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Fulltext Tracheotomy: an alternative for tracheobronchial foreign body removal

Tang CL, Lee SC, Mohamad Lal A, Thomas RA, Ngui LX, Lim LY

Med J Malaysia, 2014 Oct;69(5):241-3.
PMID: 25638243 MyJurnal

A 6 years old girl accidentally aspirated a plastic whistle while playing. Computed Tomography of thorax showed foreign body at carina level. Rigid bronchoscope under general anesthesia was attempted but unable to extract the whistle through vocal cord. Tracheostomy was later performed and foreign body was removed.

Matched MeSH terms: Anesthesia, General
Fulltext Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-

Tan PC, Esa N

Korean J Anesthesiol, 2012 May;62(5):474-8.
PMID: 22679546 DOI: 10.4097/kjae.2012.62.5.474

Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.

Matched MeSH terms: Anesthesia
Fulltext Day surgery: a post operative audit

Ng KP

Med J Malaysia, 1997 Sep;52(3):269-73.
PMID: 10968097

Fifty-five patients were followed up after day surgery for breast lumpectomy. It was found that local infiltration with bupivacaine significantly decreased analgesic requirement in recovery. Almost half of the patients could not be contacted during the 24 hour post-operative follow-up by telephone. 7.1% complained of severe pain despite oral analgesics. 14.3% of patients had queries regarding wound care and 78.6% of the patients were willing to undergo day surgery again. Ongoing patient education and good post operative analgesia are crucial to enable successful establishment of ambulatory surgery. Post-operative follow-up is encouraged to audit clinical and social outcomes of day surgery.

Matched MeSH terms: Anesthesia
Fulltext Epidural buprenorphine and bupivacaine in major gynaecological operations

Loh SP

Med J Malaysia, 1993 Jun;48(2):207-10.
PMID: 8350797

Eight patients underwent major gynaecological operations. Their post-operative analgesia was provided by epidural buprenorphine 0.15 mg and bupivacaine 0.5%. The efficacy and side-effects of this combination were assessed. All patients had satisfactory analgesia ranging in duration from 10 hours to greater than 36 hours after a single dose injection. No significant side-effect was noted.

Matched MeSH terms: Anesthesia, Inhalation
An evaluation of the modified Airway Management Device

Chiu CL, Wang CY

Anaesth Intensive Care, 2004 Feb;32(1):77-80.
PMID: 15058125

This is a preliminary report on the use of the modified Airway Management Device in 50 spontaneously breathing patients undergoing elective day care surgery. We were successful in establishing a clear airway in all 50 patients, 46 of these patients had a patient airway on the first attempt. All patients were successfully managed with the Airway Management Device throughout the surgery. Partial airway obstruction during maintenance of anaesthesia occurred in three cases requiring only minor manipulations. Our result showed that the Airway Management Device may be used as an alternative airway management in anaesthesia.

Matched MeSH terms: Anesthesia, General
Fulltext Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report

Mohd Yusof J, Abd Halim A, Wan Hamizan AK

J Taibah Univ Med Sci, 2020 Aug;15(4):334-337.
PMID: 32982639 DOI: 10.1016/j.jtumed.2020.06.007

Mild to severe epistaxis is common in pregnancy and often results from increased vascularity of the nasal mucosa and hormonal changes. Symptoms may occur in the absence of an obvious local cause or any systemic disorder; however, thorough otolaryngological (i.e., "ENT") evaluation is always warranted. Pyogenic granuloma or lobular capillary haemangioma is a benign fibrovascular proliferative tumour that is commonly found on the face, fingers, lips, and nasal mucosa. Pregnancy-induced pyogenic granuloma is not an uncommon entity and may result in torrential epistaxis if untreated. Managing a case of severe epistaxis during pregnancy usually requires multidisciplinary management. The authors present a case of severe epistaxis in pregnancy that necessitated examination of the nasal cavity under general anaesthesia. Intraoperative findings showed a bluish-red mass occupying the patient's right maxillary sinus. Bleeding was arrested and complete haemostasis was achieved. The nasal pyogenic granuloma completely resolved in the post-partum period.

