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Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study

Chen CK, Lau FC, Lee WG, Phui VE

J Clin Anesth, 2016 Sep;33:75-80.
PMID: 27555137 DOI: 10.1016/j.jclinane.2016.03.007

STUDY OBJECTIVES: To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).
DESIGN: Retrospective cohort study.
SETTING: Operation theater with postoperative inpatient follow-up.
PATIENTS: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.
INTERVENTIONS: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.
MEASUREMENTS: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.
MAIN RESULTS: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.
CONCLUSION: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

Matched MeSH terms: Anesthesia, Spinal/adverse effects; Anesthesia, Spinal/methods*
Fulltext Left Bundle Branch Block Under General Anaesthesia in an Athlete's Heart

Dharmalingam TK, Nor Azian AZ, Thiruselvi S, Abdul Aziz J

Med J Malaysia, 2013 Apr;68(2):177-8.
PMID: 23629572

Left bundle branch block (LBBB) during anaesthesia is uncommon. During general anaesthesia, LBBB may be related to hypertension or tachycardia and its acute onset makes the diagnosis of acute myocardial ischemia or infarction difficult. We would like to present a case report of a healthy patient who developed LBBB intra operatively. Acute LBBB should lead to suspicion of acute coronary syndrome until proven otherwise. Inability to exclude an acute cardiac event resulted in postponement of surgery twice after general anaesthesia was administered. Cardiological investigation of our patient showed physiological left ventricular hypertrophy (LVH), "athlete's heart" which was the most likely cause of the LBBB under anaesthesia.

Matched MeSH terms: Anesthesia, General
Caudal block analgesia in labouring women

Kuah KB

Med J Malaysia, 1974 Mar;28(3):187-90.
PMID: 4278020
Matched MeSH terms: Anesthesia, Obstetrical*; Anesthesia, Spinal*
Fulltext Prevalence of Dental Anxiety Level in 6- to 12-Year- Old South Indian Children

Kumar V, Goud EVSS, Turagam N, Mudrakola DP, Ealla KKR, Bhoopathi PH

J Pharm Bioallied Sci, 2019 May;11(Suppl 2):S321-S324.
PMID: 31198362 DOI: 10.4103/JPBS.JPBS_22_19

Background: Dental anxiety is one of the prime reasons for discouraging children to receive dental treatment. Measurement of the dental anxiety is very useful to know the prevalence level among 6- to 12-year-old children. Thus, the aim of the study was to determine the dental anxiety among 6- to 12-year-old children using Modified Dental Anxiety Scale (MDAS) score.
Materials and Methods: A total of 400 south Indian children in the age group of 6-12 years who had visited Dental College and Hospital were recruited in the study. Dental anxiety was measured before dental treatment using MDAS. Statistical analysis was performed using Wilcoxon signed rank test.
Results: Of the 400 children, 240 (61.5%) had severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) had no anxiety. Females had higher anxiety level compared to males. Many study subjects answered that local anesthesia (LA) injection was considered most fearful. Dental anxiety was highest in smaller age groups.
Conclusion: In our research, high percentage of children had dental anxiety, so counseling before dental visits is very important to reduce the dental anxiety among these 6- to 12-year-old children.

Matched MeSH terms: Anesthesia, Local
Fulltext Analgesia and Anaesthesia Management of Labour and Caesarean Delivery for a Parturient with Paramyotonia Congenita

Najid NM, Razak TA, Günaydın DB

Turk J Anaesthesiol Reanim, 2019 Aug;47(4):345-347.
PMID: 31380517 DOI: 10.5152/TJAR.2019.69094

Anaesthetic management in paramyotonia congenita (PC) or 'paradoxical myotonia' poses perioperative challenges to the anaesthesiologists both in obstetric and non-obstetric surgical patients. There are only a few case reports on the anaesthesia management particularly in the obstetric population. Therefore, we aimed to present the management of analgesia of labour and emergency caesarean delivery for a 26-year-old parturient with PC.

Matched MeSH terms: Anesthesia
Isolated hypotension after the induction of general anesthesia refractory to fluids and vasopressors: An indicator of anaphylaxis

Mok CS, Vanessa L

Med J Malaysia, 2021 03;76(2):267-269.
PMID: 33742644

Differentiating between anaphylaxis and hypotension during general anaesthesia is difficult, especially when patients present with only hypotension and without any of the other classical features of anaphylaxis. We report the successful management of an anaphylactic reaction to rocuronium that presented as isolated hypotension in a 45-year-old Indonesian man presented with lacerations on the scalp and right pinna caused by an assault to the head after the induction of general anaesthesia, refractory to fluids and high doses of vasopressors. This case highlights that a possible indicator of anaphylaxis can be the presence of isolated hypotension during.

