MyMedR

Nicholls J

Med J Malaya, 1960;15.

Motor nerves to voluntary muscle terminate in motor end plates applied to the muscle fibers. Between these two is a membrane with different electric potentials on each side of it. When a motor impulse arrives at the end plate, acetylcholine is released. As a result of this the electric potential difference across the membrane disappears (“depolarization”) and an electrical wave spreads from it throughout the muscle, causing it to contract. Curare blocks the action of the acetylcholine on the end plate, competing with it for a place on the end plate molecules, and so is called a “competitive blocker”. Gallamine (Flaxedil) acts in the same way. Scoline, on the other hand, causes depolarization of the end plate membrane (hence the description “depolarizing” group of relaxants) and this does not produce, as one might expect, a sustained tetanic contraction of the muscle, but renders it unexcitable so that nerve impulses produce no effect. Thus, we have our two groups of relaxants – the competitive blockers like curare, and the depolarizers like scoline (suxamethonium).

Matched MeSH terms: Anesthetics

Multi-model generalised predictive control for intravenous anaesthesia under inter-individual variability

Jing CJ, Syafiie S

J Clin Monit Comput, 2021 10;35(5):1037-1045.

PMID: 32833146 DOI: 10.1007/s10877-020-00581-0

Inter-individual variability possesses a major challenge in the regulation of hypnosis in anesthesia. Understanding the variability towards anesthesia effect is expected to assist the design of controller for anesthesia regulation. However, such studies are still very scarce in the literature. This study aims to analyze the inter-individual variability in propofol pharmacokinetics/pharmacodynamics (PK/PD) model and proposed a suitable controller to tackle the variability. This study employed Sobol' sensitivity analysis to identify significance parameters in propofol PK/PD model that affects the model output Bispectral Index (BIS). Parameters' range is obtained from reported clinical data. Based on the finding, a multi-model generalized predictive controller was proposed to regulate propofol in tackling patient variability. [Formula: see text] (concentration that produces 50% of the maximum effect) was found to have a highly-determining role on the uncertainty of BIS. In addition, the Hill coefficient, [Formula: see text], was found to be significant when there is a drastic input, especially during the induction phase. Both of these parameters only affect the process gain upon model linearization. Therefore, a predictive controller based on switching of model with different process gain is proposed. Simulation result shows that it is able to give a satisfactory performance across a wide population. Both the parameters [Formula: see text] and [Formula: see text], which are unknown before anesthesia procedure, were found to be highly significant in contributing the uncertainty of BIS. Their range of variability must be considered during the design and evaluation of controller. A linear controller may be sufficient to tackle most of the variability since both [Formula: see text] and [Formula: see text] would be translated into process gain upon linearization.

Matched MeSH terms: Anesthetics*; Anesthetics, Intravenous

THE USE OF HYPNOSIS AS AN ADJUNCT IN SURGERY

MUN CT

Med J Malaysia, 1964 Dec;19:154-60.

PMID: 14279240

Matched MeSH terms: Anesthetics*; Hypnosis, Anesthetic*

Anaesthetic challenges in a patient with acromegaly and multinodular goitre undergoing endoscopic pituitary surgery

Jamil J, Wan Hassan WMN, Ghani AR, Yeap TB

BMJ Case Rep, 2023 Feb 16;16(2).

PMID: 36796871 DOI: 10.1136/bcr-2022-250640

Acromegaly is a progressive systemic disorder which is common among middle-aged women. A functioning growth hormone-secreting pituitary adenoma is the most common cause. Anaesthesia for pituitary surgery in patients with acromegaly is challenging. Rarely, these patients may develop thyroid lesions that may compromise the airway. We present the case of a young man with newly diagnosed acromegaly caused by a pituitary macroadenoma complicated by a large multinodular goitre. The aim of this report is to discuss the perianaesthetic approach in patients with acromegaly with a high risk of airway compromise undergoing pituitary surgery.

Matched MeSH terms: Anesthetics*

Anaesthetic considerations for the surgical management of ocular hypotony in adults

Chua AW, Kumar CM, Harrisberg BP, Eke T

Anaesth Intensive Care, 2023 Mar;51(2):107-113.

