Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia. Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety score, level of sedation using the Bispectral Index and Observer's Assessment of Alertness and Sedation, hemodynamic stability, and overall patient's feedback on anxiolysis were assessed. Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 mm after starting surgery. Difference in median anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion. Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the propofol group (45.20%). Conclusion: Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol during regional anesthesia.

Liquid silicone (polydimethylsiloxane) is an inert material that is commonly used for cosmetic purpose. Silicone embolization syndrome (SES) can rapidly progress to pneumonitis as a consequence of the injection of nonmedical‐grade liquid silicone. We describe a case of severe silicone pneumonitis complicated with acute respiratory distress syndrome and bilateral pneumothorax secondary to silicone gluteal augmentation. In this case report, we aim to discuss our experience and approach in managing an uncommon case of SES.

Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016–2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5–8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue.

The diagnosis of invasive fungal diseases (IFDs) is time consuming and lacks sensitivity. In this research a rapid and easy to use immunochromatography-based DNA biosensor system was developed to detect Candida and Aspergillus pathogens at genus level, while specifically detecting Candida glabrata, Candida krusei and Aspergillus terreus. This system combines multiplex PCR with a lateral flow assay (LFA) dipstick. Three separate multiplexed PCR reactions were designed together with a testing algorithm, using biotin, digoxigenin and Tamra fluorophore-labelled fungal internal transcribed spacer universal fungal primers, fungal genera-specific primers, and species-specific primers to produce labelled PCR products that were detected on the LFA dipstick. The LFA dipstick, in a modified sandwich format, utilises immobilised antibodies complementary to the fluorophore labels on the PCR products, and gold nanoparticles to form a visible red line that indicates the presence of the targeted fungus. To validate the developed system, 203 clinical samples suspected of fungal infection were collected from two hospitals in Kuala Lumpur and tested. The limits of detection of the multiplexed PCR were in the range of 5–100 CFU/mL for fungal spiked human blood samples. Against the clinical diagnosis of proven or probable IFDs, the findings show that the LFA system produced a high specificity of 99.4 % while the sensitivity was only moderate at 47.8 % due to the difficulty of extracting fungal DNA from blood samples. The positive and negative predictive values however were promising at 91.7 % and 93.7 %, respectively. The developed LFA system has great potential for further refinement to be used as a new tool in the detection of IFDs.

Background and Objective: Many previous studies assessing the completeness of perioperative documentation of surgical patients were reported to be inadequate and unsatisfactory. The aim of this study was to compare the perioperative anesthetic record (PAR) at our tertiary care institution to a standard guideline and have an audit of its completeness. Methodology: It was a prospective, observational study, done in the general operating theater of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). We compared our PAR to the American Society of Anesthesiologists (ASA) policy statement on documentation of anesthesia care. We audited the completeness of PAR documentation of 358 patients by using a self-generated checklist which was created in accordance to the PAR parameters. A total of 44 parameters were studied covering three phases; preoperative, peroperative and post-operative phases. Results: Although the UKMMC PAR varied from the ASA guidelines, various salient parameters were identical in both. None of the perioperative forms were completely filled throughout the three perioperative phases. Out of 44 parameters studied, only 2 parameters were completely filled, which were medications administered and fluid therapy. Conclusion: Parameters given in the UKMMC PAR varied with the ASA guidelines and the documentation was found to be only partially complete. Hence, necessary modification of the current PAR in our institution, and the stress on filling it completely is needed to improve the quality of perioperative anesthetic documentation. Keywords: Audit; Completeness; Perioperative; Anesthetic record; Documentation Citation: Bolhan HA, Yahya N, Izaham A, Mat WRW, Rahman RA, Musthafa QA. Anaesth. pain intensive care 2020;24(6):--- Received: 23 April 2020, Reviewed: 17 August 2020, Revised: 18 October 2020, Accepted: 27 October 2020