Artificial intelligence versus human intelligence in anaesthesia: who is winning?

Artificial intelligence (AI) plays a significant role especially in the light of the COVID-19 pandemic. The position of anaesthesiologists and their role in providing anaesthetic services initially was dominant. The AI ability to overtake the human’s capability in providing an accurate medical treatment may threaten the role of a doctor. The integration of AI in anaesthesia has been tremendous. Challenges in using this technology in anaesthesia are to determine, design, test the practicality, maintain dynamicity and market the technology. In the future, we hope AI may become the strongest weapon for anaesthesiologists to deliver the best anaesthesia services to patients and not as an enem

Blood loss in caesarean section in Hospital Universiti Sains Malaysia (HUSM) : estimation by surgeons and anaesthetists in comparison with quantitative measurement and blood parameters assessments

Background: We compared the visual estimation of blood loss for Caesarean section (CS) by surgeons and anaethetists and their accuracy with relation to years of experience against quantitative measurement. Haemoglobin (Hb) trend after CS were also studied. Methods: 134 patients who underwent CS were included. Visual estimations were reported by surgeons and anaesthetists. The blood volume in collection bottle and disposable items were quantified. Hb levels pre-CS followed by 1 hour and 24 hours post CS were taken. Data were tested by Reliability Testing, Independent T-Test, Pearson’s Correlation and Multiple Linear Regressions where P <0.05 is considered significant. Results: There were strong correlation between surgeon’s and anaesthetist’s estimations of blood loss and quantitative measurement with Intraclass Correlation Coefficient of r = 0.828and r = 0.805, P <0.001. Surgeons’ accuracy in estimating blood loss has no significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.053. Anaesthetists’ accuracy in estimating blood loss has significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.038. There was moderate negative correlation in between percentage blood loss and Delta Hb 1 hour post CS, P <0.001. Percentage blood loss, intraoperative fluid administration and patient previous scars were strong predictors for Delta Hb 1 hour post CS with P < 0.05. Conclusions: Estimation blood loss for CS by surgeons and anaesthetists in HUSM correlates with quantitative measurement. Drop in Hb post CS correlates with percentage blood loss. Prediction of Delta Hb 1 hour and 24 hours post CS can be a useful tool in helping doctors in managing patient

Blood loss in caesarean section in Hospital Universiti Sains Malaysia (HUSM): estimation by surgeons and anaesthetists in comparison with quantitative measurement and blood parameters assessments.

Background: We compared the visual estimation of blood loss for Caesarean section (CS) by surgeons and anaethetists and their accuracy with relation to years of experience against quantitative measurement. Haemoglobin (Hb) trend after CS were also studied. Methods: 134 patients who underwent CS were included. Visual estimations were reported by surgeons and anaesthetists. The blood volume in collection bottle and disposable items were quantified. Hb levels pre-CS followed by 1 hour and 24 hours post CS were taken. Data were tested by Reliability Testing, Independent T-Test, Pearson’s Correlation and Multiple Linear Regressions where P <0.05 is considered significant. Results: There were strong correlation between surgeon’s and anaesthetist’s estimations of blood loss and quantitative measurement with Intraclass Correlation Coefficient of r = 0.828 and r = 0.805, P <0.001. Surgeons’ accuracy in estimating blood loss has no significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.053. Anaesthetists’ accuracy in estimating blood loss has significant difference in less and equal to 5 experience years against more than 6 experience years group, P= 0.038. There was moderate negative correlation in between percentage blood loss and Delta Hb 1 hour post CS, P <0.001. Percentage blood loss, intraoperative fluid administration and patient previous scars were strong predictors for Delta Hb 1 hour post CS with P < 0.05. Conclusions: Estimation blood loss for CS by surgeons and anaesthetists in HUSM correlates with quantitative measurement. Drop in Hb post CS correlates with percentage blood loss. Prediction of Delta Hb 1 hour and 24 hours post CS can be a useful tool in helping doctors in managing patient

Predicting haemoglobin level within 6 hours and after 24 hours after a caesarean section: are there such formulas to calculate them?

Background: We measured Haemoglobin (Hb) levels within 6 hours and after 24 hours in 134 Caesarean Section cases in Hospital Universiti Sains Malaysia in 2017. Methods: All blood loss from participants were measured gravimetrically and calculated after dry weights from the disposables and collecting bottles are excluded. Hb levels pre-CS followed by Hb within 6 hours and 24 hours post CS were taken.Data were tested by Multiple Linear Regressions where P <0.05 is considered significant. Results: Percentage blood loss, intraoperative fluid administration and patient previous scars were strong predictors for Delta Hb within 6 hours post CS and with exclusion of previous scar in Delta Hb after 24 hours post CS with P <0.05.Formula for Delta Hb within 6 hours post CS = 0.869 + (-0.055 x Percentage Blood Loss (%)) + (-0.001 x Fluid given intraoperatively (mls) + (0.205 x Previous scars (n))Formula for Delta Hb after 24 hours post CS = 0.631 + (-0.086 x Percentage Blood Loss (%)) + (-0.001 x Fluid given intraoperatively (mls) Confounders excluded are Body Mass Index (BMI), duration of surgery, total blood volume, estimated liquor, balance fluid given intraoperatively and after 24 hours, and parity. Conclusions: It is possible to estimate blood loss within 6 hours and after 24 hours after CS. The benefits will include maintaining normal Hb level and assessing need for transfusion for post CS

Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition

Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes. Case presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy. Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality. Keywords: Foreign body, Aspiration, Chicken meat, Difficult ventilatio

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury.

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion:The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes. Case presentation:We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy. Conclusion:Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality