Displaying all 11 publications

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  1. Ang E, Ng KT, Lee ZX, Ti LK, Chaw SH, Wang CY
    J Clin Anesth, 2020 Dec;67:110023.
    PMID: 32805685 DOI: 10.1016/j.jclinane.2020.110023
    OBJECTIVES: There is growing evidence on the influence of general anaesthesia (GA) in promoting the proliferation of cancer cells. The benefits of regional anaesthesia (RA) on cancer recurrence rate in cancer surgery remains unclear in the literature. The primary objective of this review was to examine the effect of RA on the incidence of post-operative cancer recurrence rate in cancer resection surgery.

    DESIGN: Systematic review and meta-analysis with trial sequential analysis.

    DATA SOURCES: Medline, EMBASE and CENTRAL were systematically searched from its inception until April 2020.

    ELIGIBILITY CRITERIA: All randomized control trials and observational studies comparing RA only versus GA in cancer resection surgery were included. Case report, case series and editorials were excluded.

    RESULTS: Ten retrospective observational studies (n = 9708; 4567 GA vs 5141 RA) were included for qualitative and quantitative meta-analysis. In comparison to GA, RA was not significantly associated with a lower cancer recurrence rate in cancer resection surgery (odds ratio 1.01, 95% CI 0.67 to 1.53, p = 0.95, certainty of evidence = very low). However, the trial sequential analysis for cancer recurrence rate was inconclusive. Our analysis demonstrated no significant difference between the RA and GA groups in the overall survival rate (odds ratio 1.51, 95% CI 0.65 to 3.51, p = 0.34, certainty of evidence = very low), time to cancer recurrence (mean difference 1.45 months, 95% CI -8.69 to 11.59, p = 0.78, certainty of evidence = very low), cancer-related mortality (odds ratio 1.79, 95% CI 0.57 to 5.62, p = 0.32, certainty of evidence = very low).

    CONCLUSIONS: Given the low level of evidence and underpowered trial sequential analysis, our review neither support nor oppose that the use of RA was associated with lower incidence of cancer recurrence rate than GA in cancer resection surgery.

    TRIAL REGISTRATION: CRD42020163780.

    Matched MeSH terms: Anesthesia, General/adverse effects
  2. Sari D, Widyastuti Y, Hendy HH, Dharma IA, Pancarani A, Krislee A
    Med J Malaysia, 2024 Mar;79(2):151-156.
    PMID: 38553919
    INTRODUCTION: Emergence delirium (ED) is a transient irritative and dissociative state that arises after the cessation of anaesthesia in patients who do not respond to calming measures. There are many risk factors for ED, but the exact cause and underlying mechanism have not been determined because the definition of ED is still unclear in consensus. This study aims to determine ED incidence, identify ED risk factors and external validation of Watcha, Cravero and expert assessment to Pediatric Anesthesia Emergence Delirium (PAED) scoring system in ED prediction.

    MATERIALS AND METHODS: This study is a prospective cohort study on 79 paediatrics who underwent elective surgery with general anaesthesia. Parameter measures include the incidence of ED, ED risk factors, and the relationship between PAED, Watcha, Cravero score and expert assessment. The ED risk factor was analysed using univariate and multivariate analysis. The relationship between PAED, Watcha, Cravero score, and expert assessment was determined using Receiver Operating Characteristic (ROC) curve analysis.

    RESULTS: The incidence of ED was 22.8%. All parameters examined in this study showed p < 0.05. Watcha's scoring correlates with the PAED scoring and shows the highest discrimination ability with AUC 0.741 and p < 0.05.

    CONCLUSION: The incidence of ED in paediatrics is relatively high. Compared to others, Watcha score are more reliable for ED prediction. However, some demographic and perioperative factors are not the risk factor of ED.

