The Medical journal of Malaysia
-
Acute respiratory distress syndrome (ARDS) has been associated with high mortality. Improved understanding of the pathophysiology, recognition of precipitating events and improved management has decreased the mortality over the years. Mechanical ventilation is still the corner stone of the management of the disease. ⋯ Pharmacological support to inhibit inflammation with non steroidal anti-inflammatory drugs, antifungal agents, prostaglandin and corticosteroids have all failed. Interestingly corticosteroid rescue treatment in the late phase of ARDS has shown promise. Antiendotoxin and anticytokine studies which began with much enthusiasm is yet to produce desirable results.
-
Multicenter Study
Multicentre study of preoxygenation practices by anaesthesia providers.
A total of 155 consecutive anaesthetics in three public Malaysian hospitals were prospectively studied to assess preoxygenation practices by their anaesthesia providers. Preoxygenation was practised in 96.1% of patients. ⋯ Arterial oxygen desaturation occurred more frequently with emergency surgery (30.2%) in comparison to elective surgery (9.8%). Arterial oxygen desaturation occurred more frequently with non-specialist (18.9%) than specialist anaesthesia providers (3.0%).
-
Critical incident reporting is a useful quality improvement technique for reducing morbidity and mortality in anaesthesia. This study analyses 93 cases in Kuala Lumpur Hospital from July 1995 to January 1997. The main incidents during anaesthesia in this study were airway incidents. ⋯ Critical incident monitoring plays an important role in identifying potential problems, which may lead to disaster. The findings from this report of the anaesthesia incident monitoring study continued to indicate the occurrence of similar problems seen in an earlier report. The identification of common incidents can be used to identify risk factors and minimise repetition of such incidents.
-
An 18-month analysis of 52 percutaneously placed central venous catheters in 48 critically ill children was done. Success rate were 91.7% (33/36) and 93.8% (15/16) for femoral and non-femoral catheters respectively. ⋯ Infections were found in 2.7% (1/36) of femoral and 6.6% (1/15) of non-femoral catheters. The low incidence of complications and the relative ease of insertion makes the femoral route the preferred site for trainee medical officers in critically ill children when central access is indicated.
-
An approach to cannulate right internal jugular vein in neutral head position is described for situations where head rotation and extension are contraindicated. Venous puncture was made immediately lateral to the carotid artery at the level of cricoid cartilage and directed caudad. In 40 patients studied, the right internal jugular vein of 97.5% of the patients were successfully located by the finder needle. ⋯ In 72.5% (29 patients), the veins were located exactly at the predicted point after the first attempt. However the overall success rate for cannulation by the angiocath cannula was 87.5% and short term complication rate was 5.0%. We conclude this technique is a reliable, safe alternative for central venous access, especially in patients where cervical spine movement is contraindicated or restricted.