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W K Lo

Publications and source records attributed to W K Lo.

At least 37 records · Page 2Linked to original sources
PubMed2000

A comparison of patient-controlled epidural analgesia following gynaecological surgery with and without a background infusion.

We conducted a randomised, controlled study to investigate the effect of adding a background infusion to patient-controlled epidural analgesia for postoperative pain relief. Forty-two patients scheduled for elective lower abdominal gynaecological surgery received patient-controlled epidural analgesia postoperatively using a mixture of 0.2% ropivacaine and 2.0 microg x ml-1 fentanyl. Patients in group B (n = 20) were given a background infusion of 5 ml x h-1, whereas those in group N (n = 21) were not. There was no difference in pain scores or patient satisfaction scores between the two groups. Patients in group B had a higher total drug consumption (156.8 +/- 34.8 ml vs. 89.5 +/- 41.0 ml; p < 0.0001) and incidence of side-effects (71.4% vs. 30.0%; p = 0.007). Motor blockade during the 24-h study period was also greater in group B (median [range] area under the curve 7.5 [0.0-39.0] h vs. 3.0 [0.0-36.0] h; p = 0.035). We conclude that the addition of a background infusion to patient-controlled epidural anaesthesia is not recommended as it confers no additional benefits.

Amides↗
PubMed2000

A randomised double-blind placebo-controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy.

OBJECTIVE: To assess whether transcervical intrauterine instillation of local anaesthetic agent reduces pain during diagnostic outpatient hysteroscopy and endometrial biopsy. DESIGN: Prospective, randomised, double blind, placebo-controlled trial. SETTING: Outpatient hysteroscopy clinic in a university teaching hospital. POPULATION: Ninety women undergoing outpatient diagnostic hysteroscopy with or without endometrial biopsy. METHODS: Transcervical intrauterine instillation of 5 mL of 2% lignocaine into the uterine cavity before performing the procedure. MAIN OUTCOME MEASURES: Evaluation of pain at different stages of the procedure using a visual analogue scale and changes in blood pressure and heart rate. RESULTS: The use of local anaesthetic did not alleviate pain experienced during hysteroscopy and endometrial biopsy. It did not prevent the occurrence of vaso-vagal reactions; however the incidence of these was low. CONCLUSIONS: Transcervical instillation of local anaesthesia neither reduced pain nor prevented vaso-vagal reaction during hysteroscopy and endometrial biopsy.

Administration, Topical↗
PubMed2000

Use of hyperbaric oxygen therapy in Hong Kong.

The Recompression Treatment Centre on Stonecutters Island has been operating in Hong Kong for more than 5 years and has been used to treat a variety of diving-related and other conditions by means of hyperbaric oxygen therapy. Up to the end of December 1997, 295 treatment sessions had been conducted for 39 patients. This article reviews the usefulness of and indications for hyperbaric oxygen therapy.

Carbon Monoxide Poisoning↗
PubMed2000

Simultaneous removal and reinsertion of Tenckhoff catheters for the treatment of refractory exit-site infection.

Exit-site infection (ESI) refractory to medical therapy is an important complication of continuous ambulatory peritoneal dialysis (CAPD). Between July 1994 and June 1998, 28 patients in our hospital underwent simultaneous removal and reinsertion of Tenckhoff catheters for the treatment of refractory ESI. The ESI was caused by Pseudomonas aeruginosa in 22 patients (78%), methicillin-resistant Staphylococcus aureus in 5 patients (18%), and diphtheroid bacilli in 1 patient (4%). The patients had received antibiotic treatment for a mean duration of 11.6 +/- 5.8 weeks (range: 3-28 weeks) before their operations. During each operation, the old Tenckhoff catheter was removed and a new catheter was inserted in the opposite side of the abdomen. CAPD was resumed after two weeks of intermittent peritoneal dialysis. All patients received intravenous antibiotic cover for seven days after the operation. Early post-operative complications were uncommon. At one year after the operation, 22 patients (78%) were free of ESI. Six patients (22%) had a recurrence of ESI 21.3 +/- 6 weeks (range: 16-32 weeks) after their operation. All new infections were treated successfully with antibiotics. Seven patients (25%) had one episode of peritonitis each, all of which resolved with intraperitoneal antibiotic treatment. We conclude that simultaneous removal and reinsertion of Tenckhoff catheters is a safe and effective method for the treatment of refractory ESI. The procedure alleviates the need for temporary hemodialysis and allows an early return to CAPD.