    Matched MeSH terms: Anesthesia, General/adverse effects
  3. Satgurunathan P
    Med J Malaysia, 1985 Dec;40(4):271-5.
    PMID: 3916211
    In this project, a retrospective study regarding the anaesthetic techniques, complications and the relevant monitoring aids needed during the procedure, is made from analysis of the 100 available anaesthetic records of cases done during the five years at the Urology Department, General Hospital, Kuala Lumpur. The total number of cases done during 1979-1984 was 112 but 12 anaesthetic record sheets were missing. The patients requiring renal transplant operation were representative of the end-stage chronic renal failure population of Malaysia with the usual high incidence of cardiovascular and biochemical abnormalities. Except for two cases of epidural anaesthesia, all the other patients received general anaesthesia. Induction was with intravenous barbiturate followed by muscle relaxant, neurolept or narcotic and halothane supplement for maintenance. There were no intraoperative or postoperative deaths due to anaesthetic complications. There were five cases of anaesthetic morbidity of which three cases had inadequate reversal of neuromuscular blocking agents and required postoperative ventilation and two cases had poor respiratory effort and required naloxone supplement. Less serious complications such as allergic manifestations were seen in three cases with use of the new muscle relaxant atracurium. The conclusion was that general anaesthesia using thiopentone for induction, pancuronium bromide for intubation and maintenance of muscle relaxation and neurolept fentanyl/droperidol and halothane supplement, all in doses tailored to the requirements ofa renal failure patient, is a suitable technique of anaesthesia for renal transplant operation. Atracurium, the new muscle relaxant, seems to be a favourable alternative to pancuronium bromide. However, as only five cases in our study received atracurium, further studies would have to be done to support it.
    Matched MeSH terms: Anesthesia, General/adverse effects
  4. Sharma S, Aminuldin AG, Azlan W
    Singapore Med J, 1994 Oct;35(5):529-31.
    PMID: 7701380
    A 3-day-old child presented with a gross swelling on the right side of the neck extending beyond the midline and inability to swallow. It was diagnosed to be cystic hygroma and decision was made to excise the swelling as an emergency operation to enable the child to swallow and thrive better. During the gaseous induction, difficulty was encountered in maintaining the airway and subsequently to intubate the patient. Intraoperatively the surgeon was not able to excise the tumour completely. Postoperatively it was decided to ventilate the child electively because of the intubation difficulties encountered and not so firm floor of the mouth because of surgical excision. The stay in the neonatal ICU was marked with infection and facial nerve palsy.
    Matched MeSH terms: Anesthesia, General/adverse effects*
  5. Chow WP, Loganath A, Peh KL, Chew PC, Gunasegaram R, Ratnam SS
    Med J Malaysia, 1993 Mar;48(1):56-63.
    PMID: 8341173
    This study investigated whether changes in circulating levels of immunoreactive oestradiol-17 beta (E2), progesterone (P) and testosterone (T) occur in women at follicular (n = 18, age 25 to 39 years) and luteal (n = 17, 25 to 39 years) phases of the normal menstrual cycles, experiencing laparoscopy after intravenous sedation with general anaesthesia. The pre- and intra-operative follicular phase plasma steroid hormone concentrations were 153.5 +/- 84.3 vs 297.4 +/- 220.8 pg/ml for E2, 2.0 +/- 3.2 vs 3.3 +/- 3.8 ng/ml for P and 746.6 +/- 415.9 vs 1325.8 +/- 535.1 pg/ml for T, respectively. The corresponding luteal phase steroid levels were 259.7 +/- 120.2 vs 382.7 +/- 188.7 pg/ml, 7.0 +/- 4.8 vs 9.9 +/- 6.1 ng/ml and 819.4 +/- 355.7 vs 1703.5 +/- 1058.1 pg/ml. Using the Wilcoxon rank sum test, intra-operative hormone levels with the exception of P in the luteal phase were found to be significantly elevated (p < 0.05). The results suggest that laparoscopy under general anaesthesia evokes increased secretion of ovarian hormones, possibly via the activation of hypothalamo-pituitary-ovarian axis.
    Matched MeSH terms: Anesthesia, General/adverse effects*
  6. Lee ZX, Ng KT, Ang E, Wang CY, Binti Shariffuddin II
    Int J Surg, 2020 Oct;82:192-199.
    PMID: 32871271 DOI: 10.1016/j.ijsu.2020.08.034
    BACKGROUND: Studies have reported that general anesthesia (GA), especially volatile agents were associated with higher cancer recurrence rate after cancer resection surgery. However, the effect of supplementary regional anesthesia (RA) in reducing the use of anesthetic agents on oncological outcomes remains unclear. The primary aim of this meta-analysis was to examine the effect of adjunctive use of RA on the cancer recurrence rate in adults undergoing cancer resection surgery.

    METHODS: MEDLINE, EMBASE and CENTRAL were systematically searched for randomized control trials (RCTs) from its inception until April 2020.

    RESULTS: Six RCTs (n = 3139 patients) were included. In comparison to the GA alone, our meta-analysis demonstrated no significant difference in the cancer recurrence rate in patients who received the adjunctive use of RA in the routine care of GA (3 studies, n = 2380 patients; odds ratio 0.93, 95%CI 0.63-1.39, ρ = 0.73, certainty of evidence = very low). Our review also showed no significant difference in cancer-related mortality (2 studies, n = 545; odds ratio 1.20, 95%CI 0.83-1.74, ρ = 0.33, certainty of evidence = low), all-cause mortality (3 studies, n = 2653; odds ratio 0.98, 95%CI 0.69-1.39, ρ = 0.89, certainty of evidence = low) and duration of cancer-free survival (2 studies, n = 659; mean difference 0.00 years, 95%CI -0.25-0.25, ρ = 1.00, certainty of evidence = high).

    CONCLUSION: This meta-analysis concluded that the adjunctive use of RA in the routine care of GA did not reduce cancer recurrence rate in cancer resection surgery. However, this finding needs to be interpreted with caution due to low level of evidence, substantial heterogeneity and potential risk of bias across the included studies.

