Pseudomonas putida is a rare pathogen leading to nosocomial and central nervous system infections. Despite having a low virulence and being a rare organism to cause bacteremia, it can evolve into a multidrug-resistant organism and lead to mortality and morbidity in the intensive care setting. A 64-year-old male gardener was presented with extensive acute subarachnoid hemorrhage with intraventricular extension causing hydrocephalus requiring embolization and coiling following a cerebral angiogram, which showed bilateral posterior circulation aneurysm and left anterior circulation aneurysm. External ventricular drain (EVD) was inserted given the worsening hydrocephalus. During his stay in the intensive care unit (ICU), he was becoming more septic and a full septic workup including a cerebral spinal fluid culture taken from the indwelling catheter of the EVD and was found to be positive for a ceftazidime-sensitive strain of P. putida. Following the treatment with intravenous ceftazidime for 1 week and a revision of the EVD on day 32 of admission, he continued to recover well and showed an improvement in his Glasgow Coma Scale (GCS) and septic parameters. Eventually, he was able to wean off mechanical ventilation. He was discharged from ICU care to the neurosurgical ward with supplemental oxygen on day 42 of admission. It is necessary to be aware of the possibility of nosocomial P. putida infection, especially in patients with indwelling catheters, and to consider the early initiation of appropriate antibiotic regimens once detected as well as strict precautions in hygiene during the management of these patients to avoid further development of multi-drug resistant (MDR) strains.

Rhodotorula mucilaginosa fungemia is rare and highly resistant to antifungal therapy. We herein report a case involving a 31-year-old male admitted after a high-velocity road traffic accident. He sustained a grade IV liver injury with right hepatic vein thrombosis, which necessitated an urgent laparotomy. Post-operatively, repeated imaging of the abdomen revealed the presence of a biloma. Percutaneous subdiaphragmatic drainage was carried out but appeared ineffective, prompting a second surgery for an urgent hemi-hepatectomy. The patient was then nursed in the intensive care unit (ICU); however, during his stay in the ICU, he became more sepsis, which was evident by worsening ventilatory support and a rise in septic parameters from the biochemistry parameters. Despite intravenous piperacillin–tazobactam and fluconazole, his septic parameters did not improve and a full septic workup was conducted and was found to be positive for Rhodotorula mucilaginosa from the blood cultures. After discussion with the infectious disease physicians and clinical microbiologists, it was decided to initiate a course of intravenous meropenem and amphotericin B based on minimum inhibitory concentration (MIC) values, considering the patient’s extended ICU stay and catheter use. Eventually, after successfully weaning off mechanical ventilation, the patient was discharged from ICU care. This case underscores the necessity of individualized approaches, combining timely imaging, appropriate drainage techniques, and tailored treatments to optimize outcomes for such intricate post-traumatic complications.

Introduction: Central nervous system (CNS) nocardiosis is a rare but lethal opportunistic infection, presenting a formidable diagnostic and therapeutic challenge, especially in immunocompromised populations. The most common presentation is a cerebral abscess.Case presentation: We report the case of a 53-year-old male with a history of relapsed and refractory multiple myeloma who presented with an acute change in mental status and ataxia. Initial clinical suspicion centered on a posterior circulation ischemic event. However, magnetic resonance imaging (MRI) revealed a large, rim-enhancing cerebellar mass with associated obstructive hydrocephalus. The patient underwent surgical excision of the lesion, and subsequent microbiological culture confirmed an abscess caused by a Nocardia species. He was treated with a prolonged course of targeted antimicrobial therapy, including intravenous imipenem, followed by oral linezolid and trimethoprim-sulfamethoxazole. At the 3-month outpatient follow-up after discharge, the patient was found to have thrombocytopenia, attributed to the side effects of oral trimethoprim-sulfamethoxazole. Treatment was subsequently maintained with oral linezolid 600 mg for 1 year. Despite improvement of the abscesses, the patient ultimately succumbed to the progression of his long-standing multiple myeloma.Conclusion: This case underscores the importance of including uncommon opportunistic pathogens like Nocardia in the differential diagnosis of CNS lesions in immunocompromised patients. A definitive diagnosis via microbiological analysis of tissue specimens is imperative to guide appropriate antimicrobial therapy and achieve a favourable clinical outcome.

