Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p50kg, 1.372(p2, 5.333 (p2 (p50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p2 were significant independent risk factors.

Background: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). Method: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. Results: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients’ CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). Conclusion: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients.

Background: Current fasting guidelines are often exceeded in clinical practice, resulting in stressful events during anaesthesia in children. This prospective study compares residual gastric volume after 1 versus 2 h of clear fluid ingestion in fasted children. METHODS: A total of 106 patients were enrolled in the study. Ultrasonography (USG) of gastric antrum (GA) was performed in the supine and right lateral decubitus (RLD) positions. All children fasted from solid food for 6 h. Blackcurrant flavoured drink (3 mL/kg) was given following the measurement of baseline (T₀) USG of GA, with follow-ups after 1 (T₁) and 2 (T₂) hours post-ingestion. Residual gastric volume (RGV) was calculated from the cross-sectional area of GA using a standard formula. Parental satisfaction with their children’s behaviour concerning fasting time was recorded. Results: RGV was significantly higher at T₁ compared to T₂ (p < 0.001). No significant difference was seen between T₀ and T₂ (p = 0.30). Parental satisfaction was similar at T₁ and T₂ (p = 0.158). Conclusions: The RGV in paediatric patients after 1 h of clear fluid ingestion was significantly higher than after 2 h of ingestion. There was no difference observed in parental satisfaction concerning the two intervals of fluid fasting. RLD and supine positions can be used reliably to measure the RGV in children.

Aims: To investigate the roles of MDR1 (1236C>T, 2677G>T/A, and 3435C>T) and OPRM1 (118A>G) gene polymorphisms on the anesthetic and adverse effects of propofol–remifentanil total intravenous anest...

Background: Post-extubation hypoxaemia and postoperative pulmonary complications (PPCs) are common in surgical patients and contribute significantly to morbidity and prolonged recovery. High-flow nasal oxygen therapy (HFNOT) has been proposed as an alternative to conventional oxygen therapy (COT) in improving oxygenation and reducing PPCs postoperatively. Objectives: To evaluate the effectiveness of HFNOT compared to COT in reducing post-extubation hypoxaemia and PPCs in adult surgical patients, and to assess its impact on other clinical outcomes including ICU and hospital length of stay, mortality, and the need for escalation of respiratory support. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA guidelines. Studies were identified from five databases including PubMed, Scopus, EBSCOHost, ProQuest, Ovid MEDLINE and Web of Science. Adult postoperative patients who received HFNOT after extubation were compared to those receiving COT. Primary outcomes included PaO₂/FiO₂ (PF) ratio and incidence of PPCs. Secondary outcomes were hospital and ICU length of stay, mortality, and need for escalation of therapy. Results: Seventeen trials comprising 1830 patients were included. HFNOT significantly improved PF ratio post-extubation and reduced the incidence of hypoxaemia and PPCs compared to COT. For secondary outcomes, HFNOT was associated with a reduced hospital length of stay and lower postoperative mortality, while no significant difference was found for ICU stay. Escalation of respiratory support was more frequent in the COT group. Subgroup analyses indicated greater improvements in oxygenation with HFNOT of shorter duration (<24 h) and in non-cardiothoracic patients. Conclusions: HFNOT is associated with improved postoperative oxygenation and a reduction in respiratory complications following extubation in surgical patients. The most pronounced benefits were observed in non-cardiothoracic populations and with short-duration applications. While the beneficial effects of HFNOT appear consistent across the included randomized controlled trials, further large-scale studies with standardized intervention durations, surgical populations, and clearly defined criteria for escalation of therapy are needed to strengthen and confirm these findings.

Background: Despite significant advancements in pediatric anesthesia training and guidelines, the incidence of severe critical events in children undergoing anesthesia in Asia remains under-researched. This knowledge gap is particularly pressing given the rare but life-threatening nature of such complications. While studies from high-income countries report a decline in pediatric anesthesia-related mortality, similar data from developing regions, including Asia, are sparse and suggest higher risks. Objective: The Peri-anesthetic Morbidity in Children in Asia (PEACH in Asia) study aims to provide a comprehensive assessment of the incidence and risk factors associated with severe critical events in pediatric anesthesia across Asia. This multinational, multicenter, prospective observational study seeks to enhance understanding of pediatric anesthesia-related risks and variability in practices within the region. Methods: The study will enroll children aged birth to 15 years undergoing elective or urgent diagnostic or surgical procedures requiring sedation or general anesthesia, with or without regional analgesia. Data collection will focus on severe critical events occurring during and up to 60 minutes post-anesthesia, including laryngospasm, bronchospasm, pulmonary aspiration, drug errors, anaphylaxis, cardiovascular instability, neurological damage, cardiac arrest, and post-anesthetic stridor. The study will also capture patient demographics, medical history, and procedural details to identify potential risk factors. Results: The pilot phase of the PEACH in Asia study, conducted from May to June 2023, included 330 patients from ten institutions across nine countries. Preliminary findings revealed a severe critical event incidence rate of 12.4% [95% CI: 9.2-16.4]. Based on these results, the main study plans to recruit approximately 10,958 children across 15 to 30 Asian countries to achieve robust statistical power and refine risk factor identification. Conclusion: The PEACH in Asia study represents a critical step towards understanding and mitigating the risks associated with pediatric anesthesia in Asia. By providing data-driven insights into the incidence of severe critical events and regional variations in anesthesia practices, this study aims to inform and improve pediatric anesthesia protocols across the continent.