01 Apr 2007

Berita Anestesiologi - April 2007


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


Click here to Download Berita Anestesiologi in PDF Format (3.01MB)



Message From The President

Dear Friends and Colleagues

After many years of involvement in the Malaysian Society of Anaesthesiologists, the time has come for me to take the helm as President for a term of two years. I see this as a responsibility, not to be shirked, and certainly not to be taken lightly. I would like to thank Dr Ng Siew Hian who has very ably led the MSA for the past two years - she has worked hard, and has set high standards that I hope I will be able tolive up to. Thank you, Siew Hian, for your leadership and dedication to the MSA and all the new ideas injected and operationalised during your term as President.

I have been ordinary member, committee member, Secretary President-Elect and now President. Nevertheless, it is still a daunting task, this steering of the Society for the next couple of years. Coming from a background of experience working in women's groups, my "style" or working is consultative and collective; sometimes not the most efficient way, but I believe in this process. However I do realize that now the buck stops with me! And the first of my responsibilities is to write a regular "President's Message" in the Berita Anestesiologi, to keep members informed about what is happening in the MSA as well as with regard to issues affecting anaesthetists in Malaysia.

Annual General Meeting and Annual Scientific Meeting

We have just concluded another successful AGM and ASM in Genting Highlands in March this year. I would like to record my sincere thanks to Dr Lim Wee Leong and his organizing committee, for their hard work and contribution, which gave us the desired outcome of a meeting that was balanced in scientific content as well as social events. I am happy to note that we have had a few volunteers to organise future ASMs, the limiting factor being the inavailability of large enough venues in towns outside of Kuala Lumpur, because of the small number of trade exhibition booths that can be accommodated in most of these places. Nevertheless, the Exco has decided that we will continue to alternate holding the AGM/ASM in KL/Klang Valley and outside of Klang Valley, in order to give more members the opportunity both to attend as well as to have the experience of organizing this most important annual event.

AGM/ASM 2008

I am pleased to announce here that the venue of the 2008 AGM/ASM will be Langkawi, and the Organizing Chairperson is Dr Mortadza from Alor Setar. Prof Jaafar Md Zain from HUKM has agreed to be the Scientific Chairman, and they will be recruiting other members for the organizing and scientific committees, from the MSA as well as from the College of Anaesthesiologists, AMM.

At this year's AGM, we had a lot of interesting discussion - this is a good sign, and I hope this will continue. We now have a few new faces in this year's Exco, including some of the "younger generation" (see later in this issue for details). We held our first Exco meeting on 10 April and I would like to use this space to inform members about the plans for this year's activities, as well as how we have assigned tasks to the various members of the Exco.

Activities for 2007 / 2008

The main thrust of our activities will again be continuing professional development (CPD), following the trend set by Dr Ng Siew Hian, our Immediate Past President. We will be continuing the Klang Valley CPD activities, and aim to have a full day or half day session at least four times a year. The main hospitals involved UMMC, HUKM, IJN and HKL have again agreed to do one session each this year, and the first activity has already been planned for 16 June 2007 at HUKM - which will be a full day meeting, jointly orga n i zed with the College SIG on Obstetric Anaesthesia. Please see this issue of Berita for more details, which will also be posted on the MSA Website. Members can attend this activity free of charge, but non-members will be charged RM20 per person per session. If you are to attend all four sessions in the Klang Valley, it would be more economical to join the MSA as a member, as you only pay RM75 for your membership fees, and it comes with a whole lot of other perks, including receiving the Berita Anesthesiologi, the MSA Yearbook, and access to the virtual library that the MSA is subscribing to. So please encourage all your colleagues to join the MSA.

The Intensive Care Section (ICS) will be holding another National Conference on Intensive Care (NCIC) from 22 to 24 June this year. Again, it was decided that this would be an annual event, as there has been so much interest in previous NCIC conferences, from doctors, nurses, medical assistants and other health care providers, as well as the industry.

The CPD committee has also been tasked to look into how to encourage our members to carry out research - we still have no applications for the K Inbasegaran Research Fund, set up last year by a generous donation from the family of Dato' Dr Inbasegaran. We hope that anaesthetists will do some research, which will enhance their own practice as well as contribute to the knowledge base of the discipline. Please see the MSA website for details of how to apply for this fund.