Matched MeSH terms: Anesthesia, General
Fulltext Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

Hamed Y, Ramesh A, Taylor R, Michaud R

Malays Orthop J, 2020 Nov;14(3):110-113.
PMID: 33403070 DOI: 10.5704/MOJ.2011.017

Introduction: Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation.
Materials and Methods: One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017.
Results: Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17).
Conclusion: There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Matched MeSH terms: Anesthesia, Spinal
Fulltext Balloon dilatation of laryngotracheal stenosis: Hospital Ampang experience

Loo, L.Y., Mawaddah, A., Shahrul, H., Khairullah, A.

International Medical Journal Malaysia, 2017;16(2):113-116.
MyJurnal

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
after dilatation, number of dilatation were observed and compared. The outcome measures are
decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
the narrowed airway.

Matched MeSH terms: Anesthesia, Intravenous
Fulltext Severe Orbital Myiasis Caused by Chrysomya bezziana: A Case Report

Ng YS, Gan YK, Tupang L

Turk J Ophthalmol, 2021 Feb 25;51(1):62-65.
PMID: 33631919 DOI: 10.4274/tjo.galenos.2020.00225

An 88-year-old woman was brought to the hospital immediately after her neighbours noticed that she was bleeding from her right eye. On examination, her right eye was phthisic with maggot infestation of her right orbit. Over a hundred live maggots were extracted using forceps. Computed tomography scan revealed the infestation was confined to the right orbit. The patient underwent exenteration of the right orbit under general anaesthesia. The species was identified by an entomologist as Chrysomya bezziana, which has aggressive larvae that eat living tissue. This case report demonstrates that orbital myiasis caused by C. bezziana poses a very real risk of intracranial invasion as they feed on living tissues. Adjacent tissue destruction can be very rapid and definitive treatment involves urgent removal of its larvae via surgical debridement. To our knowledge, we are reporting the first case of orbital myiasis from a patient in Malaysia. Therefore, our case report may be helpful in the management of similar case of orbital myiasis.

Matched MeSH terms: Anesthesia, General
Fulltext A Rhinolith Turning Out to Be an Intranasal Tooth

Ong HY, Ng JJ, Ong HJ, Wong SJ, Gopalan S

Cureus, 2021 Feb 28;13(2):e13616.
PMID: 33816015 DOI: 10.7759/cureus.13616

A tooth in the nasal cavity is an uncommon phenomenon. The exact mechanism is unclear, and patients may present with non-specific nasal symptoms. We encountered a 24-year-old patient with history of cleft palate repair, presenting to us with unilateral nasal discharge not improving with conventional medications. Rigid nasal endoscopy revealed a rhinolith-like foreign body at the floor of the left nasal cavity. Removal of the rhinolith was done under general anesthesia, and it turned out to be an intranasal tooth. Intranasal tooth is often misdiagnosed due to its non-specific symptoms. Detailed dental and oropharyngeal examination as well as imaging studies are essential in diagnosing an intranasal tooth. Early surgical removal is the mainstay of treatment in order to prevent further complications. Patients with unilateral nasal symptoms not responding to conventional treatment require proper ear, nose, and throat (ENT) evaluation to rule out other pathology.

Matched MeSH terms: Anesthesia, General
Fulltext Congenital Giant Cell Fibroma – A Case Report

Mohd Ridzuan Mohd Razi, Nabilah Sawani Harith, Nur Fazilah Mohd Tahir, Nishanti Selvaraj

Malaysian Journal of Paediatrics and Child Health, 2020;26(1):21-28.
MyJurnal

Background: This paper aims to report a rare case of congenital giant cell fibroma (GCF). To the best of our knowledge, this is the first reported case of GCF in new-born. Case Report: A healthy one-month-old baby boy was referred to Department of Paediatric Dentistry for management of swelling on the upper left alveolar region which presented since birth. Clinical examination demonstrated a well define firm swelling over the upper left alveolar ridge, otherwise the swelling was asymptomatic. Patient was monitored periodically. At 1 year and 9 months of age, there were episodes of ulcerations and bleeding from the lesion as a result of trauma from eruption of opposing teeth. Surgical excision of the lesion was carried out under general anaesthesia. The histopathological examination (HPE) report interpreted the lesion as GCF. Conclusion: GCF is rare fibrous lesion that could be diagnosed only on HPE. Although it is an uncommon congenital lesion, GCF should be considered as one of differential diagnosis of swelling over the gingiva.

