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Introduction
Systematic review and meta-analysis with trial sequential analysis; Manuscript review/ writing
Focus: review on topics that improve patient outcomes
Current institution
Additional affiliations
May 2020 - present
Publications
Publications (73)
Background and Aims
Recent trials showed that transurethral lignocaine for bladder irrigation provides excellent analgesic effects and can minimise catheter-related bladder discomfort. The primary objective was to determine the efficacy of intravesical lignocaine on the incidence of catheter-related bladder discomfort in adult patients undergoing u...
Objectives
Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock...
Background and Aims
A quality improvement project (‘Safe Anaesthesia for ALL-SEAL’) was implemented to reduce preventable medication errors and drug wastage in the operating theatre (OT) of a tertiary hospital. The primary objective of this quality improvement project was to prevent the incidence of medication errors, and the secondary objective wa...
Objective
There is limited evidence on which immunosuppressive agents produce the best outcomes for adult patients with steroid-dependent or frequently relapsing nephrotic syndrome (SDNS/FRNS). This review compares the remission rate and adverse effects of various immunosuppressants used.
Methods
Studies of adult patients with biopsy-proven SDNS/F...
Background
Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of t...
Background
Emergence delirium remains a major postoperative concern for children undergoing surgery. Nalbuphine is a synthetic mixed agonist-antagonist opioid, which is believed to reduce the incidence of emergence delirium in children. The primary objective was to examine the effect of nalbuphine on emergence delirium in children undergoing surger...
Objective
The administration of local anesthesia in intraperitoneal space as part of the multi-modal analgesic regimen has shown to be effective in reducing postoperative pain. Recent studies demonstrated that intraperitoneal lidocaine may provide analgesic effects. Primary objective was to determine the impact of intraperitoneal lidocaine on posto...
Objectives
Methylene blue exerts its vasopressor effects by inhibiting nitric oxide-mediated vasodilation. Recent studies have suggested the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock....
Midline approach of spinal anesthesia has been widely used for patients undergoing surgical procedures. However, it might not be effective for obstetric patients and elderly with degenerative spine changes. Primary objective was to examine the success rate at the first attempt between the paramedian and midline spinal anesthesia in adults undergoin...
In response to the COVID-19 pandemic, policies, and treatment guidelines underwent rapid and frequent change. This threatened to disrupt the measured practice of evidence-based medicine (EBM), which relies on tried-and-tested interventions. The uncertainty was compounded by the overwhelming amount of misinformation disseminated via social media. Th...
Tranexamic acid is an antifibrinolytic drug that is widely used during surgery, but there are concerns about its thromboembolic effects. We aimed to investigate the effect of prophylactic intravenous tranexamic acid on thromboembolic outcomes in patients undergoing non-cardiac surgery. The MEDLINE, EMBASE and Cochrane Central Register of Controlled...
Preoperative anemia affects 25-40% of cardiac surgical patients, and is associated with greater transfusion requirements, morbidity and mortality. Therapeutic options include Erythropoietin (EPO) and Iron. While intravenous iron is recommended as a first line agent, its benefits are debatable. EPO has been widely used in mixed surgical cohorts, but...
The diuretic effect of the combined furosemide and aminophylline/theophylline among pediatric patients remains unclear. The primary aim of this systematic review was to examine the clinical diuretic effects (urine output and fluid balance) of co-administration of furosemide and aminophylline/theophylline as compared to furosemide alone in pediatric...
Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic i...
High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry by correcting cerebral desaturation in the reduction of postoperative complications remains uncertain in the literature. This systematic review and meta-analysis aimed to examine the...
Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic i...
Study Objective
: To examine the effect of Bispectral index (BIS) guided anaesthesia on the incidence of post-operative delirium (POD) in elderly patients undergoing surgery.
Design
: Systematic review, meta-analysis and trial sequential analysis (TSA).
Setting
: Operating room, post-operative anaesthesia care units (PACU) and ward.
Participants...
Background:
The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients.
Methods:...