Next year is the 13th World Congress of Anaesthesiologists - this time, held in early March in Capetown, South Africa - you couldn't ask for a more attractive venue. As usual, the MSA will be providing a subsidy to all members who present a paper or a poster at the World Congress. Those applying for the MSA subsidy should not already be receiving sponsorship from another source. This year, we have also formed a committee to look through the papers/posters submitted, and if there are many applicants for the subsidy, we may have to reduce the subsidy per member, or choose the most suitable applicants. In 2004 the MSA spent RM100,000 on subsidies (RM5,000 per person) and we are willing to do the same for 2008. We are also planning to have a session where members who apply for the MSA subsidy do a presentation of their paper or poster as a way of getting some practice and/or feedback from your colleagues. So watch out for this. The closing date for submission of abstracts is early September 2007, so those interested will have to get cracking on your paper/poster now!

We are continuing the MOPS which is a web-based selfassessment tool for anaesthetists to collect CME/CPD points. Even though there may be changes in the near future, we decided to continue this so that members get into the habit of recording their CME/CPD activities.

A new activity this year which was planned from last year, is the CPR committee, headed by Dr Ng. This committee will look into coordinating trainers for ALS courses, and will also look into issues of remuneration for the trainers. At the moment, we are only focusing on ALS, but we will consider carrying out BLS training in our property in Damansara Utama. So if there is anyone interested in doing this, please contact me or any of the Exco members.

Another new activity proposed is to have training workshops on "Presentation Skills" for our members, at a heavily subsidized rate. We will be prioritizing those young anaesthetists who have already presented papers at the ASM free paper session, as well as those who have participated in the Klang Valley CPD activities. We hope that members will avail themselves of this opportunity to improve their presentations, and we also hope that this will encourage young members to "take the plunge" and present something at any of the MSA activities.

We are also continuing the MSA Year Book project started by Dr Ng last year. The first Year book, edited by Dr Rafidah Atan and Dr Nor' Azim Mohd Yunos, was very well received, and this year we have assigned Dr Thong Chwee Ling to be the editor of the Year Book. She will be inviting contributions from members, starting with those who have presented papers at the ASM and NCIC as well as other conferences. Those wishing to contribute something may contact Dr Thong directly; of course, the Exco and Editor reserve the right to select the contributions in order to maintain the standard of this publication.

The MSA website has been a source of up-to-date information for members, which is easily accessible. This year we hope that it will continue to provide a source of information and a means for communication for members. Re garding the on-line registration however, there have been some problems regarding payment of registration fees, so we would encourage members to download the registration forms and send the filled form to the MSA secretariat (c/o Academy of Medicine, 19 Jalan Folly Barat, 50480 Kuala Lumpur) together with a cheque for the annual subscription.

I am happy that Dr Rafidah Atan has agreed to continue to be the Editor of the Berita Anestesiologi for another year - this is no mean task, and Rafidah did a good job last year. I am sure she will do even better this year - as you will see from this first issue of the 2007/2008 term.

I look forward to receiving feedback and ideas from members - with today's technology it is so easy to shoot off an email or an sms to me or any member of the Exco - you are welcome to do so anytime. We will endeavo u r to respond quickly, at least with an acknowledgement of your communication, and will definitely discuss any suggestions at the next Exco meeting. My email address is mary.cardosa@gmail.com or you can send an email to acadmed@po.jaring.my.

I look forward to a fruitful and happy 2007/2008!


Mary Cardosa
16 April, 2007


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MSA Executive Committee 2007 - 2008

President Dr Mary Cardosa
President Elect Assoc Prof Norsidah Manap
Immediate Past President Dr Ng Siew Hian
Chairman Dato' Dr S Jenagaratnam
Hon Secretary
Datin Dr V Sivasakthi
Hon Treasurer Datuk Dr V Kathiresan
Committee Members Dr Thong Chwee Ling

Prof Jaafar Md Zain

Dr S Sushila

Dr R Raveenthiran

Dr Norly Ismail
Coopted Member Prof Dato' Wang Chew Yin

Committees And Members

  1. CPD and Education
    Prof Dato' Wang Chew Yin, Datin Dr V Sivasakthi,
    Prof Jaafar Md Zain, Dr Thong Chwee Ling,
    Dr S Sushila
  2. MSA/College AGM activities
    Assoc Prof Norsidah Abdul Manap, Dr S Sushila
  3. Berita Anestesiologi
    Rafidah Atan
  4. Sponsorship for Courses
    Dr Mary Cardosa, Prof Jaafar Md Zain,
    Datuk Dr V Kathiresan
  5. MOPS
    Dr Ng Siew Hian
  6. Property Management
    Dr Raveenthiran, Datuk Dr V Kathiresan
  7. CPR
    Dr Ng Siew Hian
  8. Year Book
    Dr Thong Chwee Ling
  9. Website
    Dr Norly Ismail

