched MeSH terms: Anesthesia, Epidural*

Fulltext A comparison of the induction and emergence characteristics of sevoflurane and halothane in children

Chiu CL, Chan YK, Ong G, Delilkan AE

Med J Malaysia, 1999 Sep;54(3):346-51.

PMID: 11045061

This open labelled, randomised, controlled study was designed to compare the induction and recovery characteristics of sevoflurane and halothane anaesthesia in children. Forty American Society of Anaesthesiologist (ASA) physical status class 1 or 2 children (aged 1-10 year, weighed less than 25 kg) scheduled for elective urological procedure lasting less than one hour were allocated randomly to receive either sevoflurane (group S, n = 20) or halothane (group H, n = 20). The induction time in children receiving sevoflurane was significantly shorter than in those receiving halothane (mean (SD) 46 (13.6) second vs 69 (19.4) seconds, p < 0.005). The emergence from anaesthesia was also faster in children receiving sevoflurane than in those receiving halothane (mean (SD) 9 min (4.3 min) vs 21 min (8.9 min), p < 0.001). No major adverse effects were encountered in each group. We concluded that sevoflurane is comparable to halothane in Malaysian children.

Matched MeSH terms: Anesthesia, General*

A survey of the current practice of obstetric anaesthesia and analgesia in Malaysia [correction of Malaysis]

Chan YK, Ng KP

J Obstet Gynaecol Res, 2000 Apr;26(2):137-40.

PMID: 10870307

OBJECTIVE: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996.

RESULTS: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all.

CONCLUSIONS: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom.

Matched MeSH terms: Anesthesia, Obstetrical/statistics & numerical data*

Fulltext Anaesthesia Incident Monitoring Study in Hospital Kuala Lumpur--the second report

Choy YC, Lee CY, Inbasegaran K

Med J Malaysia, 1999 Mar;54(1):4-10.

PMID: 10971998

Critical incident reporting is a useful quality improvement technique for reducing morbidity and mortality in anaesthesia. This study analyses 93 cases in Kuala Lumpur Hospital from July 1995 to January 1997. The main incidents during anaesthesia in this study were airway incidents. While human error was identified as the main factor contributing to the occurrence of adverse incidents. Critical incident monitoring plays an important role in identifying potential problems, which may lead to disaster. The findings from this report of the anaesthesia incident monitoring study continued to indicate the occurrence of similar problems seen in an earlier report. The identification of common incidents can be used to identify risk factors and minimise repetition of such incidents.

Matched MeSH terms: Anesthesia/adverse effects*

The use of modified VBM laryngeal tube compared to Laryngeal Mask Airway during spontaneous ventilation

Chiu CL, Murugasu J, Chan L

Anaesth Intensive Care, 2003 Apr;31(2):187-92.

PMID: 12712784

We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. The patients were randomized to receive either a laryngeal mask airway or a laryngeal tube. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. We recorded the speed and the ease of insertion, the number of attempts needed to successfully secure the airway and intraoperative complications, such as partial airway obstruction needing airway manipulation. The airway devices were removed with the patients fully awake at the end of surgery. Systolic arterial blood pressure, heart rate and end-tidal CO2 were recorded at various time intervals. Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.

Matched MeSH terms: Anesthesia, General/methods*

Fulltext Sevoflurane induction in the elderly

Cheong KF, Teh TS

Med J Malaysia, 2001 Dec;56(4):446-50.

PMID: 12014764

The effects of 2% and 4% sevoflurane in oxygen and nitrous oxide for induction of anaesthesia in 60 unpremedicated elderly patients was compared to those obtained during an intravenous Thiopentone induction. Intravenous induction induced anaesthesia in 27 +/- 5 seconds, significantly faster than a 2% or 4% sevoflurane induction (109 +/- 36 and 71 +/- 24 seconds respectively). One patient in both the thiopentone and 2% sevoflurane groups, and 2 patients in the 4% sevoflurane group coughed during induction. The postinduction reduction in mean arterial pressure was greatest in the thiopentone group followed by the 4% and the 2% sevoflurane groups. Heart rate changes were minimal in all groups. We conclude that 2% or 4% sevoflurane offered suitable conditions for induction of anaesthesia in the elderly with minimal cardiovascular derangement.

Matched MeSH terms: Anesthesia*

Sevoflurane induction in acute airway obstruction

Chiu CL, Delilkan AE

Hosp Med, 1998 Oct;59(10):828.

PMID: 9850310

Matched MeSH terms: Anesthesia, Inhalation*

Fulltext Spread of spinal anaesthesia with 0.5% bupivacaine: influence of the vertebral interspace and speed of injection

Chin KW, Chin NM, Chin MK

Med J Malaysia, 1994 Jun;49(2):142-8.

