MyMedR

Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur

Chan YK, Ng KP, Chiu CL

Int J Obstet Anesth, 2002 Jul;11(3):176-9.

PMID: 15321544 DOI: 10.1054/ijoa.2002.0954

Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. There was a decline in the use of general anaesthesia for both elective and emergency caesarean sections from 41.3% and 69.4% respectively in 1995 to 21.6% and 26.9% respectively in 1999. By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.

Matched MeSH terms: Anesthesia, Obstetrical*

An improved technique of anaesthesia for Caesarean section

Chin LP

Med J Malaya, 1972 Dec;27(2):142-6.

PMID: 4268040

Matched MeSH terms: Anesthesia, Obstetrical*

Pudendal block anaesthesia. A new technique in regional anaesthesia with special reference to forceps delivery

Sinnathuray TA

Med J Malaya, 1965 Sep;20(1):42-8.

PMID: 4221412

Matched MeSH terms: Anesthesia, Obstetrical*

Fulltext Anaesthetic related maternal deaths in Malaysia--a review

Dalina AM, Inbasegaran K

Med J Malaysia, 1996 Mar;51(1):52-63.

PMID: 10967980

The anaesthetic hazards for the obstetric patient are well known. Based on results of the first two reports on the confidential enquiry into maternal deaths in Malaysia for 1991 and 1992, ten cases of anaesthetic related deaths were analysed. There were 3 in 1991 and 7 in 1992 accounting for 1.34% and 2.8% of maternal deaths respectively. It was estimated that the crude mortality rate for the obstetric patient was 11.4 per 100,000 operative deliveries or a four-fold risk compared to the general surgical patient. One case resulted from administration of intravenous sedation while the rest involved general anaesthesia, seven of which were done under emergency conditions. Inadequate airway management and ventilation in the perioperative period, including during interhospital transfer was the single most important factor causing the majority of these deaths. The use of regional anaesthesia for Caesarean sections is strongly advocated. Substandard care was also present in all cases. Other issues pertinent to improvement of obstetric anaesthetic services are also discussed which include the quality of anaesthetic manpower, upgrading of infrastructure, facilities and staffing of operating and recovery areas, the use of regional anaesthesia, expanding the role of the anaesthetist and the quality of the anaesthetic services in general.

Matched MeSH terms: Anesthesia, Obstetrical/mortality*

Caesarean section under local anaesthesia

Ling NN

Med J Malaya, 1972 Mar;26(3):198-200.

PMID: 5031015

Matched MeSH terms: Anesthesia, Obstetrical*

CHILDBIRTH UNDER HYPNOSIS

CHONGTONG MUN

Med J Malaysia, 1963 Dec;18:83-6.

PMID: 14117285

Matched MeSH terms: Anesthesia, Obstetrical*

Algaphan in obstetrics

Thambu JA

Med J Malaya, 1971 Mar;25(3):234-6.

PMID: 4253256

Matched MeSH terms: Anesthesia, Obstetrical*

THE PLACE OF THE VACUUM EXTRACTOR IN OBSTETRICS

SAMBHI JS

Med J Malaysia, 1963 Jun;17:292-301.

PMID: 14060507

Matched MeSH terms: Anesthesia, Obstetrical*

Anaesthetic management of a parturient with a mediastinal mass for caesarean delivery

Lee CY, Izaham A, Zainuddin K

Int J Obstet Anesth, 2013 Nov;22(4):356-8.

PMID: 23993805 DOI: 10.1016/j.ijoa.2013.03.017

Matched MeSH terms: Anesthesia, Obstetrical/methods*

Fulltext Survey on maternal satisfaction in receiving spinal anaesthesia for caesarean section

Dharmalingam TK, Ahmad Zainuddin NA

Malays J Med Sci, 2013 May;20(3):51-4.

PMID: 23966825 MyJurnal

This study was undertaken to evaluate patient satisfaction after spinal anaesthesia, which is the most frequently administered anaesthesia in obstetric patients.

