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Biomedical subjects

C K Koay

Publications and source records attributed to C K Koay.

At least 19 recordsLinked to original sources
PubMed2005

The ProSeal laryngeal mask airway size selection in male and female patients in an Asian population.

The aim of this study was to investigate if size 5 compared with size 4 ProSeal laryngeal mask airway (PLMA) in Asian men and size 4 compared with size 3 ProSeal laryngeal mask airway (PLMA) in Asian women, would give a better glottic seal. We conducted a randomized crossover study involving 30 male and 30 female patients of Asian origin. Size 4 and size 5 PLMA were studied in men and size 3 and size 4 PLMA were studied in women. The patients were anaesthetized and paralysed and the PLMA was inserted with the introducer. The oropharyngeal leak pressure (OLP), ease of insertion, anatomical position, mucosal injury, visibility of cuff in the mouth and volume of air required to achieve an intracuff pressure of 60 cmH2O were studied. In male patients, oropharyngeal leak pressure was higher when size 5 PLMA was used (P < 0.001) and there was a higher incidence of mucosal injury (P = 0.025). For female patients, oropharyngeal leak pressure was higher with size 4 PLMA (P = 0.036) while the number of insertion attempts, anatomical position and mucosal injury were similar. The cuff was not visible in the oral cavity in any cases. The mean volume of air required to achieve an intracuff pressure of 60 cmH2O was less than the maximum recommended by the manufacturers. The size 5 PLMA in Asian men and size 4 PLMA in Asian women resulted in a more effective glottic seal. The use of size 5 PLMA in Asian men led to increased mucosal injury.

Adult↗
PubMed2002

The use of vasopressin to treat catecholamine-resistant hypotension after phaeochromocytoma removal.

A patient undergoing excision of phaeochromocytoma developed refractory hypotension which was complicated by significant intraoperative blood loss. Cardiovascular support with fluids, blood and noradrenaline failed to reverse the hypotension. Introduction of vasopressin successfully reversed the hypotension. The experience with this case suggests that vasopressin may be a useful adjunct in the treatment of catecholamine-resistant hypotension after phaeochromocytoma excision.

Adrenal Gland Neoplasms↗
PubMed2001

A randomized trial comparing two laryngeal mask airway insertion techniques.

This study was undertaken to compare laryngoscopic-guided LMA insertion with a standard insertion technique. A total of 149 patients undergoing elective general surgical and orthopaedic procedures were randomly divided into two groups. Study endpoints included ease of insertion, haemodynamic changes, local trauma bleeding, and postoperative sore throat. There were no statistically significant differences found. The laryngoscope may aid laryngeal mask airway insertion in some circumstances.

Adult↗
PubMed2001

A case report of a fractured healthytooth during use of Guedel oropharyngeal airway.

A young Chinese male with healthy dentition was admitted for haemorrhoidectomy. General anaesthesia was administered using facemask and a Guedel oropharyngeal airway with patient breathing spontaneously on nitrous oxide, oxygen, desflurane. Except for a brief episode of laryngospasm, no adverse events were noted intraoperatively. Postoperatively however patient was found to have a fractured upper incisor. Mechanism of possible events that caused the fracture are postulated. Problems associated with the use of Guedel airway are discussed and alternatives proposed.

Adult↗
PubMed2000

Towards a pain-free venepuncture.

A randomised, prospective trial was conducted to assess the efficacy of various means of alleviating the pain of subcutaneous lidocaine infiltration. One hundred and twenty-two patients were randomly allocated to different groups to receive buffered lidocaine 1%, warmed lidocaine 1% or infiltration by the counter-irritation technique. A visual analogue pain score was recorded at different stages of cannulation and results showed that pain scores were significantly lower in the group receiving buffered lidocaine 1% (p < 0.02) and in the counter-irritation group (p < 0.05). Thus buffering lidocaine 1% and administration of lidocaine 1% by the counter-irritation technique is effective in relieving the pain of lidocaine infiltration.

Anesthesia, Local↗
PubMed2000

Tuberous sclerosis presenting for laparotomy.

A 30-year-old female patient with tuberous sclerosis presented for anaesthesia and surgery for haemorrhagic renal angiomyolipoma. The anaesthetic management of this case was tailored to the prevention of seizures. Diagnostic features and possible complications of the disease are also described.

Adult↗
PubMed1999

Use of EMLA cream or alfentanil for analgesia during ophthalmic nerve blocks.

This prospective double-blind study compared the effectiveness of EMLA with alfentanil and placebo in reducing the overall pain during ophthalmic nerve blocks. Seventy-five patients scheduled for cataract surgery were divided into three groups. Patients in the EMLA group had EMLA cream applied over skin areas corresponding to injection sites for retrobulbar and facial nerve blocks one hour before the nerve blocks, and placebo intravenous normal-saline injection 2 minutes before the first nerve block. The alfentanil group had placebo cream applied and intravenous alfentanil 10 micrograms.kg-1 while patients in the placebo group received placebo cream and intravenous normal-saline at similar time intervals prior to the nerve blocks. Patients then received facial nerve blocks and retrobulbar block by the same surgeon. Pain scores by patients and independent observers were significantly lower in the EMLA and alfentanil groups compared to placebo (P < 0.005) with no significant difference between the EMLA and alfentanil groups.

Aged↗
PubMed1998

Alkalinization of lidocaine does not hasten the onset of axillary brachial plexus block.