State Representatives

State Representative
Johor Dato' Dr Subrahmanyam Balan
Kedah Dr Mortadza b Ramli
Kelantan Prof Saiful Azman
Melaka Datin Dr V Sivasakthi
Negeri Sembilan Dr Jenny Tong May Geok
Pahang Dr Asmarawati bt Yatim
Penang Dato' Dr Jahizah bt Hj Hassan
Perak Dr Asniza bin Shukor
Perlis Dr Ismail Ahmad
Sabah Dr Lily Ng Mooi Hang
Sarawak Dr Norzalina bt Esa
Terengganu Dr Aisai b Abdul Rahman
Wilayah Persekutuan No Representative (MSA Exco)


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CoA, AMM - President's Ventilation

April is the month when many of the eastern cultures celebrate the dawn of the lunar new year. It is also the month when the new President of the College of Anaesthesiologists takes office and begins his/her (recent past two Presidents were highly accomplished ladies) term to lead the College for a year.

Very eminent people have led the College in the last eleven years and I took office with great trepidation in Genting Highlands as the 12th President of the College. I wondered how I would be able to match the performance of the previous leaders. Nevertheless, now that I am here, I have to do the best to bring the prestige of the College to a higher level.

In this first message I would like to narrate the story of our College and its origin which I believe has not been told before. The College first started as a Faculty of Anaesthesiologists in the College of Surgeons of Malaysia in the 1960's. One of the aims of the Faculty then was to organize and conduct examinations locally and certify anaesthesiologists for the country. The training and examination protocol for the first part examination had been developed in the early 1970's and those for the second part examination were developed in late 1970's with the assistance of the Department of Anaesthesiology in the University of Malaya. I had the privilege and pleasure of being involved in the development of these when I was on the academic staff of the Department.

The Bill to allow the Colleges and the Faculty to conduct postgraduate examinations was in fact tabled in the Parliament in the mid 1970's but, for some reasons best known to only certain people in authority then, was killed after the first reading in the Parliament. The University Kebangsaan Malaysia and later University of Malaya were asked to start the Masters Programme to train and certify anaesthesiologists. It must be recorded here that the curriculum and the format of the examinations in the early years of the Masters Programme in both the Universities were the ones which the Faculty of Anaesthesiologists had co-developed with the Department of Anaesthesiology of University of Malaya. In a way, the Faculty had contributed to the development of training and certification of specialist anaesthesiologists in the country though this fact is little known to many of the younger members of the specialty. Today the College has a representative sitting in the Conjoint Board for Anaesthesiology (Jawatankuasa Bersama Perubatan - Anestesiologi).

When the College of Surgeons and the College of Physicians decided to come under the umbrella of the Academy of Medicine of Malaysia, the Faculty finally stepped away from the shadows of surgeons and became an independent Chapter of Anaesthesiologists and in the year 1999 was accorded the College status by the Council of the Academy of Medicine. It must also be mentioned that in the AGM of the Faculty in 1986 a resolution was adopted to form an independent college of anaesthesiologists and to negotiate with the Council of the College of Surgeons to achieve this. However, the negotiations failed and we remained as a Faculty till the Colleges came under the Academy of Medicine.

In international relations, our Faculty had close collaboration with the then Faculty of Anaesthesiologists of the Royal Australasian College of Surgeons (predecessor of ANZCA). We had co-hosted meetings and one of which had produced sufficient income to fund some of the educational activities. The balance of that fund was carried forward as the seed money for the fledging Chapter of Anaesthesiologists. This relationship had been good for the development of anaesthesiology in Malaysia as the Australian Faculty had conducted both parts of their examinations in Malaysia. In addition, we were able to tap into their vast expertise and experience in many areas of anaesthesiology and training. I am glad to say that the relationship still persists though their examinations are no longer held here as we have our own examinations. We are able to send some of our anaesthesiologists to Australia for advanced training because of this relationship. I hope to continue with this tradition of fostering good relationship with sister colleges not only in Australia but also with those in the neighbouring countries.

There are several areas of concern and challenges that are confronting the anaesthesiologists in Malaysia today. Due to space constraints I will just mention them now and elaborate on them in subsequent messages.