Adult↗
PubMed1999

Paracervical anaesthesia in outpatient hysteroscopy: a randomised double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy. DESIGN: Prospective, randomised, placebo-controlled, double-blind study. POPULATION: One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal uterine bleeding. INTERVENTIONS: Paracervical block using 10 mL of either 2% lignocaine or normal saline before the procedure. MAIN OUTCOME MEASURES: Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart rate monitoring. RESULTS: Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension. CONCLUSIONS: Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of inadvertent intravascular injection.

Adult↗
PubMed1999

Long-term renal allograft recipients from South-east Asia in the pre-cyclosporin era.

The clinical outcome of long-term renal allograft recipients in the Chinese population has not been reported previously. We analysed patients from the pre-cyclosporin era who had grafts that functioned for > 10 years. Forty-five patients (31 men, 14 women; mean age 30, follow-up duration 13.3 years), representing a 10-year graft survival of 53%, were included. Thirty-six patients (80%) received living-related allografts and 9 (20%) received cadaveric or living-unrelated renal transplantation. The mean serum creatinine at last follow-up was 1.36 mg/dl (range, 0.83-4.08). Major posttransplantation complications included: hypertension in 25 (56%), infection in 16 (36%), acute rejection in 15 (33%), lipid disorder in 13 (29%), liver disease in 7 (16%), osteonecrosis in 5 (11%), malignancy in 4 (9%), coronary artery disease in 3 (7%), and diabetes mellitus in 3 (7%). Five grafts were lost: 3 to chronic rejection, and 2 to patients with stable function who died of non-renal causes. Proteinuria correlated strongly with graft function and survival, and marginally with hypertension. In hepatitis B carriers, serum alpha-feto protein is useful in the early detection of hepatocellular carcinoma. We conclude that while patients in the pre-cyclosporin era can survive with excellent graft function beyond the first decade, the risk of complications leading to significant morbidity still remains even when patients are receiving minimal doses of immunosuppression in the second decade.

Adolescent↗
PubMed1999

Optimal peritoneal dialysis for patients from Hong Kong.

The socioeconomic statuses of Asian countries are diverse and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment but also the choice of dialysis modality. Despite the economic growth of Hong Kong over the past three decades, the resources spent by our government on health services are less than other developed countries. The National Health Service, which is run on a tight budget, supports almost 95% of the patients on renal replacement programs. Due to the cost-effectiveness and reimbursement from the government, 79% of patients with end-stage renal failure in Hong Kong are treated with continuous ambulatory peritoneal dialysis (CAPD). All new patients entering the renal replacement program run by the National Health Service are offered CAPD as the first-line dialytic treatment. Due to budgetary constraint, over the past 10 years dialysis centers in Hong Kong have adopted a small-volume regime of 3 x 2-L daily exchanges as the initial dialysis prescription. This dialysis prescription will be considered to be suboptimal by Western standards, but the survival of these patients was comparable to, or even better than, other areas despite a lower Kt/V. These preliminary studies suggest small-volume dialysis may be an acceptable compromise in Asian populations with their smaller body size, given the financial constraints. These issues are especially important in Asia, where financial resources for renal replacement therapy are still limited in most countries and many patients have to continue working to pay for their renal replacement treatment. Using this small-volume dialytic regime, more patients may be treated with the limited financial resources. Furthermore, our experience raises the question of the importance of nutritional status in patient survival.

Asia↗
PubMed1999

Combined spinal epidural for labour analgesia--duration, efficacy and side effects of adding sufentanil or fentanyl to bupivacaine intrathecally vs plain bupivacaine.

AIM OF STUDY: The aim of the study was to evaluate the efficacy and side effects of adding sufentanil 10 micrograms, fentanyl 10 micrograms or a control of 1 mL saline to 2.5 mg bupivacaine given intrathecally via combined spinal epidural (CSE) for labour pain relief in the first stage. METHOD: Sixty ASA I or II patients who requested for epidural analgesia were randomised to three groups. CSE was performed with a 16G Touhy needle and 27G Whitacre needle. RESULTS: Patients in the sufentanil/bupivacaine group had a significantly longer duration of analgesia (162.9 min +/- 63.4) compared with fentanyl/bupivacaine (110.0 min +/- 44.6) compared with plain bupivacaine (70.0 min +/- 32.1). Pruritus was significant in patients with sufentanil (80%) and fentanyl (47.4%) but did not occur with plain bupivacaine. There was no significant difference in the incidence of nausea or vomiting, hypotension and motor blockade although blood pressures in the sufentanil group were consistently lower than the other two groups. Pain scores were lowest in the sufentanil group. Fetal heart rate changes and Apgar scores were not significantly different between the groups. CONCLUSION: In combined spinal epidural for labour analgesia, adding sufentanil 10 micrograms to intrathecal bupivacaine 2.5 mg provided fast onset and good analgesia for a longer duration compared with adding fentanyl 10 micrograms and with plain bupivacaine. The main side effect was pruritus. Neonatal outcome was similar.

