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  1. Perioperative Management of Parturient Women With Severe Pulmonary Arterial Hypertension Secondary to Atrial Septal Defect
    Mokhtar MN, Abdul Rahman R, Md Nor N, Izaham A, Sayed Masri SNN
    Cureus, 2023 Nov;15(11):e48369.
    PMID: 38060730 DOI: 10.7759/cureus.48369
    At our institution, we occasionally see pregnant patients in the later stages of pregnancy who present with severe pulmonary arterial hypertension caused by congenital heart disease. The physiological changes in pregnancy may worsen the cardiovascular status leading to heart failure which is associated with a high incidence of morbidity and mortality. A scheduled caesarean section in such patients ensures delivery in a controlled environment, avoiding prolonged labour, which is detrimental. Perioperative complications that may worsen pulmonary arterial hypertension should be prevented. The perioperative management, in particular, the anaesthesia technique used and the clinical outcome of this population, is discussed through five interesting cases. Despite a multidisciplinary team and intensive care management, two patients with existing cor pulmonale, one of whom received general and the other central neural blockade anaesthesia, succumbed to their illness immediately after lower segment caesarean section. The management of severe pulmonary arterial hypertension in pregnant patients remains a multidisciplinary challenge among participating physicians. Thorough perioperative preparation encompassing monitoring, medical therapy, timing and mode of delivery, and risk consultation is vital in avoiding circumstances that could exacerbate pulmonary arterial hypertension, with physicians readily equipped to promptly detect and manage any untoward event.
  2. Fulltext Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial
    Tan KW, Sayed Masri SNN, Musthafa QA, Mohd Azidin A, Nik Mohamed Kamil A, Izaham A, et al.
    Medicine (Baltimore), 2022 Sep 02;101(35):e30515.
    PMID: 36107598 DOI: 10.1097/MD.0000000000030515
    BACKGROUND: The serratus plane block is an effective technique for providing analgesia to patients undergoing breast surgery.

    METHODS: This prospective, double-blind, randomized study enrolled 60 female patients scheduled for unilateral mastectomy and axillary clearance. The patients received either a superficial serratus plane block or deep serratus plane block. Dermatomal spread was recorded 30 minutes after block administration. Postoperatively, pain visual analog scale (VAS) scores were documented at recovery (time 0), at 30 minutes; and in the ward hourly for 4 hours, and 4-hourly until 24 hours postoperatively. The time to first analgesic rescue and cumulative morphine consumption using patient-controlled analgesia morphine (PCAM) were recorded.

    RESULTS: The results showed lower VAS scores at rest (at 1, 2, 3, and 4 hours postoperatively), and during movement (at 1, 2, 3, 4, 8, and 24 hours postoperatively) in the superficial serratus plane block group, P < .005. Similarly, cumulative morphine usage was lower in the superficial serratus plane group, P < .005. The time to the first rescue analgesic was also significantly longer in the superficial group, P < .001. More patients in the superficial serratus plane group achieved greater dermatomal spread at T2 and T7 than those in the deep group.

    CONCLUSIONS: Superficial serratus plane block provides better analgesic efficacy than deep serratus plane block in mastectomy and axillary clearance.

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