Effect of administration of ketorolac and local anaesthetic infiltration for pain relief after laparoscopic-assisted vaginal hysterectomy The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.

The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.

Brachial plexus block with midazolam and bupivacaine improves analgesia:

PURPOSE: Adjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anesthetics when given epidurally or intrathecally. The purpose of this study was to assess the effect of midazolam added to brachial plexus anesthesia. METHODS: A prospective, randomized, double blind study was conducted on 40 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 20) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 20) were given 30 mL of 0.5% bupivacaine with midazolam 50 mug.kg(-1). Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hr postoperatively. RESULTS: The onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Pain scores were significantly higher in Group B compared to Group BM from two hours to 24 hr postoperatively (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the post-operative period. CONCLUSION: Midazolam (50 mug.kg(-1)) in combination with 30 mL of bupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events

Aedes sp.

With the current hot debate over hemorrhagic dengue fever(HDF)persisting over the country,it sort of brought me back to my student days where I onced posted in a parasitology lab examining mosquitoes' species.

From the transformation from its larvaes to pupas and thence,the adult mosquitoes,its morphological cycle can be quite an alarming process.Without proper supervision on its exdysisical changes,these small blood-sucking non-human vampire does brings havoc to mankind!

Laparoscopic Adrenalectomy at HTAR?

Fat hopes!!!
The value of a laparoscopic approach to the adrenal, or suprarenal, gland in children with neuroblastoma has not been established. Therefore, 6 girls and 3 boys aged 2 months to 9 years underwent laparoscopic adrenalectomy for neuroblastoma at a single center. All procedures were performed via a 4- or 5-trocar transperitoneal approach. Tumors were mobilized, placed in a plastic bag, and removed through the umbilical trocar site. Mean surgical time was 85 min; blood loss was <100 mL. Complete resection was impossible in 1 boy with renal-vessel adhesions, even after conversion to open surgery. All tumors were well-encapsulated peripheral neuroblastomas. The only complication was an umbilical-port site infection in 1 patient. Mean hospital stay was 4.5 days; normal eating resumed within 2 days of surgery. Except for the incompletely resected patient, who had local recurrence at 7 months, all patients had no evidence of recurrence at mean follow-up of 15 months.
Laparoscopic adrenalectomy can be performed safely in children.

ASEAN Anaesthesiology Congress 2005 HANOI,VIETNAM

Detailed program of the congress
14th. ASEAN Congress of Anesthesiologists
23 to 25 November 2005 Sol Melia Hotel, Hanoi, Vietnam
Theme: "Narrowing the Gaps"
23 November 2005 (Wednesday)
08.00 - 16.00 H
Simultaneous Pre - Congress Events

VENUE (Sol Melia Hotel)

AARS WorkshopOASAO
Function Room I + IIFunction Room VI + VII

French - Vietnamese Refresher Course Lectures
Function Room III + IV + V

Lecture 1: Pancreatite aigue severe
P Montravers (France)

Lecture 2: Quelles sont les actions a mener dans les prochaines annees pour reduire la morbidite et la mortalite liees a l’anesthesie
JM Desmonts (France)

Lecture 3: L’anesthesia pour les maladies respiratoires chroniques
B Dureuil (France)

Lecture 4: Le Neuromonitorage en Anesthesie et en Reanimation
P Ravussin (Suisse)

Lecture 5: Prise en charge de la douleur post-operatoire: Concepts actuels
P Scherpereel (France)

Communications orales en francais Conferenciers vietnamiens


12.00-13H.30
Lunch

17.00H
14th ACA Opening Ceremonies
Thang Long Ballroom

followed by Opening of Exhibits ( Ballroom III and Foyer) and Welcome Cocktails ( Ballroom 1)
Sol Melia Hotel

24 November 2005 (Thursday)
AM
PLENARY LECTURES (45 minutes per speaker)
Ballroom I + II


08.00 H
Plenary Lecture 1 Update on Transfusion Therapy
R Miller (USA)
09.00 H
Plenary Lecture 2 Updates in Obstetric Anesthesia
S Gatt (Australia)
10.00 H
Plenary Lecture 3 Fluid Management in Traumatic Shock
R. Hofer (USA)



10.30 - 12.00 H
SIMULTANEOUS SYMPOSIA (20 minutes per speaker)




