01 Mar 2008

Berita Anestesiologi - March 2009


Newsletter of the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists,
Academy of Medicine of Malaysia

Malaysian Society of

College of Anaesthesiologists,
Academy of Medicine of Malaysia

Editor: Dr Rafidah Atan
Academy of Medicine of Malaysia
19 Jalan Folly Barat, 50480 Kuala Lumpur, Malaysia
Tel: 603-2093 0100, 2093 0200 Fax: 603-2093 0900
email: acadmed@po.jaring.my
website: www.msa.net.my

Table of Contents


Message from the President

Friends and colleagues,

I would like to take this opportunity to wish all members of the MSA a very happy and fruitful 2008 (albeit a little late).

The Anaesthetic Community
In the last Berita I wrote about the Anaesthetic Community in Malaysia. In this issue I would like to touch on the greater anaesthetic community, regionally and globally.


The MSA is a member of CASA or the Confederation of ASEAN Societies of Anaesthesiologists. CASA was formed in the late 1970s with the following aims and objectives:

  1. To promote closer ties amongst the national societies of anaesthesiologists in particular and the world in general by personal contact and all other means available
  2. To organise regular meetings so that anaesthesiologists in ASEAN can exchange views, information, knowledge and experiences in medicine and in anaesthesiology and critical care
  3. To help elevate the standard of training and practice in Aanesthesiologiy and Critical Care in ASEAN.

Originally, CASA had only five members - Malaysia, Singapore, Thailand, Philippines and Indonesia, but recently Vietnam, Laos and Cambodia have joined the Confederation. CASA is the body which organizes the biennial ASEAN Congress of Anaesthesiologists (ASA) - each country takes its turn to organise the ASA, and the 15th ACA was just held in Pattaya, Thailand in November 2007. As many of you may already know, the MSA has the task of organizing the 16th ACA in 2009, and we have already decided to hold the Congress in Kota Kinabalu, Sabah from 2nd to 5th July 2009. So please mark your diary. This will be the third ACA that we have organized, the last one being the 11th ACA in 1999.

CASA is a very small and close-knit community of anaesthesiologists and it is always very nice to meet up with our friends from ASEAN at the ACA. The ACA is a unique event which combines scientific program with cultural exchanges and I would certainly encourage our MSA members to attend the ACA as it is usually quite affordable.


The MSA is also a member of the WFSA or the World Federation of Societies of Anaesthesiologists. The following is taken from the WFSA webpage, http://www.anaesthesiologists.org:

"The WFSA was first formally constituted at the World Congress of Anaesthesiologists in Scheveningen, the Netherlands in 1955. There were 28 founder member societies. The WFSA is a non-governmental organisation (NGO) in relation with the World Health Organisation (WHO)... WFSA objectives are to make available the highest standards of anaesthesia, pain treatment, trauma management and resuscitation to all peoples of the world and to disseminate the same amongst them... The Federation now has 118 member societies."

The WFSA also has Regional Sections. The MSA belongs to the Asian-Australasian Regional Section (AARS) which hosts the Asian-Australasian Congress of Anaesthesiologists (AACA) every four years. The last AACA was held in Singapore in 2006 and the next meeting will be held in Japan in 2010.

The WFSA holds the World Congress of Anaesthesiologists once in four years. This year is World Congress year, and a number of our MSA members will be attending the 14t h World Congress of Anaesthesiologists (WCA) in Capetown, South Africa in early March. The next World Congress will be in Buenos Aires, Argentina in 2012. Singapore has plans to bid for the 16th WCA in 2016 and the MSA has expressed our support for them. If they are successful, we may have the opportunity to hold some pre- or post-congress meetings in Malaysia.

The WFSA views anaesthesia as a medical specialty. A physician with specialty postgraduate training in anaesthesiology should administer anaesthesia in all its forms. The development of educational programmes and all other activities to achieve that aim are supported by the WFSA. To this end, Anaesthetic training centers have been established in South Africa, Ghana, the South Pacific and Thailand.

