Publications by authors named "Rhendra Hardy Mohamad Zaini"

13 Publications

  • Page 1 of 1

Comparison of the Air-Q intubating laryngeal mask airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic assisted endotracheal intubation for simulated cervical spine injury.

Anaesthesiol Intensive Ther 2021 ;53(3):241-245

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia (USM), 16150 Kubang Kerian, Kelantan, Malaysia.

Introduction: Airway management in patients with a cervical spine injury is a difficult and challenging task. The aim of this study was to compare the effectiveness of the Air-Q intubating laryngeal airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic (FO) assisted endotracheal intubation in adult patients with a simulated cervical spine injury.

Material And Methods: A total of 66 adult patients underwent elective surgery under general anaes-thesia, and they were randomized to two groups: the Air-Q (AQ) group (n = 33) and the Ambu AuraGain (AA) group (n = 33). A simulated cervical spine injury was created using a cervical collar, which was applied after the induction of general anaesthesia. Ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, oropharyngeal leak pressure (OLP), Brimacombe score for FO laryngeal view, post-intubation complications and haemodynamic changes were recorded for both groups.

Results: The OLP was significantly higher in the AA group than in the AQ group (34.9 ± 6.4 vs. 28.6 ± 7.8 cm H 2 O; P = 0.001). Otherwise, there were no significant differences in the ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, Brimacombe score for FO laryngeal view, haemodynamic parameters or complication rate between the two groups.

Conclusions: Air-Q was comparably effective as Ambu AuraGain as a conduit for FO endotracheal intubation in patients with a simulated cervical spine injury; however, Ambu AuraGain has a better seal with significant OLP.
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http://dx.doi.org/10.5114/ait.2021.105759DOI Listing
January 2021

Comparing the Effects of Pre-loading with Gelatine 4% Plasma Volume Expander and 6% Hydroxyethyl Starch Solution Before Spinal Anaesthesia for Lower Limb Orthopaedic Surgery.

Malays J Med Sci 2020 Dec 29;27(6):68-78. Epub 2020 Dec 29.

Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Background: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.

Methods: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte ( 47) or Gelaspan ( 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.

Results: Both fluids could not prevent significant reductions in SBP ( 0.011), DBP ( 0.002) and MAP ( 0.001). There was also significant reduction in HR over time ( 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.

Conclusion: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.
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http://dx.doi.org/10.21315/mjms2020.27.6.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785271PMC
December 2020

Comparison of the Baska mask and the i-gel supraglottic airway devices in patients undergoing elective surgery.

Anaesthesiol Intensive Ther 2020 ;52(5):383-388

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Introduction: The Baska mask and i-gel are two new types of second-generation supraglottic airway devices. The aim of this study was to compare these two devices in terms of quality of insertion, quality of ventilation and post-insertion complications.

Material And Methods: A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications.

Results: Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). There were no significant differences in other parameters.

Conclusions: The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.
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http://dx.doi.org/10.5114/ait.2020.101407DOI Listing
January 2020

Comparison of the Parker flex tip and the unoflex reinforced endotracheal tube for orotracheal fibreoptic intubation in simulated difficult intubation patients.

Anaesthesiol Intensive Ther 2020 ;52(5):377-382

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia.

Introduction: The choice of endotracheal tube (ETT) is important for successful orotracheal fibreoptic intubation (OFI). The aim of this study was to compare the use of the Parker flex tip (PFT) with the unoflex reinforced (UFR) ETT during OFI.

Material And Methods: A total of 58 patients who underwent elective surgery under general anaesthesia were randomised to two ETT groups, the PFT group (n = 29) and the UFR group (n = 29), for OFI in simulated difficult intubation patients using a rigid cervical collar. After successful standardised induction and relaxation, OFI and railroading of selected ETT were subsequently performed by a similarly experienced practitioner. Ease of insertion, degree of manipulation, time to successful intubation, post-intubation complications and haemodynamic changes were recorded for both groups.

Results: he percentage of easy intubation was comparable between both groups with a slightly higher percentage in the UFR group than the PFT group (69.0% vs. 62.0%; P = 0.599). Degree of manipulation was also comparable between the two groups; the percentage of cases in which manipulation was not required was slightly higher in the UFR group than the PFT group (69.0% vs. 62.1%; P = 0.849). Time to successful intubation was also comparable between the groups, although the time was slightly shorter for the UFR group than the PFT group (56.9 s ± 39.7 s vs. 63.9 s ± 36.9 s; P = 0.488). There were also no significant differences in other parameters.

Conclusions: The Parker flex tip ETT was comparable to the unoflex reinforced ETT for OFI in simulated difficult airway patients.
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http://dx.doi.org/10.5114/ait.2020.101387DOI Listing
January 2020

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings.