  1. National Specialist Register
  2. Single organization for the Malaysian Anaesthesiologists
    - C Merger of the College and the Malaysian Society of Anaesthesiologists
  3. Private Healthcare Facilities and Services Act (1998) and Regulations (2006)
  4. Career Pathway for Anaesthesiologists in the Public Sector in relation to possible corporatisation/privatization of health care
  5. National Healthcare Financing Policy and the implications for Anaesthesiologists.
  6. Challenges for Anaesthesiologists in the Private Sector and the emerging trend of monopoly in private healthcare
  7. Hospital Accreditation and the role of Anaesthesiologists.

Please do communicate your views and opinions regarding the above issues with me at namazie@streamyx.com


Dr Mohamed Namazie Ibrahim
28 April 2007


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CoA, AMM - Council 2007 - 2008

President Dr Mohamed Namazie Ibrahim
Deputy President Assoc Prof Lim Thiam Aun
Hon Secretary Prof Felicia Lim
Hon Treasurer Prof Chan Yoo Kuen
Council Members Dato' Dr Mohd Hassan Ariff
Dr Joseph Manavalan
Dr V Sivasakthi
Coopted Council Members Assoc Prof Nik Abdullah
Prof Ramani Vijayan
Dr Mary Cardosa

Special Interest Groups (SIG)

The following have been appointed as the convenors for the SIG's :

Airway & Simulation Prof Dato' Wang Chew Yin
Paediatric Anaesthesia Dr Sushila Sivasubramaniam
Cardiac Anaesthesia Dato' Dr Mohd Hassan Ariff
Pain Management Dr Kavita Bhojwani
Ambulatory Anaesthesia Assoc Prof Norsidah Abdul Manap
Obstetric Anaesthesia Prof Lee Choon Yee


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Peripheral Nerve Block Workshop

The above workshop was successfully conducted with a total number of 31 delegates attending. From the evaluation form obtained at the end of the workshop it was clear that most of the delegates were happy with the conduct of the course including the venue, catering services, materials provided and the secretariat services.

The titles of the four scientific presentations were Introduction to Peripheral Nerve Blockade, Peripheral Nerve Stimulator, Upper Limb Blocks and Lower Limb Blocks. Participants found that the level of scientific content of these lectures was good and that they benefited greatly from them. There was a similar response to the practical sessions held in the operation theatre.

The overall rating of the course was good to excellent and participants were of the opinion that the workshop had met their expectations and had succeeded in providing information to improve their standards of clinical practice.

The following comments and suggestions were also volunteered by the participants. These comments will be useful to future organizers of similar workshops.

Comments And Suggestions

A dedicated video cameraman to get the best shots. Overall, well-organized. Should provide more time on practical section.

On Topics
Upper Limb Blocks: Suggest to give examples of blocks in different area of surgery, for example, in AKA, what blocks & the volume should be given.

On Faculty
Upper Limb Blocks: Presenter should speak slower during presentation for the benefit of those who do not have a good command in English.
Lower Limb Blocks: Some sentences were left hanging in the air. It's difficult to grasp what the presenter was referring to.

On OT Sessions
Suggest to have more demonstrations. Well-organized. Good cameramen work.

Suggestions for future workshops

  • To increase duration of practical session in OT (with increase number of patient).
  • Suggest to organize higher level PNB eg paraventebral block.
  • Emphasis on incidence of complications. Guidelines on patients with anticoagulants and antiplatelets.
  • To include topic on 'Mechanical Ventilation'.
  • More patients for Demonstrations.
  • Organize a workshop on nerve blockade for facial nerves.

We must congratulate Hospital Melaka for conducting such a successful workshop!

Anaesthesia Day at Hospital Melaka


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Research Methodology And Biostatistics Workshop (Melaka)

Report by Chow Yen (Yong)

A workshop on Research Methodology and Biostatistics was conducted at Melaka Manipal College from the 9 to 12 January 2007; organized jointly by the Malaysian Society of Anaesthesiologists in collaboration with the Clinical Research Centre, Ministry of Health and Department of Anaesthesiology and Intensive Care, Hospital Melaka.

There were a total of 29 attendees from various states in Malaysia, including one participant who came all the way from Sarawak. All participants were provided with a desk top and lecture notes. They were also given a pre test which was followed by, at the end of the workshop, a post test. A marked improvement in the majority of participants were noted, bringing about lots of cheer and also indicating both the keen interest of both participants in acquiring knowledge, and facilitators in imparting it to them.

