duli yang maha mulia raja zarith sofiahst john’s institution, kuala lumpur and maktab sultan abu...
TRANSCRIPT
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DULI YANG MAHA MULIA RAJA ZARITH SOFIAH BINTI ALMARHUM SULTAN IDRIS SHAH
AL MUTAWAKKIL ALALLAHI SHAH
PERMAISURI JOHOR
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Messages
• President,MalaysianSocietyofAnaesthesiologists 2
• President,CollegeofAnaesthesiologists,AcademyofMedicineofMalaysia 3
• OrganisingChairperson 4
CitationonMSAHonoraryMember 5–6
MalaysianSocietyofAnaesthesiologists–OfficeBearers2016-2017 7
CollegeofAnaesthesiologists,AMM–OfficeBearers2016-2017 8
LocalOrganisingCommittee 9
ScientificCommittee 10
OpeningCeremonyProgramme 11
GalaDinnerProgramme 12
InvitedSpeakers 13
Pre-CongressWorkshops 14–18
ProgrammeSummary 19
ScientificProgramme 20–24
ConferenceInformation 25
FloorPlan&TradeExhibition 26
Acknowledgements 27
Abstracts 28–113
• PlenariesAndSymposia 28–62
• MSAAward/MSA-AZYIAAward 63–71
• PosterPresentations 72–113
CONTENTS
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MESSAGE FROM THE PRESIDENT, MALAYSIAN SOCIETY OF ANAESTHESIOLOGISTS
On behalf of the Malaysian Society of Anaesthesiologists, it gives me great pleasure to welcome all of you to the Annual Scientific Congress 2017 of the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists Academy of Medicine of Malaysia to be held at the Berjaya Waterfront Hotel, Johor Bahru, Johor, on 27th to 30th April 2017.
First of all, a heartfelt thank you to the Organising Committee who under the able leadership of both Dato’ Dr Subrahmanyam Balan and Dr Raha Mohd Daud, has lined up some exciting programmes with renowned speakers for the event. The theme of this year’s Congress is “Re-Emergence”. The phrase ‘Old is Gold’ comes to mind when talking about re-emergence. Today, where robotic surgeries no longer remain as one man’s dream, we would need to revisit our history books and look at the contributions and relevance that old techniques and practices have in the current scenario.
This is the second time the Annual Scientific Congress has been held in Johor Bahru.
To those who are in Johor Bahru for the first time, I would encourage you to take this opportunity to try the local cuisine and cool off at the pristine beaches that Johor has to offer.
I hope we can all walk away with our minds enriched with new ideas, hearts filled with the joy of meeting old and new colleagues and memories to last us a lifetime.
Warm regards,
Dr Raveenthiran Rasiah
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Greetings! On behalf of the College of Anaesthesiologists, Academy of Medicine of Malaysia, I would like to extend a warm and cheerful welcome to all of you to the Annual Scientific Congress 2017, Malaysian Society of Anaesthesiologists and College of Anaesthesiologists to be held in Johor Bahru from 27th to 30th April 2017.
Both the Organising and Scientific Committees have worked tirelessly towards ensuring a comprehensive and varied scientific programme with an exciting social programme not to be missed! The Scientific Committee has planned workshops with a difference, as well as interesting plenaries and symposium sessions.
The theme “Re- Emergence” addresses the resurgence of some of the old practices in anaesthesia that have long been forgotten.
The conference will see distinguished and renowned invited speakers both foreign and local, who are experts in their respective fields share their knowledge and experience.
Enjoy the conference and enjoy renewing old ties and making new ones!
Dr Sushila Sivasubramaniam
MESSAGE FROM THE PRESIDENT, COLLEGE OF ANAESTHESIOLOGISTS, ACADEMY OF MEDICINE OF MALAYSIA
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Welcome to Johor Bahru, Johor Darul Takzim
It is our pleasure to welcome you to the Annual Scientific Congress 2017 of the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists. It is an honour for us to once again, host this much awaited annual congress within our anaesthesiology fraternity.
The Scientific Committee has chosen “Re-emergence” as the theme to reflect on old or previous practices that have been less adopted but now have come back into trend. The scientific programme will consist of pre-congress workshops, plenaries and concurrent symposium sessions.
Distinguished and renowned speakers, both local and overseas, will share their knowledge and expertise on a wide variety of topics.
As for the venue, Berjaya Waterfront Hotel (formerly known as The Zon Regency Hotel by the Sea) will give you a nice view of the Selat Tebrau and Johor Bahru city.
Please do not miss the Gala Dinner. We have chosen the theme “Simply Traditional” and are looking forward to see you in your lovely and colourful traditional costumes. We promise you an entertaining programme and a memorable night.
May we have a pleasant and fruitful Congress.
Dr Raha Mohd Daud
MESSAGE FROM THE ORGANISING CHAIRPERSON
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Citation by Dato’ Dr A Damodaran
It is indeed my privilege and pleasure to give this citation for my good friend and a distinguished doctor of our specialty, Dato’ Dr Sylvian Das.
Dr Das as he is affectionately called, was born in Simpang Valley Estate to the late Mr & Mrs Vincent Das.
Early education was in three different places: St Paul’s Institution, Seremban; St John’s Institution, Kuala Lumpur and Maktab Sultan Abu Bakar, Johor Bahru.
For Medicine, he went to India. He graduated from the Christian Medical College, Vellore in 1971. After completing his housemanship in General Hospital, Johor Bahru, he took up the position of medical officer in anaesthesia in Kluang Hospital, Johor. After five years of training, he chose to pursue his career in anaesthesia. He joined University Hospital in 1977 for training in anaesthesia and intensive care.
Going back a few years in history, the Academic Department of Anaesthesia, University of Malaya was established in 1965. In 1972, the department was recognised by the Faculty of Anaesthesia of the Australian Royal College of Surgeons for training of eight medical officers from 1972 onwards. Dr Das successfully completed his post-graduate studies and obtained his Australian Fellowship in 1981.
Following this, he became a Fellow of the Academy of Medicine of Malaysia and a Fellow of the Indian Academy of Medical Sciences.
As a lecturer in the Department of Anaesthesiology, he taught the postgraduate students. During his four years in the department, he was mainly responsible for revising and fine tuning the undergraduate programme for medical students to the department.
After gaining experience in anaesthesia for various surgical disciplines, he joined the Tun Hussein Onn Eye Hospital in 1985. He left the Eye Hospital and joined Pantai Medical Centre, Bangsar, Kuala Lumpur in 1991 at a time when I was bringing about rapid changes in the hospital by establishing intensive care units, both adult and neonatal, open heart surgery and management of acute pain and labour epidural services. Dr Das’ arrival at that time to join me with his wide academic experience and organisational capabilities was indeed a boon to the hospital.
As Organising Chairman of the ASEAN Congress of Anaesthesiologists 1998, Organising Chairman of the 11th Asian Australasian Congress of Anaesthesiologies
MSA HONORARY MEMBER – DATO’ DR SYLVIAN DAS
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MSA HONORARY MEMBER – DATO’ DR SYLVIAN DAS(CONTINUED)
in 2002, Honorary Secretary (2001 – 2003) of Asian-Oceanic Society of Regional Anaesthesia, and as Vice Chairman (2002 – 2006) of Asian-Australasian Regional Section of the World Federation of Societies of Anaesthesiologists, he actively promoted collaborative ventures for training and improving the delivery of anaesthesia in the region. He also presented numerous academic papers and chaired scientific sessions in various conferences.
At home, he was the Honorary Secretary of MSA (1981 – 1987), President of MSA (1988 – 1990), Dean of Faculty of Anaesthesiologists, College of Surgeon of Malaysia, Chairman of MSA, Council Member of Academy of Medicine of Malaysia – all these are a testament to the numerous contributuions he had made to the profession and the country.
His generosity in the care of the indigent is also noteworthy. He is a Rotarian and was the Past President of the Rotary Club of Ampang. Currently, he is the Chairman of Rumah Bethany, a home for special children.
For the services he had rendered to this profession and country, he was awarded DIMP by His Royal Highness, Sultan of Pahang, in 2012 which carries the title ‘Dato’.
His gentle demeanour, empathetic approach and delightful humour during challenging times are endearing experiences we continue to admire and relish.
He is married to Doreen Kamalini Das and has two beautiful daughters. He is a grandfather.
This award is a tribute to a life of activities and creative endeavours bringing honours and reverences for this man and his crucial roles in the history of anaesthesia in the country.