Matched MeSH terms: Anesthesia, General
Fulltext Devastating insomnia experience following general anaesthesia for mastoidectomy surgery

Misron, L.H., Misron, K., Misron, S.N.F.

International Medical Journal Malaysia, 2018;17(2):139-142.
MyJurnal

Sleep disorder including insomnia is one of the complications of general anaesthesia. It is not uncommon and it is temporary but majority remains unnoticed and untreated. The effect of insomnia ranges from mild to severe, influencing both physical and mental health. Surgeon and anaesthetist need to identify this complication so that an appropriate treatment can be delivered. In complicated case, psychiatrist involvement is crucial. The treatment is symptomatic and temporary. We reported a case of distressful sleep disorder as a sequelae of general anaesthesia for mastoidectomy surgery. Subsequently after symptomatic treatment, he recovered completely and regained his normal sleep pattern.

Matched MeSH terms: Anesthesia, General
The clinical anatomy of accessory mandibular canal in dentistry

Ngeow WC, Chai WL

Clin Anat, 2020 Nov;33(8):1214-1227.
PMID: 31943382 DOI: 10.1002/ca.23567

The mandibular canal is a conduit that allows the inferior alveolar neurovascular bundle to transverse the mandible to supply the dentition, jawbone and soft tissue around the gingiva and the lower lip. It is not a single canal but an anatomical structure with multiple branches and variations. The branches are termed accessory, bifid or trifid canals depending on their number and configuration. A bifid mandibular canal is an anatomical variation reported more commonly than the trifid variant. Because of these variations, it is of the utmost importance to determine the exact location of the mandibular canal and to identify any branches arising from it prior to performing surgery in the mandible. This article reviews the prevalence, classification and morphometric measurements of these accessory mandibular canals, emphasizing their clinical significance.

Matched MeSH terms: Anesthesia, Dental
Fulltext Non-Traumatic Snapping Tendon on the Dorsal Aspect of the Thumb: A Diagnostic Challenge

Kesu Belani L, Abdullah S, Soh EZF, Abd Jabar F, Nasseri Z

Cureus, 2021 Apr 11;13(4):e14417.
PMID: 33987066 DOI: 10.7759/cureus.14417

A snapping tendon on the dorsal aspect of the thumb is a rare condition as opposed to the common triggering on the volar aspect of the thumb. This condition is known as triggering of the extensor pollicis longus (EPL). A 21-year-old female presented with a clicking or snapping sensation that was felt on the dorsum of her thumb when it is extended. There was no history of trauma. She worked in an ice-cream parlor with repetitive scooping ice-cream motions. Her triggering immediately resolved on releasing the EPL fascia ulnar to Lister's tubercle. Upon wake-up surgery, we could immediately confirm this. We recommend dynamic ultrasound as an investigation and do not recommend MRI. The surgical method of choice is either wake-up surgery or wide-awake local anesthesia no tourniquet (WALANT) surgery.

Matched MeSH terms: Anesthesia, Local
Fulltext Thirty-Day Morbidity and Mortality after Simultaneous Bilateral Total Knee Arthroplasty

Tai, C.C., Tan, S.H., Misnan, N.A., Nam, H.Y., Choon, S.K.

Malays Orthop J, 2008;2(1):38-43.
MyJurnal

The safety of simultaneous bilateral total knee arthroplasty (TKA) remains controversial. The objective of the current study was to investigate perioperative morbidity and mortality rates within 30 days of simultaneous bilateral TKA. A detailed analysis of medical, surgical and anaesthesia records of 183 consecutive patients who underwent total knee arthroplasty between 2002 and 2006 was performed. The mean age of the patients was 67.6 years old. More than 80% had one or more co-morbidities, but none of them had ASA score greater than class 2. The mean hospital stay was 10 days, and the mean surgical time 156 minutes. Less than half of the patients (42.6%) required blood transfusion. The rate of perimorbidity was 15.3 % and there was no mortality in this series. We believe that simultaneous bilateral total knee arthroplasty is a safe and cost effective option for our patients, provided that patients are selected and informed appropriately.