UNLABELLED: We assessed the onset of sensory and motor blockade as well as the distribution of sensory blockade after axillary brachial plexus block with 1.5% lidocaine hydrochloride 1:200,000 epinephrine with and without sodium bicarbonate in 38 patients. The onset of analgesia and anesthesia was recorded over the distributions of the median, ulnar, radial, and medial cutaneous nerves of the forearm, medial cutaneous and lateral cutaneous nerves of the arm, and musculocutaneous nerve. The onset of motor blockade of elbow and wrist movements was also recorded. Data were analyzed by using survival techniques and compared by using log rank tests. Only the onset of analgesia in the medial cutaneous nerves of the arm and forearm, and the onset of anesthesia in the medial cutaneous nerve of the arm were significantly faster (P < 0.05) with alkalinization of lidocaine. Our study showed that alkalinization of lidocaine does not significantly hasten block onset in most terminal nerve distributions. IMPLICATIONS: We examined whether alkalinizing a local anesthetic would quicken the onset of a regional upper limb nerve blockade. We found that alkalinization of lidocaine did not offer a significant clinical advantage in axillary brachial plexus blockade.

Adult↗
PubMed1998

Pain on injection of propofol. A comparison of cold propofol with propofol premixed with lignocaine.

Propofol is frequently associated with pain on injection. Previous studies have suggested that chilling of the propofol decreases pain significantly. This prospective, randomised, double-blind trial was designed to assess the effectiveness of cold propofol compared with propofol premixed with lignocaine in minimising pain on injection. Patients were allocated to one of four groups: propofol + lignocaine 0.1 mg.kg-1, propofol + lignocaine 0.2 mg.kg-1, cold propofol and a control group consisting of propofol premixed with normal saline and maintained at room temperature. The results of this study show that cold propofol is associated with a very high incidence of injection pain while lignocaine 0.1 mg.kg-1 premixed with propofol significantly decreases the incidence of pain (p < 0.001). Increasing the dosage of lignocaine above 0.1 mg.kg-1, however, does not significantly decrease the incidence of pain further. The addition of lignocaine also significantly decreases the incidence of excitatory side-effects.

Adolescent↗
PubMed1998

Difficult tracheal intubation--analysis and management in 37 cases.

AIM: To analyse the anatomical features of difficult airways encountered during general anaesthesia and study how difficult intubation was circumvented during anaesthesia in our local population. METHOD: Difficult intubation was defined as failure to visualise the larynx during laryngoscopy after neck flexion and external cricoid pressure was applied. All cases of difficult intubation collected over 1 1/2 years during general anaesthesia were recorded prospectively and analysed. RESULTS: Thirty-seven cases of difficult intubation were identified among 5,379 cases of general anaesthesia requiring endotracheal intubation. 40.5% of the cases were not expected to be difficult pre-operatively. 5.4% of the cases were Lehane II, 91.9% Lehane III and 2.7% Lehane IV. The anatomical features encountered included receding chin, limited mouth opening, limited neck extension, abnormal dentition, short thyromental distance, large tongue, supraglottic mass and floppy epiglottis. Gum elastic bougie was commonly used to overcome the intubation difficulties. Laryngeal mask, blind nasal tracheal intubation, fiberoptic bronchoscopic intubation and sometimes an alternative anaesthetic technique, such as regional anaesthesia, were resorted to. CONCLUSION: Assessment of multiple anatomical features would improve prediction of difficult intubation. Assessment of receding chin, neck extension, mouth opening, teeth, tongue size, thyromental distance might pick up 81% of difficult airways. Unexpected problems with epiglottis and glottic inlet are the potential sources of danger that are difficult to predict pre-operatively.

Adolescent↗
PubMed1998

Planning and design of a surgical intensive care unit in a new regional hospital.

Critical care unit design has profound effect on work efficiency, infection control and psychology of patients and staff working in the area. A multidisciplinary team was involved in the design and planning of a surgical intensive care unit (SICU) in a new regional hospital. A workgroup consisting of clinicians, nurses, engineers and hospital administrators were involved in its planning. The Hospital Planning Committee oversaw the activities of the workgroup to ensure co-ordination and integration of the unit plan with the hospital plan. The issue on "single room" versus "open unit" patient room design was much debated. "Single room" concept was adopted and the cubicles were arranged radially facing a central station. Access of patients from the operating theatres and wards to the SICU was an important consideration. The design and facilities of various rooms in the SICU are described. New technology such as the automated guided vehicle, pneumatic tube system, floor mounted power column and closed circuit television were some of the useful assets available in the unit.

Hospital Design and Construction↗
PubMed1997

Intrathecal pethidine: an alternative anaesthetic for transurethral resection of prostate?

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine. A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.5% bupivacaine intrathecally and group B received 40 mg pethidine intrathecally. Changes in blood pressure and heart rate were measured over the first 30 minutes. The highest sensory block and the time to reach it were documented. The degree of motor blockade was also recorded. There was no significant difference in the incidence of hypotension. The pethidine group had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting. Intrathecal pethidine did not offer any advantage over intrathecal bupivacaine for TURP.

Aged↗
PubMed1991

Shivering during regional anaesthesia and its control with pethidine.

Ninety-seven consecutive patients who underwent four different types of regional anaesthesia such as lumbar epidural, spinal, caudal and brachial blocks were studied for their incidence of shivering. Fifty percent of patients who received epidural anaesthesia shivered compared to 19% of patients who received either spinal or caudal anaesthesia. None of the patients who had brachial block shivered. Intravenous injection of 25 mg pethidine would stop shivering in almost all patients who shivered during regional blocks.

Adult↗