Symposium 1
Trauma
Function Room VI + VII

Speaker 1
The Burn Patient
Hwang Nian Chih( Singapore)

Speaker 2
Head injured patient: Anesthetic Considerations
P. Ravussin (Switzerland)

Speaker 3
Indonesian Experiences in Hemodilution and Transfusion
Eddy Rahardjo (Indonesia)


Symposium 2
OB Anesthesia
Function Room I + II

Speaker 1
Fetus in distress: which anesthetic ?
C Cruz (Philippines)

Speaker 2
Painless Labor: is it attainable ?
S Chandra (Indonesia)

Speaker 3
Obstetric Emergencies: are we coping well?
Shusee Visalyaputra(Thailand)


Symposium 3
Pediatric Anesthesia
Function Room IV

Speaker 1
Neonatal Resuscitation
Wanna Sombooviboon (Thailand)

Speaker 2
Anesthesia for Congenital Heart Disease
Kiyoshi Morita (Japan)

Speaker 3
Peri - operative Cardiac Arrests in Pediatrics
Agnes Ng (Singapore)


Symposium AARS Continuation of anesthesia workshop
Function Room III
12.00 - 13.30 H
Lunch
14.00 - 15.30 H
SIMULTANEOUS SYMPOSIA (20 minutes per speaker)


Symposium 4
Intensive Care
Function Room VI + VII

Speaker 1
Advances in Nutrition for Surgical Critically ill patients
P. Bouletreau (France)

Speaker 2
Updates in Mechanical Ventilation
Chen Fun Gee (Singapore)

Speaker 3
Strategies of Ventialtion in ARDS
D. Brown ( USA)

Speaker 4
Fluids, Fluids and more Fluids: When will it ever be enough?
Alan Wong (Malaysia)


Symposium 5
Pre-anesthetic Preparation
Function Room I + II

Speaker 1
Patients on Anticoagulation Therapy
G Herbosa (Philippines)

Speaker 2
Preparation of the critically ill patient for surgery
Alan Wong (Malaysia)

Speaker 3
Peri-operative Use of Beta-blockers for Cardiovascular Risk Reduction
Brian Warriner (Canada)


Symposium 6
Post - anesthesia Care
Function Room IV

Speaker 1
Discharged Protocol: is there a standard?
Naville Chia (Singapore)

Speaker 2
What is new for acute surgical pain relief?
Ramani Vijayan (Malaysia)

Speaker 3
Safety in the Recovery Room
R. Eltringham (UK)

Speaker 4
Current concepts in Postoperative Pain Management
Scherpereel (France)


Free Paper Presentation 2
Function Room III

16.00 - 17.00 H
SIMULTANEOUS SYMPOSIA


Symposium 7
Disaster Medicine
Function Room VI + VII

Speaker 1
The Tsunami Experience
Eddy Rahardjo (Indonesia)

Speaker 2
Role of anesthesiologit in Tsunamia disaster, Thailand Experience
Thara Tritrakarn (Thailand)

Speaker 3
Surviving SARS
Loo Shi (Singapore)

Speaker 4
Bioterrorism: what do we know?
Ronald Miller (USA)


Symposium 8
Day-case Surgery
Function Room I - II

Speaker 1
Is the Free - Standing Day Surgery Units Cost Effective?
Tan Su Meng (Singapore)

Speaker 2
Regional Anesthesia for Outpatients
R De Castro (Philippines)

Speaker 3
Anesthesia for Ambulatory Surgery: Narrowing the Gaps?
Somrat Charuluxananan (Thailand)


Symposium 9
Geriatric Anesthesia
Function Room IV

Speaker 1
What's New in Geriatric Anesthesia?
F Nuevo (Philippines)

Speaker 2
Implications of the Aging Brain
F Nuevo (Philippines)

Speaker 3
Pain management in the Elderly
Mary Cardosa (Malaysia)


Free Paper Presentation 3
Function Room III



17.00 - 19.00 H
CASA Executive Committee Meeting
Function Room V
20.00 - 23.00 H
Speaker’s Night
Function Room .....
25 November 2005 (Friday)
AM
PLENARY LECTURES (45 minutes per speaker)
Ballroom I + II
08.00 H
Plenary lecture 4
Updates on NMBs
P. Duvaldestin (France)
09.00 H
Plenary lecture 5
Updates on Loco - Regional Anesthesia
L. Dohlman (USA)
10.00 H
Plenary lecture 6
Update on Septic Shock
M. Gropper (USA)

