|Title:||Berita Anestesiologi - June 2014|
|Description:||JILID 18 BIL 1 JUNE 2014|
Table of Contents
Dear Colleagues and Friends
It is indeed an honour and privilege to continue to serve another year as the President of the Malaysian Society of Anaesthesiologists.Recently, we concluded the 51st Annual General Meeting of the Society and it was a distinct pleasure to have met so many of you. A new Executive Committee (2014-2015) is in place with members from the previous Executive Committee and some fresh faces. To the outgoing Executive committee members, ‘thank you’ for your good work and dedication. It was indeed an enjoyable year! To the new Committee members, I hereby, sincerely welcome you and look forward to your contributions, ideas and support.
This year also sees a new Chairman of the Society being elected. To the outgoing Chairperson, Professor Dr Chan Yoo Kuen, I say a ‘big thank you’ for her outstanding contribution, untiring effort and wise counsel. By the way Prof, “your task is not complete yet”. I will pen further in this message on why I write that! We hereby, welcome the newly elected Chairman of the Society, Dr Mohamed Namazie Ibrahim. We look forward to a fruitful partnership.
Annual Scientific Congress 2014, Malaysian Society of
The Annual Scientific Meeting has been renamed Annual Scientific Congress to acknowledge the magnitude of delegates in recent times in comparison to our humble beginnings. The renaming also attests to the numerous subspecialties that have evolved in tandem with the advancement of the field of Anaesthesiology.
The Congress was a tremendous success. The pre-congress workshops were well-received with excellent attendance. 860 delegates attended the Congress. The Opening Ceremony was officiated by the Deputy Director General of Health, Datuk Dr Jeyaindran Tan Sri Sinnadurai, who represented the Minister of Health Malaysia. This year, the Society conferred the Honorary Membership on Dato’ Dr A Damodaran. Dato’ Dr Sylvian Das gave an elegant citation on Dato’ Dr A Damodaran‘s life and vast contributions.
The scientific content of the Congress definitely addressed the theme ‘Evidence Meets Experience.’ The numerous emails from our distinguished speakers from overseas acknowledged the high standard of the scientific programme. They were also pleasantly surprised by the spirit of fellowship and camaraderie that they experienced in our Congress.
The Gala Dinner was made even more special and enjoyable as it was graced by the Director-General of Health Malaysia, Dato’ Seri Dr Noor Hisham Abdullah. It was indeed a night filled with laughter and music.
I sincerely wish to congratulate Dr Raveenthiran Rasiah, our Organising Chairman, and Dr Ina Ismiarti Shariffudin, our Scientific Committee Chairperson, and their respective committees for a very successful Congress. Well done!
The next Annual Scientific Congress will be held in Penang, the Pearl of the Orient. The Asian Society of Paediatric Anaesthesiologists Congress will be held in conjunction with the ASC 2015. We look forward to an exceptional scholastic, stimulating and influential congress with the participation of prominent paediatric anaesthesiologists from all around the globe. So mark your calendar!
14th Asian Australasian Congress of Anaesthesiologists 2014
This was a combined meeting with the 4th Australasian Symposium of Ultrasound and Regional Anaesthesia (ASURA). It was held over four days. Prior to that, there were one and a half days of workshops. The conference was rich in content and covered all aspects of anaesthesia including the sub-specialities. The fourth day saw only workshops and PBLDS.
As we were bidding for the 2022 AACA meeting, we had a booth and it was definitely the meeting ground for our Malaysian delegates. I am proud to write that we were well-represented. The general assembly was held on the afternoons of the first two days of the conference. During the first day of the assembly, after the business meeting, we did our presentation for the bid. The bidding process was an eye opener. We were competing against Korea but unfortunately, we did not win the bid. The AACA 2022 will be in Korea. All in all, I am glad we made an attempt for the bid. It was really a learning experience as the system for bidding is not based on one vote per country but the number of votes each country has. This translates to the number of anaesthesiologists the Society has.
I would also like to take this opportunity to thank the bidding team, Datin Dr V Sivasakthi, Dr Raveenthiran Rasiah, Dr Kok Meng Sum, Dr Cindy Thomas and Ms Y M Kong for their hard work and effort. I would also like to thank the delegates who came out to our booths and helped us.
