MyMedR

Continuous spinal technique in surgery and obstetrics

Kumar CM, Seet E

Best Pract Res Clin Anaesthesiol, 2023 Jun;37(2):139-156.

PMID: 37321763 DOI: 10.1016/j.bpa.2023.02.007

Continuous Spinal Anaesthesia (CSA) technique has all the advantages of single-shot spinal anaesthesia with the added benefit of prolonging the duration of anaesthesia. CSA has been used as a primary method of anaesthesia as an alternative to general anaesthesia in high-risk and elderly patients for various elective and emergency surgical procedures involving the abdomen, lower limbs, and vascular surgeries. CSA has also been used in some obstetrics units. Despite its advantages, CSA technique remains underutilised because it is surrounded with myths, mysteries, and controversies concerning neurological, other morbidities and minor technical difficulties. This article includes a description of CSA technique compared to other contemporary central neuraxial blocks. It also discusses the perioperative applications of CSA for different surgical and obstetrics procedures, advantages, disadvantages, complications, problems, and pointers on how to perform the technique safely.

Matched MeSH terms: Anesthesia, Conduction*

Fulltext Anaesthetic complications in the recovery room

Norsidah AM, Puvaneswari A

Singapore Med J, 1997 May;38(5):200-4.

PMID: 9259599

The immediate post-operative period in the recovery room is a known period of high risk for anaesthetic complications to occur.

Matched MeSH terms: Anesthesia Recovery Period*; Anesthesia, Conduction/adverse effects*; Anesthesia, General/adverse effects*

Fulltext Compliance with monitoring standards for anaesthesia in Malaysian hospitals

Khoo TH, Cardosa MS, Inbasegaran K

Med J Malaysia, 1999 Mar;54(1):72-8.

PMID: 10972008

The Malaysian Society of Anaesthesiologists published a document entitled "Recommendations for Standards of Monitoring during Anaesthesia and Recovery" in 1993. This paper examines the results of two surveys, carried out in 1995 and 1996 respectively; to determine compliance with published Monitoring Standards in Malaysian public and private hospitals. In the private sector, compliance with the recommended standards during anaesthesia varied greatly. Of the 28 government hospitals surveyed in 1996, compliance with monitoring standards during anaesthesia was almost 100%. Standards in recovery areas were less than ideal. The majority of anaesthesiologists thought that the current recommended standards were adequate.

Matched MeSH terms: Anesthesia/adverse effects; Anesthesia/standards*

Fulltext Retrospective study of anaesthesia for renal transplantation during the years 1979 till 1984

Satgurunathan P

Med J Malaysia, 1985 Dec;40(4):271-5.

PMID: 3916211

In this project, a retrospective study regarding the anaesthetic techniques, complications and the relevant monitoring aids needed during the procedure, is made from analysis of the 100 available anaesthetic records of cases done during the five years at the Urology Department, General Hospital, Kuala Lumpur. The total number of cases done during 1979-1984 was 112 but 12 anaesthetic record sheets were missing. The patients requiring renal transplant operation were representative of the end-stage chronic renal failure population of Malaysia with the usual high incidence of cardiovascular and biochemical abnormalities. Except for two cases of epidural anaesthesia, all the other patients received general anaesthesia. Induction was with intravenous barbiturate followed by muscle relaxant, neurolept or narcotic and halothane supplement for maintenance. There were no intraoperative or postoperative deaths due to anaesthetic complications. There were five cases of anaesthetic morbidity of which three cases had inadequate reversal of neuromuscular blocking agents and required postoperative ventilation and two cases had poor respiratory effort and required naloxone supplement. Less serious complications such as allergic manifestations were seen in three cases with use of the new muscle relaxant atracurium. The conclusion was that general anaesthesia using thiopentone for induction, pancuronium bromide for intubation and maintenance of muscle relaxation and neurolept fentanyl/droperidol and halothane supplement, all in doses tailored to the requirements ofa renal failure patient, is a suitable technique of anaesthesia for renal transplant operation. Atracurium, the new muscle relaxant, seems to be a favourable alternative to pancuronium bromide. However, as only five cases in our study received atracurium, further studies would have to be done to support it.

Matched MeSH terms: Anesthesia, General/adverse effects; Anesthesia, General/methods*

Anaesthesia in the tropics. Basal narcosis with "avertin"

Barnsley A

Malayan Medical Journal, 1932;7:1-12.

Matched MeSH terms: Anesthesia; Anesthesia, Inhalation; Anesthesia, Rectal

Fulltext Brain laryngeal mask--study in 50 spontaneously breathing patients

Reddy SV, Win N

Singapore Med J, 1990 Aug;31(4):338-40.