PMID: 36524304 DOI: 10.1177/0310057X221111183

Ocular hypotony can occur from many causes, including eye trauma, ophthalmic surgery and ophthalmic regional anaesthesia-related complications. Some of these patients require surgical intervention(s) necessitating repeat anaesthesia. While surgical management of these patients is well described in the literature, the anaesthetic management is seldom discussed. The hypotonous eye may also have altered globe anatomy, meaning that the usual ocular proprioceptive feedbacks during regional ophthalmic block may be altered or lost, leading to higher risk of inadvertent globe injury. In an 'open globe' there is a risk of sight-threatening expulsive choroidal haemorrhage as a consequence of ophthalmic block or general anaesthesia. This narrative review describes the physiology of aqueous humour, the risk factors associated with ophthalmic regional anaesthesia-related ocular hypotony, the surgical management, and a special emphasis on anaesthetic management. Traumatic hypotony usually requires urgent surgical repair, whereas iatrogenic hypotony may be less urgent, with many cases scheduled as elective procedures. There is no universal best anaesthetic technique. Topical anaesthesia and regional ophthalmic block, with some technique modifications, are suitable in many mild-to-moderate cases, whilst general anaesthesia may be required for complex and longer procedures, and severely distorted globes.

Matched MeSH terms: Anesthetics*

Fulltext Anaesthetic challenges for a patient with huge superior mediastinal mass in prone position

Yeap TB, Teah MK, Ramly AKM, Bong CP

BMJ Case Rep, 2021 Apr 09;14(4).

PMID: 33837036 DOI: 10.1136/bcr-2021-242118

Anaesthesia for patients with huge mediastinal mass is very challenging due to the cardiorespiratory embarrassment that may occur. We present a patient with this condition, which was complicated by total airway obstruction, intraoperatively. We discuss the importance of patient positioning and the role of spontaneous ventilation.

Matched MeSH terms: Anesthetics*

Inhaled anaesthetic gas for severe bronchospasm at the emergency department

Adi O, Apoo FN, Fong CP, Ahmad AH, Roslan NL, Khan FA, et al.

Am J Emerg Med, 2024 Jan;75:179-180.

PMID: 37487778 DOI: 10.1016/j.ajem.2023.07.027

Matched MeSH terms: Anesthetics, Inhalation*

Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC

J Endod, 2019 Oct;45(10):1175-1183.e3.

PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008

INTRODUCTION: This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).

METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.

CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.

Matched MeSH terms: Anesthetics*; Anesthetics, Local

Sintesis dan pencirian kobalt sulfida menggunakan misel ester sukrosa dan kegunaan sebagai penjerap pewarna

Huang N, Radiman S, Chia C, Lim H, Khiew P, Chiu W, et al.

Sains Malaysiana, 2009;38.

Kobalt sulfida telah dihasilkan dengan kaedah pemendakan kimia di dalam kehadiran 0.1% ester sukrosa S1670s. Corak pembelauan sinar-x (XRD) menunjukkan kobalt sulfida yang dihasilkan mempunyai sifat amofos dan analisis sinar-x (EDX) menunjukkan kobalt sulfida yang terbentuk mempunyai nisbah atom Co: S dalam 1:1.08 iaitu CoS. CoS yang terbentuk mempunyai struktur liang bersaiz nano (~10 nm) apabila diperhatikan di bawah elektron mikroskop transmisi (TEM) dan disahkan oleh ujian penjerapan gas nitrogen (BET). Pembentukan struktur liang adalah disebabkan oleh struktur misel ester sukrosa yang mempunyai saiz misel dalam lingkungan 10 nm. CoS yang dihasilkan diuji keupayaan penjerapan dengan metilena biru sebagai sampel pewarna. Didapati keupayaan penjerapan optimum CoS ialah 110 mg/g dan pH yang paling sesuai untuk penjerapan berlaku adalah lebih daripada 6.

Matched MeSH terms: Anesthetics

Neuroleptanaesthesia using pentazocine and propanidid

Tay G

Med J Malaya, 1970 Sep;25(1):50-2.

PMID: 4249496

Matched MeSH terms: Anesthetics*; Preanesthetic Medication

Review of anaesthetic management for cataract surgery in transplant recipients

Chua AW, Chua MJ, Harrisberg BP, Kumar CM

Anaesth Intensive Care, 2020 Jan;48(1):25-35.

PMID: 31914784 DOI: 10.1177/0310057X19891737

Matched MeSH terms: Anesthetics*

Fulltext Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy

Yeap TB, Teah MK, Thevarajah S, Azerai S

BMJ Case Rep, 2021 Mar 25;14(3).