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President Dr Raveenthiran Rasiah
Immediate Past Pres ident Dr Sushila Sivasubramaniam
President-Elect Dato’ Dr Jahizah Hassan
Chairman Dr Mohamed Namazie Ibrahim
Hon Secretary Professor Dr Marzida Mansor
Hon Treasurer Datuk Dr V Kathiresan
Committee Members Dr Gunalan a/l Palari
Dr Mafeitzeral Mamat
Dr Norliza Mohd Nor
Dato’ Dr Subrahmanyam Balan
Dr Suresh Kumar
Hon Audi tors Professor Dr Chan Yoo Kuen
Professor Dr Jaafar Md Zain
MALAYSIAN SOCIETY OF ANAESTHESIOLOGISTSOFFICE BEARERS 2016 – 2017
Dato’ Dr Subrahmanyam Balan
Dr Norliza Mohd Nor
Dato’ Dr Jahizah Hassan
Professor Dr Marzida Mansor
Dr Gunalan a/l Palari
Dr Mohamed Namazie Ibrahim
Dr Mafeitzeral Mamat
Dr Sushila Sivasubramaniam
Dr Raveenthiran Rasiah
Datuk Dr V Kathiresan
Dr Suresh Kumar
Professor Dr Jaafar Md ZainProfessor Dr Chan Yoo Kuen
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President Dr Sushila Sivasubramaniam
Vice Pres ident Associate Professor Dr Raha Ab Rahman
Hon Secretary Professor Dato’ Dr Wang Chew Yin
Hon Treasurer Dr Tan Cheng Cheng
Counci l Members Associate Professor Dr Ina Ismiarti Shariffudin
Dato’ Dr Jahizah Hassan
Datin Dr V Sivasakthi
Dr Muhammad Maaya
Coopted Counci l Members Dr Lim Wee Leong
Dr Raveenthiran Rasiah
COLLEGE OF ANAESTHESIOLOGISTS, ACADEMY OF MEDICINE OF MALAYSIAOFFICE BEARERS 2016 – 2017
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LOCAL ORGANISING COMMITTEE
Dato’ Dr Subrahmanyam BalanDr Ismawaty SukawiPPP Zoolfadhli Hashim
PPP Zakuan Mohd Nor
Dr Nadzirah Mohd Shah
KJ Eswazilah Bt Md Esa
Dr Raha Mohd DaudDr Murniati Mustafa
Dr Azmiza Maharani
Dr Ng Chong Hin
PPP Razi bin SahilPPP Ainie Leong
KJ Asmah Bt Rahmat
PJ Ushadevi Kumaran
KJ Siti Suryani BohariKJ Rahimah Hashim KJ Siti Hajar LaiKJ Salinder KaurPJ Norsiah Mustapha
PPP Mohd Ali bin Kassim
Dr Hanizah MohamedPPP Mohd Haidzir b Mohamed
PPP Anuar Ismail
Dr Lakshmi Thiyagarajan
Dr Nur Fadhlina Ari�n
PPP Naswadi Zakaria
AdvisorDato’ Dr Subrahmanyam Balan
ChairpersonDr Raha Mohd Daud
Secretary 1Dr Ismawaty Sukawi
Secretary 2PPP Zoolfadhli Hashim
TreasurerDr Murniati MustafaDr Lakshmi Thiyagarajan
Sub-Committee MembersDr Azmiza MaharaniPPP Anuar IsmailPPP Zakuan Mohd NorDr Nur Fadhlina Ari�nDr Ng Chong HinPPP Mohd Ali bin KassimDr Hanizah Mohamed
PPP Mohd Haidzir b MohamedDr Nadzirah Mohd ShahPPP Naswadi ZakariaPPP Razi bin SahilPPP Ainie LeongPJ Ushadevi KumaranKJ Eswazilah Bt Md Esa
KJ Asmah Bt RahmatKJ Rahimah HashimKJ Siti Suryani BohariKJ Salinder KaurPJ Norsiah MustaphaKJ Siti Hajar Lai
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Chairpersons
Dr Mafeitzeral bin Mamat
Dr Maria Lee Hooi Sean
Committee Members
Dr Ra�dah Atan
Dr Shahridan Fathil
Dr Muhammad Maaya
Local Sub-Committee Members
Dr Faizal Zuhri Abd Aziz
Dr Mahazir Kassim
Dr Soh Wei Ney
Dr Lim Wei Tat
Dr Seethal Padmanathan
SCIENTIFIC COMMITTEE
Dr Maria Lee Hooi Sean
Dr Muhammad Maaya
Dr Mafeitzeral bin Mamat
Dr Shahridan FathilDr Ra�dah Atan
Dr Soh Wei Ney
Dr Faizal Zuhri Abd AzizDr Mahazir Kassim
Dr Lim Wei Tat Dr Seethal Padmanathan
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VENUE
Grand Ballroom, Berjaya Waterfront Hotel
0930 –0935 ArrivalofGuestofHonour DuliYangMahaMuliaRajaZarithSofiahbintiAlmarhumSultanIdrisShah,PermaisuriJohor
0935 –0940 RecitalofDoabyMuftiofJohor
0940 –0945 SpeechbyDrRaveenthiranRasiah, President,MalaysianSocietyofAnaesthesiologists
0945 –0950 SpeechbyDrSushilaSivasubramaniam, President,CollegeofAnaesthesiologists,AcademyofMedicineofMalaysia
0950 –0955 SpeechbyGuestofHonour DuliYangMahaMuliaRajaZarithSofiahbintiAlmarhumSultanIdrisShah,PermaisuriJohor followedbydeclarationandofficialopening
0955 –1005 LaunchingofGuidelinesonSugammadex
1005 –1010 PresentationofMontage
1010 –1020 CitationonDato’DrSylvianDas,HonoraryMemberbyDato’DrADamodaran
1020 –1025 ConfermentofHonoraryMembershiponDato’DrSylvianDas byDrRaveenthiranRasiah,President,MalaysianSocietyofAnaesthesiologists
1025 –1030 OpeningofTradeExhibitionatExhibitionCentreby DuliYangMahaMuliaRajaZarithSofiahbintiAlmarhumSultanIdrisShah,PermaisuriJohor
1030 –1100 Coffee/TeaforDelegatesatExhibitionCentre
OPENING CEREMONY28TH APRIL 2017, FRIDAY
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VENUE
Grand Ballroom, Berjaya Waterfront Hotel
THEME
Simply Traditional
1930 –2000 ArrivalofGuestsandDelegates
2000 –2010 TraditionalDancePerformance
2010 –2015 WelcomeSpeechbyDrRahaMohdDaud,OrganisingChairperson
2015– 2020 SigningofMOUwithKoreanSocietyofAnaesthesiologists
2020 –2120 Dinnerisservedandperformancebysinger
• PresentationofMSAAwardandMSA-AZYIAAwardByDrRaveenthiranRasiah,President,MalaysianSocietyofAnaesthesiologists
• GamesbyMC
• PresentationofBestPosterAwardsByDrSushilaSivasubramaniam,President,CollegeofAnaesthesiologists,AMM
2120 –2140 PerformancebySinger
2140 –2150 GamesbyMC
2150 –2210 BestDressAwards
2210 –2220 PerformancebySinger
2220 –2230 TraditionalDancePerformance
2230 Ends
GALA DINNER29TH APRIL 2017, SATURDAY
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INTERNATIONAL FACULTY
Belgium
Lynette Dominguez
Jan Mulier
Hong Kong
Gordon Wong
Italy
Sabino Scolletta
Singapore
Joseph Abueg
Soon Yuen
Thailand
Supranee Niruthisard
The Netherlands
Reynaldo Joey Soria
United Kingdom
Andrew Klein
Western Australia
Richard Riley
MALAYSIA
Adi Osman
Alan @ Abdul Hanan
Arif�n Marzuki Mokhtar
Azlina Masdar
Mary Cardosa
Chan See Yun
Fahmi Lukman
Eleanor Fe Fey Chew
Haslan Ghazali
Andrew Gunn Kean Beng
Jahizah Hassan
Kiung Sze Ting
Kwok Fan Yin
Lakshmi Thiyagarajan
Lim Wee Leong
Mahazir Kassim
Marzida Mansor
Mohamed Hassan Ariff
Murniati Mustafa
Nor’Azim Mohd Yunos
Noorjahan Haneem Md Hashim
Nora Azura Dintan
Nur Fadhlina Ari�n
Nurhayati Mohd Idris
Omar Sulaiman
Ra�dah Atan
Raha Abdul Rahman
Sheila Menon
Sivasakthi Velayuthapillai
Teo Shu Ching
Ungku Kamariah Ungku Ahmad
Vanitha Sivanaser
Yoga Bhavani
INVITED SPEAKERS
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PRE-CONGRESS WORKSHOP 1
Field Surgical CareIn collaboration with Medicins Sans Frontiere (MSF) and Mercy Malaysia (MM)
DATE & TIME
27th April 2017, Thursday
VENUE
Gleneagles Medini Hospital
FACULTY
Shahridan Fathil (Organising Chairman)
Reynaldo Joey Soria
Lynette Dominguez
Mafeitzeral Mamat
Shalimar Abdullah
Nasuha Yaacob
Theworkshopisdesignedtoprepareanaesthetists,surgeonsandobstetricianstoprovidequalitysurgicalcareintheimmediatepost-disasterresponseand/orresourcelimitedenvironment.
Thefacultywillbe ledbyreferentsfromMSFOperationCenterBrussels,andassistedbyveteransfromMercyMalaysia.
PROGRAMME
0745 –0815 Registrat ion
0815 –0830 IntroductionShahridan Fathil
0830 –0900 SurgicalactivitiesinthefieldReynaldo Joey Soria
0900 –0930 PrerequisitetosurgeryLynette Domiguez
0930 –1000 MSFprotocolsReynaldo Joey Soria
1000 –1030 Tea
1030 –1100 MSFsurgicaltoolsLynette Dominguez
1100 –1130 MMemergencyresponseunitShalimar Abdullah
1130 –1200 MasscasualtymanagementReynaldo Joey Soria
1200 –1230 WarsurgeryLyntte Dominguez
1230 –1300 FieldorthopaedicsShalimar Abdullah
1300 –1400 Lunch
1400 –1430 FieldobstetricsNasuha Yaacob
1430 –1500 FieldanaesthesiaReynaldo Joey Soria
1500 –1530 FieldregionalanaesthesiaMafeitzeral Mamat
1530 –1600 UltrasoundinthefieldShahridan Fathil
1600 –1630 Q&A EndofSession
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PRE-CONGRESS WORKSHOP 2
Crisis For The Anaesthetist: Short. Sharp. Intense.