Aim
The robotic assisted surgery has become prevalent in most of the surgical subspecialty. The adaption of such technique in spine surgery has resulted in minimising several issues encountered with fluoroscopic guided approach. The aim of this study is to compare the outcomes of robotic assisted approach and fluoroscopic guided approach in pedicle...
Objective
The evidence on the use of cerebral oximetry during surgery to minimise postoperative neurological complications remains uncertain in the literature. We aimed to assess the value of cerebral oximetry in the prevention of postoperative cognitive dysfunction, postoperative delirium and postoperative stroke in adults undergoing surgery.
Des...
Study objective
To review the effects of prone position and supine position on oxygenation parameters in patients with Coronavirus Disease 2019 (COVID-19).
Design
Systematic review and meta-analysis of non-randomised trials.
Patients
Databases of EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until March 2021.
Interv...
Purpose
Perioperative blood loss remains a major challenge to surgeons in anterior cruciate ligament reconstruction (ACLR) surgery, despite of the introduction of minimally invasive approach. Tranexamic acid (TXA) is believed to reduce blood loss, which may minimise the complication of postoperative haemarthrosis with insufficient evidence on its e...
Silent or ‘happy’ hypoxemia has been noticed in patients with Coronavirus Disease 2019 (COVID-19). In some of the hypoxemic COVID-19 patients, there was no correlation between the degree of hypoxemia and the severity of parenchymal lung injury on chest imaging. The presence of micro thrombi in the peripheral pulmonary vasculature, endotheliitis, va...
Dexmedetomidine is a highly selective α2-adrenoceptor agonist, which is off-labelled use for pediatric sedation. However, the hemodynamic responses of dexmedetomidine remain unclear in the pediatric population. The primary objectives of this systematic review and meta-analysis were to examine the hemodynamic effects of high-dose and low-dose dexmed...
Silent or ‘happy’ hypoxemia has been noticed in patients with Coronavirus Disease 2019 (COVID-19). In some of the hypoxemic COVID-19 patients, there was no correlation between the degree of hypoxemia and the severity of parenchymal lung injury on chest imaging. The presence of micro thrombi in the peripheral pulmonary vasculature, endotheliitis, va...
Objectives
There is growing evidence on the influence of general anaesthesia (GA) in promoting the proliferation of cancer cells. The benefits of regional anaesthesia (RA) on cancer recurrence rate in cancer surgery remains unclear in the literature. The primary objective of this review was to examine the effect of RA on the incidence of post-opera...
Objectives
Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position.
Methods
PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from inception u...
Objectives:
Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position.
Methods:
PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from incepti...
Background
Low level of fibrinogen is a risk factor of perioperative bleeding, which is a major complication in surgical patients. However, the safety and efficacy of fibrinogen supplementation with fibrinogen concentrate to minimize postoperative bleeding remains unclear.
Objectives
The primary aim of this review was to investigate the effect of...
Background
Studies have reported that general anesthesia (GA), especially volatile agents were associated with higher cancer recurrence rate after cancer resection surgery. However, the effect of supplementary regional anesthesia (RA) in reducing the use of anesthetic agents on oncological outcomes remains unclear. The primary aim of this meta-anal...
Results: > After applying inclusion and exclusion criteria, seventy-one parallel-arm RCTs (N=7,539 subjects) were included. > Compared to placebo, topical TXA significantly reduced intraoperative blood loss, total blood loss and incidence of blood transfusion. (Table 1) > No adverse events associated with the use of topical TXA were observed, namel...
Results: > The titles and abstracts of 859 non-duplicate articles were screened, of which 10 articles were retrieved for full-text screening. After applying inclusion and exclusion criteria, two parallel-arm RCTs with a total of 8548 subjects were included. > Compared to placebo, epinephrine cohort was associated with a significant increase in the...
Objectives:
Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the lite...
Objectives:
The repetitive hypoxic and hypercapnia events of obstructive sleep apnea (OSA) are believed to adversely affect cardiopulmonary function, which make them vulnerable to a higher incidence of postoperative complications. The primary aim of this systematic review and meta-analysis was to examine the association of OSA and the composite en...
Corticosteroids are often administered prophylactically to attenuate the inflammatory response associated with cardiac surgery using cardiopulmonary bypass (CPB). However, the efficacy and safety profile of corticosteroids remain uncertain. The primary aim of this systematic review and meta-analysis was to investigate the effect of corticosteroids...