During the general assembly, we were introduced to the newly appointed CEO of the WFSA, Mr Julian Gore-Booth. The WFSA is on a mission to improve their status as a world representative body of anaesthesiologists and address the challenges faced by the lower income countries.
NYSORA Asia K2 Mission
The New York School of Regional Anaesthesia conducted a two-day workshop at the Istana Hotel, Kuala Lumpur. This is their second workshop at our shores. The first one was in 2009. It is a philanthropic educational outreach programme. The first day saw a didactic session on regional anaesthesia with a concurrent practical TEE workshop. On the second day, a two-hour teaching workshop on obstetric emergencies and concurrent intensive comprehensive ultrasound guided regional anaesthesia was conducted. The Comprehensive Hands-On Ultrasound Workshop was designed to offer an overview of anatomical facts, indications, tips for success, pharmacological choices and techniques to accomplish the necessary sonographic view for the successful performance of blocks. It definitely benefited the delegates. Personally, I am of the view that it is good to bring these international workshops to Malaysia as more members can attend and benefit. It was also a proud moment to see our local talent on the NYSORA faculty!
World Congress of Anesthesiologists, 28th August – 2nd
Professor Dr Chan Yoo Kuen is in the midst of discussions on organising the Obstetric Anaesthesia Satellite Symposium in Malaysia as a pre-event to the World Congress of Anesthesiologists 2016
There is a 14.4% increase in the fee schedule. This was gazetted in December 2013. We will continue to pursue the relative value base unit. Please read the brief write-up by Dr Raveenthiran Rasiah in this issue.
ASEAN Travelling Fellowship
A team of three anaesthesiologists led by Dr Lim Wee Leong will be going to Vientiane, Laos, from the 15th to the 17th August 2014, to conduct a three-day refresher course. They will cover neuroanaesthesia, paediatric and obstetric anaesthesia including crisis management. Since the inception of this programme, we have been hosting anaesthesiologists from the Asean countries who come here on a two-week visit. We had hosted anaesthesiologists from Cambodia, Myanmar and Laos. This will be the first time we are going overseas to conduct an educational seminar.
Travelling Fellowship Programme - Outreach Programme
The Outreach Programme was initiated for local teaching and training especially for East Malaysia. I sincerely encourage the East Malaysian hospitals to conduct courses and seminars under this programme. We hope to conduct at least one workshop per year.
Year Book 2013-2014 and Year Book 2014-2015
The editor for Year Book 2013-2014 is Associate Professor Dr Basri Mat Nor. We are looking forward to launch the book during the National Anaesthesia Day 2014. Dr Ina Ismiarti Shariffudin and Dr Muhammad Maaya have kindly consented to be the authors of Year Book 2014-2015.
I am proud to announce that we have added an intensive care journal to our collection of journals. It is the Current Opinion in Critical Care. We now have six journals to our armamentarium. Our Ovid journal downloads range from 120-1200 per month. I encourage all members to use this valuable opportunity to keep updated on your knowledge as you can download full articles for all the six journals that we are subscribing to. It is indeed a golden opportunity. Not many Societies in the world offer online journals to their members. However, it does require a password to login. So, please make sure your membership data and your email address is current.
K Inbasegaran Research Fund
Please take note of this valuable opportunity to fund your research programme. I do hope more members will put in their requests for funding and benefit from this fund.
At A Glance
Upcoming CPD Activities
I would like to take this opportunity to thank Dr Shireen Jayan as she leaves the Berita Anestesiologi as its editor. On behalf of the Executive Committee, I sincerely thank you for all your effort and contribution to the Berita since 2009. I know it has been a monumental task but you have always made it look so easy!
I would like to take this opportunity to welcome Dr Gunalan Palari who has agreed to be the new editor and Dr Vanitha Sivanaser as the co-editor. On behalf of the Executive Committee 2013-2014, I would also like to thank Dr Kok Meng Sum for all her support and contribution. We will not only miss your meticulous work for details but also your wonderful company!
All the best!
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Conferment of Honorary Membership of MSA on Dato’ Dr A Damodaran on 4th April 2014
A man dedicated to his family.
A man dedicated to his profession.
A man dedicated to his hospital.
These sentences characterise the character of this man.
I consider it my privilege and pleasure to give the citation for such a man.
Dr Anavangot Damodaran was born in Sungkai, Perak, to Dr and Mrs K P Krishnankutty. Dr Krishnankutty was practising at the SungkaI Estate Group Hospital, Perak.