DATE & TIME
27th April 2017, Thursday
VENUE
Monash Medical School
FACILITATORS
Ra�dah binti Atan Monash University Malaysia, Johor Bahru
Nor’azim bin Mohd Yunos Monash University Malaysia, Johor Bahru
Mafeitzeral Mamat Gleneagles Medini Hospital, Johor Bahru
Noorjahan Haneem binti Md Hashim University of Malaya, Kuala Lumpur
Richard Riley Royal Perth Hospital and University of Western Australia
CO-FACILITATORS
Hanizah binti Mohamed Hospital Sultanah Aminah, Johor Bahru
Nurhanani Zaini binti Mohd Sapiee Hospital Sultanah Aminah, Johor Bahru
Nur Ilyani Bujang Hospital Sultan Ismail, Johor Bahru
Won Kang Lin Hospital Sultan Ismail, Johor Bahru
We invite medical officers, nurses and anaesthetists to participate in this short and intense course on crisismanagement. This half-day coursewill start off with a short briefing on principles of crisismanagement andorientation to the simulation environment plus its rules of engagement.Participants are thendivided into fourgroupsandwillrotatethroughfourstationsonvariouscrisisscenariosrelevanttothepracticeofanaesthesiaandintensivecare.Timeallocatedforeachscenarioisapproximately45minutesincludingdebriefingtime.
Thisshortcoursemayactasanintroductorycourseoncrisismanagementfornewbies,orarefreshercourseforthosealreadyfamiliarwithitsconcept.Facilitatorsofthiscoursehaveundergoneformaltrainingtorunsimulationsessionsandareexperiencedinprovidingasafelearningenvironmentforalllevelsofparticipants.
ThecoursewillbeheldattheClinicalSchoolJohorBahru,MonashUniversityMalaysia,whichhousessimulationroomsthatarefullyequippedtorunimmersivesimulations.
Comeandjoinusforthisshortandsharpcourse!Itwillbeahalf-daywellspent!
0730 –0800 Registrat ion
0800 –0805 Introductionandwelcomingaddress
0805 –0835 PrinciplesofcrisismanagementRichard Riley
0835 –0850 Rulesofengagementandicebreaking
0850 –0950 Scenario1anddebriefing
0950 –1010 Tea
1010 –1110 Scenario2anddebriefing
1110 –1210 Scenario3anddebriefing
1210 –1310 Scenario4anddebriefing
1310 –1330 Takehomemessagesandclosingremarks
1330 –1400 Lunch
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Basic Renal Replacement Therapy (CRRT)
DATE & TIME
27th April 2017
VENUE
Angsana & Hibiscus, Level 6, Berjaya Waterfront Hotel
COORDINATOR
Faizal Zuhri
FACILITATORS
Mahazir KassimIsmawaty Sukawi
We invite specialists,medical officers,pharmacists andnurses involved in thedeliveryofCRRT tocritically illpatients.
Participantswillbeableto:
1. DescribethebasicsofCRRTprovisiontopatientsacrosstheentirespectrumofcriticalillness.
2. Discussthe latest informationregardingtheentireCRRTprescriptionfrommodalitychoice,anticoagulation,accesschoiceandtimingofCRRTinitiation,andtheapplicationofCRRTinvariousdiseasestates.
3. Experience hands-on-training using CRRTmachines and learn the practicalities of initiation and commonproblemsduringprovisionofCRRTincludingplasmapheresistocriticallyill.
Comeandjoinusinthisenlighteninghalf-daycourse!
1200–1300 Registrat ion
1300–1350 Lunch
1350–1400 Welcomenote
1400–1445 IntroductiontocontinuousRRTinanaesthesiaandcriticalcare
–UnderstandingdifferenttypesofRRT
–IntroductiontoCRRT
–TherapiesofCRRT
1445–1500 Q&A
1500–1545 Managingcontinuousrenalreplacementtherapyinanaesthesiaandcriticalcare
–Renalrecovery–RRTmodalities
–CRRTinitiation
–CRRTdose
1545–1600 Q&A
1600–1630 Tea
1630–1730 Hands-on
PRE-CONGRESS WORKSHOP 3
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How To Ventilate Like Intensivists!
DATE & TIME
27th April 2017
VENUE
Arcadia & Daffodil, Level 6, Berjaya Waterfront Hotel
COORDINATOR
Ng Chong Hin
FACILITATORS
Azmin HudaLam Hui Lin
Weinvitespecialistsandmedicalofficersinvolvedinthedeliveryofventilationtocriticallyillpatients.Wheneveryoudialthenobsontheventilator,haveyoueverwonder,howmuchistoomuchortoolittle?
Theworkshopwill cover thephysiological basisof ventilation, thenew features in advance ventilator and theprotectiveventilationstrategiestominimiseventilatorassociatedlunginjury.
Comeanddiscoverhowyoucanindividualiseyourtherapy!
PROGRAMME
1200–1300 Registrat ion Committee
1300–1350 Lunch
1350–1400 WelcomenoteNg Chong Hin
1400–1430 Stress,strainvilliLam Hui Lin
1430–1500 PVloops:SpirodynamicLam Hui Lin
1500–1530 LungprotectivestrategyAzmin Huda
1530–1600 UpdateinARDSAzmin Huda
1600–1630 Break
1630–1700 IndirectcalorimetryLam Hui Lin
1700–1800 Hands-onLam Hui Lin, Azmin Huda
PRE-CONGRESS WORKSHOP 4
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Extracorporeal Membrane Oxygenation (ECMO)
DATE & TIME
27th April 2017
VENUE
Daisy, Level 5, Berjaya Waterfront Hotel
FACILITATORS
Yong Chow Yen (Organising Chairperson)Norly binti IsmailAbdul Halim bin Abdul HamidFaradh Anas bin MasdokhiHermi bin Sapian
0730 –0830 Registrat ion
0830 –0835 WelcomenoteYong Chow Yen
0835 –0900 Evidence,patientselectionandoutcomeLim Chew Har
0900 –0925 PhysiologyofVVandVAECMOLim Chew Har
0925 –0950 Cannula,tubing,pump,oxygenator,monitorsMohamad Hana� Mohd
0950 –1015 CannulationandsurgicalconsiderationsFaisal Ismail
1015 –1040 Initiationandstabilization(VAandVV)Zuraini Md Nor
1040 –1110 Tea
1110 –1135 AnticoagulationMohamad Hana� Mohd
1135 –1200 MonitoringandECMOcircuitmanagementHamidah Ismail
1200 –1225 NursingcareofpatientonECMONur Asmayanti Leman
1225 –1250 ComplicationsandmanagementHamidah Ismail
1250 –1315 Weaninganddecannulation(VAandVV)Zuraini Md Nor
1315 –1430 Lunch
1430 –1630 Practicalsessionsin4groupsrotation
A. CannulaselectionFaisal Ismail, Mohamad Hana�, Hj Halim
B. CircuitjigsawpuzzleYong Chow Yen, Faradh Anas Masdokhi
C. Circuitassembly,priming,initiation,troubleshootingHamidah Ismail, Hermi Sa�an
D. MonitoringanddocumentationZuraini Md Nor, Nur Asmayanti Leman
1630 –1700 Tea & End
PRE-CONGRESS WORKSHOP 5
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DateTime
28th April 2017 Friday
29th April 2017 Saturday
30th April 2017 Sunday
0700–0730MEET-THE-EXPERT 1 AEROBIC
0730–0800REGISTRATION
0800–0830PLENARY 2
0830–0900PLENARY 1 PLENARY 5
0900–0930PLENARY 3
0930–1000OPENING CEREMONY
SYMPOSIAWORKSHOP
ON HYPNOSIS1000–1030 Tea Break 18 19
1030–1100 Tea Break SYMPOSIA
1100–1130 SYMPOSIA9 10 11
Tea Break
1130–12001 2 3
SYMPOSIA
1200–1230PLENARY 4 20 21
1230–1300
Lunch Symposium 1
Fr iday Prayers
1300–1330Lunch Symposium 2
1330–1400
1400–1430SYMPOSIA
SYMPOSIA
12 13 141430–15004 5 6
1500–1530
1530–1600 Tea BreakTea Break
1600–1630 SYMPOSIA MSA / MSA-AZ YIA
AWARDS
OFFICIAL POSTER ROUND
SYMPOSIA
1630–17007 8 15 16 17
1700–1730
1730–1900COLLEGE OF
ANAESTHESIOLOGISTS AGM
MALAYSIAN SOCIETY OF ANAESTHESIOLOGISTS
AGM
2000onwards
FACULTY DINNER(by inv i ta t ion on ly )
