Does Epidural During Labour Lead To Chronic Low Backpain? A Malaysian Retrospective Study

@#Introduction: The question as to whether epidural analgesia during labour can cause chronic low backpain has become a concern lately but this association has not been tested locally and remains controversial. This retrospective study aimed to ascertain the relationship between labour epidural analgesia and development of subsequent chronic low backpain. Methods: We contacted 200 primiparous women who had delivered by normal vaginal delivery via telephone at six months after delivery. While 100 of them had previously received epidural analgesia for labour, the other 100 had not. The women had to quantify their backpain by yes/no responses, numeric rating score, and impairment of daily function. Both the epidural and the non-epidural groups were compared using independent t-test and Chi-squared test while logistic regression was used to control for confounding factors. Results: The two groups had similar baseline characteristics except for body mass index, employment status and labour duration. The women who received epidural analgesia had significantly higher prevalence of low backpain at six months after delivery than those who had not (28% versus 9%, P = 0.001). However, the two groups did not show any difference in terms of numeric rating score or level of impairment of daily function. The low back pain at six months (epidural versus non-epidural) had an adjusted odds ratio of 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: While epidural analgesia during labour was shown to be associated with chronic low back pain, this association may not be causal, suggesting the need for a randomized-controlled study in this area.

A Comparison Between Measured Maxillopharyngeal Angle On Lateral Cervical Radiograph with Modified Mallampati Classification In Predicting Difficult Larnygoscopy: A Blinded Interventional Study

@#Background: Existing techniques of predicting difficult laryngoscopy are inadequate requiring evaluation of Maxillopharyngeal Angle (MP-A) on lateral cervical radiograph described. Objectives: This study aimed to compare MP-A test with Modified Mallapati Test (MMT) in predicting their diagnostic values and Area Under Curve of Receiver Operating Characteristic Curve (AUCROCC) of both test. Methods: This is a double blinded interventional study of 93 patients. Each patient’s MMT score was assessed during preoperative assessment and subsequent MP-A test done by obtaining lateral cervical radiograph with the head in neutral position. Laryngeal view was assessed using Cormack-Lehane grade after induction of anesthesia, was used as reference standard to determine the diagnostic values of MMT and MP-A respectively. Results: The MP-Acompared to MMT in predicting difficult larngoscopy had higher sensitivity (77.78 vs 44.44) specificity (88.10 vs 67.86) and accuracy (87.10 vs 65.59) with higher Odd Ratio(26.12 vs 1.68). The AUCROCC was significantly higher in MP-A test 0.83(95%CI: 0.67, 0.99) (P = 0.001) vs MMT 0.56(95%CI: 0.36, 0.76) (P = 0.546) with LR+ of 6.53 vs 1.38. Conclusion: The Maxillopharyngeal Angle test was superior in predicting difficult laryngoscopy as compared to Modified Mallampati Test.difficult intubation

The Needs of Malaysian Family Members of Critically Ill Patients Treated in Intensive Care Unit, Hospital Universiti Sains Malaysia

Background: The needs of intensive care patient’s family members are often neglected. Many healthcare practitioners do not realize that meeting the family needs in the intensive care settings actually may improve outcome for their patients and enable the family members to cope and deal with the patient’s hospitalization period effectively. With this in mind, the present study aimed to address the needs of Malaysian family members of intensive care unit patients. Methods: This cross-sectional survey was conducted among family members of Intensive Care Unit of Hospital Universiti Sains Malaysia, Malaysia. A total of 60 family members were recruited using a convenience sampling manner. A Malay validated Critical Care Family Needs Inventory was used to identify the family needs among the respondents. Descriptive statistics as well as mean comparison analyses were employed to achieve the study. Results: The findings showed that family members ranked Assurance items as the most important needs. In terms of subscales scores, Assurance and Information evidenced higher mean scores compared to other dimensions. All the family need dimensions had positive and significant associations with one another. The highest correlation was noted among Comfort – Support pair, r(58) = 0.73, p < 0.001. No significant differences in the mean values found across gender, history of admission and types of relationships. In contrast, significant mean difference was observed across level of education. Conclusion: Identifying the needs of family members in the intensive care unit is imperative as it raises awareness and contributes knowledge in terms of family needs to healthcare providers, policy makers, medical social workers and general public.

Novel Usage of Dexmetomidine In A Paediatric Patient With Giant Tongue Haemangioma

Giant haemangioma of the tongue is a disease which can obstruct the oropharyngeal airway and is presented with obstructive symptoms. Due to its vascularity, inserting laryngoscope for intubation can cause high risks, such as inducing bleeding. Hypoxia and excessive bleeding must be anticipated while securing the airway. We present a case of novel usage of dexmetomidine as a conscious sedation agent for awake fibre optic intubation in a 9-year-old child with obstructive symptoms secondary to a huge tongue haemangioma, who was presented for interventional sclerotherapy of the lesion.