Matched MeSH terms: Anesthesia
Fulltext Treatment of Developmental Dysplasia of the Hip: Short and Mid-term Outcome

Malays Orthop J, 2011;5(1):17-20.
MyJurnal

Objective: To review the presentation and outcome of developmental dysplasia of the hip (DDH) cases in the last 6 years. Methodology:We retrospectively reviewed the presentation as well as short and mid-term outcome of 17children (18 hips) with DDH seen and treated from 2004 to 2010. Treatment was either splinting with Pavlik harness,closed or open reduction depending on age at presentation and the individual needs of each patient. Results:Theaverage age at presentation was 31.1 months, and the male to female ratio was 1:4.6. Six patients (35%) presented early(less than 6 months old) while 7 patients (41%) presented between 6 -24 months. In these 2 groups splinting or closed reduction under anaesthesia was initially utilized for treatment depending on age, and open reduction was use dafter failure of closed reduction and for those presented late.Average age at the time of closed reduction was 11 months,and 6 years for those underwent open reduction. The average period of follow up for all patients was 29.4 months. The final outcome was successful in 12 hips (66%) in 11 patients.Ten of these presented at less than 2 years old, in the other 6 hips in which there was failure, 50% presented after 3 years of age. Conclusion:Late presentation of DDH is still common in Malaysia, which necessitates more complex management and more frequent occurrences of unfavourable results.

Matched MeSH terms: Anesthesia
Fulltext A Review of 80 Supernumerary Teeth Removed Under General Anaesthesia

Ngeow, W.C., Anuar, A.M.

Ann Dent, 2004;11(1):-.
MyJurnal

A retrospective study was carried out to review the records of 47 patients who had had in total 80 supernumerary teeth (ST) removed under general anaesthesia between 1975 and 2002. Malays made up 38.30%, Chinese 51.06%, and Indians 10.64% of the patients. The predominant age group was 6-10 year-old. The mean age was 12.96 ± 9.49 years. The male and female ratio was 1.35:1. Most of the patients had either one ST (n=31; 65.96%) or two ST (n=11; 23.40%). Five cases of multiple supernumeraries were recorded. Two patients experienced late formation of subsequent ST after the first surgery, thus requiring a second surgery. The majority of ST were conical in shape (n=35; 43.75%). Most of the ST were located in the premaxilla (n=55; 68.8%). Almost a quarter (23.75%) of ST were inclined towards the oral cavity. Some of the effects on the dentition were diastema, cystic changes, rotation, displacement, and retention of the permanent teeth and these were the indications for removal of ST. The most common surgical approach for maxillary ST was from the labial, buccal or labio-buccal approach.

Matched MeSH terms: Anesthesia, General
Fulltext Isobolographic analysis of the hypnotic interaction between propofol and thiopental

Wong, W. H., Lim, T. A., Lim, K. Y.

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):83-89.
MyJurnal

Introduction: Giving two intravenous anaesthetic agents simultaneously generally results in an additive effect. The aim of this study was to investigate the interaction between propofol and thiopental when given to patients who have had sedative premedication. Methods: Fifty patients were admitted into the study. All patients received oral midazolam 3.75 mg and intravenous fentanyl 100 mg before induction of anaesthesia. Twenty patients received an infusion of either propofol or thiopental while 30 patients received an infusion of an admixture of both drugs. Isobolographic analysis was used to determine the interaction between the two drugs. Results: The interaction between propofol and thiopental was
additive. The average dose at loss of the eyelash reflex for propofol and thiopental was 0.71 mg kg-1 and 1.54 mg kg-1 respectively. Premedication decreased the induction dose by 38.2%. Conclusion: Propofol and thiopental interact in an additive fashion when given at induction of anaesthesia.

Matched MeSH terms: Anesthesia
Fulltext Debulking biopsy of a huge intraoral mass avoiding tracheostomy

Roselinda Abdul Rahman, Irfan Mohamad, Rohaizam Jaafar

Archives of Orofacial Sciences, 2015;10(2):65-68.
MyJurnal

Managing a patient with a huge intraoral mass is always challenging. Manipulation or even a simple biopsy of the mass may lead to hemorrhage and further compromise the airway. An examination under anesthesia is not without risk. The method of securing the airway itself may become an issue if the mass is fully occupying the airway before intubation. Usually a tracheostomy is indicated. We share a gentleman presented with a huge intraoral mass occupying the oropharynx, which initially necessitates tracheostomy. We utilized the ultrasonic scalpel-assisted instrument to biopsy by debulking the tumour, thus avoiding the tracheostomy while waiting for the definitive treatment.

Matched MeSH terms: Anesthesia
TRENDS IN OBSTETRICS

MACAFEE CH

Med J Malaysia, 1963 Jun;17:274-81.
PMID: 14060504
Matched MeSH terms: Anesthesia*; Anesthesia, Obstetrical*
Fulltext Intraoperative glycaemic control in non insulin dependent diabetes mellitus: a comparison between normal saline and ringer’s lactate

Sulaiman, I.M., HS, Lee, Balan, S., Jaafar, M.Z.

Medicine & Health, 2006;1(1):20-24.
MyJurnal

Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L in Group 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significant.