2000–2300
GALA DINNER
PROGRAMME SUMMARY
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0730–0830 REGISTRATION
0830–0930 PLENARY 1 Grand BallroomChairperson: Vanitha SivanaserAnaesthesiaresponseinconflictareas:TheMSFexperience [PAGE 28]Reynaldo Joey Soria
0930–1030 OPENING CEREMONY* (refer programme in page 11) Grand BallroomGraciouslyofficiatedbyDuliYangMahaMuliaRajaZarithSofiahbintiAlmarhumSultanIdrisShah,PermaisuriJohor
1030–1100 Tea Break Exhibition Centre
1100–1230 Ballroom 3SYMPOSIUM 1EMERGING TRENDSChairperson: Vanitha Sivanaser
Ballroom 1 & 2
SYMPOSIUM 2PAIN MANAGEMENTChairperson: Nita Salina Abdullah
Auditorium 2
SYMPOSIUM 3PERIOPERATIVE MEDICINEChairperson: Yoga Bhavani
1100 – 1130Anaesthesiafortheelderly:Howmuchtogive? [PAGE 29]Omar Sulaiman
1100 – 1130
PainfreehospitalanditsimplementationMary Cardosa
1100 – 1130
OptimizationofperioperativehaemoglobinAndrew Klein
1130 – 1200Real-timeclinicaldebriefingRa�dah Atan
1130 – 1200
Proceduralpainmanagementinadults [PAGE 30]Ungku Kamariah Ungku Ahmad
1130 – 1200
PerioperativecareofthehighrisksurgicalpatientsSoon Yuen
1200 – 1230
Thereturnofnitrousoxide![PAGE 29]
Nur Fadhlina Ari�n
1200 – 1230
ConsentandethicsinpainmanagementMarzida Mansor
1200 – 1230
Preoperativebloodinvestigationsinelectivesurgery:AnationalauditonMinistryofHealthanaestheticpractices [PAGE 31]Jahizah Hassan, Kiung Sze Ting
1230–1315 Lunch Symposium 1 [Merck, Sharp & Dohme] Ballroom 1 & 2Chairperson: Mafeitz bin MamatRoleoftheanaesthesiologistinenhancedrecovery [PAGE 32]Jan Mulier
1315–1415 Fr iday Prayers
SCIENTIFIC PROGRAMMEDAY 1 | 28TH APRIL 2017 (FRIDAY)
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1415–1545 Ballroom 1 & 2SYMPOSIUM 4NEUROANAESTHESIAChairperson: Ng Chong Hin
Ballroom 3
SYMPOSIUM 5RESEARCH & TRAININGChairperson: Muhammad Maaya
Auditorium 2
SYMPOSIUM 6SPECIAL INTERESTChairperson: Shahridan Fathil
1415 – 1445
Thefutureanddirectionofneuro-anaesthesiainMalaysia [PAGE 33]Lim Wee Leong
1415 – 1445
Postoperativecomplicationsofunrecognizedsleepapnea(POSA)trial [PAGE 34]Eleanor Fe Fey Chew
1415 – 1445
Fieldanaesthesia [PAGE 36]Reynaldo Joey Soria
1445 – 1515
Traumaticbraininjury–MalaysiaExperience [PAGE 33]Fahmi Lukman
1445 – 1515
Patientcentrichealthcare[PAGE 34]
Arif�n Marzuki
1445 – 1515
Donationaftercardiacdeath(DCD):Areweready? [PAGE 37]
Omar Sulaiman
1515 – 1545
Thebrainbulge:ManagementstrategiesVanita Sivanaser
1515 – 1545
Simulationasanessentialtoolinanaesthesiatraining [PAGE 35]
Richard Riley
1515 – 1545
MedicalcannabisMary Cardosa
1545–1600 Tea Break Exhibition Centre
1600–1730
Ballroom 1 & 2
SYMPOSIUM 7ALLIED HEALTH 1 : COMMUNICATION DURING PATIENT CAREChairperson: Subrahmanyam Balan
Auditorium 2
SYMPOSIUM 8AMBULATORY ANAESTHESIAChairperson: Lakshmi Thiyagarajan
Ballroom 3
MSA / MSA-AZ YOUNG INVESTIGATOR AWARDS [PAGE 63-71]
Chairperson: Maria Lee Hooi Sean
OFFICIAL POSTER ROUND1600 – 1630KISS–EffectivecommunicationSivasakhti Velayuthapillai
1600 – 1630
TIVAindaysurgery [PAGE 38]Gordon Wong
1630 – 1700
ISBARandgradedassertivenessRa�dah Atan
1630 – 1700
MISpracticeindaycareSoon Yuen
1700 – 1730
Communicatingtreatmentgoalsinacutepainmanagement:Communicationduringpatientcare [PAGE 37]Ungku Kamariah Ungku Ahmad
1700 – 1730
Extendedcriteriafordaycarepatients [PAGE 38]Eleanor Fe Fey Chew
1730–1900 COLLEGE OF ANAESTHESIOLOGISTS AGM Auditorium 2
2000onwards FACULTY DINNER (by invitation only)Venue: Makan Kitchen, DoubleTree by Hilton, Johor Bahru
SCIENTIFIC PROGRAMME (CONTINUED)DAY 1 | 28TH APRIL 2017 (FRIDAY)
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SCIENTIFIC PROGRAMME (CONTINUED)DAY 2 | 29TH APRIL 2017 (SATURDAY)
0700–0800 MEET THE EXPERT 1 Angsana & HibiscusChairperson: Shahridan FathilWhateditorslookforAndrew Klein
0800–0900 PLENARY 2 Ballroom 1 & 2Chairperson: Jahizah HassanAnaesthesiologyandthelaw [PAGE 39]Mohamed Hassan Ariff
0900–1000 PLENARY 3 Ballroom 1 & 2Chairperson: Raveenthiran RasiahHaemodynamicmonitoringforperioperativeoptimization [PAGE 40]Sabino Scolletta
1000–1030 Tea Break Exhibition Centre
1030–1200 Ballroom 1 & 2SYMPOSIUM 9POST ANAESTHESIA CAREChairperson: Maria Lee Hooi Sean
Auditorium 2
SYMPOSIUM 10AIRWAY MANAGEMENTChairperson: Muhammad Maaya
Ballroom 3
SYMPOSIUM 11UPDATES IN MONITORING & TECHNOLOGYChairperson: Gunalan a/l Palari
1030 – 1100Essentialsetupofpostanaestheticcareunit(PACU)[PAGE 41]
Raha Abdul Rahman
1030 – 1100
Musclerelaxantforthedifficultairway [PAGE 43]Jan Mulier
1030 – 1100
Arterialpressuremonitoringinanaesthesia [PAGE 45]Sabino Scoletta
1100 – 1130
Mythsandfactsofpostoperativenauseavomiting[PAGE 41]
Nora Azura Dintan
1100 – 1130
Airwayultrasound [PAGE 44]Adi Osman
1100 – 1130
Adequacyofanaesthesia–NMT/ENTROPY/BIS [PAGE 46]Joseph Abueg
1130 – 1200
Bestpracticeswithhealthinformatics [PAGE 42]Arif�n Marzuki
1130 – 1200
Futureofsupraglotticairwaydevices [PAGE 44]Fahmi Lukman
1130 – 1200
CVPwaveforms–Theforgottenmonitor[PAGE 47]Mohamed Hassan Ariff
1200–1300 PLENARY 4 Ballroom 1 & 2Chairperson: Sushila SivasubramaniamSaveblood,savelives [PAGE 48]Andrew Klein
1300–1400 Lunch Symposium 2 [Pf izer (M) Sdn Bhd] Ballroom 1 & 2Chairperson: Sivasakthi VelayuthapillaiMakingmultimodalanalgesiaworkforyouandyourpatientSupranee Niruthisard
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SCIENTIFIC PROGRAMME (CONTINUED)DAY 2 | 29TH APRIL 2017 (SATURDAY)
1400–1530 Ballroom 3SYMPOSIUM 12VENTILATION STRATEGIESChairperson: Nur Fadhlina Ari�n
Auditorium 2
SYMPOSIUM 13CARDIOTHORACIC ANAESTHESIAChairperson: Salamah Azerai
Ballroom 1 & 2
SYMPOSIUM 14PERIOPERATIVE COMPLICATIONSChairperson: Ina Ismiarti Shariffudin
1400 – 1430
Managementofatelectasis[PAGE 48]
Joseph Abueg
1400 – 1430
Optimizingoxygendeliveryduringextracorporealcirculation [PAGE 50]Nurhayati Mohd Idris
1400 – 1430
Nightmareofanaphylaxis[PAGE 52]
Kwok Fan Yin
1430 – 1500
HelmetCPAP [PAGE 49]Adi Osman
1430 – 1500
Viscoelastictestofcoagulationincardiacsurgery [PAGE 51]Haslan Ghazali
1430 – 1500
SafetystandardsinmanagementofdrugslistedunderDangerousDrugsAct[PAGE 52]
Lim Wee Leong1500 – 1530
Nasalhighflowoxygentherapy [PAGE 49]Raha Abdul Rahman
1500 – 1530
Liberalvsrestrictivetransfusionthresholdincardiacsurgery [PAGE 51]Andrew Klein
1500 – 1530
Timeout&SSSL:Doingitright!Andrew Gunn Kean Beng
1530–1600 Tea Break Exhibition Centre
1600–1730
Ballroom 3
SYMPOSIUM 15MEDICOLEGAL & ETHICS ISSUE IN ANAESTHESIAChairperson: Mohamed Namazie
Ibrahim
Auditorium 2
SYMPOSIUM 16TRAUMA ANAESTHESIAChairperson: Shahridan Fathil
Ballroom 1 & 2
SYMPOSIUM 17ALLIED HEALTH 2 : CARING FOR THE ANAESTHETISEDChairperson: Azlina Masdar