PMID: 8090093

Three millilitres of plain 0.5% bupivacaine were injected intrathecally at two different spinal interspaces (L2/3 and L4/5) and at two different speeds (15 and 30 sec) in four groups of ten patients. Injection at L2/3 over 15 sec produced a significantly higher mean maximum spread of analgesia (T6.4) when compared to injection at L4-5 over 15 sec (T10.3) (P < 0.05). Over the same interspace L2/3, injection over 15 sec also produced a higher level of spread as compared to the 30 sec group (p < 0.05). At 15 min there was a greater fall in blood pressure in the L2/3 15 sec group when compared to the other groups (p < 0.01). There was a further decrease in the blood pressure in L2/3 15 sec and L4/5 30 sec groups after 30 minutes of blockade (p < 0.01). Therefore close monitoring of cardiovascular parameters must be continued for at least 30 min in spinal anaesthesia with bupivacaine.

Matched MeSH terms: Anesthesia, Spinal*

Fulltext Response of ovary in young women experiencing laparoscopy under general anaesthesia

Chow WP, Loganath A, Peh KL, Chew PC, Gunasegaram R, Ratnam SS

Med J Malaysia, 1993 Mar;48(1):56-63.

PMID: 8341173

This study investigated whether changes in circulating levels of immunoreactive oestradiol-17 beta (E2), progesterone (P) and testosterone (T) occur in women at follicular (n = 18, age 25 to 39 years) and luteal (n = 17, 25 to 39 years) phases of the normal menstrual cycles, experiencing laparoscopy after intravenous sedation with general anaesthesia. The pre- and intra-operative follicular phase plasma steroid hormone concentrations were 153.5 +/- 84.3 vs 297.4 +/- 220.8 pg/ml for E2, 2.0 +/- 3.2 vs 3.3 +/- 3.8 ng/ml for P and 746.6 +/- 415.9 vs 1325.8 +/- 535.1 pg/ml for T, respectively. The corresponding luteal phase steroid levels were 259.7 +/- 120.2 vs 382.7 +/- 188.7 pg/ml, 7.0 +/- 4.8 vs 9.9 +/- 6.1 ng/ml and 819.4 +/- 355.7 vs 1703.5 +/- 1058.1 pg/ml. Using the Wilcoxon rank sum test, intra-operative hormone levels with the exception of P in the luteal phase were found to be significantly elevated (p < 0.05). The results suggest that laparoscopy under general anaesthesia evokes increased secretion of ovarian hormones, possibly via the activation of hypothalamo-pituitary-ovarian axis.

Matched MeSH terms: Anesthesia, General/adverse effects*

Fulltext Incidence of postdural puncture headache. A prospective study of 101 spinal anaesthetics in orthopaedic patients

Chan L, Delilkan AE

Med J Malaysia, 1992 Mar;47(1):20-6.

PMID: 1387444

Spinal anaesthesia was performed on 101 patients with a 25-Gauge (0.52 mm) needle. We found a 13.9% overall incidence of postdural puncture headache (PDPH) in an orthopaedic population whose mean age was 33.6 years. This incidence is too high and an alternative technique may be needed.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Type IV laryngotracheo-oesophageal cleft--management of a difficult airway

Lim SK, Fadhilah T, Ibtisan I

Paediatr Anaesth, 1998;8(4):337-40.

PMID: 9672933

Congenital laryngotracheo-oesophageal cleft is a rare anomaly which presents a challenge to the anaesthetists because of the potential problems of establishing and maintaining an airway. We report the anaesthetic management of a one-month old baby with complete or type IV laryngotracheo-oesophageal presenting for the repair of the defect. The management of the precarious airway is presented and the various techniques of managing the airway are reviewed.

Matched MeSH terms: Anesthesia, General/methods*

Fulltext Incidence of back pain after lumbar epidural anaesthesia for non-obstetric surgery--a preliminary report

Chan ST

Med J Malaysia, 1995 Sep;50(3):241-5.

PMID: 8926902

This prospective survey attempt to study the incidence of post-operative back pain after lumbar epidural anesthesia for non-obstetric patterns and the correlation of this symptom with various contributing factors. One hundred and five patients who were given lumbar epidural anaesthesia as the sole anaesthesia for non-obstetric surgery were studied. The choice of equipment, number of attempts at giving the injection, duration of surgery and position of patient during surgery were documented. One week post-operatively, the patients were asked whether they recalled any back pain. The nature, duration and severity of the back pain was documented. Statistical analysis was achieved by using Chi-squared test. Twenty-eight patients recalled "injection site tenderness" post-operatively. The pain was mild to moderate in severity and lasted up to 4 days. None of the studied patients had post-operative "backache". The pain showed no significant correlation with needle size, technique of injection, use of epidural catheter, patient's position during surgery, duration and number of attempts made during epidural injection.