PMID: 2255930

Brain laryngeal mask (BLM) was used to assess its suitability in 50 spontaneously breathing patients by one lecturer and 4 Medical Officers. Insertion of the laryngeal mask was successful at the first attempt in 42 patients, second attempt in 7 and third attempt in one. The incidence of airway obstruction secondary to downfolding of the epiglottis, which was corrected by reinsertion, was 16%. Post-operative complications included clenching of teeth in 5 patients, vomiting in 2 and excessive salivation in 3. The incidence of sore throat was 10%.

Matched MeSH terms: Anesthesia, Inhalation/instrumentation*; Anesthesia, Inhalation/methods

Fulltext Retrospective analysis of dental treatment under general anesthesia among children with early childhood caries in Malaysia

Ibrahim NA, Nor NAM, Azizi NZ, Hamzah TNNT, Dziaruddin N, Musa S

J Clin Pediatr Dent, 2023 Jul;47(4):46-53.

PMID: 37408346 DOI: 10.22514/jocpd.2023.034

Many children are affected by early childhood caries (ECC) with some requiring dental treatment under general anesthesia (GA). In pediatric dentistry, GA is one of the established methods of behavior management. GA data is useful for understanding the caries burden among young children. This study aimed to determine the trends, patient characteristics, and types of treatments conducted under GA among young children in a Malaysian dental hospital over a 7-year period. A retrospective study using pediatric patient records from 2013 to 2019 was conducted on children aged 2-6 years (24-71 months) having ECC. Relevant data were collected and analyzed. In total, 381 children with a mean age of 49.8 months were identified. Some of the ECC cases were associated with abscesses (32.5%) and multiple retained roots (36.7%). Over a 7-year period, there was an upward trend of preschool children receiving GA. Of the 4713 carious teeth treated, 55.1% were extracted, 29.9% were restored, 14.3% had preventive procedures, and 0.4% were pulp treated. Mean extractions were significantly higher among preschoolers compared to toddlers (p = 0.001), while preventive treatment was markedly higher among toddlers. In terms of the type of restorative materials, almost similar distribution was observed between the two age groups with 86.5% treated using composite restorations. Dental treatment under GA was more frequently used among preschoolers than in toddlers, with extractions and restoration with composite resin being the common treatment options. The findings can help decision-makers or relevant parties address the burden of ECC and enhance oral health promotion activities.

Matched MeSH terms: Anesthesia, Dental*; Anesthesia, General

Automated detection of anesthetic depth levels using chaotic features with artificial neural networks

Lalitha V, Eswaran C

J Med Syst, 2007 Dec;31(6):445-52.

PMID: 18041276

Monitoring the depth of anesthesia (DOA) during surgery is very important in order to avoid patients' interoperative awareness. Since the traditional methods of assessing DOA which involve monitoring the heart rate, pupil size, sweating etc, may vary from patient to patient depending on the type of surgery and the type of drug administered, modern methods based on electroencephalogram (EEG) are preferred. EEG being a nonlinear signal, it is appropriate to use nonlinear chaotic parameters to identify the anesthetic depth levels. This paper discusses an automated detection method of anesthetic depth levels based on EEG recordings using non-linear chaotic features and neural network classifiers. Three nonlinear parameters, namely, correlation dimension (CD), Lyapunov exponent (LE) and Hurst exponent (HE) are used as features and two neural network models, namely, multi-layer perceptron network (feed forward model) and Elman network (feedback model) are used for classification. The neural network models are trained and tested with single and multiple features derived from chaotic parameters and the performances are evaluated in terms of sensitivity, specificity and overall accuracy. It is found from the experimental results that the Lyapunov exponent feature with Elman network yields an overall accuracy of 99% in detecting the anesthetic depth levels.

Matched MeSH terms: Anesthesia, General/standards*

Effect-compartment equilibrium rate constant (keo) for propofol during induction of anesthesia with a target-controlled infusion device

Lim TA, Wong WH, Lim KY

J Anesth, 2006;20(2):153-5.

PMID: 16633780

The effect-compartment concentration (C(e)) of a drug at a specific pharmacodynamic endpoint should be independent of the rate of drug injection. We used this assumption to derive an effect-compartment equilibrium rate constant (k(eo)) for propofol during induction of anesthesia, using a target controlled infusion device (Diprifusor). Eighteen unpremedicated patients were induced with a target blood propofol concentration of 5 microg x ml(-1) (group 1), while another 18 were induced with a target concentration of 6 microg x ml(-1) (group 2). The time at loss of the eyelash reflex was recorded. Computer simulation was used to derive the rate constant (k(eo)) that resulted in the mean C(e) at loss of the eyelash reflex in group 1 being equal to that in group 2. Using this population technique, we found the k(eo) to be 0.57 min(-1). The mean (SD) effect compartment concentration at loss of the eyelash reflex was 2.39 (0.70) microg x ml(-1). This means that to achieve a desired C(e) within 3 min of induction, the initial target blood concentration should be set at 1.67 times that of the desired C(e) for 1 min, after which it should revert to the desired concentration.

Matched MeSH terms: Anesthesia, Intravenous*

Fulltext A preliminary report on anaesthesia for thoracoscopic oesophagectomy

Sia AT

Med J Malaysia, 1997 Dec;52(4):433-7.