1600 – 1630
Bullyingandharassmentintheoperatingtheatre [PAGE 53]Richard Riley
1600 – 1630
Preoperativetraumastabilization [PAGE 54]Adi Osman
1600 – 1630
Pregnantmothersandanaesthesia [PAGE 56]Chan See Yun
1630 – 1700
Inappropriatesurgery?Theanaesthetistaspatient’sadvocateNoorjahan Haneem Md Hashim
1630 – 1700
Warsurgeryinhumanitariansettings [PAGE 55]Lynette Dominguez
1630 – 1700
I’mconfused:Postopdelirium/emergencedelirium/POCD [PAGE 56]Haslan Ghazali
1700 – 1730
Consentoftheminor [PAGE 54]Teo Shu Ching
1700 – 1730
ATLSupdates&changesAndrew Gunn Kean Beng
1700 – 1730
PatientpositioningVanitha Sivanaser
1730–1900 MALAYSIAN SOCIETY OF ANAESTHESIOLOGISTS AGM Auditorium 2
2000–2300 GALA DINNER (refer programme in page 12) Grand BallroomTheme:SimplyTraditional
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0700–0800 AEROBIC Open space parking area, beside the straits
0830–0930 PLENARY 5 Ballroom 1 & 2Chairperson: A Damodaran Hypnosedationinthe21stCentury:IsIttimeforanaesthetiststoembracehypnosis? [PAGE 57]Alan @ Abdul Hanan
0930–1100 Auditorium 2SYMPOSIUM 18OBSTETRIC ANAESTHESIAChairperson: Ismawaty Sukawi
Ballroom 1 & 2
SYMPOSIUM 19ALLIED HEALTH 3 : CRISIS MANAGEMENTChairperson: Ina Ismiarti Shariffudin
Ballroom 3
WORKSHOP ON HYPNOSISPracticalsinclinicalhypnosis[PAGE 60]
Facilitators: Alan @ Abdul Hanan, Sheila Menon
0930 – 1000Abnormalinvasiveplacenta:Avoidingbloodbath [PAGE 57]Azlina Masdar
0930 – 1000
ALSUpdate2015 [PAGE 59]Murniati Mustafa
0930 – 1000
Demonstrationofhypnoanagesia–Livevolunteerexplanationanddiscussion
1000 – 1030Pointofcarecoagulationtestinginthemanagementofpostpartumhaemorrhage [PAGE 58]
Chan See Yun
1000 – 1030
CrisisresourcemanagementrolesNoorjahan Haneem Md Hashim
1000 – 1030
Practicalskillstraininginclinicalhypnosisinduction,deepeningtechnique,awakeningpracticeanddiscussion
1030 – 1100Enhancedrecoverypathwayaftercaesarean [PAGE 58]Nora Azura Dintan
1030 – 1100
Preventionofhypothermiaintheneonate [PAGE 59]Lakshmi Thiyagarajan
1030 – 1100
Perioperativecare–Multi-dimentionalapproachtopainmanagementwithclinicalhypnosis.Whatcanyoudo?howitmakesadifference?
1100–1130 Tea Break
1130–1300 Ballroom 3SYMPOSIUM 20PAEDIATRIC ANAESTHESIAChairperson: Murniati Mustafa
Ballroom 1 & 2
SYMPOSIUM 21UPDATES IN CRITICAL CAREChairperson: Nurhayati Mohd Idris
1130 – 1200
Challengeoftheneonates [PAGE 60]Lakshmi Thiyagarajan
1130 – 1200
Fluids2017:Balanceorunbalanced?Nor’Azim Mohd Yunos
1200 – 1230
TIVAinchildren [PAGE 61]Teo Shu Ching
1200 – 1230
SteroidsinpneumoniaMahazir Kassim
1230 – 1300
URTIanaesthesiarisk?Evidenceversustraditionalpractice? [PAGE 61]Yoga Bhavani
1230 – 1300
AdvancesinICU:Whatcanmicrocirculationtellus? [PAGE 62]Sabino Scoletta
SCIENTIFIC PROGRAMME (CONTINUED)DAY 3 | 30TH APRIL 2017 (SUNDAY)
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CONGRESS VENUEBerjaya Waterfront Hotel, Johor Bahru – Malaysia88 Jalan Ibrahim Sultan, Stulang Laut, 80300 Johor Bahru, Johor Darul Takzim Tel: (607) 221 9999
REGISTRATIONThe registration hours are:
27th April 2017 (Thursday) 1500 to 1900 hrs
28th April 2017 (Friday) 0700 to 1700 hrs
29th April 2017 (Saturday) 0730 to 1700 hrs
30th April 2017 (Sunday) 0730 to 1100 hrs
IDENTITY BADGESDelegates are kindly requested to wear identity badges during all sessions and functions.
ENTITLEMENTSRegistered delegates will be entitled to the following:
• Admissiontothescientificsessions,satellitesymposiaandtradeexhibition
• Conferencebagandmaterials
• GalaDinner
• Lunches&Coffee/Tea
GALA DINNER RegistereddelegatescanbringtheirguestsfortheGalaDinneron29th April 2017 (Saturday). The cost is RM 100 per person. Please enquire at the registration counter.
SPEAKERS AND PRESENTERSAll speakers and presenters are requested to check into the Speaker Ready Room at least two hours prior to their presentation. There will be helpers on duty to assist with your requirements regarding your presentation.The operating hours are:
27th April 2017 (Thursday) 1700 to 1900 hrs
28th April 2017 (Friday) 0800 to 1700 hrs
29th April 2017 (Saturday) 0800 to 1700 hrs
30th April 2017 (Sunday) 0800 to 1100 hrs
All presentations will be deleted from the conference computers after the presentations are over.
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MOBILE PHONEFor the convenience of all delegates, please ensure that your mobile phone is silenced during the conference sessions.
CONFERENCE INFORMATION
DISCLAIMERWhilsteveryattemptwouldbemadetoensurethatallaspectsoftheConventionasmentionedinthispublicationwilltakeplaceasscheduled,theOrganisingCommitteereservestherighttomakethechangesshouldtheneedarises.
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JB CONVENTION &EXHIBITION CENTRE
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The Organising Committee of the 2017 Annual Scientific Congress of the Malaysian Society of Anaesthesiologists and the
College of Anaesthesiologists, Academy of Medicine of Malaysia (ASC of the MSA/CoA)
wishes to thank the following for their support and contributions:
3MMalaysiaSdnBhdAbbvieSdnBhd
AFTPharmaceutials(SEA)SdnBhdAspenpharma
ATNMedicSdnBhdBBraunMedicalSuppliesSdnBhdBaxterHealthcare(M)SdnBhd
DayaCergas(M)SdnBhdDraegerMalaysiaSdnBhd
FreseniusKabiMalaysiaSdnBhdGemilangAsiaTechnologySdnBhd
GetzHealthcare(M)SdnBhdGlobalmedSdnBhdIDSMedicalSystemsInsanBaktiSdnBhd
KLMedSupplies(M)SdnBhdMarcheWorld(M)SdnBhdMedental(M)SdnBhd
MedicDotComSdnBhdMedik-LinkSales&ServicesSdnBhd
Medilife(M)SdnBhdMerck,Sharp&Dohme(Malaysia)
MundipharmaPharmaceuticalsSdnBhdOralixMarketingSdnBhd
Pfizer(M)SdnBhdPharm-D
PharmaniagaSdnBhdPrimedMedicalSdnBhd
RadiometerMalaysiaSdnBhdRoche(Malaysia)SdnBhd
SchchmidtBioMedTechSdnBhdStarMedikSdnBhd
StraitsScientific(M)SdnBhdTransmedicHealthcareSdnBhdTri-GTechnologiesSdnBhdUMMISurgicalSdnBhd
UnimedSdnBhdViforPharmaAsiaPacificPteLtd
XcoreServicesSdnBhd
ACKNOWLEDGEMENTS
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P L E N A R Y 1
ANAESTHESIA RESPONSE IN CONFLICT AREAS: THE MSF EXPERIENCEReynaldo Joey Soria1, Rafael Van Den Bergh2,3
1Medecins Sans Frontieres – OCA; Amsterdam, the Netherlands 2Médecins Sans Frontières (Doctors without Borders)
3Operational Research Unit, Medical Department, Operational Centre Brussels
O B J E C T I V E S
DoctorswithoutBorders(MSF)hasproventhatinconflictcontexts,safeanaesthesiaispossible,andthe“donoharm”principlecanandmustbeupheld;regardlesslocalmeansandcapabilities.
M E T H O D S
ThisisaretrospectivedescriptionofMSFexperiencethatmainlyreliesinthedeliveryofstandardizedcarewithflexibilitytotailorittoagivensetting.