Background:
Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain.
Objectives:
The aim of this review was to investigate the effect of intravenous mag...
Introduction
Several articles have suggested a potential synergistic relationship between periodontal disease and systemic inflammatory diseases, such as Polycystic Ovarian Syndrome (PCOS) and diabetes mellitus. However, the associations between periodontal disease and PCOS population remain unclear in the literature.
Objective
The primary aim of...
Background:
Ketamine is believed to reduce incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomised controlled trials reported conflicting findings.
Aims:
To investigate the effect of ketamine on emergence agitation in children.
Methods:
Databases of MEDLINE, EMBASE and CENTRAL were systematicall...
Introduction
Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.
Methods
A systematic review...
Objectives
Melatonin is an endogenous hormone, which regulates circadian rhythms and promotes sleep. In recent years, several randomised controlled trials examining the prophylactic use of melatonin to prevent delirium were published with conflicting findings. The primary aim of this review was to determine the effect of melatonin on the incidence...
Background
Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectal cancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectal cancer remain unclear in the literature. The primary aim of this review was to determine whether robotic-assisted lap...
Background
Several randomised control trials comparing conservative management (watchful waiting/observation/active monitoring) and radical treatments (radical prostatectomy/radiotherapy) for localised prostate cancer with at least more than 10 years of follow-up (median) have been published with conflicting findings. The primary aim of this study...
Delirium is common in intensive care patients. Dexmedetomidine is increasingly used for sedation in this setting, but its effect on delirium remains unclear. The primary aim of this review was to examine whether dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. We sought randomised clinical trials in MEDLIN...
Objectives:
Patients with preoperative low left ventricular ejection fraction (LVEF) are known to be associated with high morbidities and mortality in cardiac surgery. The primary aim of this review was to examine the clinical outcomes of levosimendan versus placebo in patients with preoperative low LVEF ≤ 50% undergoing cardiac surgery.
Data sou...
Introduction
Bispectral index (BIS) and monitoring of end-tidal concentration may be associated with a reduction in the incidence of awareness during volatile-based general anaesthesia. An analogue of end-tidal concentration during cardiopulmonary bypass (CPB) is measuring exhausted isoflurane concentration from the oxygenator as an estimate to blo...
Objective
Fluid overload is a common phenomenon seen in intensive care units (ICUs). However, there is no general consensus on whether continuous or bolus furosemide is safer or more effective in these haemodynamically unstable ICU patients. The aim of this meta-analysis was to examine the clinical outcomes of continuous versus bolus furosemide in...
Results: The titles and abstracts of 3,624 non-duplicate articles were screened, of which 31 articles were retrieved. After applying inclusion and exclusion criteria, eight parallel-arm RCTs with a total of 669 subjects were included in this meta-analysis. No significance differences were demonstrated in the all-cause mortality, length of hospi...
Nicotine replacement therapy is widely used in critically ill smokers and its effect on delirium, mortality and duration of intensive care unit (ICU) admission is unknown. The aims of this review were to determine whether the management of nicotine withdrawal with nicotine replacement therapy reduces delirium, mortality or length of stay in critica...
Loop diuretics remain a fundamental pharmacological therapy to remove excess fluid and improve symptom control in acute decompensated heart failure. Several recent randomised controlled trials have examined the clinical benefit of continuous vs. bolus furosemide in acute decompensated heart failure, but have reported conflicting findings. The aim o...
Background:
Anastomotic leak (AL) following oesophagectomy carries a high mortality and morbidity. Early detection and intervention is required for a successful outcome. We have examined the role of a high postoperative serum lactate in predicting which patients are at risk of developing an anastomotic leak(AL).
Materials and methods:
All patien...
Objective
Volatile anesthetic agents such as isoflurane may be associated with fewer adverse myocardial events compared with total intravenous anesthesia in cardiac surgery. The authors aimed to determine whether reasonable isoflurane concentrations at tissue level were being achieved to protect the myocardium using this agent. The isoflurane conce...