He had his early school education at the Anderson School in Ipoh, Perak, before continuing his education in India. He graduated in Medicine from the Madras Medical College in 1961. After graduation, he came back to Malaysia and served as houseman and medical officer in various hospitals in Perak before being posted to the Department of Anaesthesia at General Hospital Kuala Lumpur, where he became a Registrar in 1965.
In 1965, he was awarded a scholarship to pursue his postgraduate studies in Anaesthesiology in the United Kingdom. He successfully completed his post-graduate course and obtained the following:
He also became a Fellow of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons, in 1975.
In 1992, he was awarded the Fellowship of the Australian and New Zealand College of Anaesthetists.
He was a Consultant Anaesthetist at General Hospital Kuala Lumpur, in 1969. From 1970 to 1978, he was the Consultant Anaesthetist at General Hospital, Alor Star, Kedah. From 1973 to 1975 concurrently, he was the Medical Superintendent of the General Hospital, Alor Star, Kedah, the first Anaesthetist to be appointed to such a post.
He then joined the Assunta Hospital in Petaling Jaya, as Consultant Anaesthetist in 1978, and stayed there till 1986. In 1986, he joined Pantai Hospital, Kuala Lumpur, and has been there since then. He was also the Chief of Medical Staff at Pantai Hospital, Kuala Lumpur, from 2003 to 2005.
In the course of his illustrious career, Dr Damodaran has published and presented a number of papers in various journals and symposia and has participated in various international and regional conferences.
Among the highlights in his career is the fact that, he established the first intensive care unit at General Hospital, Alor Star, Kedah, in 1974, which gained fame for the treatment of snake bites, obstetric emergencies and tetanus. He also established the first Paediatric and Neonatal Intensive Care Unit in a private hospital namely, Assunta Hospital in Petaling Jaya, in 1982. Dr Damo as he is popularly known, was instrumental in developing the Intensive Care Unit in Pantai Hospital Kuala Lumpur, in addition to promoting the Neonatal ICU.
He was the Anaesthetist for the first Cardiac surgery to perform in Pantai Hospital, Kuala Lumpur.
For the services that he has rendered, he was awarded the following awards;
He became the President of the Malaysian Society of Anaesthesiologists in 1979, and was the Chairman of the Society from 1990 to 1993. One of his outstanding contributions to the profession is the fact that, he co-authored the book “History of Anaesthesia in Malaysia” together with Dr Alex Gurubatham, which was launched in June 2013.
Dr Damodaran is a very homely person and his whole life centered around his hospital and his home. He has been fortunate to have had a very loving and understanding wife and two daughters who have been very supportive of him in his work and busy schedules.
He is a man with a kind heart and has a unique sense of humour.
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"Our Care, Patient’s Outcome - A Relook" Effective Presentation Skills Workshop
A scientific meeting and workshop organised in joint collaboration of Malaysian Society of Anaesthesiologists (MSA) and the Department of Anaesthesiology and Intensive Care, Hospital Queen Elizabeth, Sabah, was conducted on the 27th August 2013 in Rafflesia Hall, Hospital Mesra, Bukit Padang, Kota Kinabalu, Sabah.
The morning started at 8.00 am, with participants arriving in bus loads. At approximately 8.15 am, the meeting kicked off with a short introduction to the theme of the meeting and itinerary for the day.
Both the meeting and the workshop had a total of 125 participants from different hospitals throughout Sabah. There was a wide spectrum of participants that ranged from specialists and medical officers of Hospital Queen Elizabeth’s anaesthesiology department to anaesthetic nurses and assistant medical officer anaesthetists from district hospitals in the interior such as Kinabatangan.
After a brief but robust ice breaking session, the Chairperson introduced our honorary invited speaker, Professor Dr Y K Chan, who then proceeded to continuously enthral the audience with her amazing presentations.
The first talk entitled “Lessons learnt from Michael Jackson’s death” was one that caught the floor’s attention immediately. Michael Jackson’s untimely demise shocked the world. Professor Dr Y K explained that what many failed to appreciate was that light sedation, deep sedation and anaesthesia were a continuum. The cardiologist who looked after Michael Jackson administered a massive cocktail of drugs to him to help him sleep. Drugs included benzodiazepines and even an infusion of propofol throughout the night, which amounted to a very high dose. The doctor did not understand that airway patency may be lost under deep sedation, and he also did not have the skills to perform CPR correctly. Had the case been handled differently (according to Dr Lily Ng, if he had been handled by an anaesthesiologist….!!? ), MJ may still be alive today.