10.30 - 12.00 H
SIMULTANEOUS SYMPOSIA


Symposium 10
Patients with Cardiac Disease
Function Room VI + VII

Speaker 1
Valvular Heart Disease
B Mets ( USA)

Speaker 2
Perioperative Use of Betablockers
Sophia Ang (Singapore)

Speaker 3
Perioperative Myocardial Ischemia
JP Depoix (France)




Symposium 11
Patients with Pulmonary Disorders
Function Room I + II

Speaker 1
Considerations of NMBs use in Vietnam
Chu Manh Khoa (Vietnam)

Speaker 2
Obesity, Sleep Apnea and Anesthesia
Chan KY (Malaysia)

Speaker 3
Perioperative Bronchospasm
T Alcantara (Philippines)

Speaker 4
Updates on Thoracic Anesthesia
Ungkab Prakanrattana (Thailand)


Symposium 12
Other Problems
Function Room I + II

Speaker 1
Renal Transplantation
Nguyen Thu (Vietnam)

Speaker 2
Anesthesia for Patients with Transmisible Disease
P. Montravers (France)

Speaker 3
Bleeding Disorders in Anesthesia & Intensive Care
J. Abenstein (USA)

Speaker 4
Systemic Local Anesthetics for Acute and Chronic Pain Relief
S. Schwarz (Canada)


Free Paper Presentation 4
Function Room III

14.00 - 15.30 H
SIMULTANOEUS SYMPOSIA


Symposium 13
Anesthesia Education and Research
Function Room VI + VII

Speaker 1
Judging Clinical Competence of Trainees
M. Odi (Philippines)

Speaker 2
Ethical Issues in Anesthesia Research
R. Vijayan ( Malaysia)

Speaker 3
Medicolegal Issues on Complications in Obstetrical Anesthesia
JM. Desmont ( France)

Speaker 4
Teaching Practical Anesthesia in the Operating Theatres
B. Mets (USA)


Symposium 14
Anesthesia Manpower
Function Room I + II

Speaker 1
Recruitment of Anesthesia Trainees
Tharnthip Pranootnarabhal (Thailand)

Speaker 2
Shortage of Anesthetists: Fact or Fallacy
Chan Yew Weng (Singapore)

Speaker 3
Expanding Role of Anesthetists in Japan
Keiichi Tada (Japan)


Symposium 15
Anesthesia Technology
Function Room IV

Speaker 1
Experiences with the Glostavent Anaesthetic Machine in Vietnam
R. Eltringham (UK)

Speaker 2
Non - invasive ventilation of the Crtically Ill
Vu Van Dinh (Vietnam)

Speaker 3
LMA Proseal: is it safer to use?
Lim Boon Leng (Singapore)




Free Paper Presentation 5
Function Room III

15.30 H
ASEAN Presidents" Forum
Ballroom I + II
Each President of the CASA Member Societies shall make a 10 minute presentation on the topic:
"Narrowing the Gaps in Anesthesia Practice"
17:00H 14th ACA Turnover and Closing Ceremonies
20:00H-23:00H ASEAN Congress Night Venue: West Lake Water Park

So typical.......

HOSPITAL INFECTIONS
This is with regards to the news report in the New Straits Times (12th July 2005) on "25 doctors, nurses and health workers were infected with TB last year. The air, the staff, the equipment...... Just how safe are our hospitals?"
The Malaysian Medical Association (MMA) is of the opinion that this report is timely and a keen reminder to all about the occupational health risks to all health care workers.
The MMA wishes to congratulate and thank the Ministry of Health for being so frank and forthright in its reporting. We wish to reiterate our support to the Ministry of Health in its efforts to make the workplace a safer environment.
All doctors should be reminded of the precautions and procedures to minimize the transmission of infectious diseases. Last week, at the British Medical Association's meeting, doctors in the National Health Service (NHS) were informed that the traditional white coat might in fact be the guilty agent in the transmission of the super bug MRSA (Methicillin Resistant Staphylococcus Aureus). There is a reported move to abandon the white coat for the green scrub vest used in North America. Perhaps, the Ministry of Health Malaysia should also study the evidence for this.