The Medical journal of Malaysia
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Randomized Controlled Trial
Fentanyl pre-treatment alleviates pain during injection of propofol-lipuro premixed with lignocaine.
We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. ⋯ The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.
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Case Reports
Anaesthetists' nightmare: masseter spasm after induction in an undiagnosed case of myotonia congenita.
We report an undiagnosed case of myotonia congenita in a 24-year-old previously healthy primigravida, who developed life threatening masseter spasm following a standard dose of intravenous suxamethonium for induction of anaesthesia. Neither the patient nor the anaesthetist was aware of the diagnosis before this potentially lethal complication occurred.
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This study to evaluate the relationship between end-tidal carbon dioxide pressure (ETCO2) and arterial partial pressure of carbon dioxide (PaCO2) included 35 patients between the ages of 18 and 65 years, ASA grade 1 and 2, who had elective craniotomies. Measurements of PaCO2 and ETCO2 were taken simultaneously: 1) 10 minutes after induction of general anaesthesia, 2) after cranium opening prior to dural incision, 3) start of dural closure. ⋯ Although there was agreement, the bias is of significant clinical importance. In conclusion, we find that ETCO2 consistently underestimated the value of PaCO2 during craniotomy.
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This report deals with an elderly lady with Guillain-Barre Syndrome (GBS), who presented with features of unusually severe hyponatraemia. The hyponatraemia was probably due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The hyponatraemia resolved with water restriction and infusion of hypertonic saline; GBS was treated with human immunoglobulin (IVIG). This patient's experience stresses the importance of monitoring serum sodium levels as hyponatraemia has been identified to be a marker of poor prognosis in GBS.
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To investigate the case incidence, causes, clinical profile and outcome of temporal bone fracture complicating head trauma. A 1-year (2005) retrospective study of head injured patients presented to the Emergency Department, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. Gender distribution, cause of injury, radiological findings and otorhinolaryngological clinical presentations were analyzed. ⋯ The case incidence of temporal bone fracture in head injured patients in our centre is 4.7%. The petro-mastoid type fracture predominates. Proper early diagnosis and management minimize complications.