A prospective study of relationship of vascular pedicle width and central venous pressure with ventilator parameters in ventilated patients

The objective of this study is to determine relationship ofVascular Pedicle Width (VPW), Central Venous Pressure (CVP), Positive End Expiratory Pressure (PEEP) and Peak Inspiratory Pressure (PIP) in adult ventilated patients using single supine chest radiograph. This was prospective, randomized study and had been approved by the Research and Ethics Committee, School Of Medical Sciences, Universiti Sains Malaysia. One-hundred and forty adult ventilated patients in Intensive Care Unit (ICU) and Neuroscience Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) involved, from May 2006 until December 2006. CVP, PEEP and PIP was taken within 1 hour after chest radiograph taken. VPW was measured on digitalized chest radiograph by Radiology Researcher at separate occasion without clinical data related to patient's condition. There was a significant linear relationship between CVP and VPW (p<0.001, CI 0.48- 0.97 mmHg), with those who had CVP of 10 mmHg will have VPW wider for 7 .3mm. There was also significant linear relationship between PEEP and VPW {p<0.05, CI 0.00-0.97 cmH20) with those who had PEEP of 10 em H20 have VPW wider for 4.9mm. However, there was no significant linear relationship between PIP and VPW. There was no interaction between independent variables. From these three variables, CVP has a strongest correlation with VPW, which indicate it's usefulness in ICU. PEEP and PIP, served as ventilator parameters, have weaker relationship with VPW which makes implementation of VPW in ventilated patient regardless of ventilator setting become valuable

Continuous spinal anesthesia for lower limb surgery in patient with poor left ventricular function

Continuous spinal anaesthesia (CSA) has been found to produce good haemodynamic control and prolongation of anaesthetic and analgesic. This is particularly useful in patients with cardiovascular compromise. In contrast to general anaesthesia, CSA allow us to communicate with the patient throughout the operation and thus give us information regarding their degree of anaesthesia and analgesia. By intermittent administration of small doses of local anaesthetic through spinal catheter in CSA, the spread of the block can be better regulated and the risk of abrupt decreases in arterial pressure can be reduced as compared to a single-shock spinal anaesthesia. We reported the use of Pajunk IntraLong ® 21G cannula and 25G spinal microcatheter with 2.5mg of 0.5% heavy bupivacaine in a 59-year-old man with history of diabetes mellitus, hypertension, ischaemic heart disease and poor left ventricular function who had undergone a lower limb surgery. A special technique was introduced during the insertion of microcatheter by slipping it in between a cut-gauze to reduce kinking which is the most common problem encountered during the procedure. The CSA had successfully provided adequate anaesthesia and analgesia to the patient as well as providing haemodynamic stability throughout the operation. From this case we learned that CSA can be offered as an anaesthetic technique with good haemodynamic control in patient with poor left ventricular function. Our technique also offers an alternative method to reduce kinking of the microcatheter to minimize catheter blockade

A prospective study of relationship of vascular pedicle width with Cardiothoracic Ratio, Hemodynamic Data and Pulmonary Edema in Vertilated Intensive Care Unit patients

In order to explore problems facing by local Small Medium Enterprises (SMEs) in adopting Enterprise Resource Planning (ERP) systems, this paper seeks to investigate what are the barriers to ERP system adoption by SMEs? The research was conducted in a Malaysian medium-sized company that planned to adopt ERP systems. Prior researches have identified that high cost; lack of knowledge; highly centralized structure; and issue of misfit to be barriers to ERP adoption by SMEs. From the case study, apart from the previous mentioned factors, the company has to do without a project champion and influenced by the perceived risk associated ERP systems implementation. Limitation of the research is that it was based on a single-case study, imposes care in generalizing the results of the study. This research, however, allows the identification and understanding of barriers to ERP adoption in local setting

Role of pulse radiofrequency in entrapment nerve causing neuralgia in pain management : case series

Chronic Pain is major public health problem that is associated with reduced in quality of life and great loss to the nation. Oral analgesics are considered as first-line treatment along with physiotherapy and psychological therapy. When pharmacology treatment or conventional surgery fails to control the chronic pain, minimally invasive interventional procedures become an option as to control the pain and to prevent the potential side effects due to high dose of analgesics. The first step involves the identification of target nerve through prevention of neuronal transmission by blocking the membrane ion channels using local anaesthetics or steroids which act as anti-inflammatory agent. Once the target nerve or source of pain has been identified, therapeutic minimally invasive pain intervention was carried out. This procedure gave a temporary or permanent relief for chronic pain patients by reversibly interfering with neuronal transmission or eliminating the source of pain. As a result, muscle spasm vanishes and ranges of mobility increases. This facilitates physical therapy and rehabilitation. This is the mechanism in which minimally invasive pain intervention breaks up the pain cycle and aids the relief of pain symptoms. We presented case series of entrapment neuralgia who failed conservative treatment. All of them were successfully treated with pulse radiofrequency