Matched MeSH terms: Anesthesia, Epidural/adverse effects*

Fulltext Delayed recovery following lorazepam premedication

Inbasegaran K, Aun LT

Med J Malaysia, 1990 Sep;45(3):251-3.

PMID: 2152088

Oral lorazepam is a commonly used premedicant both locally and abroad. We studied its effect on recovery time after minor gynaecological procedures. The results showed a significant prolongation of recovery time.

Matched MeSH terms: Anesthesia Recovery Period*

Fulltext Continuous brachial plexus block--regional anaesthesia for reimplantation surgery of the hand: a preliminary study

Sivarajah RS, Keh SA, Ong G, Teo WS, Delilkan AE

Med J Malaysia, 1984 Jun;39(2):112-5.

PMID: 6513849

Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.

Matched MeSH terms: Anesthesia, Conduction/methods*

Thyroid regulation of body temperature in anaesthetized chickens

Lam SK, Harvey S

Comp Biochem Physiol A Comp Physiol, 1990;95(3):435-9.

PMID: 1970531

1. Anaesthesia caused marked decreases in the plasma concentrations of triiodothyronine (T3) and thyroxine (T4) and in the body temperature of young fowl. 2. Exogenous T4 or a thyroid hormone secretagogue (somatostatin antiserum), increased endogenous T3 and T4 concentrations and body temperature in conscious birds and prevented the body temperature decline in anaesthetized fowl. 3. These results provide further evidence for a role of T3 and T4 in temperature regulation in birds, particularly during anaesthesia.

Matched MeSH terms: Anesthesia*

Fulltext Inadvertent injection of adrenaline into subarachnoid space--a case report

Mustafa WNA, Mohandas K

Med J Malaysia, 1982 Jun;37(2):108-9.

PMID: 7132830

A local anaesthetic agent with adrenalin meant for infiltration block was inadvertently given into spinal canal without any serious sequelae. The consequences of adrenalin in the subarachnoid space are discussed. Measures to prevent such accidents are suggested.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Reduction of the aspiration hazard in anaesthesia: use of methohexitone-suxamethonium mixtures

Khawaja AA

Med J Malaya, 1971 Jun;25(4):295-7.

PMID: 4261305

Matched MeSH terms: Anesthesia/mortality

A comparison of bleeding efficiency, microbiological quality and lipid oxidation in goats subjected to conscious halal slaughter and slaughter following minimal anesthesia

Sabow AB, Sazili AQ, Zulkifli I, Goh YM, Ab Kadir MZ, Abdulla NR, et al.

Meat Sci, 2015 Jun;104:78-84.

PMID: 25732178 DOI: 10.1016/j.meatsci.2015.02.004

The study assessed the effect of conscious halal slaughter and slaughter following minimal anesthesia on bleeding efficiency of goats and keeping quality of goat meat. Ten Boer cross bucks were divided into two groups and subjected to either halal slaughter without stunning (HS) or minimal anesthesia prior to slaughter (AS). The blood lost during exsanguination was measured. Residual blood was further quantified by determination of hemoglobin and myoglobin content in longissimus lumborum muscle. Storage stability of the meat was evaluated by microbiological analysis and lipid oxidation. Blood loss at exsanguination, residual hemoglobin and lipid oxidation were not significantly different (p>0.05) between HS and AS. Lactic acid bacteria was the only microbe that was significantly elevated after 24h of storage at 4°C in the AS group. In conclusion, slaughtering goats under minimal anesthesia or fully conscious did not affect bleeding efficiency and keeping quality of goat meat.

Matched MeSH terms: Anesthesia*

Efficient halal bleeding, animal handling, and welfare: A holistic approach for meat quality

Aghwan ZA, Bello AU, Abubakar AA, Imlan JC, Sazili AQ

Meat Sci, 2016 Nov;121:420-428.

PMID: 27468102 DOI: 10.1016/j.meatsci.2016.06.028

Traditional halal slaughter and other forms of religious slaughter are still an issue of debate. Opposing arguments related to pre-slaughter handling, stress and pain associated with restraint, whether the incision is painful or not, and the onset of unconsciousness have been put forward, but no consensus has been achieved. There is a need to strike a balance between halal bleeding in the light of science and animal welfare. There is a paucity of scientific data with respect to animal welfare, particularly the use of restraining devices, animal handling, and efficient halal bleeding. However, this review found that competent handling of animals, proper use of restraining devices, and the efficient bleeding process that follows halal slaughter maintains meat eating quality. In conclusion, halal bleeding, when carried out in accordance with recommended animal welfare procedures, will not only maintain the quality and wholesomeness of meat but could also potentially reduce suffering and pain. Maintained meat quality increases consumer satisfaction and food safety.

Matched MeSH terms: Anesthesia/veterinary*

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