Matched MeSH terms: Anesthesia, Obstetrical

Fulltext Comparison between preloading with 10 ml/kg and 20 ml/kg of Ringer's lactate in preventing hypotension during spinal anaesthesia for caesarean section

Muzlifah KB, Choy YC

Med J Malaysia, 2009 Jun;64(2):114-7.

PMID: 20058569 MyJurnal

This prospective, randomized, study was designed to compare the effect of two different preloading volumes of Ringer's lactate for prevention of maternal hypotension induced by spinal anaesthesia for Caesarean section. Eighty ASA I or II obstetric patients were randomized to two groups. Group 1 (n = 40) received 20 ml/kg of Ringer's lactate and Group 2 (n = 40) 10 ml/kg of Ringer's lactate over 20 minutes before spinal anaesthesia. The lowest mean arterial pressure (MAP) for both groups were recorded at 15 minutes after giving spinal anaesthesia, This difference in the drop of MAP from base-line at 15 minutes (mean decrease of 12.5 mmHg from baseline), between preloading with 10 ml/kg and 20 ml/kg of Ringer's was statistically significant. Twelve patients from Group 1 required bolus doses of ephedrine and 15% of these needed additional crystalloid whereas two patients from Group 2 needed ephedrine boluses and 22% of these required additional crystalloid. The difference in frequency of requirement for treatment of hypotension was not statistically significant. There were five patients in Group 1 and six patients in Group 2 who experienced nausea and vomiting, the frequency of occurrence did not show any statistically significant difference between the two groups. In conclusion, for prevention of hypotension during spinal anaesthesia for Caesarean section, infusing 20 ml/kg or 10 ml/kg of Ringer's Lactate gave similar results and we do not recommend the use of a larger volume of crystalloid for preloading before spinal anaesthesia.

Matched MeSH terms: Anesthesia, Obstetrical/adverse effects*

A survey of the current practice of obstetric anaesthesia and analgesia in Malaysia [correction of Malaysis]

Chan YK, Ng KP

J Obstet Gynaecol Res, 2000 Apr;26(2):137-40.

PMID: 10870307

OBJECTIVE: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996.

RESULTS: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all.

CONCLUSIONS: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom.

Matched MeSH terms: Anesthesia, Obstetrical/statistics & numerical data*

Loss of consciousness following spinal anaesthesia for caesarean section

Chan YK, Gopinathan R, Rajendram R

Br J Anaesth, 2000 Sep;85(3):474-6.

PMID: 11103195

A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.

Matched MeSH terms: Anesthesia, Obstetrical/adverse effects*

Fulltext Epidural anaesthesia for caesarean section: a comparison of 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl

Wang CY, Ong GS, Delilkan AE

Med J Malaysia, 1994 Sep;49(3):269-74.

PMID: 7845278

Thirty-one healthy women who underwent Caesarean section were studied in a double-blind trial to compare the effectiveness of epidural 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl in the prevention of intraoperative pain. There was no difference in the quality of analgesia between the three groups. The incidence of complications was significantly higher in the 0.5% bupivacaine plus 100 micrograms fentanyl group compared with the other two groups.

Matched MeSH terms: Anesthesia, Obstetrical*

Fulltext Propofol and methohexitone for elective caesarean--a comparative study

Miranda AF, Kyi W, Sivalingam N

Med J Malaysia, 1992 Dec;47(4):280-6.

PMID: 1303480

Two identical groups of females underwent caesarean operations. One group was induced with propofol 2.04 (SD 0.023) mg per kilogram and the other group induced with methohexitone 1.05 (SD 0.15) mg per kilogram body weight. Maintenance of anaesthesia was identical in both groups. Post-intubation blood pressure in the methohexitone group was significantly raised whereas with propofol the changes were not significant. There were no significant differences in the Apgar scores, uterine contractility and umbilical venous or arterial blood gases. There was a significant difference in the analgesic requirement in the first hour of the post-operative period; in the propofol group, patients needed less analgesia compared to the methohexitone group. There was no maternal awareness in both groups.

Matched MeSH terms: Anesthesia, Obstetrical*

The value of maternal and fetal blood gas analysis in cesarean sections under general anesthesia

Thavarasah AS, Lobo RM

Biol Res Pregnancy Perinatol, 1987;8(2 2D Half):76-83.