The Federation supports Update in Anaesthesia, a continuing education publication intended for the developing world. This now appears in five languages: French, Spanish, Russian, Mandarin and English. The WFSA has helped develop a basic anaesthetic manual, Anaesthesia at the District Hospital, in conjunction with the WHO. It has helped fund Intensive Care in the Tropics. The WFSA funds educational programmes have either initiated or supported intensive courses in East and West Africa, Fiji, Eastern Europe, Central and South America, South East Asia, the Caribbean and the Far East. The WFSA also promotes Primary Trauma Courses adapted to less affluent countries. Courses on the Maintenance and Repair of Essential Anaesthesia Equipment are arranged in Africa.

As you can see from the above, the WFSA is very active in the developing world and has had many dynamic presidents who have promoted the specialty of anaesthesiology in the world. We in Malaysia can be proud of the fact that our very own Dato? Dr Lim Say Wan has been a President of the WFSA from 1992 - 1996 and has contributed immensely to the WFSA. He has certainly raised the international profile of Malaysia. Other members of the MSA have served in various committees of the WFSA and contributed in other ways as well.

Back to the country...

Presentation Skills Workshop

The MSA has just completed a workshop on Presentation Skills run by a trainer from the British Council. About 16 members attended, many of whom were already "seasoned" speakers. The full report on this workshop is in this issue of the Berita, but my comment is that although the training was not up to our expectations, it did show us that we have, amongst our own senior (and not so senior) members, many who are already very skilled at public speaking. In the future, I think we can conduct similar workshops for our junior members on our own without engaging anyone from external agencies.

AGM/ASM 2008

Preparations for the 2008 AGM/ASM to be held in Awana Porto Malai Langkawi from 24th to 26th April 2008 are well underway. The full details of the program and registration are available on the MSA website, www.msa.net.my. In addition, each member of MSA should have already received the announcement of the AGM/ASM. I urge members to register early and to avoid the "last minute rush" that seems to be ingrained in many of us. As the Annual General meetings of the MSA, the Intensive Care Section and the College of Anaesthesiologists will be held in conjunction with this meeting, it is important for members to attend so that you can be updated in all the activities of the Society and the College as well as the issues that are facing us as anaesthesiologists in Malaysia today.

MSA Website and Newsletter

We are constantly trying to update our website, but this is no easy task. I urge members to visit the website regularly and to give us some feedback on what should be added (and deleted) from the website. We wish the website to be a source of information for members, but we do need your input in order to make it meaningful and useful.

This Berita Anaesthesiologi is also another means of communication and interaction for MSA members, and I would like to take this opportunity to thank Dr Rafidah Atan who has been the editor of the Berita for three years running. Rafidah has done a great job, chasing many people for articles (including me!) and has indicated that she is ready to hand over the job to someone else - so - any takers? Please email me - mary.cardosa@gmail.com, or Ms Y M Kong acadmed@po.jaring.my or Rafidah if you are interested. The Society will try to give you as much support as we can in this challenging task.

Regards and best wishes to all.

Mary Cardosa

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I refer to the College President?s message in the last issue of Berita under section "What?s in a Name?" Dr Namazie wrote: "...recently I have heard anaesthesiologists being called a name that sounds similar to an orifice in the human derriere and that certainly does not smell as sweet. I am sure you all know what I mean... Some nurses in my hospital who returned after completing post basic training in ICU and OT used this term as well. When questioned they said this term is commonly used in the government hospitals where they trained and that too by the anaesthetists themselves. We do have a serious problem here."

I must say that I differ with Dr Namazie. He seems to imply that because anaesthetists and members of the anaesthetic team in the government hospitals, specifically the Ministry of Health (where his nurses were trained) are called 'Anes" which sounds like a bodily orifice, they must be a despicable lot and this is therefore a "serious problem" for the whole anaesthetic community!

My colleagues in the government sector will agree with me that the word "Anes? in the government hospitals has no implications other than the word it stands for until Dr Namazie made it an issue. We do not condone the use of the word "Anes" not because it is offensive but because it is part of the bigger problem of the rampant use of abbreviations which raises patient safety concerns.

