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Fulltext Comparison between magnesium sulphate and esmolol in attenuating haemodynamic responses to laryngoscopy and endotracheal intubation

Norhuzaimah, J., Liu, C. Y., Muhammad, M., Joanna Ooi ,S. M.

Journal of Surgical Academia, 2018;8(1):0-0.
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During induction of general anaesthesia, the act of laryngoscopy and tracheal intubation stimulates the sympathetic
nervous system resulting in an increase in blood pressure and heart rate which may be harmful especially in elderly
patients with pre-existing ischaemic heart disease. Several drugs have therefore been used to obtund this increase
including esmolol, nicardipine, magnesium sulphate and lignocaine. This prospective, double blind randomised
clinical trial compared the efficacy of magnesium sulphate and esmolol in attenuating haemodynamic responses to
laryngoscopy and tracheal intubation. One hundred and twenty six ASA I-II patients scheduled for elective surgery
requiring general anaesthesia with tracheal intubation were enrolled and randomised into two groups: Group 1 (n =
67) received MgSO4 40 mg/kg diluted in 100 ml normal saline administered over ten minutes, whereas Group 2 (n =
59) received a bolus of esmolol 1.0 mg/kg diluted to 10 ml. Systolic and diastolic blood pressures and heart rate were
recorded every minute for subsequent 10 minutes following laryngoscopy and tracheal intubation. Attenuation of the
mean systolic and diastolic blood pressures following laryngoscopy and tracheal intubation was significantly larger
in Group 2 compared to Group 1. Patients in Group 2 had significantly better suppression of heart rate response
compared to Group 1 during the first four minutes after laryngoscopy and tracheal intubation (p
Ketamine and tramadol for the prevention of shivering during spinal anaesthesia

Hidayah MN, Liu CY, Joanna OS

Clin Ter, 2014;165(4):193-8.
PMID: 25203332 DOI: 10.7417/CT.2014.1732

INTRODUCTION: Anaesthesia and surgery promote significant thermal disorder in the human body. Spinal anaesthesia causes lower limb vasodilation and redistribution of body heat from central to the peripheral compartments.
MATERIALS AND METHODS: This was a prospective, randomised, double-blind clinical study to compare the effectiveness of IV ketamine and tramadol in the prevention of shivering associated with spinal anaesthesia. We prospectively studied 150 ASA classification I and II patients between 18 and 70 years old scheduled for any elective surgery performed under spinal anaesthesia. Patients were randomly allocated to receive either prophylactic IV ketamine 0.5 mg/kg (Group K), IV tramadol 0.5 mg/kg (Group T) or normal saline as control (Group P) after intrathecal injection of 0.5% hyperbaric bupivacaine 12.5 mg (2.5 ml) and 25 mcg fentanyl. The frequency and degree of shivering, haemodynamic parameters, core body temperature and side effects of the studied drugs were recorded for the first 30 minutes.
RESULTS: The incidence of shivering was 8% in Group K, 16% in Group T and 24% in Group P. This result was statistically significant between Groups K and P. Patients from Group K also exhibited significantly higher mean arterial blood pressure and heart rate at 5 and 15 minutes post intrathecal injection while their mean core temperature was also significantly higher. Side effects such as nausea, vomiting, hallucination, agitation and sweating were comparable between all three groups. Patients from Group K however, had significant higher incidence of behavioural changes (blunted affect or catatonic state) and nystagmus.
CONCLUSIONS: Prophylactic use of IV ketamine 0.5 mg/kg significantly reduced the frequency and the intensity of perioperative shivering associated with spinal anaesthesia but also exhibited some side effects of the drug. Lower doses of prophylactic ketamine should be studied.
KEYWORDS: ketamine; shivering; spinal anaesthesia; tramadol
Levobupivacaine for postoperative epidural analgesia in orthopaedic surgery

Afaf AA, Liu CY, Joanna OS

Clin Ter, 2013;164(2):91-5.
PMID: 23698199 DOI: 10.7417/CT.2013.1524

Levobupivacaine is the S(-)enantiomer of bupivacaine, a long acting amino-ester local anaesthetic agent. Cocktail mixture of levobupivacaine and fentanyl infusion is commonly given via epidural for post-operative analgesia. The concentration of levobupivacaine for optimal pain relief with least side effects remained uncertain.
Fulltext Can the use of 70% isopropyl alcohol swab or aspiration using 5 microm Filter Straw reduce bacterial contamination of fentanyl solution used for regional anaesthesia?