J Vasc Access 2021 Jan 14;22(1):34-41. Epub 2020 May 14.

Kerala Institute of Medical Sciences, Thiruvananthapuram, India.

Background: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available.

Methods: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

Results: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: (22.9%), spp (10.7%), (5.3%), spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were (11.4%).

Conclusions: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
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http://dx.doi.org/10.1177/1129729820917259DOI Listing
January 2021

Anastomotic Leak after Bariatric Surgery from a Critical Care Perspective: A Lesson Shared.

Malays J Med Sci 2018 Sep 30;25(5):158-159. Epub 2018 Oct 30.

Department of Anaesthesiology and Critical Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Anastomotic leak after bariatric surgery is a rare complication with a recent prevalence ranging from 0.8% to 1.5%. The complication nevertheless can result in morbidity and even mortality. The purpose of this paper is to present a patient who suffered from an anastomotic leak presenting 2 days after laparoscopic sleeve gastrectomy in our intensive care unit. Review of the current literature regarding this complication from critical care perspective is also attempted.
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http://dx.doi.org/10.21315/mjms2018.25.5.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419880PMC
September 2018

Sugammadex Rescue in Avoiding Intensive Care Unit Admission in an Octogenarian Undergoing Emergency Laparotomy.

J Perianesth Nurs 2018 Oct 29;33(5):727-731. Epub 2017 Jul 29.

Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission. He recovered fast and was discharged home 4 days after surgery. This case study aims to contribute to the literature on experience of a successful conduct of anesthesia in a high-risk geriatric patient when ICU facilities are limited.
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http://dx.doi.org/10.1016/j.jopan.2017.06.001DOI Listing
October 2018

Target-controlled Infusion Propofol Versus Sevoflurane Anaesthesia for Emergency Traumatic Brain Surgery: Comparison of the Outcomes.

Malays J Med Sci 2017 Oct 26;24(5):73-82. Epub 2017 Oct 26.

Department of Anaesthesiology, School of Medical Sciences, Jalan Sultanah Zainab II, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia.

Methods: total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) ( = 55) and Group S (sevoflurane) ( = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0-1.5. Both groups received TCI remifentanil 2-8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters.

Results: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S ( = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2-3) [29.1% versus 41.8%] and good outcome (GOS 4-5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters.

Conclusion: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.
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http://dx.doi.org/10.21315/mjms2017.24.5.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772817PMC
October 2017

Comparison of Single-Shot Intrathecal Morphine Injection and Continuous Epidural Bupivacaine for Post-Operative Analgaesia after Elective Abdominal Hysterectomy.

Malays J Med Sci 2017 Dec 29;24(6):21-28. Epub 2017 Dec 29.

Department of Anaesthesiology, School of Medical Sciences, Jalan Sultanah Zainab II, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Abdominal hysterectomy (AH) is painful. The aim of this study was to compare intrathecal morphine (ITM) and epidural bupivacaine (EB) for their analgaesia effectiveness after this surgery.

Methods: Thirty-two patients undergoing elective AH were randomised into Group ITM (ITM 0.2 mg + 2.5 mL 0.5% bupivacaine) ( = 16) and Group EB (0.25% bupivacaine bolus + continuous infusion of 0.1% bupivacaine-fentanyl 2 μg/mL) ( = 16).The procedure was performed before induction, and all patients subsequently received standard general anaesthesia. Both groups were provided patient-controlled analgaesia morphine (PCAM) as a backup. Visual analogue scale (VAS) scores, total morphine consumption, hospital stay duration, early mobilisation time and first PCAM demand time were recorded.

Results: The median VAS score was lower for ITM than for EB after the 1st hour [1.0 (IqR 1.0) versus 3.0 (IqR 3.0), < 0.001], 8th hour [1.0 (IqR 1.0) versus 2.0 (IqR 1.0), = 0.018] and 16th hour [1.0 (IqR1.0) versus (1.0 (IqR 1.0), = 0.006]. The mean VAS score at the 4th hour was also lower for ITM [1.8 (SD 1.2) versus 2.9 (SD 1.4), = 0.027]. Total morphine consumption [11.3 (SD 6.6) versus 16.5 (SD 4.8) mg, = 0.016] and early mobilisation time [2.1 (SD 0.3) versus 2.6 (SD 0.9) days, = 0.025] were also less for ITM. No significant differences were noted for other assessments.

Conclusions: The VAS score was better for ITM than for EB at earlier hours after surgery. However, in terms of acceptable analgaesia (VAS ≤ 3), both techniques were comparable over 24 hours.
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http://dx.doi.org/10.21315/mjms2017.24.6.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771512PMC
December 2017

The dangers of accepting a single diagnosis: case report of concurrent Plasmodium knowlesi malaria and dengue infection.