Anaesthetists in the government hospitals enjoy high professional standing and hold important positions at hospital and national level. We are recognized for our important roles in the operating theatre, intensive care unit and acute pain service and respected for our professionalism, ethical practice and commitment to patient care.

Dr Ng Siew Hian
Consultant Anaesthetist
Hospital Kuala Lumpur

Letter to the Editor

I refer to the comments by Dr Ng Siew Hian on my writing about the Malaysian penchant for abbreviating the names and other terms. I am glad to note that efforts are being made to correct the situation and that anaesthetists will from now on will be referred to correctly and not in the shortened version as was being used by some.

Let me assure Dr Ng that I commented on this fixation for shortening the terms so as to bring awareness about it and that it is unacceptable which she herself has acknowledged and not because I consider anyone "despicable". On the contrary I hold the government anaesthetists in high regards for their selfless service to the Malaysian people. I am sad to note that Dr Ng has read in my writings more than what was intended. I hope this note from me will put to rest all unnecessary reactions.

I had also written that currently two terms are being used namely - anaesthesiologist (anaesthesiology) and anaesthetist (anaesthesia). I had suggested that we use anaesthetist (anaesthesia) only and do away with the other term as the Australians had done. The Anaesthesia speciality sub committee for credentialing has recommended the term "Anaesthesia" in the specialist register instead of Anaesthesiology. The change will be effected when the Academy Council gives clearance to the change.

Thank you.

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The Malaysian Society of Anaesthesiologists would like to congratulate the following candidates (names in alphabetical order) for passing the recent examinations

Primary Examination

  1. Dr Adawiyah binti A Bakar
  2. Dr Anisa Aisha bt Abu Baker
  3. Dr Azila binti Ahmad
  4. Dr Basir Ahamad bin Sybudhin
  5. Dr Chan See Yun
  6. Dr Cheah Keen Hoe
  7. Dr Chong Tian Huat
  8. Dr Eleanor Fe Fey Chew
  9. Dr Hui Mun Tsong
  10. Dr Imran Osman
  11. Dr Jayakumar a/l Pararajasingam
  12. Dr Liu Chian Yong
  13. Dr Loo Su Yin
  14. Dr Mazlila bt Meor Ahmad Shah
  15. Dr Md Fakhrurrazi Md Salleh
  16. Dr Melvin K Kandasamy @ Alfred
  17. Dr Ng Lip Yang
  18. Dr Norliza binti Yasin
  19. Dr Rohanizah bt Alias
  20. Dr Sajidah Ilyas bt Mohammad Ilyas
  21. Dr Samsul Johari bin Mohd Amin
  22. Dr Sharifah Nor bt Mohd Salleh
  23. Dr Sharon Oh Yeok Gim
  24. Dr Sivakumal a/l Selvanayagam
  25. Dr Sou Shin Ling
  26. Dr Teoh Sim Chuah
  27. Dr Wong Yoke Mooi
  28. Dr Yeoh Chih Nie

Final Examination

  1. Dr Andre Kevin Fernandez
  2. Dr Azarinah bt Izaham
  3. Dr Azizul Hisham bin Bahari
  4. Dr Azmin Huda binti Abdul Rahim
  5. Dr Lim Ern Ming
  6. Dr Mohamed Kamal Eldin Abdalla Dafa Alla
  7. Dr Rosfadhilah bt Mohd Desa
  8. Dr Rosman bin Noor Ali
  9. Dr Saiful Aizar bin Kesut
  10. Dr Sheliza bt Jamil
  11. Dr Tan Hung Ling
  12. Dr Vasanthan a/l Vajiravelu
  13. Dr Yap Huey Ling
  14. Dr Yap Soon Sin
  15. Dr Yoga Bhavani a/p M Shanmuganathan
  16. Dr Zuraini bt Md Noor

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Successful Presentation Workshop

By Dr Premela Naidu, Hospital Sungai Buloh

Public speaking and having to give a presentation has almost always freaked me out. So, when MSA organised the ÔSuccessful PresentationÕ workshop on the 11th and 12th of January 2008, I seized the opportunity to attend.

