Change in endotracheal tube cuff pressure during nitrous oxide anaesthesia: a comparison between air and distilled water cuff inflation.

In this prospective, randomized controlled trial, changes in endotracheal tube cuff pressure were studied in 60 patients undergoing elective surgery under general anaesthesia with nitrous oxide and oxygen. The cuffs were inflated with either air or distilled water. The mean pressure in the air-filled cuffs increased steadily throughout the procedure, reaching 47.5 +/- 7.3 cmH2O at one hour compared with 31.6 +/- 2.4 cmH2O mean pressure in the water-filled cuffs. The pressure and the rate of rise in cuff pressure were significantly lower (P<0.05) in the water-filled cuffs throughout the hour of study. When an endotracheal tube cuff is distended with water, the rise in cuff pressure during nitrous oxide anaesthesia is lower than that of an air-filled cuff.

Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

Anaesthetic complications in the recovery room.

INTRODUCTION: The immediate post-operative period in the recovery room is a known period of high risk for anaesthetic complications to occur. AIMS: We wanted to know the incidence and nature of our recovery room patients in the main-theatre complex of Hospital Kuala Lumpur. METHOD: A prospective study was conducted over a two-month period on all patients receiving either regional and/or general anaesthesia by an anaesthetic doctor admitted to this recovery room. Complications were documented according to predefined criteria. RESULTS: Out of a total of 1,995 patients, 50(2.5%) had some form of anaesthetic complication. Fifteen patients had more than one complication. The most common was pain (23 patients) followed closely by nausea and vomiting (21 patients). There were 32 patients with CNS problems (including the 23 with pain), 21 with GIT, 10 with CVS, 2 with respiratory and 3 with other problems. CONCLUSION: Our recovery room complication rate is acceptably low. Knowing the type and frequency of problems (in this case, mainly pain and nausea and vomiting) can further improve the figure. The role of anaesthesiologists has expanded as they are not only expected to ascertain the safety but also the comfort of patients post-operatively.

Teaching of basic life support in the undergraduate medical curriculum.

There is now increased public awareness of the value and role of cardiopulmonary resuscitation (CPR). It is therefore not surprising that the public expects a reasonable level of expertise of medical doctors in the application of the CPR techniques during emergency situations. Newly qualified doctors often lack confidence and are usually at a loss when faced with such situations as they have never had practical training before graduation. Most doctors are gradually introduced to CPR as part and parcel of their clinical experience. Many begin to attend formal CPR workshops later in their careers. Medical schools are expected to produce well trained doctors who are competent in clinical practice which include the techniques of basic resuscitation. By virtue of their expertise in airway management and clinical resuscitation, anaesthesiologists can significantly contribute to the teaching of CPR in the undergraduate medical curriculum. This is a retrospective review of Basic Life Support programmes conducted at the Department of Anaesthesiology, Faculty of Medicine, Universiti Kebangsaan Malaysia.

Anaesthetic management of conjoined twins: experience with six sets of twins.

Anaesthesia for the separation of conjoined twins requires a well-prepared, multidisciplinary team. Each patient for surgery is different and the extent of organ sharing and coexisting anomalies must be determined before surgery so that problems can be anticipated. We report our experience of the anaesthetic management for the separation of six sets of conjoined twins. Anaesthesia and surgery were prolonged, massive blood loss and transfusion, hypothermia, electrolyte imbalance and infection being the main perioperative problems encountered.