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  1. Zawiah Kassim, Fauziah Ahmad, Rusnaini Mustapha Kamar, Karis Misiran
    MyJurnal
    Safety and feasibility of transoral robotic surgery (TORS) in adults for otolaryngology surgery,
    mainly in the treatment of oropharyngeal carcinoma and obstructive sleep apnoea has already
    been established several years ago. However, less is known with respect to the role and safety
    of TORS for otolaryngology surgery in the paediatric age group and its description in the
    literature is currently insufficient. As paediatric patients are unique in their anatomy, physiology
    and pharmacological kinetic, special attention and consideration has to be applied when using
    TORS, hence this increases the perioperative challenges. Herewith we present our experience
    in anaesthetising a paediatric patient for TORS adenotonsillectomy which is the first not only
    in our centre but in Malaysia. Our major obstacle was the limited airway access as the area of
    concern was shared by the anaesthesiologist, surgeon and also the robotic system.
    Haemodynamic stabilisation was a challenge compared to the conventional method as the
    operative time increased due to robot docking time and the new surgical learning process. In
    our opinion, the key point for the success of TORS adenotonsillectomy in paediatric patients is
    good communication and teamwork between all personnel involved in the surgery.
  2. Zawiah Kassim, Norliza Mohd Nor, Ariffah Mokhtar, Suhaina Mohamad, Sarina Osman, Isqandar Adnan
    MyJurnal
    Introduction: Over three decades, patient-controlled epidural analgesia with a basal infusion
    regimen (PCEA+BI) has successfully improved labour analgesia quality due to its advantage
    in allowing self-titration by the parturients. Recently, a newer programmed intermittent epidural
    bolus with PCEA regimen (PIEB+PCEA) was suggested to improve the epidural spread of
    local anaesthetic hence resulted in better analgesia quality and higher maternal satisfaction.
    Methods: We conducted a one-year retrospective analysis of data from obstetric analgesia
    service record sheet and hospital information system comparing maternal satisfaction towards
    their labour analgesia quality, mode of delivery and neonatal Apgar scores between these two
    methods of epidural delivery techniques. A total of 343 parturients were recruited in this study
    (PCEA+BI n=171, PIEB+PCEA n=172). Results: There were no significant difference in
    maternal satisfaction between the two groups (P=0.398) with a higher percentage of excellent
    satisfaction were found in the PIEB+PCEA group (PIEB+PCEA 146/172 (84.9%) vs PCEA+BI
    138/171 (80.7%)). No significant difference in the mode of delivery (P=0.296). However, the
    PIEB+PCEA group shown a higher spontaneous vaginal delivery rate (PIEB+PCEA 87/172
    (50.6%) vs PCEA+BI 70/171 (40.9%) and lower Caesarean delivery rate (PIEB+PCEA 71/172
    (41.3%) vs PCEA+BI 87/171 (50.9%)). Despite statistically significant differences found in
    Apgar scores at 1 minute (P=0.036), there was no significant difference in the scores at 5
    minutes (P=0.107). Mean Apgar scores (SD) at 1 minute and 5 minutes for PIEB+ PCEA were
    7.77(0.85) and 8.91(0.55) respectively and for PCEA + basal infusion, the scores for 1 minute
    and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA is
    a newer epidural delivery technique for labour analgesia which produces a comparable
    outcome to PCEA with basal infusion.
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