Matched MeSH terms: Anesthesia, Epidural
Fulltext Management of an unerupted, dilacerated maxillary permanent central incisor by a combined surgical - orthodontic approach: a case report

Sockalingam, G., Ngah, I.

Malaysian Dental Journal, 2007;28(2):99-102.
MyJurnal

This case report presents a combined surgical – orthodontic approach to the management of an unerupted maxillary right permanent central incisor in a 13 year-old Chinese male. Radiographic investigations revealed that the tooth was severely dilacerated, most likely as a result of trauma sustained to the upper maxillary right deciduous central incisor at the age of 3 years. After securing adequate space for the unerupted tooth by fixed appliance therapy, surgical exposure of the crown was carried out under local anaesthesia and oral sedation.
A gold chain was bonded to the exposed crown of the tooth. Traction was then carried out and the tooth was successfully brought to its final and correct position in the arch after 36 months of active orthodontic treatment.

Matched MeSH terms: Anesthesia, Local
Fulltext Smoker Desaturation during General Anaesthesia: A Case Report

Hadi, M.A., Azrina, M.R., Zamzila, A., Ariff, O.

International Medical Journal Malaysia, 2009;8(1):57-59.
MyJurnal

We report a case of sudden hypoxaemia after intubation in a patient who had smoked a few hours prior to a surgical procedure. The cause of his desaturation was not related to bronchial secretions, bronchospasm or obstruction of the upper airways but most likely due to reduced oxygen saturation in the body prior to surgery. We managed to secure the airway and prevent prolonged desaturation by instituting remedial measures. Our conclusion is that cessation of smoking is very important and need to be emphasized in all patients having surgery under general anaesthesia. This applies to emergency cases as well.

Matched MeSH terms: Anesthesia, General
Fulltext Robotic-assisted thyroidectomy: a new experience in anaesthesia

Adlin Dasima, A.K., Nadia Hanom, I., Siti Aznida, A.K., Rusnaini, M.K., Mohd Fahmi, Z., Mohd Nazir, M.S., et al.

Journal of Surgical Academia, 2017;7(1):51-54.
MyJurnal

This is our first experience in providing general anaesthesia for robotic-assisted thyroidectomy (RAT). It is rather a
new experience for our anaesthetic team and few issues should be addressed. The conduct of RAT must be fully
understood and familiarized as it may present with few challenges for the anaesthesiologists. The key point of
success during this learning curve period is the importance of teamwork between the anaesthesiologists and the
operating surgeons. The specific anaesthetic challenges include limited access to the patient post-docking of the
robot, the need of extra precautions of the anaesthetic circuit and IV line connections, a vigilant anaesthesiologists
and options for postoperative pain relief.

Matched MeSH terms: Anesthesia, General
Fulltext Dexamethasone and postoperative capillary glucose levels in type 2 diabetes mellitus

Elliza, R., Nadia, M.N., Azlina, M., Yeoh, C.N., Maryam, B., Hanita, O.

Journal of Surgical Academia, 2018;8(2):11-16.
MyJurnal

Perioperative intravenous (IV) dexamethasone is administered prophylactically for post operative nausea and vomiting. However, its glucocorticoid property which raises blood glucose is of concern, especially among diabetic patients. The surgical stress response also contributes to increased perioperative blood glucose. Prior studies showed higher glucose levels with dexamethasone 8 mg compared to 4 mg, hence we studied the effect of the lower dose amongst diabetic patients. This prospective, single blinded, randomised study recruited forty-six type 2 diabetes mellitus patients planned for surgery under general anaesthesia. They received IV dexamethasone 4 mg or saline (placebo) after induction of anaesthesia. Capillary blood glucose levels were recorded preoperatively, and subsequently at recovery (T0), and at 6, 12, 18 and 24 (T6, T12, T18, T24) hours post-operatively. Median glucose levels were higher at 9.0 [10.5-7.7] mmol/l in the dexamethasone group, versus 7.4 [9.2-5.9] mmol/l in the placebo group at T0, p = 0.022. Similarly at T6, the dexamethasone group recorded higher glucose levels of 11.2 [15.0-9.3] mmol/l, versus 7.7 [9.0-6.2] mmol/l in the placebo group, p = 0.001. This corresponded to a significant difference between the groups, in the change of glucose levels from baseline values, p = 0.042. Subsequent readings at T12, T18, and T24 were comparable between the groups. In conclusion, IV dexamethasone 4 mg in type 2 diabetic patients, resulted in higher glucose levels immediately postoperative and 6 hours later. The change in blood glucose from baseline levels was significant between the groups at 6 hours postoperatively. Glucose levels however remained within acceptable range of approved guidelines in both groups at all recorded intervals.

Matched MeSH terms: Anesthesia, General

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