A 50-year old nulliparous vegan lady presented to the emergency department with heavy menstrual bleeding for 1 month and shortness of breath for 2 weeks. She was treated with tranexamic acid. Her only risk factor for VTE was her heavy menstrual bleeding which restricted her mobility and kept her house bound. Iron-deficiency anaemia secondary to hea...
An anecdotal observation of patients developing VTE who are treated with TXA for a pre-existing Gynaecological condition that often leads to iron deficiency anaemia.
Introduction
Compared to total intravenous anaesthesia, volatile anaesthesia is associated with a lower mortality and incidence of adverse myocardial outcomes following cardiac surgery.(1) However, when administering volatile anaesthetic, ensuring an adequate depth of anaesthesia during cardiopulmonary bypass (CPB) is challenging because of the abs...
Anastomotic leak (AL) from the oesophago-gastric conduit anastomosis, following oesophagectomy, carries high morbidity and mortality. In the long term, it is also associated with disease recurrence and adverse quality of life. Early identification of anastomotic leak and control of its septic complications may lead to better outcomes.
Chyle leak (CL) following oesophagectomy is a major morbidity. In the long term, it is also associated with disease recurrence and adverse quality of life. Early identification and control of chyle leak may lead to better outcomes.
The adverse psychiatric effects of NPS or legal highs a systematic review
Mr Ka Ting Ng, University of Edinburgh; Prof Mark Taylor, Royal Edinburgh Hospital
Background: Novel psychoactive substance (NPS) or legal high use has increased rapidly and has been associated with adverse psychiatric effects. Objective: To systematically review the differin...
Intramuscular injection is a common procedure performed in healthcare settings. Improper
technique of injection could expose patient to severe complications. I would like to present a case
of secondary gluteal abscess as differential diagnosis of back pain resulting from administration of
intramuscular injections on dorsogluteal region. The abscess...
The applications of hypnosis are gradually receiving highlighted attention and credibility among
physicians and young healthcare workers nowadays. The objective of this review is to provide a
short summary on hypnosis and its’ supporting evidences on the applications of hypnosis based on
recent researches. The major finding of this review demonstra...
Aims: To determine the prevalence of depression and factors associated with depression among rural communities in Negeri Sembilan, Peninsular Malaysia.
Study Design: A cross-sectional study with simple random sampling.
Place and Duration of Study: Port Dickson, Negeri Sembilan, between June 2013 and July 2013.
Methodology: A total of 223 responden...
Questions
Questions (14)
May I know what does repeated significance testing means in TSA manual?
For binary outcome (mortality), we only insert n/N from each trial into the revMan to meta-analytic the result. If there are some new trials recently, we will added n/N of new trials into the existing table? However, I am not understand how this update meta-analysis will contribute to problem of repeated significance testing in TSA as we will re-do statistical test when new data are added?
Kindly please advise me.
May I know what does repeated significance testing means in TSA manual?
For binary outcome (mortality), we only insert n/N from each trial into the revMan to meta-analytic the result. If there are some new trials recently, we will added n/N of new trials into the existing table? However, I am not understand how this update meta-analysis will contribute to problem of repeated significance testing in TSA as we will re-do statistical test when new data are added?
Kindly please advise me.
Would it be bispectral index or exhausted anaesthetic gas from CPB circuit (analogue to end tidal anaesthetic gas)?
Many thanks for your time and atttention,
Ka
Hi all,
I would like to see how strongly the exhausted isoflurane correlates with the coronary sinus isoflurane level. Basically, I hypothesised that we could use exhausted isoflurane to predict the level of isoflurane in coronary sinus blood during cardiopulmonary bypass.
By doing a normal correlation on spss, my correlation coefficient is 0.68, p<0.01. However, when I plotted a scattered dot, I found it might be curvilinear relationship.
Kindly please advise what could i do?
Many thanks,
Ka
Could iron-deficiency anaemia secondary to heavy menstrual bleeding be a potential risk factor to the formation of venous thromboembolism (bilateral PE)?
I encountered two cases within 2 months of obstetrics and gynaecology posting? Especially those were given trenaxamic acid.
Appreciate your comments and thoughts.