At 9 a.m. on the first day, I made my way to the seminar room at Pusat Pengajian Lanjutan, Hospital Selayang. To my horror, I found myself in a room filled with very experienced speakers who have presented at international conferences!

It seemed like, our facilitator for the workshop, Mr Johnathan Tangri from the British Council was not prepared for this lot. It was only a matter of time before his capabilities were questioned. Soon af ter lunch Mr TangriÕs presence was overshadowed by the brilliant minds and strong personalities in that room.

All 18 participants were provided with a training module but sadly it is meant to cater for novices like me. However, all was not lost. The two hourly feeds allowed the participants to exchange notes and gossip to their hearts content.

The highlight of the workshop was on the second day when each participant had to give a five minutes presentation, followed by constructive criticism and comments from the audience. Weaknesses and strengths were pointed out and taken with goodwill. Sixteen presentations and hundreds of comments later the congregation broke up at 5 p.m. As public speaking plays a vital and pivotal role in most peopleÕs success, it was a good attempt by MSA to organise a workshop with the aim of honing this skill amongst its members.


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Malaysian Society of Anaesthesiologists & College of Anaesthesiologists, AMM Annual General Meeting / Annual Scientific Meeting 2008

Theme: "Safety in Anaesthesia"
Date: 25th to 27th April 2008
Venue: Awana Porto Malai, Langkawi, Kedah, Malaysia

Organising Chairperson: Dr Mortadza Ramli
Scientific Chairperson: Assoc Prof Jaafar Md Zain
Scientific Co-Chairperson: Dr Felicia Lim


Watch out for further news on the MSA website www.msa.net.my

MSA ASM 2008

19 Jalan Folly Barat, 50480 Kuala Lumpur, Malaysia
Tel: (603) 2093 0100, 2093 0200
Fax: (603) 2093 0900
Email: acadmed@po.jaring.my

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Introduction to Appraising Medical Literature Workshop

27th - 28th October 2007
by Dr Shireen Sree Jayan

A new paradigm for medical practice is emerging. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience and pathophysiologic rationale as sufficient grounds for clinical decision-making and stresses the examination of evidence from clinical research. Evidence-based medicine requires new skills of the physician, including efficient literature-searching and the application of formal rules of evidence in evaluating the clinical literature.

With these thoughts in our minds, "The Introduction to Appraising Medical Literature Workshop 2007" was conducted at Melaka Manipal Medical College from the 27th - 28th October 2007 and was organized jointly by the Malaysian Society of Anaesthesiologists and the Department of Anaesthesiology and Intensive Care, Hospital Melaka. We had with us distinguished speakers from the National University Hospital of Singapore, Assoc Prof Dr Eugene Liu Hern Choon and Dr Poon Keah How.

Graced with the attendance of 32 enthusiastic participants from various states in Malaysia, our two very passionate and dedicated facilitators kicked off the two day workshop with an introduction to literature appraisal and evidence based medicine where differences in systemic reviews and meta-analysis were elaborated on and old terms like case control, cohort studies and randomized controlled trials were reintroduced.


We were also taught on how to formulate clinical questions and then were taken on a journey through Pubmed and other search engines like Cochrane Collaboration and Google Scholar where we were taught quicker and very efficient methods of extraction of literature in a systemic manner to acquire Evidence based information.

The afternoons were filled with knowledge on concepts for article appraisal, application of Evidence Based Medicine and how to keep ourselves updated with the latest literature published.

In a simple and concise manner our facilitators guided us through these issues, patiently answering burning questions participants had for them. We were also exposed to some statistical techniques commonly used in published articles and how to evaluate the analysis.

The participants were also treated to an Ikan bakar session after the first day of lectures where the night was spent relishing the deliciously cooked fish while enjoying the exotic ambience Muara Anjung Batu offered.

To conclude, the workshop was indeed a brilliant exercise, familiarizing participants with the importance of understanding and extracting useful information from the sea of medical literature available on our search engines. Medical practice is changing, and these workshops would enable us to use the medical literature more effectively in guiding our medical practice.