    STUDY REGISTRATION NUMBER: CRD42020171368.

    Matched MeSH terms: Anesthesia, General/adverse effects*
  7. Norsidah AM, Puvaneswari A
    Singapore Med J, 1997 May;38(5):200-4.
    PMID: 9259599
    The immediate post-operative period in the recovery room is a known period of high risk for anaesthetic complications to occur.
    Matched MeSH terms: Anesthesia, General/adverse effects*
  8. Hannah HB
    Br J Anaesth, 1971 Oct;43(10):991-3.
    PMID: 5115036
    Matched MeSH terms: Anesthesia, General/adverse effects*
  9. Ng KT, Sarode D, Lai YS, Teoh WY, Wang CY
    Paediatr Anaesth, 2019 12;29(12):1163-1172.
    PMID: 31587414 DOI: 10.1111/pan.13752
    BACKGROUND: Ketamine is believed to reduce the incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomized controlled trials reported conflicting findings.

    AIMS: To investigate the effect of ketamine on emergence agitation in children.

    METHODS: Databases of MEDLINE, EMBASE, and CENTRAL were systematically searched from their start date until February 2019. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. The primary outcome was the incidence of emergence agitation. Secondary outcomes included postoperative pain score, duration of discharge time, and the adverse effects associated with the use of ketamine, namely postoperative nausea and vomiting, desaturation, and laryngospasm.

    RESULTS: Thirteen studies (1125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odds ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison with the placebo, ketamine group achieved a lower postoperative pain score (odds ratio: -2.42, 95% confidence interval: -4.23 to -0.62, certainty of evidence: very low) and lower pediatric anesthesia emergence delirium scale at 5 minutes after operation (odds ratio: -3.99, 95% confidence interval: -5.03 to -2.95; certainty of evidence: moderate). However, no evidence was observed in terms of incidence of postoperative nausea and vomiting, desaturation, and laryngospasm.

    CONCLUSION: In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. However, the use of ketamine is well-tolerated without any notable adverse effects across all the included trials.

    PROSPERO REGISTRATION: CRD42019131865.

    Matched MeSH terms: Anesthesia, General/adverse effects*
  10. Chiu CL, Ong GS
    Ann Acad Med Singap, 2000 Mar;29(2):256-8.
    PMID: 10895351
    INTRODUCTION: We report a case of subcutaneous emphysema and pneumomediastinum that presented postoperatively after tracheal extubation.

    CLINICAL PICTURE: A 51-year-old man had an uneventful anaesthesia lasting about 6.5 hours. Intubation was performed by a very junior medical officer and was considered difficult. He developed sore throat, chest pain, numbness of both hands and palpable crepitus around the neck postoperatively. Chest X-ray revealed diffuse subcutaneous emphysema, pneumomediastinum and possible pneumopericardium.

    TREATMENT: He was treated conservatively with bed rest, oxygen, analgesia, antibiotic prophylaxis, reassurance and close monitoring.

    OUTCOME: The patient made an uneventful recovery.

    CONCLUSIONS: We discussed the possible causes.

    Matched MeSH terms: Anesthesia, General/adverse effects
  11. Wong HM, Woo XL, Goh CH, Chee PHC, Adenan AH, Tan PCS, et al.
    World Neurosurg, 2022 01;157:e276-e285.
    PMID: 34648987 DOI: 10.1016/j.wneu.2021.10.074
    BACKGROUND: Burr hole drainage is the criterion standard treatment for chronic subdural hematoma (CSDH), a common neurosurgical condition. However, apart from the surgical technique, the method of anesthesia also has a significant impact on postoperative patient outcome. Currently, there are limited studies comparing the use of local anesthesia with sedation (LA sedation) versus general anesthesia (GA) in the drainage of CSDH. The objective of this study was to compare the morbidity and mortality outcomes of using LA sedation versus GA in CSDH burr hole drainage.

    METHODS: This retrospective study presents a total of 257 operations in 243 patients from 2 hospitals. A total of 130 cases were operated under LA sedation in hospital 1 and 127 cases under GA in hospital 2. Patient demographics and presenting features were similar at baseline.

    RESULTS: Values are shown as LA sedation versus GA. Postoperatively, most patients recovered well in both groups with Glasgow Outcome Scale scores of 4-5 (96.2% vs. 88.2%, respectively). The postoperative morbidity was significantly increased by an odds ratio of 5.44 in the GA group compared with the LA sedation group (P = 0.005). The mortality was also significantly higher in the GA group (n = 5, 3.9%) than the LA sedation group (n = 0, 0.0%; P = 0.028). The CSDH recurrence rate was 4.6% in the LA sedation group versus 6.3% in the GA group. No intraoperative conversion from LA sedation to GA was reported.

    CONCLUSIONS: This study demonstrates that CSDH drainage under LA sedation is safe and efficacious, with a significantly lower risk of postoperative mortality and morbidity when compared with GA.

    Matched MeSH terms: Anesthesia, General/adverse effects
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