PMID: 3427139

Maternal and fetal blood gas values were studied in 90 selected mothers of comparable age, weight, duration of pregnancy and hematocrit values undergoing cesarean section under balanced general anesthesia in four differing clinical situations: elective with and without placental dysfunction, and emergency with and without fetal distress in apparently normal mothers. Pre-induction (Fi O2 0.21) and pre-delivery (Fi O2 0.60) maternal blood gas analysis, along with umbilical cord blood gas analysis were performed in all cases. Apgar scoring was carried out at one minute and three minutes and correlated with the blood gas values. Out of the 90 cases studied, 36 neonates (40%) showed good apgar scores of greater than seven at one minute and three minutes and correlated well with maternal blood gas values which were within normal ranges. Of the remaining 54 cases (60%) with similar mean maternal gas values the neonates showed an apgar score of less than seven in the first minute. The score improved in three minutes in 35 of them (66%), and umbilical cord blood gas values showed a low pH (umbilical vein 7.22 +/- 0.02 units, umbilical arterial 7.21 +/- 0.01 units) but satisfactory pO2 (umbilical vein 39.4 +/- 1.9 torr, umbilical arterial 2.5 +/- 1.3 torr).(ABSTRACT TRUNCATED AT 250 WORDS)

Matched MeSH terms: Anesthesia, Obstetrical*

Manual removal of placenta under hypoaesthesia

Menon R

Med J Malaya, 1970 Sep;25(1):17-20.

PMID: 4249487

Matched MeSH terms: Anesthesia, Obstetrical*

Preoperative free access to water compared to fasting for planned cesarean under spinal anesthesia: a randomized controlled trial

Ng YL, Segaran S, Yim CCW, Lim BK, Hamdan M, Gan F, et al.

Am J Obstet Gynecol, 2024 Dec;231(6):651.e1-651.e11.

PMID: 38521233 DOI: 10.1016/j.ajog.2024.03.018

BACKGROUND: Contemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women.

OBJECTIVE: This study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction.

STUDY DESIGN: A randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized: 252 undergoing preoperative free access to water up to the call to dispatch to the operating theater (intervention group) and 252 undergoing fasting from midnight (fasting arm). The primary outcomes were perioperative vomiting and maternal satisfaction. Analyses were performed using t test, Mann-Whitney U test, and chi-square test, as appropriate.

RESULTS: Of note, 9 of 252 patients (3.6%) in the intervention group and 24 of 252 patients (9.5%) in the control group had vomiting at up to 6 hours after completion of cesarean delivery (relative risk, 0.38; 95% confidence interval, 0.18-0.79; P=.007), and the maternal satisfaction scores (0-10 visual numerical rating scale) were 9 (interquartile range, 8-10) in the intervention group and 5 (interquartile range, 3-7) in the control group (P

Matched MeSH terms: Anesthesia, Obstetrical/methods

Fulltext Post spinal meningitis with subdural collection:an uncommon complication after spinal anaesthesia for caesarean section

Seng, Wee Cheo, Qin, Jian Low, Yee, Ann Tan, Yuen, Kang Chia

Neuroscience Research Notes, 2018;1(2):1-5.

MyJurnal

Abstract: Meningitis after spinal anaesthesia is a rare yet devastating complication of spinal anaesthesia. The exact incidence is unknown. Our patient developed signs and symptoms of meningitis 48 hours after spinal anaesthesia and required intensive care unit admission. Her cerebrospinal fluid was sterile. Computed tomography of brain showed left subdural collection. She recovered well after 6 weeks of intravenous antibiotics. No neurological sequela noted from subsequent follow-upexaminations. Our case provides an important insight of meningitis with subdural collection after spinal anaesthesia for emergency caesarean section.

Matched MeSH terms: Anesthesia, Obstetrical

Caudal block analgesia in labouring women

Kuah KB

Med J Malaysia, 1974 Mar;28(3):187-90.

PMID: 4278020

Matched MeSH terms: Anesthesia, Obstetrical*

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