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National Anaesthesia Day 2007

Report by Dr Shireen Sree Jayan

Our National Anaesthesia Day was celebrated with much merriment on 19t h October 2007 in Hospital Melaka.

The occasion not only commemorated a significant historic event, which is the founding of pain free surgical procedures, it also marked the opening of an additional Intensive Care Unit (ICU) and the official launching of the Chronic Pain Clinic in Hospital Melaka.

Two weeks prior to our Anaesthesia Day celebrations, a display of posters was set up at our hospital lobby depicting the establishment of our new services such as the New ICU and the Chronic Pain Clinic by the Anaesthesiology Department. The excitement in the air was clearly palpable even at this initial stage, when our efficient and eager department staff worked closely together as a team, to make the event a success.

A week before the actual day, Dr Harijah Wahidin participated in a radio talk on FM 102.3 (Radio Melaka) on the topic of Chronic Pain where an elaborate explanation of the clinic?s services was given to the Melaka population.

The Anaesthesia Day ceremony itself was graced by the presence of Dr Hajjah Nooraini Bt Baba, Pengarah Kesihatan Negeri Melaka, and Dr Dul Hadi Bin Mat Junid, Pengarah Hospital Melaka, along with all the Heads of Departments of the various specialties. Our Head of Department, Datin V Sivasakthi welcomed all the dignitaries and guests in her opening speech followed by the launch of the Anaesthesia Day Ceremony by Dr Hajjah Nooraini Bt Baba, Pengarah Kesihatan Negeri Melaka.

Datin Sivasakthi brought to everyone?s attention the historic significance of celebrating the Anaesthesia Day. Anaesthesia was officially founded on 16t h October 1846 by Dr Morten at the Massachusetts Hospital in Boston when he demonstrated a painless tooth extraction under anaesthesia. This subsequently opened a world of opportunities, where various life saving operations could be done with the help of anaesthesia, which would have been impossible before.

Dr Harijah Wahidin spoke on the cures and treatment of chronic pain. The chronic pain clinic which began in September 2005 was initially conducted once a month but has now been extended to twice a month and is currently benefiting 37 patients from Tampin, Muar and Malacca.

Datin Sivasakthi then announced that an additional intensive care unit had been set up. The existing ICU would be named ICU Mawar while the new one would be named ICU Orkid. These ICU?s would be run under the management of our intensivist, Dr Anita Alias. Datin Sivasakthi also added that the ICU?s have been named after flowers as we believe our service in providing healthcare will grow everyday, just like a flower.

To conclude, this day was indeed an excellent opportunity to introduce to the general public the multiple roles of an anaesthetist and to convey information regarding services offered by an anaesthetic department to the people.

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Continuing Professional Development Activity

on 8th September 2007
at the Institut Jantung Negara


This year, the Department of Anaesthesia, Institut Jantung Negara (IJN) is again given the task to organize the above activity to promote Continuing Professional Development of the Anaesthesiologists around Klang valley as per mandated by the society. This year?s theme is perioperative management of patients who has heart disease coming for a non-cardiac surgery, as a follow-up to last year?s basic cardiothoracic anaesthesia. This theme was chosen due to the importance of the condition for general anaesthetists in their daily work due to the high incidence of the disease in our community. Topics were chosen to give an overview of perioperative management of ischemic and congenital heart diseases. A total of seven (7) lectures and lecturers comprising of cardiologists, pediatric cardiologists, electrophysiologist and consultant anaesthesiologists were invited to give the lectures in their related field during the half day meeting.

The Program

The Master of Ceremony was Dr Hoe Kah Siong. The lectures scheduled for the morning that was divided into two sessions by a tea break. The first session covered perioperative management of ischemic heart disease patients coming for non-cardiac surgery and the second session was perioperative management of congenital heart disease patients coming for non-cardiac surgery. The lectures in the first session covered topics ranging from investigations for ischemic heart diseases to risk stratification and perioperative management of the said group of patients. The second session covered the overview of congenital heart disease and Perioperative management of congenital heart patient for non-cardiac surgery. The last lecture covered perioperative management of arrhythmias. The list of the lectures and the speakers are as follows:

Diagnosing ACS in the preoperative setting:
The role of biochemical markers

Dr Shaiful Azmi
(Cardiologist, IJN)

Role of echocardiography in stratifying risk
perioperatively: What is new and which is relevant?