PMID: 10968123

The anaesthetic experience in three patients undergoing thoracoscopic oesophagectomy is discussed. The indications for surgery and the premorbid states are outlined. The necessity for one-lung ventilation, with its attendant cardiopulmonary effects, the difficulty of patient access and the assessment of blood loss were the main problems encountered. Pulmonary morbidity was high in the post-operative period despite the avoidance of thoracotomy. Two patients developed persistent vocal cord paralysis. In conclusion, the role of thoracoscopic oesophagectomy needs further evaluation.

Matched MeSH terms: Anesthesia/methods*

Fulltext Safety with anaesthesia--the paradigm of continuous improvement

Tan SK

Med J Malaysia, 1999 Mar;54(1):1-3.

PMID: 10971997

Matched MeSH terms: Anesthesia/adverse effects*

Fulltext Anaesthetic management of conjoined twins: experience with six sets of twins

Norsidah AM, Lim SK, Ibtisan I, Misiran K

Med J Malaysia, 1996 Dec;51(4):420-5.

PMID: 10968028

Anaesthesia for the separation of conjoined twins requires a well-prepared, multidisciplinary team. Each patient for surgery is different and the extent of organ sharing and coexisting anomalies must be determined before surgery so that problems can be anticipated. We report our experience of the anaesthetic management for the separation of six sets of conjoined twins. Anaesthesia and surgery were prolonged, massive blood loss and transfusion, hypothermia, electrolyte imbalance and infection being the main perioperative problems encountered.

Matched MeSH terms: Anesthesia*

Fulltext Anaesthetic related maternal deaths in Malaysia--a review

Dalina AM, Inbasegaran K

Med J Malaysia, 1996 Mar;51(1):52-63.

PMID: 10967980

The anaesthetic hazards for the obstetric patient are well known. Based on results of the first two reports on the confidential enquiry into maternal deaths in Malaysia for 1991 and 1992, ten cases of anaesthetic related deaths were analysed. There were 3 in 1991 and 7 in 1992 accounting for 1.34% and 2.8% of maternal deaths respectively. It was estimated that the crude mortality rate for the obstetric patient was 11.4 per 100,000 operative deliveries or a four-fold risk compared to the general surgical patient. One case resulted from administration of intravenous sedation while the rest involved general anaesthesia, seven of which were done under emergency conditions. Inadequate airway management and ventilation in the perioperative period, including during interhospital transfer was the single most important factor causing the majority of these deaths. The use of regional anaesthesia for Caesarean sections is strongly advocated. Substandard care was also present in all cases. Other issues pertinent to improvement of obstetric anaesthetic services are also discussed which include the quality of anaesthetic manpower, upgrading of infrastructure, facilities and staffing of operating and recovery areas, the use of regional anaesthesia, expanding the role of the anaesthetist and the quality of the anaesthetic services in general.

Matched MeSH terms: Anesthesia, Obstetrical/mortality*

Fulltext Anaesthesia for closed embolisation of cerebral arteriovenous malformations

Foo KL, Woo M

Med J Malaysia, 1992 Mar;47(1):31-7.

PMID: 1387447

Anaesthetic experience of the first nine patients in Singapore who underwent closed embolisation of cerebral arteriovenous malformations is reported. Six patients had neurolept analgesia and three had general anaesthesia.

Matched MeSH terms: Anesthesia/methods*

Fulltext Failed intubation in a case of oculoauriculovertebral dysplasia (Goldenhar's syndrome)

Mohandas K, Selvarajah S

Med J Malaysia, 1988 Sep;43(3):255-8.

PMID: 3241587

Matched MeSH terms: Anesthesia, General*

Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC

J Endod, 2019 Oct;45(10):1175-1183.e3.

PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008

INTRODUCTION: This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).

METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.

CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.

Matched MeSH terms: Anesthesia, Dental*

The first anaesthetic in the straits settlements (Singapore, Penang and Malacca)--1847

Lee YK

Br J Anaesth, 1972 Apr;44(4):408-11.

PMID: 4555711

Matched MeSH terms: Anesthesia, Inhalation/history*

Cost per anaesthetic

Liew RP

Med J Malaysia, 1973 Mar;27(3):182-7.

PMID: 4268920

Matched MeSH terms: Anesthesia, Inhalation; Anesthesia, Intravenous

Anaesthetic problems of space-occupying lesions of the chest

Manavalan AS

Med J Malaya, 1969 Dec;24(2):124-7.

PMID: 4244137

Matched MeSH terms: Anesthesia, General*

Anaesthetic management of patients with myasthenia gravis undergoing thymectomy

Lim Say Wan, Gunendran A

Med J Malaya, 1969 Dec;24(2):128-37.

PMID: 4244138

Matched MeSH terms: Anesthesia, General*

Displaying publications 41 - 60 of 345 in total