The facilitators, from the Clinical Research Center in KL, had arranged an array of informative lectures with lots of hands on exercises using the STATA programme, which all participants had access to via their desk-tops. The topics were similar to those covered during our post graduate study days, yet there were groans of oooh's and aaaah's as participants strived to grasp the essence of the lectures in their quest for self improvement and excellence in this field of clinical research. The thirst for knowledge was clearly evident as questions poured forth after and sometimes even during the lectures, and the facilitators were fast to quench this thirst with explanations and examples.

Datin Dr V Sivasakthi, the organizing chairperson for the workshop and her team worked hard with the facilitators to ensure the smooth conduct of the sessions and that the participants, though mentally exhausted, also had an interesting night out at an ikan bakar outlet at Muara Sg Duyong where they sat as a family and enjoyed an evening of seafood and fun.

On the last day of the workshop, the fruits of our labour at the group work sessions were judged by a panel and the topics of the clinical research methodology presented were as below:

  1. Comparison of the efficacy of sedation and side effects of ketamine and midazolam vs morphine and midazolam in the ICU setting.
  2. Randomized comparison of different forms of Erythromycin as prokinetic for gastroparesis in Intensive Care Unit.
  3. Does the timing of administration of metoclopramide change the incidence of postoperative nausea and vomiting?
  4. Epidural levobupivacaine vs Epidural pethidine as analgesia following Lower Segment Caesarean Section.
  5. Comparison of analgesic efficacy between 20mg and 40mg parecoxib sodium in post-operative pain control for Total Abdominal Hysterectomy in adults.
  6. Comparative study of cardiovascular changes of two methods of proseal LMA insertion in patients going for Elective Surgery in Hospital Kuala Lumpur.

To conclude, the 21st century is the era for greater continuous professional development and thus all of us should try to attend a similar workshop which will be held again next year and strive to improve our expertise in this very grey area to achieve excellence in implementation of clinical trials and gaining world class standards.

Finally something one participant wrote that left us, the organizing committee, with a smile...

A big thank you to Datin Dr Sivasakthi, Dr Shireen, Dr Zainal and the Melaka Hospital team for taking the effort to organize this course. I would rate this course as one of the most useful and inspiring courses I've been to. I wasn't planning to go until the very last minute but have no regrets, think it is time well spent. Using the computer lab at Manipal was brilliant, food was simple but absolutely delicious and the CRC team dedicated. Thanks again.

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Annual Scientific Meeting of MSA & CoA, AMM

by Dr Andrew Ng Wei Aun, University Malaya Medical Centre
9 - 11 March 2007, Genting International Convention Centre

Themed "Refining the Art of Anaesthesia", held above the clouds at Malaysia's favourite highland resort, the p e rennially much awaited Annual Scientific Meeting of the Malaysian anaesthesia community was a resounding success from the start to the end.

The OT-like temperature was a welcomed respite from the heat of the month of February/March. Participants who came expecting an enjoyable, relaxing time while updating their knowledge were not disappointed on both accounts.

The ASM started with three concurrent Pre-Conference Workshops, all held on 8 March 2007, on Acute Pain Management, Fluid Managements and Updates on ACLS respectively. All the workshops were well attended by specialists and medical officers alike. The workshop on Fluid Management saw two experts sharing their experience on current advances surrounding the topic and the controversial Stewart's approach to acid base balance. Of note, the long standing issue on various fluid management strategies remains but, perhaps with the current availability of 'balanced fluids', a consensus should not be long time in coming. Participants of the ACLS Updates and Acute Pain Management workshops were also left satisfied despite a long day.

The Conference proper started off with an excellent plenary by Professor George Hall from St George Hospital, London on Diabetes Mellitus & Anaesthesia. Prof Hall deserved special mention for his British poise and humour, which held the audience's attention throughout his well articulated talk. This memorable plenary thus set the tone for the rest of the Congress. Topics of the symposia and plenaries held throughout the three days were well balanced, covering various aspects and subspecialities of anaesthesia. Prominent speakers from local and abroad spoke on Obstetrics, Monitored Anaesthesia Care, Transplant Medicine, Haematology, Paediatrics, Obesity & Metabolic Syndrome, Pain and TIVA. Also held was the Free Papers session. The number of quality papers bode well for the future of our field. Congratulations to Dr Siti Rohayah bt Sulaiman from HUSM for winning the MSA Aw a rd and Dr Lee Yan Wei from Hospital Ipoh for winning the MSA-AstraZeneca Young Investigator's Award.