PMID: 33766970 DOI: 10.1136/bcr-2020-241176

Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.

Matched MeSH terms: Anesthetics*

Adverse reactions to local anaesthetics

Reddy SVG

Family Physician, 1989;1:42-42.

Matched MeSH terms: Anesthetics*

Cost per anaesthetic

Liew RP

Med J Malaysia, 1973 Mar;27(3):182-7.

PMID: 4268920

Matched MeSH terms: Anesthetics*

Anesthetic Molecule Interaction of Noble Gases with Proteins and Lipids and their Effect: A Review

Kundu SK, Chakraborty C, Yagihara S, Teoh SL, Das S

Curr Drug Deliv, 2018;15(10):1381-1392.

PMID: 30124152 DOI: 10.2174/1567201815666180820101255

Surgical operations are impossible without administering proper analgesia. Advancement in the field of anesthesia has invariably resulted in the accomplishment of all surgical processes without any inconvenience. Admittedly, the use of noble gas is on the decline. The noble gases may not interact chemically with any other substance under normal temperature and pressure but they may interact with proteins and lipids. Different anesthetic molecules may stimulate either proteins or lipids in membrane. There is a connection between the anesthetic molecules and the hydrophobic region of the membrane. In the present review, we attempt to highlight the interaction between the anesthetic molecule with proteins and lipids and their effects. We sketched few noble gases and some other existing molecules such as halothane and alcohol which interacted with proteins and lipids.

Matched MeSH terms: Anesthetics/chemistry*

Fulltext Anaesthetic challenges in the spine surgery of a young Asian man with lumbar amyloidosis

Jamil J, Tay CY, Bong CP, Yeap TB

BMJ Case Rep, 2021 Nov 29;14(11).

PMID: 34844969 DOI: 10.1136/bcr-2021-246359

Primary amyloidosis is a rare systemic disorder often associated with multiple organ dysfunction. The most common form, light chain amyloidosis, has an estimated age-adjusted incidence of 5.1-12.8 cases per million person-years. Spine involvement is extremely uncommon. We present the case of a young Asian man with newly diagnosed amyloidosis involving the lumbar spine among multiple organs with a pathological vertebral fracture that required urgent spine surgery. We believe this is the first reported case to discuss the perianaesthetic challenges in the management of lumbar spine amyloidosis.

Matched MeSH terms: Anesthetics*

Injection of sodium hypochlorite into soft tissues of the oral cavity: A literature review with clinical preventive recommendations

Pai ARV

J Stomatol Oral Maxillofac Surg, 2023 Dec;124(6S2):101581.

PMID: 37544507 DOI: 10.1016/j.jormas.2023.101581

Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.

Matched MeSH terms: Anesthetics, Local/therapeutic use

Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review

Chua AW, Chua MJ, Harrisberg BP, Kumar CM

Anaesth Intensive Care, 2024 Mar;52(2):82-90.

PMID: 38041616 DOI: 10.1177/0310057X231215826

Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.

Matched MeSH terms: Anesthetics, Local/adverse effects

Fulltext [Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose]

Lim HJ, Hasan MS, Chinna K

Rev Bras Anestesiol, 2016 Jul-Aug;66(4):341-5.

PMID: 27155777 DOI: 10.1016/j.bjan.2016.04.006

A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline.

Matched MeSH terms: Anesthetics, Local

Predicted effect compartment concentration of thiopental at loss of eyelash reflex

Lim TA, Inbasegaran K

Br J Anaesth, 2001 Mar;86(3):422-4.

PMID: 11573534

We derived the predicted effect compartment concentration of thiopental, at loss of the eyelash reflex, following three different injection regimens. Sixty patients were given thiopental for induction of anaesthesia. Twenty patients received multiple small boluses, 20 patients received a single bolus and 20 patients received an infusion. Computer simulation was then used to derive the effect compartment concentration. The median concentration was not significantly different between the three groups. EC50, derived after combining all three groups was 11.3 microg ml(-1). The EC05-EC95 range was 6.9-18.3 microg ml(-1), suggesting wide inter-individual variation.

Matched MeSH terms: Anesthetics, Intravenous/administration & dosage*; Anesthetics, Intravenous/pharmacokinetics; Anesthetics, Intravenous/pharmacology

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