Dr Mohd Rahal Yusoff
(Clinical Specialist Cardiology, IJN)

Assessment and preparation of IHD patients for
non-cardiac surgery: What is new?

Dr Ariffin Marzuki Mokhtar
(Consultant Anaesthesiologist, IJN)

Perioperative management of the IHD patients for
non-cardiac surgery

Dr Thiru Kumar Namasiwayam
(Consultant Anaesthesiologist, IJN)

The paediatric congenital heart disease patients:
An overview for the anaesthetist

Dr Choo Kok Kuan
(Paediatric Cardiologist, IJN)

Managing post congenital correction surgery patients
for non-cardiac surgery

Dr Nor Azlina Abdul Jalil
(Consultant Anaesthesiologist, IJN)

Diagnosing and managing perioperative arrhythmias
Dr Azlan Hussin
(Consultant Cardiologist, IJN)

Tea break was at 10.30am and light meal was catered for the participants and speakers. There was a lot of questions and discussion during the break with questions directed to some of the speakers.


A total of 70 participants (excluding the MC and speakers) attended the programme that consists of mainly Klang valley anaesthesiologists, masters candidate from Universiti Kebangsaan Malaysia and Universiti Sains Malaysia and from the private sectors. This is an increase from the last year?s 56 participants. It shows that the last year programme was a success as more participants find it useful to attend the programme this year. However, this year there was no involvement from the paramedical staff as it was felt that the discussion are to cater more for the practicing anaesthesiologists.


Overall, the program went on smoothly and there were suggestions for the next year?s topic being brought forth by the attending participants that include the management of a pregnant heart disease patients managements for example. We will continue to carry the theme for managing cardiac and thoracic diseases in the future to cater for the wide variety of practice of the participants.

Prepared by:
Dr Ariffin Marzuki bin Mokhtar
Consultant Anaesthesiologist
Department of Anaesthesia
Institut Jantung Negara

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15th ASEAN Congress of Anaesthesiologists

Pattaya, Thailand
by Assoc Prof Datin Norsidah Abdul Manap

The 15t h ASEAN Congress of Anaesthesiologists was held in Pattaya Exhibition and Conference Hall (PEACH), Thailand from 10th - 13th November 2007 with the theme ?Globalization and Cooperation in Anaesthesia, Pain and Critical Care Medicine?. The two-hour drive from Bangkok introduced us to the famed traffic jam but the stress was subdued once we reached the scenic and comfortable Royal Cliff Beach Resort. Around 35 Malaysians attended (this figure was taken from the organizers as we had no way of doing a head count) out of a total of more than 1200 participants.

A wide variety of anaesthesia topics by international speakers from the UK, USA, Australia, Europe, South Africa and, of course, ASEAN countries, catered for the various interests of the anaesthetic subdisciplines. Four concurrent pre-congress workshops, plenaries, three concurrent symposium sessions, lunch symposia and poster presentations were held.

MSA sent three representatives to the Confederation of ASEAN Societies of Anesthesiologists (CASA) meeting and our incumbent President, Dr Mary Cardosa, is now CASA?s President, as it will be Malaysia?s turn to host the 16th ACA from 2nd - 5th July 2009 in Kota Kinabalu, Sabah.

Thailand?s rich culture shone in the opening ceremony and extended to the ?Alangkarn? extravaganza night. The tradition of each Asean country performing before the audience saw Malaysia making a debut ?boria? to entice participants to our future Congress in 2009. The best part was the late night practice that was full of laughter and squeals. We must thank everyone involved, especially to Dr Thohiroh Abd Razak who organised and scripted it. Let?s hope we?ll enjoy hosting the next ACA with the same enthusiasm and teamwork. It is time to expose our very own rich untapped culture and warm hospitality!

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