After a morning break with light beverages, Prof Dr Y K resumed the meeting with her next talk, entitled, “Two lives, the anatomy and physiology of death.” Though morbid sounding, Prof Dr Y K had again successfully captured the imagination of the audience through the talk. She spoke of a concept that was very dear to her; that is G.O.D sustains life (G.O.D = Good oxygen delivery). She emphasized on the significance of oxygen delivery, especially on its effects on the Na-K ATP pump, using the examples of a person after death, and a foetus in utero, to illustrate her points. After death, a person’s face looked “beautiful” because of the failure of Na-K pump, causing sodium to move into cells, causing them to swell up and thus reducing the wrinkles on the face. A foetus’ will die if oxygen does not get delivered from its mother. Hopefully, the powerful messages would bring a change to the way many of us manage our patients, and hence, their outcome.
During lunch time, a group photograph was taken before the participants were released to devour the food. Following an hour-long lunch break, the participants were reassembled and the “Effective Presentation Skills” workshop was commenced.
Prof Dr Y K started by stating, “Know yourself, know your talk, know the media and know your audience.” A good presenter was one who prepared well and did his/her homework on the subject, audience and media used. She also shared on how to reach out to the audience, and suggested strategies for self improvement. She managed to engage the audience and made them walk hand-in-hand with her and “get intimate”. At the end of her talk on effective presentation, it truly felt like we had developed a sense of closeness to the speaker, and a better understanding of what she had aimed to deliver.
Five participants, consisting of anaesthetic medical officers, among the audience were selected to give a five-minute presentation each, on the topic of their choice, followed by a feedback session by Prof Dr Y K and the floor, including Dr Lily and Dr Nagarajan. The topics were varied and included setting up an aquarium. It was a truly eye-opening and constructive session for all, and really beneficial and enjoyable to those who presented, as well as those who did not. Many paramedics also praised it highly and expressed their gratitude for the opportunity that was given to them to attend.
The day ended at 4.00 pm with a note of thanks and gift presentation to Prof Y K for her willingness to come to Sabah and share her knowledge in many areas.
A special thanks to the Malaysian Society of Anaesthesiologists and Department of Anaesthesiology and Intensive Care, Sabah, for their collaborative efforts to invest and improve the standard of patient care through sowing the seed of knowledge.
That there should one man die ignorant who had capacity for knowledge, this I call a tragedy.’ - Thomas Carlyle
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Obstetric Anaesthesia Symposium 2013
The Department of Anaesthesia and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, in collaboration with the Special Interest Group in Obstetric Anaesthesia, Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists successfully conducted the Obstetric Anaesthesia Symposium, 2013 on the 25th and 26th October, 2013. The event was officiated by Dato’ Dr Haji Anwa bin Sulaiman, Director of Terengganu State Health Department and was attended by 143 doctors and paramedics from the whole country including Sabah and Sarawak.
The main objectives of the symposium were to update issues related to labour anaesthesia and Caesarean Section delivery, to highlight the on-going issues related to haemorrhage in obstetric patients as well as current maternal issues including obesity, eclampsia and embolism.
This two-day programme was filled with lectures, forums and discussion regarding current issues and update on labour anaesthesia, resuscitation of collapsed parturient, issues with regards to parturients with pre-eclampsia/eclampsia and a lot more interesting topics. All speakers were specially invited from the SIG and are experts in Obstetric issues. Among them were Dr Mohd Rohisham bin Zainal Abidin from Hospital Tengku Ampuan Rahimah, Klang, Dr Thohiroh binti Abd Razak from Hospital Kuala Lumpur, Prof Y K Chan from Pusat Perubtan Universiti Malaya, Dr Norliza binti Mohd Nor from Hospital Selayang, Dr Nora Azura binti Dintan from Hospital Kuala Lumpur, Dr Noraslawati binti Razak from Hospital Kuala Lumpur and Dr Chan See Yun from Hospital Kuala Lumpur.
Other than that, participants also had an opportunity to visit the exhibition booths displaying a variety of cutting edge medical and anaesthetic equipment prepared by medical companies. There were 12 medical companies involved during this symposium.