Malar J 2017 01 3;16(1). Epub 2017 Jan 3.

Hospital Raja Perempuan Zainab II, 15000, Kota Bharu, Kelantan, Malaysia.

Background: Dengue and malaria are two common, mosquito-borne infections, which may lead to mortality if not managed properly. Concurrent infections of dengue and malaria are rare due to the different habitats of its vectors and activities of different carrier mosquitoes. The first case reported was in 2005. Since then, several concurrent infections have been reported between the dengue virus (DENV) and the malaria protozoans, Plasmodium falciparum and Plasmodium vivax. Symptoms of each infection may be masked by a simultaneous second infection, resulting in late treatment and severe complications. Plasmodium knowlesi is also a common cause of malaria in Malaysia with one of the highest rates of mortality. This report is one of the earliest in literature of concomitant infection between DENV and P. knowlesi in which a delay in diagnosis had placed a patient in a life-threatening situation.

Case Presentation: A 59-year old man staying near the Belum-Temengor rainforest at the Malaysia-Thailand border was admitted with fever for 6 days, with respiratory distress. His non-structural protein 1 antigen and Anti-DENV Immunoglobulin M tests were positive. He was treated for severe dengue with compensated shock. Treating the dengue had so distracted the clinicians that a blood film for the malaria parasite was not done. Despite aggressive supportive treatment in the intensive care unit (ICU), the patient had unresolved acidosis as well as multi-organ failure involving respiratory, renal, liver, and haematological systems. It was due to the presentation of shivering in the ICU, that a blood film was done on the second day that revealed the presence of P. knowlesi with a parasite count of 520,000/μL. The patient was subsequently treated with artesunate-doxycycline and made a good recovery after nine days in ICU.

Conclusions: This case contributes to the body of literature on co-infection between DENV and P. knowlesi and highlights the clinical consequences, which can be severe. Awareness should be raised among health-care workers on the possibility of dengue-malaria co-infection in this region. Further research is required to determine the real incidence and risk of co-infection in order to improve the management of acute febrile illness.
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http://dx.doi.org/10.1186/s12936-016-1666-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210313PMC
January 2017

Overcoming airway challenges with the C-MAC video laryngoscope in a child with Goldenhar syndrome.

Indian J Anaesth 2016 Nov;60(11):868-869

Department of Anaesthesiology and Critical Care, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia.

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http://dx.doi.org/10.4103/0019-5049.193704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125198PMC
November 2016

Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery.

Malays J Med Sci 2016 Mar;23(2):28-37

Department of Anaesthesia and Intensive Care Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Background: Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB.

Methods: Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2-4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss.

Results: The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss.

Conclusion: The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976711PMC
March 2016

The effects of topical viscous lignocaine 2% versus per-rectal diclofenac in early post-tonsillectomy pain in children.

Int J Pediatr Otorhinolaryngol 2010 Apr 2;74(4):374-7. Epub 2010 Feb 2.

Department of Anaesthesiology and Intensive Care, University Sains Malaysia Hospital, 16150, Kubang Kerian, Kelantan, Malaysia.

Introduction: Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesic such as NSAIDs and local anaesthetics.

Objective: The aim of this study was to evaluate the efficacy between 2% viscous lignocaine and sodium diclofenac based upon the visual analogue scores (VASs), consumption of pethidine 0.5mgkg(-1) as the rescue drug postoperatively and time taken to resume feeding.

Methods: 130 patients aged between 5 and 12 years old were randomly allocated into 2 groups to be given either 2% viscous lignocaine 4mgkg(-1) body weight topically post-tonsillectomy or sodium diclofenac 1mgkg(-1) per-rectal post-induction of anaesthesia. Postoperatively visual analogues score was done for 24h, the amount of pethidine given and time when the patient start taking oral feeding of clear fluid, soft diet and normal diet were documented.

Results: There was no significant difference in the visual analogue scores in both groups, however the requirement of pethidine as the rescue drug postoperatively was significant 2h post-tonsillectomy (p=0.023) in viscous lignocaine group compared to sodium diclofenac. The time taken to resume oral feeding and soft diet was also significant in viscous lignocaine group (p=0.016 and p=0.007) whereas there was no significant in taking normal diet.

Conclusion: We concluded that 2% viscous lignocaine applied topically post-tonsillectomy is comparable to sodium diclofenac per-rectal in providing analgesia and faster oral feeding.
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http://dx.doi.org/10.1016/j.ijporl.2010.01.005DOI Listing
April 2010
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