Matched MeSH terms: Anesthesia, General
Fulltext Fish Endoparasites from Streams near Paddy Fields in Serian and Padawan, Western Sarawak

FELLICIA INCHING UCHANG, YANG LEE, FREDDY KUOK SAN YEO, YEE LING CHONG

Trends in Undergraduate Research, 2019;2(1):0-0.
MyJurnal

The fish health status and parasitic infection in paddy fields are understudied in Borneo. This study was done to compare the prevalence and abundance of parasites on freshwater fishes in the upstream and downstream rivers of paddy fields. Parasite study on freshwater fishes was done by collecting live fish samples using ten minnow traps with baits at each site in Serian and Padawan, Sarawak, from October 2017 until March 2018. A total of 120 freshwater fishes were examined during this study period. Cold anaesthesia was applied on live samples prior to ectoparasite and endoparasite microscopic screening, which involved scraping of outer body mucous and removal of fish intestines, respectively. No ectoparasites were recovered from the fish samples. A total of 19 (15.83%) fishes from Cyprinids were infected with endoparasites. From these, 58 individuals of endoparasites were recovered. Two groups of parasites, namely Nematoda (Cucullanus sp.) and Trematoda (unidentified), were recovered from the fish intestines. From this study, there was a significant difference between the upstream fishes and downstream fishes in their endoparasite infection at both Triboh Village (p = 0.035) and Annah Rais Village (p = 1.445 × 10-6) using two samples t-test. The endoparasite abundance in fish was higher in the streams where there was less human disturbance. This study may serve as a baseline study on the parasitic infections of freshwater fishes in streams near paddy fields or other agricultural area in Sarawak.

Matched MeSH terms: Anesthesia
Fulltext Post-intubation airway related adverse effects: a aomparison between intra-cuff dexamethasone and intra-cuff alkalinized lignocaine

Kep, Kee W., Nadia, M.N., Melvin, K., Muhammad, M., Raha, R., Nurlia, Y.

Journal of Surgical Academia, 2013;3(2):26-31.
MyJurnal

Post-intubation airway related adverse effects such as coughing on the endotracheal tube (ETT), restlessness, hoarseness and sore throat are common and undesirable outcomes of anaesthesia using endotracheal intubation. This prospective randomized single blind study was carried out to compare the effectiveness of intra-cuff dexamethasone and alkalinized lignocaine in reducing the incidence of post-intubation airway related adverse effects. Eighty four patients aged 18 – 60 years, of ASA status I or II, were randomly allocated into three groups: air, dexamethasone and alkalinized lignocaine. Their ETT cuffs were inflated according to the group they were allocated to. The incidence of coughing on the ETT, restlessness, hoarseness and sore throat was assessed, postoperatively. The results showed a significant difference in the incidence of cough, restlessness, hoarseness and sore throat in the dexamethasone group compared to the air group. All the patients had minimal or no sore throat at all documented times. Both intra-cuff dexamethasone and alkalinized lignocaine significantly reduced the incidence of hoarseness. However, alkalinized lignocaine additionally lowered the incidence of restlessness, significantly.

Matched MeSH terms: Anesthesia
Fulltext Ultrasound guided transversus abdominis plane block versus intrathecal morphine for analgesia post caesarean section: which is better?

Aizatul Isla, A.L., Wan Rahiza, W.M., Azrin, M.A., Thohiroh, A.R., Nurlia, Y., Nadia, M.N.

Journal of Surgical Academia, 2013;3(2):39-45.
MyJurnal

The tranversus abdominis plane (TAP) block for postoperative analgesia after caesarean section may confer potential benefits comparable to that of intrathecal opioids. We compared postoperative analgesia, and the incidence of nausea, vomiting, pruritus and sedation between the TAP block and intrathecal morphine (ITM) in patients undergoing Caesarean section. This was a prospective, randomised clinical study. Fifty American Society of Anaesthesiologists physical status I or II patients, planned for elective caesarean section under spinal anaesthesia, were randomly allocated to the TAP group (patients receiving spinal anaesthesia with bilateral TAP block without ITM) or ITM group (patients receiving spinal anaesthesia with ITM without a TAP block). Assessment for pain, postoperative nausea and vomiting, pruritus and sedation was done upon arrival and discharge from recovery, and at 6, 12 and 24 hours, postoperatively in the post natal ward. Results were analysed using analysis of variance (ANOVA). There was no pain at rest in either groups. Both groups experienced pain on movement at the 12th (p = 0.6) and 24th hour (p = 0.4). None of the patients in the TAP group experienced nausea, vomiting, pruritus or sedation. However, these incidences were found to be significantly higher in the ITM group. Ultrasound guided TAP block provided comparable postoperative analgesia to ITM without the side effects of the latter.