S U M M A RY
Conflictsarelinkedwithhighnumbersoftraumaandaremainlyoccurindevelopingcountrieswherehealthcaresystems are weak, compromising care for other health issues present in the affected population. Presently,healthcaresuffersthedestructionoffacilitiesandkillingofstaff.Whilerequiredanaesthesiamaybesimilarinnon-conflictcontexts, it is importanttoaccount in localresourcesavailability,supplypossibilities,andtheextentofsurgicalcareneeds.Toperformqualityanaesthesia,itshouldberecognizedtheconstraintslinkedtothecontext:healthsystemcharacteristicswherehospitalsarenolongerfunctional,humanresourcesarescarce,diagnostictools and therapeuticmeansare lacking, and referrals arenotpossible; andpatient characteristicswhereco-morbidities are present and late arrival aggravates thepatient’s health status. TheMSFexperience in conflictcontexts is valuable to understand the typeof anaesthesia that shouldbeused, andwhere some techniquesarenotappropriate.Widelyacceptedare localandspinalanaesthesia;andgeneral intravenoustechniquewithKetamineremainsoneofthepreferredoptions.
C O N C L U S I O N S
Anaesthesiainconflictsischallengingduetoseveralconstraints,butitispossibletoperformsafeanaesthesiabycarefullyconsideringtheneedforbasicinfrastructureandmeans,competenthumanresources,standardoperativeproceduresandadaptedandtailoredtechniquestothecontext:local,spinalandgeneralintravenous.Surgicalcareshouldnotbeprovidedatanycostcompromisingsafetyandquality.Clearpoliciesregardinginformedconsentshouldbeinplace.
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ANAESTHESIA FOR THE ELDERLY: HOW MUCH TO GIVE?Omar Sulaiman
Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
Theelderlypatientposesaspecificchallenge to theanaesthesiawhose rolemightextend fromperioperativephysiciantopalliativecareprovider.Theadage“startlow,goslow”stillholdstrue,butmoreresearchandeducationingeriatricagegroupwillimproveoutcomeandhelpustodevelopexpertiseinthisrelatively“young”subspecialityofgeriatricanaesthesia.
No ideal anaesthetic technique has been describe, but if a through understanding of changes that occur inphysiologyandpharmacologyisthere,anoptimalanaesthetictechniquecanbeindividuallydesigned.Thedegreeofpreparednessandacumenoftheanaesthesiologistismoreimportantthantheanaesthetictechniqueandagents.
Finally,mostofthesurgeryisdonetoimprovequalityofliferatherthantoincreasesurvival.
S Y M P O S I U M 1E M E R G I N G T R E N D S
THE RETURN OF NITROUS OXIDE!Nur Fadhlina Arifin
Hospital Sultanah Aminah, Johor Bharu, Johor, Malaysia
Nitrousoxideisoneoftheoldestdrugsinanaesthesiapracticewhichisstillinusesincediscoveredin18thcentury.Theuseofnitrousoxidehasbecomepopularamonganaesthesiologistinensuringfasterandsmootherinductionprocess,acuteanalgesia inbalancedanaesthesiaand risk reduction in intraoperativeawareness.However,onthenegativeside,nitrousoxideinterfereswithvitaminB12metabolismcausinghematologicalandneurologicaladverse effect, increases incidenceof postoperative nausea and vomiting (PONV) and expansionof gas filledcavity.Therearealsotheoreticalconcernthatadministrationofnitrousoxide increasehealthrisk inpatientsorproviderexposedtothisdrugsandenvironmentalpollution.Thecontroversieslingeringaroundnitrousoxidecausedeclineinitsusage,butwearelookingatthepotentialbeneficialeffectofnitrousoxideoncentralnervoussystem,cardiovascularsystemandacuteandchronicpainmanagement.
S Y M P O S I U M 1E M E R G I N G T R E N D S
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PROCEDURAL PAIN MANAGEMENT IN ADULTUngku Kamariah Ungku Ahmad
Anaesthesiologist and Pain Specialist, Hospital Sultan Ismail Johor Bahru, Johor Bahru, Johor, Malaysia
PainManagementduringprocedureareverychallengingespeciallyifprocedurearetobedonewithoutanesthesia.InahospitalworkingtowardsPainFreeHospitalcertification,PainFreeProcedureisoneofthefiveobjectivestobeachieved.Weasanaesthesiologyteamareverywellknowntohavemoreknowledgeinprovidinganalgesiaforintraoperativeprocedureandduringpost-operativeperiodusingvarioustechniques.WiththisknowledgewePainManagementTeaminHSIJBmanagedtohelpoursurgicaldisciplineteamtoprovideadequatereliefforsomecommonproceduredoneinopenwardoremergencydepartmenteg.Wounddressingandfracturereduction.
Aspecificprotocolwasdesigntoensureproperselectionofpatients;safety,patientscomfortduringproceduresusingmultimodalanalgesiaandspecifictechniques.Follow-upwasmadepostprocedureandcontinuationofcarewasgiventillpatient’sdischarged.Atdischargedallpatientswhoreceivedstrongopioidswasbegivenanappointmenttopainclinicforcontinuationofcaretoensuregoodrehabilitationprocess.
Ourdataindicatesthatduringdressingmeanpainscoreis2,morethen90%ofpatientwasabletobeconvertedtooralanalgesia,lessthen10%requiressedationoranaesthesia,21%requiresadditionalmedicationorspecialtechniquesforpainreliefduringdressing.Sixtysevenpercentwasdischargedwithstrongopioids.Morethen50%attendpainclinicforcontinuationofcareandaveragedstrongopioidsusewas3-5weeks.Infracturereductionproceduresitwasnotedthatmorethen70%ofpatientswhohadfracturereductiondoneunderadequatepainreliefwithoutsedationhadsuccessfulreduction.Meanpainscoreduringreductionwas3and95%hadsedationscoreof0,5%hadsedationscoreof1butnonhadsedationscoreof2andabove.
S Y M P O S I U M 2P A I N M A N A G E M E N T
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PREOPERATIVE BLOOD INVESTIGATIONS IN ELECTIVE SURGERY: A NATIONAL AUDIT ON MINISTRY OF HEALTH ANAESTHETIC PRACTICES
S T Kiung1, N H Hadzrami1, R J Ryan2, HA Hashim3, H Jawahir3, CA Ang4, R L Alias4, L S Tay5, L F Phang6, L K Tan7, K W S Ng8, A Y Zainal Abidin9, W L Lim2, J Hassan1,
V Sivasakthi1
1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia 2Hospital Sungai Buloh, Selangor, Malaysia
3Hospital Selayang, Selangor, Malaysia 4Hospital Melaka, Melaka, Malaysia
5Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia 6Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
7Hospital Wanita dan Kanak Kanak, Likas, Sabah, Malaysia 8Hospital Sultan Hj Ahmad Shah, Temerloh, Pahang, Malaysia
9Hospital Pulau Pinang, Georgetown, Penang, Malaysia
Preoperativebloodtestingiselementaryintheanaestheticassessmentforpatientsgoingforelectivesurgeriestoimprovepatients’overalloutcome.Previousstudieshavedemonstratedthatupto90%ofpreoperativebloodinvestigationsweredeemedunnecessary.Thishasmajorimpactintermsofworkloadandcoststheministrywithnoaddedclinicaladvantagetothepatients.
Anationalcrosssectionalstudywasrecentlycompletedtocapturetheproportionofinappropriatepreoperativeblood investigations done in ASA I andASA II patients, the costs incurred from inappropriate blood orderingpracticeswithintheanaesthesiafraternity.Atotaldatafrom2955patientswerecollected.Meanagewas32.93(±19.93),majorityofpatientswerefemales(60.3%)withequalproportionsofASAIandIIpatientsgoingformostlyminor surgery (64.7%). The blood tests analyzed were full blood count, coagulation profile, renal profile andliverfunctiontest.TheappropriatenessofthetestorderedbyanesthetistswasexaminedinaccordancetotheAnaestheticClinicProtocol2012,publishedbytheMinistryofHealthMalaysia.
Anaesthesiadepartmentdidmassof theblood testordering (72.1%)onfirstencounterandonsecondreview(27.6%).Thishasresultedinatotalof1795indiscriminatebloodtests.Commonestreasonforreorderingofbloodinvestigationswasstatedasroutine(18.8%).ThisamountstoatotalofunnecessaryexpenditureofRM13515.48over3months.However,wedidnotstudythesurgicalcontextoftheirinvestigationorderingpractices.
Thissurveyprovidesaglimpseofnonadherencetoguidelinesandgrosswastage.Protocolimplementationsandfortificationsarestillmandatorytominimizeexpendituresandtoimprovebloodorderingpractices.
S Y M P O S I U M 3P E R I O P E R A T I V E M E D I C I N E
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L U N C H S Y M P O S I U M 1
ROLE OF THE ANAESTHESIOLOGIST IN ENHANCED RECOVERY (based on article of Abdelazeem Eldawlatly8)
Jan P MulierDepartment of Anesthesiology, Intensive Care and Reanimation AZ,
Sint Jan Brugge-Oostende Campus Sint Jan Brugge Ruddershove, Bruges, Belgium
Therehavebeenmanypublishedarticleson implementing theenhanced recoveryafter surgery (ERAS) (www.erassociety.org) protocols with first special reference to gastrointestinal surgery.1,2 ERAS is a clinical pathwayproposedtoimprovetheoutcomeandtospeedtherecoveryprocessaftersurgery.3Inimplementingenhancedrecoveryafterbariatricsurgery(ERABS)protocol,itwasfoundthattheuseofERABSensuredthehighestsafetystandards.3,4ERASguidelinesforthepostoperativemanagementweresuccessfullyimplementedingynaecologic/oncologysurgery.5LookingindepthtotheERASprotocols,youwillfindthatanaesthesiaplaysanimportantroleinmanyaspectsofERAS,includingpatienteducation,preoperativeevaluationandoptimization,anaesthesiachoiceandmedication,fluidtherapy,temperaturemonitoring,andpostoperativeanalgesia.Therefore,thetermenhancedrecoveryafteranaesthesia(ERAA)accuratelydescribestheanaesthesiasectionintheERASprotocols.