Down's syndrome child with subglottic stenosis : a case report

An asymptomatic subglottic stenosis in Down’s syndrome can be missed. This problem will be manifested after the child had certain general anaesthesia procedure. We describe a Down’s syndrome child with subglottic stenosis (Cotton grade III) whom was diagnosed after underwent cardiac surgery for congenital heart disease which was successfully treated by endolaryngeal microscopic laser treatment

Pain intervention for failed conservative chronic pain treatment: The light at the end of the tunnel

Chronic pain is a major public health problem that places serious stress on afflicted individuals and associated with deficits in quality of life, psychological adjustment, disability, reduced income potential, high levels of health care utilization and great loss to the nation as a whole. Chronic pain with the multitude of aetiologies is not only difficult to diagnose but also impose a great challenge in its management. Oral analgesics are considered as first-line therapy where stronger analgesics are used when pain control is not optimised. However, when pharmacological therapy or conventional surgery fails to control the pain, the role of minimally invasive interventional procedures become an option for the treatment of chronic pain. Interventional procedures target the neural structures that are presumed to mediate the experience of pain. This service is still very limited in our country as a result of limited expertise in this area. The Pain Management Clinic and Intervention Service at the International Islamic University Malaysia, Kuantan is one of the few centres in this country to have such a service. This service can be a niche area for research and a centre of excellence for our university in the future. We reported two classical cases of chronic pain that were treated with pain intervention to control severe pain after failing conservative management. After suffering for such a long period, these patients finally see lights at the end of the tunnel. Author Keywords: Chronic pain, conservative management, pain interventio

Survey on knowledge and practice of intraoperative temperature management

PURPOSE OF STUDY Intraoperative temperature monitoring and management is critically important to prevent complications associated with hypothermia. Satisfactory knowledge and practice in this area amongst the clinicians who are managing the patients intraoperatively is of utmost important to prevent development of hypothermia and its subsequent complications. METHODS USED This study was conducted in two phases in two hospitals. The first phase was conducted to investigate the level of knowledge and practice in this area among clinicians at the Anaesthesia Department. The second phase was performed to determine the incidence of intraoperative hypothermia and its associated risk factors at the two hospitals. The data were analyzed using single proportion, single mean, chi-square, independent t-test, bivariate analysis, linear regression and multiple linear regressions. SUMMARY OF RESULTS Overall mean knowledge score was 56.91% (SD 16.50), with no significant difference between the two hospitals (p=0.826). 44.7% of respondents had acceptable satisfactory score of knowledge. Overall mean practice score was 77.66% (SD 16.05), with no significant difference between HSNZ and HTAA (p=0.164). However, only 19.1% of respondents had acceptable satisfactory score of practice. There was a weak correlation (r=0.186) between mean knowledge score (56.91%) and mean practice score (77.66%). The weakest area on knowledge and practice were sites for peripheral temperature monitoring (10.6%) and temperature monitoring during RA (19.1%). In the second phase of the study, 43.4% of patients developed mild and moderate hypothermia at the end of operation. There was a significantly higher percentage of development of mild and moderate hypothermia at 1,2 and 3 hour at HSNZ compared to HTAA. There were significant association in the development of hypothermia between different type of surgery at 1 hour (p=0.01) and 2 hours (p=0.01), but not at 3 hours. On the other hand, there was no significant association in the development of hypothermia between different type of anaesthesia. There was no significant correlation between patients’ temperature with patients’ age, OT temperature, OT humidity and amount of blood and fluid transfusion at 1 hour (r=0.26, p=0.48), 2 hours (r=0.28, p=0.78), and 3 hours (r=0.89, p=0.69). CONCLUSION These findings showed that knowledge and practice of intraoperative temperature monitoring and management was still poor amongst clinicians in these hospitals. 44.7% achieved acceptable standard of knowledge, however only 19.1% achieved acceptable standard of practice. Furthermore, there was poor correlation between knowledge and practice possibility due to other factors such as availability of temperature monitoring and warming devices. This probably influences the high prevalence of hypothermia in both hospitals. 43.4% developed either mild or moderate hypothermia at the end of operation. Correlation between hypothermia and its risk factors could not be demonstrated due to small sample size. Hence it is important to create awareness in this area amongst clinicians to prevent unnecessary complications, especially in high risk patients undergoing surgery associated with strong risk factor