Punctuated between the talks were opportunities for walking around the numerous interesting exhibition booths, set up by the pharmaceutical and equipment companies, as well as the poster presentations. Games and prizes at various booths added fun to the process of familiarizing oneself with new drugs and gizmos. The exhibition hall was especially spacious and well laid.

As per tradition, the highlight is the MSA Annual Dinner. A time for good food and entertainment while acquainting with friends old and new. This year's dinner turned out to be an unforgettable event for everyone, being treated to an extended energetic cultural dance performance by the Sutra Dancers.

After the daily programmes, everyone unwound their own way in this City of Entertainment. Some went for the spills and thrills of the theme park, some just loitered around the colourful "city", while others still went for a flutter of the heart at the tables. In the end, all went home sufficiently rejuvenated, their knowledge updated and their anaesthetic art refined.


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MMS & CoA, AMM - Annual Scientific Meeting 2007

Free Paper Presentations

The Annual Scientific Meeting this year saw free scientific communications being presented as posters in addition to the annual oral competition for the Young Investigator¡'s Award.

There was a total of 15 Free Papers. Five were presented at the MSA/Young Investigator's Award Competition while the remaining 15 were presented as posters.

It was indeed very encouraging to see the enthusiasm displayed by the researchers. The presenters must be commended for all the hard work and effort they had put in. This is a healthy trend and we expect a larger number of presentations at the next ASM.

In addition, the competition judges of both the oral and poster sessions were impressed with the quality of the presentations. Selecting the winner in each of the categories was a difficult task as only a narrow margin separated the eventual winner from the other contestants. However, it must also be mentioned that there is still room for improvement. We hope to see progressive improvement in the quality of anaesthetic research in the coming years.

Results Of The MSA/Young Investigator's Award Competition

Best Free Paper Presentation - MSA Award
Presenter Dr Siti Rohayah binti Sulaiman
Department of Anaesthesia & Intensive Care,
Hospital Universiti Sains Malaysia
Paper Titled A comparative study of continuous anaesthetic infusion through an elastomeric pump (ON-Q Pain Relief System) and continuous epidural infusion for postoperative pain in abdominal gynaecological surgery


Young Investigator - MSA - AstraZeneca Award
Presenter Dr Lee Yan Wei
Department of Anaesthesia & Intensive Care,
Hospital Ipoh
Paper Titled Impact of post-operative epidural analgesia regimen on the participation of patient in physiotherapy after total knee replacement (TKR): A comparison of 2 techniques


Oral Presentation Merit Awards
Presenter Dr Norsham Khairati
Hospital Ipoh
Dr Marini bt Othman
Hospital Universiti Sains Malaysia
Dr Tan Bee Hooi
Hospital Pulau Pinang

Results Of The Poster Competition

Best Poster
Presenter Dr Javed Fareed
Department of Anaesthesia & Intensive Care,
Hospital Taiping
Paper Titled Comparison between 2ml and 1.8ml 0.5% Heavy Bupivacaine for elective LSCS under spinal anaesthesia


1st Runner-up
Presenter Dr Lai Hou Yee
University Malaya Medical Center
Paper Titled The longest journey: Road transport of the critically ill


2nd Runner-up
Presenter Dr Goh Paik Kee
Department of Anaesthesia & Intensive Care,
Hospital Ipoh
Paper Titled Exploring the benefit of peripheral nerve block (PNB). An audit of first 500 cases at Hospital Ipoh


Poster Presentation Merit Awards
Presenter Dr Lawrence Tan Chor Loon
Hospital Seberang Jaya
Dr Ariff bin Osman
International Islamic University
Dr Teoh Wei Tsung
Hospital Seberang Jaya
Dr Lim Yee Hoon
Hospital Pulau Pinang
Dr Tan Bee Hooi
Hospital Pulau Pinang
Dr Noor Airini Ibrahim
Universiti Putra Malaysia
Dr Wong Wai Hong
Universiti Putra Malaysia


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3rd Paediatric Anaesthesia & Analgesia Workshop

by Professor Lucy Chan

Date: 9 - 10 July 2006
Venue: Ambulatory Care Centre, Hospital Ipoh
Organized By: Special Interest Group in Paediatric Anaesthesia
College of Anaesthesiologists, Academy of Medicine of Malaysia
Faculty/Committee: Prof Lucy Chan
Prof Felicia Lim
Dr Sushila Sivasubramaniam
Dr Kavita Bhojwani
Dr Usha Nair

Summary Of Report

The 3rd Paediatric Anaesthesia & Analgesia Workshop was held in the Ambulatory Care Centre, Hospital Ipoh over  2 days, offering participants both theory and practical sessions. A total of 47 participants attended the program.