Inthepreoperativesection,patientinformationandriskstratificationarethemostimportant.Smokingcessationforatleast4weeksyishighlyrecommendedasisavoidingsedativepremedicationandrequestingweightreductionforobesepatients.Oralhydrationandenergymightbelessimportant.
Intheintraoperativesection,astandardaestheticprotocolshouldbeadhered.Monitoringaestheticdepthtopreventawarenessandtominimizeaestheticsideeffectsisrecommended.Neuromusculartransmissionmonitoringandreversalofneuromuscularblockadearestronglyrecommended.Webelievethatsugammadexwhichisspecificreversalagentforrocuroniumhasensuredtheadequatereturnofmusclefunctionandnearlyeliminatestheproblemofresidualparalysisduringtherecoveryperiod.Anaestheticdrugsshouldbeshortactingwithafocusonmaximalopioidreductionbyusingadditivesthatblocksympatheticactivity.
Inthepostoperativesection,opioidsparingtechniquesincludingregionaltechniquesarestronglyrecommendedasmultimodalanalgesiastrategy.Thisiseasiertoachievewhenusingtotalopioidfreeanaesthesiaintraoperativebypreventingtherapiddevelopingtoleranceandhyperalgesiaafteranormalopioidanaesthesia.Thoracicepiduralanalgesiaisstronglyrecommendedonlyinopenlaparoscopicandthoracicsurgery.
Opioidfreeanaesthesiacanbeachievedbyusingalpha2agonists,lidocaine,magnesiumandketamine,allfourinareduceddosewhencombined.ParacetamolandNSAIDsmightbsufficientasanalgesicspostoperativeandcanbecombinedwithverylowdosesofalpha2agonists,lidocaine,ketamineandmagnesiumagain.6Singledoseorcontinuouswound infiltrationof localanaesthetic isalsohelpfulasanalgesics.7 Inaddition it is important topreventandavoidpostoperativedeliriumwhichincludesavoidanceoflongfastinghours,deepanaesthesia,anduseofbenzodiazepines.
ERAAincludesallaspectsoftheERASprotocolandgivesthepracticinganaesthesiologistthemostimportantfacts;belongtoourspecialty,tobeimplementedinaneasywaytoachieveattheendbetteroutcomeforourpatients.
R E F E R E N C E S1. FeldheiserA,AzizO,BaldiniG,CoxBP,FearonKC,FeldmanLS,etal.EnhancedRecoveryAfterSurgery (ERAS) forgastrointestinalsurgery,part2:Consensus
statementforanesthesiapractice.ActaAnaesthesiolScand.2016;60:289–334.[PubMed:26514824]2. LassenK,SoopM,NygrenJ,CoxPB,HendryPO,SpiesC,etal.Consensusreviewofoptimalperioperativecareincolorectalsurgery:EnhancedRecoveryAfter
Surgery(ERAS)Grouprecommendations.ArchSurg.2009;144:961–9.[PubMed:19841366]3. DoganK,KraaijL,AartsEO,KoehestanieP,HamminkE,vanLaarhovenCJ,etal.Fast-trackbariatricsurgeryimprovesperioperativecareandlogisticscomparedto
conventionalcare.ObesSurg.2015;25:28–35.[PubMed:24993524]4. PedziwiatrM,KisialeuskiM,WierdakM,StanekM,NatkaniecM,MatlokM,etal.Early implementationofEnhancedRecoveryafterSurgery (ERAS®)protocol–
Complianceimprovesoutcomes:Aprospectivecohortstudy.IntJSurg.2015;21:75–81.[PubMed:26231994]5. NelsonG,AltmanAD,NickA,MeyerLA,RamirezPT,AchtariC,etal.Guidelinesforpostoperativecareingynecologic/oncologysurgery:EnhancedRecoveryAfter
Surgery(ERAS®)Societyrecommendations–PartII.GynecolOncol.2016;140:323–32.[PubMed:26757238]6. KhanJS,YousufM,VictorJC,SharmaA,SiddiquiN.Anestimationforanappropriateendtimeforanintraoperativeintravenouslidocaineinfusioninbowelsurgery:A
comparativemeta-analysis.JClinAnesth.2016;28:95–104.[PubMed:26342631]7. HughesMJ,HarrisonEM,PeelNJ,StutchfieldB,McNallyS,BeattieC,etal.Randomizedclinicaltrialofperioperativenerveblockandcontinuouslocalanaesthetic
infiltrationviawoundcatheterversusepiduralanalgesiainopenliverresection(LIVER2trial)BrJSurg.2015;102:1619–28.[PubMed:26447461]8. AbdelazeemEldawlatlyIsenhancedrecoveryafteranesthesiaasynonymtoenhancedrecoveryaftersurgery?SaudiJAnaesth.2016Apr-Jun;10(2):119–120.
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THE FUTURE AND DIRECTION OF NEURO-ANAESTHESIA IN MALAYSIALim Wee Leong
Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
Sub-specialisationtrainingenablesanaesthesiologiststoprovidesuperiorexpertiseinperioperativepatientcare,useofexpensive technology,andclosecollaborationwithsurgeons inspecial interestfields.This isespeciallytrueinneurosurgeryandtheirallieddisciplineswheretheincreasingcomplexityofsurgicalprocedures,expandingknowledgeand increasinglychallengingneurosurgicalpatient requiresthat theanaesthetistundergotrainingtoacquireextraknowledgeandskillstoensuregoodperioperativecaretoourpatients.
Thislecturewillhighlighttheneedsandchallengesinneuro-anaesthesiologyservicesinourcountry.Bycreatingawareness, it ishopedthatmanyyounganaesthetistswillpursuethisexcitingcareer inneuro-anaesthesiaandhencecontributetothebettermentofpatientcareinMalaysia.
S Y M P O S I U M 4N E U R O A N A E S T H E S I A
TRAUMATIC BRAIN INJURY – MALAYSIA EXPERIENCEMohd Fahmi Lukman
Faculty of Medicine & Defence Health, National Defence University of Malaysia
Traumaticbrain injury (TBI) isamajorcauseofmorbidityandmortality inallagegroups. It isamajorcauseofdisability and the survivors often suffer cognitive,moodandbehavioural disorders.Currently, the treatment isaimedatminimizingthesecondarybraininjury,noeffectivetreatmenttoreversetheeffectsofprimarybraininjuryyet.Worldwide,around10milliontraumaticbraininjuriesdetrimentalenoughtoresultinhospitalization,life-longdisability,ordeathoccurannually.Forourcountry,in2007,outof584majortraumapatients,55.6%hadinitialGCSof3to8and90%hadinjuriestotheheadandneck.45%ofallTBIswereintracranialinjurieswithtraumaticsubduralhaemorrhageasthecommonestfindings(28.3%).In2008,0.8%from147607traumapatientswhowereadmitted to the8participatinghospitalswereclassifiedasmajor trauma.65.2%ofmajor traumapatientshadinjurestotheheadandneckand51.7%hadGCS3to8.43.7%oftheintracranialinjurieswereduetotraumaticsubduralhaemorrhage.46.9%ofmajortraumapatientsunderwentsurgerywith54.5%ofthesewereintracranialinjuries.In2009,withthesameparticipatinghospitalsasin2008,outof166768patients,1.2%werediagnosedasmajortraumawith85.4%ofthemhadinjuriestotheheadandneck;63.6%underwentintracranialsurgeries;anincrementofmorbidityfromthepreviousyears.Inconclusion,asotherpartsoftheworld,TBIisanimportantpublichealthproblemsofourcountry.
S Y M P O S I U M 4N E U R O A N A E S T H E S I A
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POSTOPERATIVE COMPLICATIONS OF UNRECOGNIZED SLEEP APNEA (POSA) TRIAL
Eleanor Fe Fey ChewHospital Kuala Lumpur, Kuala Lumpur, Malaysia
Overthelastfewdecades,therehasbeenincreasingconcernthatamajorityofpatientswithOSAareundiagnosedanduntreated.DespitethegrowingawarenessofOSA’seffectonpostoperativeoutcomes,upto80%ofpatientspresentingforsurgerymayhaveundiagnosedOSA.
MajorityofstudiesreportedthatOSApatientshaveworseoutcomesforanumberofevents,especiallypulmonarycomplications.AssociationbetweenOSAandin-hospitalmortalityvariedamongstudies.
POSAtrialisaninternational,prospective,observationalstudyinpatients,withknown,oratriskof,atheroscleroticdisease, undergoingmajor non-cardiac surgery to determine the associationbetweenOSAandpostoperativevasculareventsat30daysaftersurgery.
Resultsofthestudyshowedthatofthe1,212high-riskpatientswhohadundergonesurgery,78%hadadiagnosisor suspicionofOSA,ofwhich40%weremoderate- to- severe.Moderate- to- severeOSA isassociatedwithincreasedriskofpostoperativevascularevents(myocardialinfarction),higherriskforICUreadmission/re-ventilationaswellasriskforrespiratoryinfection.