The event ended around 1.00 pm on the 26th October 2013, with positive feedback from all participants – they gained priceless exposure and knowledge from all the lectures and discussions, satisfaction with the hospitality provided was high and mentioned that it was a well-organised course. Overall, this programme was successful and we hope that it will become an annual event from next year onwards.
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NYSORA Asia KL 2014
The New York School of Regional Anesthesia (NYSORA) lead by Prof Admir Hadzic with full endorsement from the Malaysian Society of Anaesthesiologists (MSA), came back to our shores for the second time, after the initial 2009 event. NYSORA Asia has transformed itself into philanthropic educational outreach programme to preach the gospel of Regional Anaesthesia (RA) to Asia.
The Regional Anaesthesia workshop was held at Hotel Istana during the 8th - 9th March 2014 weekend. The Malaysian Special Interest Group in Regional Anaesthesia (SIGRA) members, Dr Shahridan Fathil and Dr Julina Johami were invited as speakers in this year’s edition. Dr Shahridan delivered his “Brachial Plexus Blocks: Below the Clavicle” talk and Dr Julina spoke on “Essential Paediatric Regional Anaesthesia”. It was such an honour to see our national experts speaking side by side with the renowned and well-published international faculty such as Admir Hadzic himself, Phillippe Gautier and Catherine Vandepitte, among many others. Ten of our SIGRA stalwarts were invited to be part of the Associate Faculty, namely:
The workshop managed to attract 200 participants from all around Malaysia, Australasia and even as far abroad as New Zealand, Europe and the USA. It was indeed overwhelming to have the world experts speaking in our backyard. The participants were exhilarated during the hands-on sessions as the overseas faculty was generous in guiding and sharing their experience on ultrasound guided blocks; giving tips on achieving success with regional anaesthesia techniques at the same time. The dedication and enthusiasm in spreading their knowledge of RA was apparent in the way the faculty addressed the questions and challenges expressed by the RA practitioners/participants. A fair number of participants did not hesitate to have “selfies” with Admir Hadzic, the guru and admittedly, rock star of RA! The MSA Executive Committee and SIGRA members celebrated the International faculty with both authentic and fusion Malaysian cuisines on two separate occasions.
It was truly a delightful experience for both the participants and the local faculty. Besides strengthening our network, it was also an opportunity for RA enthusiasts in Malaysia to establish and strengthen ties with the NYSORA.
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14th Asian Australasian Congress of Anaesthesiologists
“Are you going on a hunt for hobbits?”
“Hmm….meeting a hobbit or two would be nice; but, a glimpse of Legolas or Gandalf would definitely be the highlight of my trip”, was my response.
That was the chit chat amongst friends and family as I made preparations to attend the 14th Asian Australasian Congress of Anaesthesiologists (AACA) in New Zealand from the 21st to the 25th February 2014.
It was my first experience at an international congress which was enough to fuel my excitement. This year, the AACA was held hand-in-hand with the 4th Australasian Symposium on Ultrasound & Regional Anaesthesia (ASURA). It was a well-rounded and holistic congress with various programmes including workshops, plenary sessions, lectures and problembased learning discussions (PBLD). The organisers made great efforts organising a wide scope and multitudes of experts to impart their knowledge on all things anaesthesia.
The venue for the conference was very wisely chosen being the Skycity Auckland Convention Centre, which is a state of the art convention centre located just off Queen Street, the city’s central retail street and the hub of the central business district.
The congress commenced with the opening ceremony which was filled with colour and rich Maori culture. “Kia Ora” - this was the common greeting used which means “Hello”. We had the privilege of being a part of the ‘powhiri’ which is a welcome ceremony normally held on Maori grounds. Dressed in the splendour of their Maori attire, the ‘powhiri’ began with the hosts challenging the guests, seeking to see whether they are friend or foe. The leader of the hosts carried a ‘taiaha’ (a spear like weapon) and laid down a token; a branch, which the guest picked up to show that they came in peace. To cap off formal proceedings, the hosts and guests greeted each other with a ‘hongi’; a ceremonial touching of noses. We were entertained with Maori dance and song intended to ward off war and bring peace.