For the seminar on 9 July 2006, the topics included  many practical aspects of paediatric anaesthesia such as management considerations of upper respiratory tract infections, fluids and electrolyte therapy, neonatal surgical emergencies and anaesthesia for ex-premature babies.

The Faculty also conducted a session on interesting case discussions on ¡°Fluid Resuscitation¡± and "Foreign Body in  a Child's Airway". Participants were encouraged to reflect  on the case presentations and to contribute to decision making in managing the cases presented. There was an active exchange of knowledge and sharing of expertise.  The Faculty involved in these sessions were Dr Sushila Sivasubramaniam, Professor Felicia Lim and Professor Lucy Chan.

In addition to the didactic sessions, hands-on sessions were conducted in the Operating Theatre on 10 July 2006 to provide participants with an opportunity to try their hands on a variety of nerve blocks. The faculty demonstrated their skills and guided participants on performance of ilioinguinal nerve blocks, dorsal nerve blocks and caudal epidurals in a total of thirteen cases. The cases included herniotomies, circumcision and orchidopexy.

The feedback received was generally very good, and the workshop met the expectations of most of the participants. There were requests to conduct the workshop twice a year,  so that more trainees could benefit. Many participants also felt that more time should be allocated to OT sessions and that there should be more variety in the cases presented.

This workshop has run successfully for the 3rd year and  will continue to reach greater heights in the future.  The commitment and dedication of the Special Interest Group in Paediatric Anaesthesia in sharing their expertise and knowledge is appreciated by all.


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Intensive Care Section, MSA

Office Bearers

Chairperson Dr Ng Siew Hian
Hon Secretary Dr Nor' Azim Mohd Yunos
Hon Treasurer Dato' Dr V Kathiresan
Committee Members Dr Tai Li Ling
Dr Shanti Rudra Deva
Dr Tan Cheng Cheng
Assoc Prof Nik Abdullah

Regional Advanced Airway Workshop

Date: 28 July 2007, Saturday
Venue: Hospital Pulau Pinang

Organised by the Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang.

A one-day workshop that gives you a chance to hone your skills at managing difficult airways. Local and foreign experts will provide hands-on training for fibreoptic intubations, percutaneous tracheostomies and the use of airway adjuncts.

Who Should Attend

Anaesthesia medical officers/trainees*. Anaesthesiologists*

Kindly e-mail Dr Lakshmi at benshawlly@cooltoad.com for further information.

*From hospitals in Perlis, Kedah, Penang and Perak.

4th Paediatric Anaesthesia & Analgesia Workshop

Date: 28 - 29 July 2007 (Saturd ay & Sunday)
Venue: Hospital Sultanah Aminah, Johor Bahru

Organised by:

- SIG in Paediatric Anaesthesia, College of Anaesthesiologists, AMM
- Aesculap Academy Malaysia
Cost: RM 150.00

Please contact:

Secretariat of 4th Paediatric Anaesthesia & Analgesia Workshop
Aesculap Academy Malaysia
Grd, 1st & 2nd Flrs, Bangunan Hino
Lot PT 24, Jalan 223, Section 51A, 46100 Petaling Jaya, Selangor
Tel: 603-7955 0455   Fax: 603-7955 671 5
Email: aes_academy@bbraun.com


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Hi folks!

For a change, the quiz this month tests your knowledge on the history of anaesthesia. The information required is widely available (just 'Google' right?) and I trust that you'll have no difficulty answering these questions.

The contest is open only to medical officers who are MSA members (for those who aren't members, it's time to become one!). That's right! The prize of yet another copy of the latest edition of Morgan and Mikhail's Clinical Anesthesiology will be given away. All you have to do is participate.

Please email your answers to: rafidah10@hotmail.com or rafidah.atan@med.monash.edu.my


(The first person to provide the most number of correct answers will be declared the winner)

  1. Who discovered nitrous oxide?
  2. Regarding the first public demonstration of anaesthesia:
    1. Name the person conducting the anaesthetic.
    2. What was the date?
    3. What agent was used?