Matched MeSH terms: Anesthesia, Spinal
Fulltext Spinal anaesthesia with bupivacaine and intrathecal morphine versus combined spinal-epidural anaesthesia using Bupivacaine and Epidural infusion of bupivacaine plus fentanyl for postoperative analgesia after hip and knee arthroplasty

Mohd Azizan, G., Karis, M., Noordin, Y.

Journal of Surgical Academia, 2013;3(2):46-53.
MyJurnal

This randomised single-blinded study was conducted to evaluate if there was any difference between spinal anaesthesia with hyperbaric bupivacaine 0.5% and intrathecal morphine 0.2mg and combined-spinal epidural using hyperbaric bupivacaine 0.5% with epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml for 24 hours, postoperative analgesia following hip and knee arthroplasty, in terms of pain score and side effects (nausea, vomiting, pruritus and respiratory depression). Eighty patients ASA I or ASA II, aged between 18 to 75 years who underwent knee and hip arthroplasty of approximately 3-4 hours, duration were recruited. They were randomly allocated to one of two groups by using computer generated randomised numbers. The pain score during the postoperative period was evaluated using Visual Analogue Score (VAS pain score) and the side effects were documented and treated accordingly. Results showed that patients in Group 1 and Group 2 were comparable in terms of age, gender, height, weight and race. There was no statistical difference in VAS pain score between the two groups at all times intervals. However, patients in Group 1 had a higher incidence of nausea and pruritus than patients in Group 2. None of the patients in either group, experienced respiratory depression. Thus, it was concluded that both intrathecal morphine 0.2mg and epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml were comparable in providing postoperative analgesia up to 24 hours following hip and knee arthroplasty. Nevertheless, the use of spinal morphine led to a higher incidence of side effects namely nausea and pruritus.

Matched MeSH terms: Anesthesia, Spinal
Fulltext Comparison between patient-controlled epidural analgesia and continuous epidural infusion for pain relief after gynaecological surgery

Suhaila, N., Nurlia, Y., Azmil Farid, Z., Melvin, K., Muhammad, M., Nadia, M.N.

Journal of Surgical Academia, 2013;3(2):14-19.
MyJurnal

This prospective, randomised study compared the effectiveness of patient controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI) in providing pain relief post gynaecological surgery. Sixty six ASA I or II patients planned for gynaecological surgery via Pfannensteil incision under combined spinal epidural anaesthesia were recruited. They were randomised into two groups: Group A patients received PCEA while Group B patients received CEI. In the recovery area, both groups received an epidural combination of levobupivacaine 0.1% and fentanyl 2 μg/ml. Group A patients were allowed demand bolus doses of 5 ml with a 20 minute lockout interval, while Group B patients had their epidural infusion initiated at 6 ml/hour with increments as required to a maximum of 12 ml/hour. Pain score and degree of motor blockade was assessed hourly in the first four hours and subsequently at four hourly intervals. Side effects were recorded at four-hourly interval. The total amount of analgesia, number of anaesthetic interventions and patient satisfaction was assessed 24 hours, postoperatively. There was no significant difference in pain score, total amount of analgesia, number of anaesthetic interventions and patient satisfaction. The degree of motor blockade and side effects were comparable between the groups. In conclusion, PCEA was comparable to CEI for pain relief after gynaecological surgery.

Matched MeSH terms: Anesthesia, Epidural
Fulltext Comparison of cardiovascular responses between remifentanil and fentanyl on laryngoscopy and tracheal intubation in patients undergoing elective surgery

Lai, S.C., Choy, Y.C.