Roshaliza HM, Liu CY, Joanna OSM

Med J Malaysia, 2011 Jun;66(2):92-4.
PMID: 22106684

This prospective study aimed to determine the extent of contamination of fentanyl solutions used for central neuraxial injection by wiping the neck of the ampoules with 70% isopropyl alcohol swabs (Kendall) before breaking open the ampoules and aspiration of fentanyl solutions using a 5 microm Filter Straw (B. Braun). In Group A, fifty fentanyl ampoules were wiped with 70% isopropyl alcohol swab prior to opening and the contents were aspirated immediately using a 21G needle and a 5 microm filter straw for culture. The same steps were repeated on the remaining solutions after two hours. In Group B, all the above steps were repeated but without wiping the ampoules with 70% isopropyl alcohol swabs. None of the samples from the wiped ampoules or aspiration using filter straw grew microorganisms. Six percent of the samples from unwiped group grew microorganisms when fentanyl were aspirated using a 21G needle and the contamination increased to 16% when repeated after two hours. Wiping the outsides of the fentanyl ampoules with 70% isopropyl alcohol swabs before opening or aspirating the contents using a 5 pm filter straw has been shown to be equally effective in avoiding bacterial contamination and should be practiced routinely when performing regional anaesthesia.
KEY WORDS: Fentanyl solution, Isopropyl alcohol swab, Filter straw, Contamination, Regional anaesthesia, Hospital Kuala Lumpur, Malaysia
Fulltext Comparison between LMA-Classic and AMBU AuraOnce laryngeal mask airway in patients undergoing elective general anaesthesia with positive pressure ventilation

Suzanna AB, Liu CY, Rozaidi SW, Ooi JS

Med J Malaysia, 2011 Oct;66(4):304-7.
PMID: 22299547

The LMA-Classic laryngeal mask airway (Classic LMA) is an autoclavable and reusable laryngeal mask airway with strong evidence supporting its efficacy and safety. Due to the concern of infection risk particularly of prion disease, various single-use laryngeal mask devices were developed. The Ambu AuraOnce LMA (Ambu LMA) is a single use disposable laryngeal mask airway with special design that conforms better to the anatomy of the airway.
Nurses compliance to hand hygiene practice and knowledge at Klang Valley hospital

Ho SE, Ho CC, Hng SH, Liu CY, Jaafar MZ, Lim B

Clin Ter, 2013;164(5):407-11.
PMID: 24217826 DOI: 10.7417/CT.2013.1604

Hand hygiene is the most important measure in the prevention of healthcare-associated infections (HCAI). Adherence to hand hygiene protocols in hospital by nurses enables in prevention and control the HCAI. The main aim of the present study was to assess nurses' compliance to hand hygiene practice and knowledge in a hospital.
Effect of transcutaneous electrical acupoint stimulation in heart rate variability in post-on-call trainees

Low HJ, Cheah OK, Ng BH, Siti Nidzwani MM, Wan Rahiza WM, Liu CY

Med J Malaysia, 2024 Nov;79(6):764-769.
PMID: 39614796

INTRODUCTION: Anaesthesiology is a high-demand speciality with 24-hour on-call shifts, which can lead to significant stress and impaired sleep quality among anaesthetists. Nonpharmacological interventions like acupuncture have been widely explored for stress relief. This study aims to evaluate the impact of transcutaneous electrical acupoint stimulation (TEAS) on physiological parameters, specifically heart rate variability (HRV) and sleep quality, in anaesthesiology trainees following 24-hour on-call duty.
MATERIALS AND METHODS: A total of 38 anaesthesiology trainees, following 24-hour ICU on-call shifts, were recruited for this single-centre cross-sectional clinical trial. The participants were required to complete two 24-hour on-call duties. Demographic data and baseline sleep quality assessments were collected following the first on-call duty. Upon completion of the second on-call shift, participants underwent 20 minutes of TEAS at bilateral PC6 (Neiguan), LI4 (Hegu), LR3 (Taichong), and ST41 (Jiexi) points. Heart rate variability (HRV) parameters, blood pressure, and heart rate were recorded before and after TEAS. Post-TEAS sleep quality was assessed following an overnight rest.
RESULTS: The results demonstrated a significant reduction in systolic blood pressure compared to baseline (109.5±8.9 vs 111.9±10.1 mmHg, p = 0.006), as well as a significant decrease in diastolic blood pressure (69.3±8.0 vs 70.9±9.0 mmHg, p = 0.037) and heart rate (65.8±9.2 vs 67.4±9.8 bpm, p = 0.034). There was significant improvement in all aspects of sleep quality (p < 0.001). However, no statistically significant changes were observed in heart rate variability (HRV) parameters, including high-frequency (HF) power, lowfrequency (LF) power, and the LF/HF ratio.
CONCLUSION: TEAS may offer potential benefits in managing cardiovascular stress and improving sleep quality in highstress environments, such as post-call recovery. Nevertheless, its impact on autonomic nervous system regulation, as reflected by HRV, appears limited.