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  1. Gan EK, Tan JSK
    Med J Malaysia, 1981 Jun;36(2):112-5.
    PMID: 7343819
    Male albino rats were chronically loaded with sodium by giving 1% NaCl solution as the sole source of drinking water. Daily fluid intake, daily urinary output and daily Na+ and K+ excretion rates were compared with control rats receiving tap water for six weeks. At the end ofsix weeks, sodium loaded animals were found to have raised plasma Na+ concentration, lowered plasma K+ concentration and lowered haematocrit value. Sodium loaded rats were also significantly more responsive to the pressor effect of submaximal doses of adrenaline, noradrenaline and angiotensin II given intravenously. It is concluded that the increase in sensitivity to adrenaline and noradrenaline may be due to changes in EGF and alterations of plasma electrolytes concentration. For angiotensin II, additionally, it may be due to low circulating endogenous angiotensin II, consequent of reduction in renin release attributed to chronic sodium loading.
  2. Phoon PHY, MacLaren G, Ti LK, Tan JSK, Hwang NC
    J Cardiothorac Vasc Anesth, 2019 Dec;33(12):3394-3401.
    PMID: 30131218 DOI: 10.1053/j.jvca.2018.07.018
    Singapore is a small Southeast Asian island city-state located at the tip of the Malay peninsula with a population of 5.61 million people. It was a former British colony that went on to become a part of Malaysia before gaining independence in 1965. Since then, Singapore has developed tremendously from a small fishing village into the region's medical hub. This article will explore the roots of cardiac anesthesia in Singapore and how it has developed into a subspecialty today.
  3. Obara S, Bong CL, Ustalar Ozgen ZS, Abbasi S, Rai E, Villa EK, et al.
    Paediatr Anaesth, 2024 Nov 09.
    PMID: 39520199 DOI: 10.1111/pan.15034
    BACKGROUND: Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings.

    AIMS: The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.

    METHODS: This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.

    RESULTS: The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).

    CONCLUSIONS: The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.

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