Adjuvants, Anesthesia↗
PubMed1998

New development of laparoscopic ultrasound and laparoscopic pelvic lymphadenectomy in the management of patients with cervical carcinoma.

OBJECTIVES: The objectives of this study were to evaluate the use of laparoscopic ultrasonography (USG) in combination with laparoscopic pelvic lymphadenectomy in the management of patients with cervical carcinoma. METHODS: A technique for detecting pelvic and para-aortic lymph node metastases through laparoscopic USG was developed. Laparoscopic USG was done prior to pelvic lymphadenectomy performed either laparoscopically or by laparotomy. Laparoscopic USG findings were compared with pathologic findings. RESULTS: The sensitivity and specificity of laparoscopic USG in detecting pelvic lymph node metastases were 91 and 100%, respectively. Metastatic pelvic lymph nodes could be completely removed through laparoscopes in 7 of 11 patients, with no complications. CONCLUSION: Laparoscopic USG is highly sensitive in detecting metastatic pelvic lymph nodes. Detection and removal of metastatic pelvic lymph nodes laparoscopically allow quick recovery from the operation and early commencement of radiotherapy.

Adult↗
PubMed1998

Intrathecal sufentanil as the sole agent in combined spinal-epidural analgesia for the ambulatory parturient.

PURPOSE: To compare the effect of a combination of intrathecal (i.t.) sufentanil plus bupivacaine with i.t. sufentanil alone, on the incidence of hypotension and the success of ambulation in parturients. METHODS: This was a controlled, double-blind prospective trial involving 50 parturients in early labour who had received combined spinal-epidural analgesia (CSE). They were divided equally into two groups; group A received 10 micrograms i.t. sufentanil while group B received i.t. 10 micrograms sufentanil plus 2.5 mg plain bupivacaine. The blood pressure, pain scores, the highest sensory block and the degree of motor blockade were documented over the first 30 min by an unbiased anaesthetist. The ability and the desire to ambulate was studied 30 min after CSE. The side effects were documented throughout labour. RESULTS: Group B had a higher incidence of hypotension; (12 vs 3: P < 0.01). Fewer parturients in group B could ambulate (19 vs 25: P < 0.05). Group B also had a higher sensory blockade than group A (median T4 VS T7-8: P < 0.01). Of all the 44 parturients who could ambulate, 13 desired not to do so, usually due to sedation. CONCLUSION: The quality of analgesia in all subjects in the study was excellent. Side effects were more common in the i.t. sufentanil-bupivacaine combination group.

Analgesia, Epidural↗
PubMed1998

Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis.

We examined the effects of a 12-week exercise program on the exercise tolerance, blood biochemistry, blood pressure (BP) control, cardiac function, and quality-of-life (QOL) scores in 13 patients undergoing continuous ambulatory peritoneal dialysis (CAPD; six men, seven women; mean age, 46.5+/-12.8 years; mean duration on dialysis, 4.8+/-3.8 years). The patients underwent exercise training on treadmill, bike, and arm ergometers thrice weekly. Seven CAPD patients matched for age, sex, and duration on dialysis served as controls. The mean peak aerobic capacity (VO2peak) of the exercisers increased by 16.2% after training (pre- and postexercise, 17.2+/-5.2 v 20.0+/-6.4 mL/kg/min; P=0.004). Although there were no significant changes in serum urea, creatinine, albumin, and hematocrit levels; left ventricular diastolic/systolic diameters; and ejection fraction, an increasing trend of high-density lipoproteins (HDLs) was observed in the exercisers (baseline v postexercise, 33+/-11 v 40+/-14 mg/dL; P=0.06). Twenty-four-hour ambulatory BP monitoring showed a significant increase in daytime systolic BP in the exercisers (pre- and postexercise, 142+/-26 v 157+/-22 mm Hg; P=0.003), but no significant changes could be found in the ambulatory daytime diastolic BP, nocturnal BP, and resting clinic BP. The patients' QOL improved after training, with better scores in two Kidney Disease Quality of Life scales (KDQOL): burden of kidney disease and physical functioning. Two mild and uncomplicated hypotensive episodes were reported in two patients immediately after training. No changes occurred in exercise capacity, blood biochemistry, BP profile, and QOL scores in the controls. We conclude that structured aerobic exercise is safe and can improve the exercise tolerance and QOL outcomes in CAPD patients.

Adult↗