I would like to congratulate Dr Andrew Ng Wei Aun from University Malaya Medical Centre for winning the previous contest. He is now the proud owner of a copy of the 4th edition of Morgan and Mikhail's Clinical Anesthesiology.


The following are the (simplified) answers to the previous contest:

  1. What is your comment?
    Inadequate lateral view of the cervical spine Xray. You must be able to see all seven cervical spine before you can fully comment on the Xray.
  2. What will you do next?
    Obtain further views such as swimmer's view or proceed to CT scan. Please note that there are different protocols for clearance of cervical spine in different centres.

Multiple Choices Questions

  1. Regarding propofol
    1. CYP2B6 is the principal determinant of interindividual variability in hydroxylation of propofol
    2. About 10-20% of propofol undergoes glucuronidation
    3. The bsubunit of the GABA receptor is likely to contain binding sites for propofol
    4. It may act as an agonist at glycine receptor to produce excitatory movements
    5. It increases the serotonin concentrations in area postrema
  2. Regarding etomidate
    1. It is lipid soluble at acidic pH
    2. Cyclodextrin preparation of etomidate is associated with very high incidence of haemolysis
    3. Ethanol is one of the metabolites of etomidate
    4. The d-isomer of etomidate is pharmacologically active
    5. Induction with etomidate usually causes a transient period of apnoea similar to propofol
  3. Regarding etomidate
    1. The incidence of myoclonus may reduced with prior administration of benzodiazepine
    2. It inhibits adrenocortical 18-hydroxylase
    3. Suppression of cortisol synthesis may last for 12-18 hours after a single standard induction dose
    4. Structurally it may be related to some antifungal medication
    5. Rearrangement of molecular structure is crucial in the pharmacological action
  4. Regarding ketamine
    1. It is available as an aqueous solution with chlorobutanol as preservative
    2. It requires benzethonium chloride as the solvent in its preparation
    3. Two optical isomers are identified as there are two asymmetrical carbon atoms found in the structure
    4. S (+) isomer is 4 times more potent than the R (-) isomer
    5. R (-) isomer offers better neuroprotection than the S (-) isomer
  5. Regarding ketamine
    1. The binding site of ketamine within the NMDA receptor is similar to that of glutamate
    2. Analgesic action is partly related to stimulation of nitric oxide synthase
    3. It inhibits the uptake of serotonin and causes nausea and vomiting
    4. Administration of ketamine to critically ill patients may lead to hypotension
    5. Transient cortical blindness is one of the features of emergence delirium


  1. TFTFF
    CYP2B6 and to a lesser extent CYP2C9 contribute to oxidative metabolism of propofol to 4-hydroxypropofol. CYP2B6 is the  principal determinant of interindividual variability in hydroxylation of propofol. Approximately 40-80% of propofol undergoes glucuronidation. Propofol causes antagonism of glycine receptors at subcortical levels to give rise to excitatory movements. It is thought that reduction of serotonin cencentrations in area postrema contributes to anti-emesis.

  2. FFTTF
    Imidazole renders etomidate water soluble at acidic pH and lipid soluble at physiological pH. Formulation in cyclodextrin produces minimal or no haemolysis. Etomidate undergoes ester hydrolysis to produce ethanol and a corresponding carboxylic acid metabolite. Induction with etomidate usually does not cause apnoea unless opioid is also administered.

  3. TTFTT
    There is a dose dependent inhibition of adrenal steroidogenesis by interaction with adrenocortical mitochondria affecting 11 β-, 17 α-, and 18-hydroxylases and 20,22 lyase. After a single standard induction dose, steroid synthesis is suppressed for 4-6 hours. Similar to midazolam, etomidate undergoes intramolecular rearrangement at physiologic pH resulting in a closed ring structure with enhanced lipid solubility.

  4. TFFTF
    Ketamine is available in solutions with either chlorobutanol or benzethonium chloride as preservative agent. It only has one asymmetrical carbon and this gives rise to two optical isomers. S(+) is about 3-4 times more potent than R(-) isomer as anaesthetic and analgesic agent. Better neuroprotection is noted with S(+) isomer.

  5. FFFTT
    The binding sites for glutamate and ketamine are located at different sites. ketamine-induced nitric oxide synthase inhibition may be involved in analgesic action. Uptake of serotonin is inhibited causing increased risk of emesis.


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