Background & objective: Preoperative anxiety is a natural human psychology, and the physicians usually prescribe tranquillizers to allay the anxiety of their anxiety. Various other means have also been employed for this purpose. We aimed to investigate the impact of lavender aromatherapy on preoperative anxiety and propofol requirement at induction of anesthesia. Methodology: A total of 108 female patients were enrolled in the study, and their anxiety levels were evaluated using the Visual Analogue Scale (VAS) at three different time points. Patients were randomly divided into two groups. Group A (Lavender Group) patients were given lavender aromatherapy via a cotton strip infused with two drops of 100% pure lavender essential oil, while the patients in Group B (Control Group) had no aromatherapy. Results: The results showed that the lavender aromatherapy significantly reduced anxiety in Group A (P < 0.001) compared to Group B, and the mean differences of VAS scores for all anxiety assessments were also significantly reduced in Group A (P < 0.000). In addition, the mean total amount of propofol required was significantly less in Group A than in Group B (118.46 ± 40.01 vs 140.38 ± 35.29 mg; P = 0.003), while the mean duration to reach loss of consciousness was similar in both groups. Conclusion: The findings of our study suggest that lavender aromatherapy can be a simple, safe, and cost-effective way to reduce preoperative anxiety and decrease the amount of propofol required for the induction of anesthesia. Therefore, the use of lavender aromatherapy may be a valuable addition to the preoperative care of patients undergoing elective surgeries. Abbreviations: APAIS- Amsterdam Preoperative and Information Scale; LOC- Loss of Consciousness; OT- Operation Theatre; OR- Operating Room; STAI- State-Trait Anxiety Inventory; VAS- Visual Analogue Scale Key words: Aromatherapy; Benzodiazepines; Lavender; Anxiety, Preoperative; Propofol; Anxiety / therapy; Anxiety Disorders Citation: Rahman RA, Vasu Dewan MM, Sayed Masri SNN, Mokhtar MN, Abdullah FH, Md Nor N. Lavender aromatherapy: Its effect on preoperative anxiety and propofol requirement for anesthesia. Anaesth. pain intensive care 2024;28(1):20−25; DOI: 10.35975/apic.v28i1.2376 Received: April 26, 2023; Reviewed: November 22, 2023; Accepted: November 22, 2023

Utilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users’ feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™. Forty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale. Blue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p < 0.001) were recorded for the Blue Phantom model. We postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training.

A logbook system is essential to ensure standardized competency in medical education. This survey will provide the first overview of our current logbook and can serve as an initial proposal for improvement to a more relevant and valuable tool to assess our postgraduate training programme. This survey was conducted among all Universiti Kebangsaan Malaysia (UKM) anaesthetic trainees. The data for this survey was collected by using Google Forms. A link to the form was distributed to all UKM anaesthetic trainees. The survey questionnaire consisted of five sections, demographic data, strengths and weaknesses of logbook content, evaluation of logbook usage experience, perception of the feedback received regarding the logbook performance, and potential improvements that can be made. 107 anaesthetic trainees participated in this study. All of the sections in the logbook were deemed relevant by more than 60% of the trainees except for the on-call section which was seen as relevant only by 37.4% of them. 53.3% agreed that the logbook is useful for learning during the course. However, only 43.9% of them perceived that the logbook was easy and convenient to use. Only 59 respondents received feedback regarding their logbook performance. The analysis of open-ended answers highlights the necessity of transitioning to a fully digitalized logbook system for easy accessibility. It also reveals the need to re-evaluate specific logbook contents and incorporate additional teaching and learning tools to enhance the overall training process. Moreover, the findings emphasize the importance of effectively implementing feedback mechanisms within the logbook system to optimize student learning. Serving as a foundational step towards developing a more efficient and structured educational tool, this research provides valuable insights for future advancements in medical education, particularly in anaesthesiology.