Journal of Surgical Academia, 2014;4(1):20-25.
MyJurnal

This was a prospective, randomized, double-blind study comparing the effect of remifentanil and fentanyl on cardiovascular responses from laryngoscopy and tracheal intubation. Forty-four ASA I or II patients aged between 18-65 yrs scheduled for elective surgery under general anaesthesia, were recruited and randomized into two groups. Each patient in Group R received remifentanil of 0.5 mcg/kg bolus over 30 seconds followed by an infusion of 0.25 mcg/kg/min and each patient in Group F received fentanyl of 2 mcg/kg bolus over 30 seconds followed by an infusion of normal saline. Anaesthesia was then induced with propofol, rocuronium and 2% sevoflurane with 100% oxygen. Cardiovascular changes were recorded every minute for 3 minutes after induction and 5 minutes after tracheal intubation. The heart rate remained stable throughout the induction and intubation period in both groups. None of the patients in the remifentanil group develop bradycardia. Systolic blood pressure (SBP) and mean arterial pressure (MAP) were significantly lower in the fentanyl group at the 3rd minute post-induction and 5th minute post- intubation (p < 0.05). Diastolic blood pressure (DBP) in the fentanyl group was significantly lower at the 2nd and 3rd minute post-induction and 4th and 5th minute post-intubation (p < 0.05). The blood pressure remained stable for the remifentanil group throughout the induction and intubation period. Six patients (27.2%) in the fentanyl group and one patient (4.5%) in the remifentanil group experienced hypertension. Three patients (13.7%) from each group experienced hypotensive episodes. In conclusion, remifentanil 0.5 mcg/kg bolus followed by 0.25 mcg/kg/min infusion resulted in SBP, MAP and DBP remained slightly lower than baseline throughout the whole period but still consider stable, as these changes were not statistically significant.

Matched MeSH terms: Anesthesia, General
In vitro and in vivo Evaluation of New Topical Anaesthetic Cream Formulated with Palm Oil Base

Khodari SNK, Noordin MI, Chan L, Chik Z

Curr Drug Deliv, 2017;14(5):690-695.
PMID: 27480118 DOI: 10.2174/1567201813666160801113302

BACKGROUND: Topical local anaesthetic cream was reported to be useful for pain relief for cutaneous procedures such as minor surgery and venipuncture.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of new formulation of lidocaine topical anaesthetic using palm oil base, HAMIN® and to determine how fast this new formulation produces adequate numbness compared to the currently used EMLA cream, in the University of Malaya Medical Centre (UMMC) set-up.
METHOD: The skin permeation test was conducted by using Franz type diffusion cell and pain assessment was carried out in healthy subject by using Verbal Rating Score (VRS) and Visual Analogue Score (VAS) evaluation.
RESULT: Result of permeation test demonstrated that the cumulative amount of lidocaine released from HAMIN® cream was increased with time and slightly higher than EMLA cream. The clinical study showed that HAMIN® single lidocaine cream can produces numbness through venepuncture procedure and comparable with EMLA cream which is a combination therapy for local anaesthetic (lidocaine and prilocaine).
CONCLUSION: It can be concluded that HAMIN® Lidocaine cream is suitable for cream preparation especially for topical application and it can be regarded as an achievement in palm oil and medical industries.

Matched MeSH terms: Anesthesia, Local
Fulltext The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation

Chong, K.C., Sulaiman, A.R., Yusof, M.I., Vishvanathan, T., Anwar Hau, M.

Malays Orthop J, 2010;4(3):3-6.
MyJurnal

Phantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients(Group A) and intramuscular diclofenac sodium in 28 patients (Group B) in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 %) patients from group A and 21 patients (75 %) from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p

Matched MeSH terms: Anesthesia, Spinal
Fulltext Malignant sertoli cell tumour: an uncommon testicular tumour

Sia, S.F., Dublin, N., Nurul, B., Wong, K.T.

JUMMEC, 2006;9(2):18-21.
MyJurnal

We report a case of an 86 year old Chinese man who presented with a painless right testicular swelling that had persisted for one year. There was no history of maldescend or cryptorchid testes. Clinical and ultrasound examination revealed testicular tumour with two round masses within the right scrotal sac, with minimal fluid seen within the sac. Tumour markers were normal. He subsequently underwent a right inguinal orchidectomy under local anaesthesia as he had an underlying cardiac insufficiency. Histopathological examination revealed malignant Sertoli cell tumour. True Sertoli cell mesenchyme tumours constitute less than 1% of all testicular cancers.Current literature on histopathological and clinical features and treatment options are reviewed.

Matched MeSH terms: Anesthesia, Local

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