ThissuggestthatimprovingtherecognitionofOSA,ensuringadequatetherapyandcloseobservationofthesepatientsmaybeastrategytoreducetheincidenceofadversepostoperativeoutcomes.
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PATIENT CENTRIC HEALTHCAREAriffin M Mokhtar
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
“That theultimate testof thequalityofahealthcaresystem iswhether ithelps thepeople it intends tohelp…”(NationalAcademies,2001).Thisquoteservedasthepivotpoint for thepresentation.Thissessionwilldefinewhata“patientcentrichealthcare”concept is.Afterwhich thepresenterwillexplain thedimensionsofpatientcenterednessaccordingtoGerteiss(1993)andhowitrelatetotheInternationalPatientSafetyGoalsasadvocatedbytheJointCommissionInternational(2017).Theconceptthenislinkedtothecomplexadaptivenatureofthehealthcaresystemandtheneedtoredesignthecurrentsystemtoachievethepatientcenterednessrequiredtoensuresafetyofthepatient.ThesessionlaterwillconcludewithelaborationofthekeychallengesofredesigningandimplementationofapatientcentrichealthcareorganizationusingexamplesfromtheliteratureandthepresenterwillsharehisexperienceindesigningandimplementingthehealthcareenterprisearchitectureforasimilarinitiativeinMalaysia,fortheparticipantstolearnfrom.
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SIMULATION AS AN ESSENTIAL TOOL IN ANAESTHESIA TRAINING Richard H Riley
University of Western Australia, Nedlands, WA Australia
B A C K G R O U N D
Trainingwith realistic devices is not a newphenomenon inmilitary, aviation and other high-stakes industries.Healthcare education has increasingly incorporated training aids to supplement traditional techniques oflectures,discussionsandapprenticeships.Thus,part-tasktrainers,animalandcadavermodelsandincreasinglysophisticatedmannequinsbecamecommonplace forskills trainingofmedicalproceduralists.But thiswasnotenoughtoprepareanaesthetistsandotheracute-carephysiciansformedicalcrises.
E V I D E N C E
Publishedstudiesfromanaesthesiaincidentmonitoringsurveysandauditsofadverseoutcomeshavedeterminedthatmedicalstaffdonotmanageperioperativeemergenciesoptimally.Well-trainedandknowledgeabledoctorswere often impeded by inadequate or incorrect behaviours. Healthcare looked to aviation to understand theimportanceofnon-technicalskills(humanfactors)insupplementingmasteryofthecomponentskillstoenhancepassengerandpatientsafety.Immersivesimulationwithsophisticated,realisticmannequinsrepresentsthemostrecentstepinevolutionofeducationinmedicalcrisismanagement.
A P P R O A C H
As academic educationalists, andother relatedprofessionals, such aspsychologists, turned their attention tosimulationcentres,‘simulationists’werechallengedandsomeoftheirearlyideaswerequestioned.Coursestructureswere refinedandextra levelsofacademic rigourwere imposed.With thesenew interprofessional relationshipscamenewopportunities.Simulation-richcoursesbecamemoreacceptableforestablishedcurriculaandallowedthemtoachieve‘mainstream’status.SimulationisnowembeddedintrainingprogramsforAnaesthesia[MOCA(USA);EMAC(Australasia,HongKong)],andEmergencyMedicine[ACME,(Australia)].
C O N C L U S I O N
Withtherelativerarityofanaestheticcrisesandtheacceptancethatcliniciansoftenperformpoorlyduringrealemergencies, it is imperative that trainees and practitioners be exposed to simulated emergencies at regularintervals.
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FIELD ANAESTHESIAReynaldo Joey Soria
Anesthesia And Pain Management Advisor (Medecins Sans Frontieres –OCA; Amsterdam, the Netherlands)
O B J E C T I V E S
Surgicalcareneedsaredifferentfromcontexttocontextandanaesthesiaprovidersneedtorecognizethedifficultieslinked to thesecontexts.MSF (DoctorswithoutBorders)hasproven thateven in low-resourcedsettings, safeadministrationofanaesthesiaispossible.
M E T H O D S
ThisisaretrospectivedescriptionofMSFexperiencethatmainlyreliesinthedeliveryofstandardizedcarewithflexibilitytotailorittoagivensetting.
S U M M A RY
Theaimoffieldanaesthesiaistosavelivesandtofacilitatesurgery,andalthoughconditionsareunfavourable,itisstillpossibletoadministersimpleanaesthesiaofgoodquality.Thereisnoessentialdifferencebetweennormalanaesthetic practice and those of anaesthesia in low-resourced settings. What make the differences are thepracticalaspects,constraintsandconditions.Thefundamentalprinciplemustbe‘DoNoHarm’andsometimesnotoperatingmaybemoreappropriatethansurgeryunderunacceptablydangerousconditions.Usually,thestandardisverybasicwithverylittleavailableelectronicmonitoringequipmentbutatleast,apulseoximetermustbeavailable.Alsooxygencylindersareoftennotavailableandoxygenconcentratorsareausefulalternative.Asanaesthesiamachineswithventilatorsarenotcommon,self-inflatingbagsmightbethesolution.Anaesthesiatechniquesshouldconsidertherisksandthebenefitsforthepatientandthefollowingshouldbetakenintoaccount:cardiorespiratorydepression and muscular paralysis and low dependency on oxygen and biomedical devices. Recommendedtechniques: local infiltration,spinalanaesthesiawhileepidural isnot recommended, regionalblocksonly if theanaesthetistisproficient,andgeneralintravenouswhilegeneralinhalationisverydifficulttoachieve.
C O N C L U S I O N S
Anaesthesiaofqualityinthefieldremainsachallengeduetoweakhealthcaresystemsandlackofadequatehumanresourcesandmaterial.However,anaesthesiashouldaimforthebestpossiblequalitythatcanbeofferedinagivencontext.
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DONATION AFTER CARDIAC DEATH (DCD) : ARE WE READY?Omar Sulaiman
National Transplant Resource Centre (NTRC) & HSA
Organdonation after cardiac death (DCD) is not new concept but one that has gained increased attention inthepast several yearsasaviableandappropriatemethodof recoveringorgans.Thiswas thefirstmethodoforgandonorrecoveryeverutilisedandwascalled“non-heartbeatingdonation”.Inthoseearlyyearsonlykidneyswere recovereddue toavarietyof limitation includingsurgical technique, ischaemiaandavailablemethodsofpreservation.Today, kidneys, liver,pancreasand in somecases lungsandheartscanalsobe recoveredandsuccessfullytransplantedfromdonorswhohavehadacardiacarrest.DCDisanoptionforfamiliesofpatientswhohaveasevereneurologicalinjuryand/orirreversiblebraindamagebutstillhaveminimalbrainfunction.Afteraphysicianhasdeterminedthatapatienthasnochanceforrecoveryandthefamilyhasdecidedtowithdrawnsupport,thefamilyisofferedtheoptionofDCD.Thisallowthemtohonourtheirlovedone’sdecisiontobeanorgandonoranddirectlyhelpsthoseawaitingalife-savingorgantransplant.Throughouttheprocess,thereareconflict-of-interestsafeguards,withseparatetimesandpersonnelforimportantdecisions.Organrecoverystaffisseparatefromthoseareprovidingcareforthepatient.Thedeterminationthatapatienthassufferedalifeendinginjuryanddecisiontowithdrawsupportaremadepriortoanyrequest,decisionfororgandonation.
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COMMUNICATING TREATMENT GOALS IN ACUTE PAIN MANAGEMENT: COMMUNICATION DURING PATIENT CARE
Ungku Kamariah Ungku AhmadAnaesthesiologist and Pain Specialist, Hospital Sultan Ismail Johor Bahru, Johor Bahru, Johor, Malaysia
Managingpatient’spainisanartwhichrequirespassionsandskillstoprovidebesttreatmentbecausepainisverysubjective.Asaprovideralotofissuesruninmindwhiledealingwithpatient’spain.Thecommonquestionsare,“howmuchcanyoutrustyourpatient’spaincomplaint”,‘isthepatienttellingthetruthorheisjustmalingering?’.
Indeliveringagoodacutepainmanagementitisveryimportanttohaveagoodcommunicationskill;howevertocreateagoodcommunicationhealthcareproviderarerequireto:
• Haveknowledgeonassessmentofpain,principleofpainmanagement,drugsforanalgesia,varioustechniquesinprovidingpainrelief
• Understandpatient’sperceptionsandlevelofunderstandinginexpressingtheirpain,thepatient’sknowledgeontheirright’sforpainreliefandoptionthatcanbeprovidedforthem.
• Havefeelingsofempathy,sympathyandwillingness’toprovidehelporcaretopatient’sandmostimportanceistolistenandtrustthepatient’sword
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TIVA IN DAY SURGERYGordon T C Wong
Department of Anaesthesiology, University of Hong Kong, Hong Kong
Successful ambulatory surgery requires the use of an anaesthetic technique that produces good quality ofrecoveryinthephysiological,functional,emotionalandcognitivedomains,incombinationwithappropriatelogisticarrangements.Tothisend,propofolbasedtotalintravenousanaesthesia(TIVA)techniqueiseminentlysuitabletoachievetheseaims.Withtheavailabilityofopentargetcontrolledinfusion(TCI)systemsandgenericpropofolthecostsarenolongerprohibitiv