Publications by authors named "Wan Fadzlina Wan Muhd Shukeri"

9 Publications

  • Page 1 of 1

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

Levels and Diagnostic Value of Model-based Insulin Sensitivity in Sepsis: A Preliminary Study.

Indian J Crit Care Med 2018 Jun;22(6):402-407

Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia.

Background And Aims: Currently, there is a lack of real-time metric with high sensitivity and specificity to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models; however, its effectiveness as a diagnostic test of sepsis is unknown. Our aims were to determine the levels and diagnostic value of model-based SI for identification of sepsis in critically ill patients.

Materials And Methods: In this retrospective, cohort study, we analyzed SI levels in septic ( = 18) and nonseptic ( = 20) patients at 1 (baseline), 4, 8, 12, 16, 20, and 24 h of their Intensive Care Unit admission. Patients with diabetes mellitus Type I or Type II were excluded from the study. The SI levels were derived by fitting the blood glucose levels, insulin infusion and glucose input rates into the Intensive Control of Insulin-Nutrition-Glucose model.

Results: The median SI levels were significantly lower in the sepsis than in the nonsepsis at all follow-up time points. The areas under the receiver operating characteristic curve of the model-based SI at baseline for discriminating sepsis from nonsepsis was 0.814 (95% confidence interval, 0.675-0.953). The optimal cutoff point of the SI test was 1.573 × 10 L/mu/min. At this cutoff point, the sensitivity was 77.8%, specificity was 75%, positive predictive value was 73.7%, and negative predictive value was 78.9%.

Conclusions: Model-based SI ruled in and ruled out sepsis with fairly high sensitivity and specificity in our critically ill nondiabetic patients. These findings can be used as a foundation for further, prospective investigation in this area.
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http://dx.doi.org/10.4103/ijccm.IJCCM_92_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020646PMC
June 2018

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury.

Respir Med Case Rep 2018 8;23:93-95. Epub 2018 Jan 8.

Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia.

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist.

Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.

Case Presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.

Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.
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http://dx.doi.org/10.1016/j.rmcr.2018.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772507PMC
January 2018

Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment.

Malays J Med Sci 2017 Oct 26;24(5):83-93. Epub 2017 Oct 26.

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

Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU.

Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS ( 33) and BF therapy groups ( 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA.

Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, 0.003) and magnesium (0.94 versus 0.80 mmol/L, 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO, lactate, and sodium level.

Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.
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http://dx.doi.org/10.21315/mjms2017.24.5.9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772818PMC
October 2017

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

Sepsis mortality score for the prediction of mortality in septic patients.

J Crit Care 2018 Feb 6;43:163-168. Epub 2017 Sep 6.

Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia. Electronic address:

Purpose: To derive a prediction equation for 30-day mortality in sepsis using a multi-marker approach and compare its performance to the Sequential Organ Failure Assessment (SOFA) score.

Methods: This study included 159 septic patients admitted to an intensive care unit. Leukocytes count, procalcitonin (PCT), interleukin-6 (IL-6), and paraoxonase (PON) and arylesterase (ARE) activities of PON-1 were assayed from blood obtained on ICU presentation. Logistic regression was used to derive sepsis mortality score (SMS), a prediction equation describing the relationship between biomarkers and 30-day mortality.

Results: The 30-day mortality rate was 28.9%. The SMS was [еlogit(p)/(1+еlogit(p))]×100; logit(p)=0.74+(0.004×PCT)+(0.001×IL-6)-(0.025×ARE)-(0.059×leukocytes count). The SMC had higher area under the receiver operating characteristic curve (95% Cl) than SOFA score [0.814 (0.736-0.892) vs. 0.767 (0.677-0.857)], but is not statistically significant. When the SMS was added to the SOFA score, prediction of 30-day mortality improved compared to SOFA score used alone [0.845 (0.777-0.899), p=0.022].

Conclusions: A sepsis mortality score using baseline leukocytes count, PCT, IL-6 and ARE was derived, which predicted 30-day mortality with very good performance and added significant prognostic information to SOFA score.
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http://dx.doi.org/10.1016/j.jcrc.2017.09.009DOI Listing
February 2018

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

A rare complication of tracheal intubation.

Indian J Crit Care Med 2016 May;20(5):299-301

Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI.
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http://dx.doi.org/10.4103/0972-5229.182209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876653PMC
May 2016
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