This trip was a special event as it was in conjunction with the Malaysian Society of Anaesthesiologists bid for the AACA 2022. Nights of research, strategising and team work, in collaboration with the Malaysian Convention and Exhibition Bureau (MyCEB), was invested in preparing for this bid which included bid documents, advertisements, pre-emptive congress programmes and venues, not forgetting prospective social events. We put up a Malaysian booth filled with colourful highlights from Malaysia such as the ‘orang utan’ and the ‘kampung melayu’, just to name a few. Dr R Raveenthiran painstakingly and proudly put up a professional and well-delivered presentation bid which I had the opportunity of attending behind closed doors as we went against the Korean Society of Anaesthesiologists in a friendly but fierce competition. The Korean Society of Anaesthesiologists also wowed the crowds with their culture, colourful booth and eyecapturing bid presentation. Sadly, victory was not in our favour this time around. Regardless, the opportunity to bid was an eye-opener and an experience not to be forgotten.
New Zealand in itself, is breathtakingly beautiful with many gorgeous lakes, every lake being different from the other. The trip definitely cultivated our interest in photography with us competing against each other as to who gets the best sunset, lake and so forth. I must admit one of the most important lessons that New Zealand taught me is the true pride that the country has in their indigenous culture and how it is so proudly embraced and entwined in their lives.
Needless to say, I did not see any hobbits or any other characters from the Lord of the Rings.
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Difficult Airway Workshop January 2014
Following the good response from the Difficult Airway Workshop held in March 2014, the Department of Anaesthesia & Intensive Care, Hospital Kuala Lumpur, decided to organise another Difficult Airway Workshop this year. This year, the Difficult Airway Workshop was held on the 8th January 2014. It was organised by the Department of Anaesthesia and Intensive Care, in collaboration with the Malaysian Society of Anaesthesiologists, UMMI Surgical Sdn Bhd and COOK Asia Sdn Bhd.
The total number of participants was limited to 30 trainees for better teaching and hands-on experience. There were participants from Seremban, Selangor, Kuala Lumpur and Sarawak (Sibu). The workshop opened up an opportunity for the medical officers from the Anaesthesiology Departments to have hands-on experience on fibreoptic intubation, as well as other difficult intubation devices (CMAC video laryngoscope, Bonfils intubating fiberscope and Fastrach intubating LMA)
Registration started at 7.15 am on that morning. Our guest speaker and facilitator was Dr Lee Yan Wei, an Anaesthesiologist from our department. She started off the workshop at 7.45 am by giving a short lecture on difficult airway management, followed by an eye-opening video presentation. Datin Dr V Sivasakthi (Head of Department, Hospital Kuala Lumpur), also welcomed all the participants and mentioned that the workshop would benefit everyone present.
A short tea break was held which was then followed by the highlight of the workshop – the hands-on sessions. Participants were divided into five groups (six persons per group). This year, we decided to have smaller groups to ensure every participant has a chance to practice. We also added a CICV (Can’t Intubate, Can’t Ventilate) station this year. The first three groups were stationed to our main General Operating Theatre for intubation on live patients. Participants had the chance to practice fibreoptic (awake and asleep) intubation, CMAC, Bonfils and Fastrach intubation, supervised by anaesthesiologists from our department. The fourth group was stationed in our department’s 3rd floor conference room to practice fibreoptic intubation, CMAC and Bonfils intubation, as well as to use other difficult airway adjuncts on mannequins supervised by specialists. The fifth group was stationed at the AV room to practice cricothyroidotomy and jet ventilation on mannequins, in a CICV scenario. The groups would then rotate to different stations after an hour.
We managed to recruit more patients this year so that more participants could have hands-on experience intubating them. Thanks to our surgical colleagues from the Department of Oral Surgery, Orthopaedics, Orthopaedics Oncology, Opthalmology, Breast and Endocrine Surgery and Surgery, we managed to recruit a total of 15 patients with various indications for fibreoptic intubation, and other surgical procedures which required general anaesthesia and intubation. The patients were all coming in for elective surgery that day. The GA nurses were of great help in ensuring the smooth transition of patients from individual OT suites to the recovery area.
In between group rotation, we had lunch, followed by an MCQ session relevant to the topic of difficult airway at the end of the workshop. Apologies to those who came in late for lunch, as there was an underestimation of the total amount of people involved. The workshop ended at 3.30 pm with very positive feedback - participants gained priceless exposure, satisfaction with the hands-on practice, and mentioned that it was a well-organised workshop. Prizes were given to the first three participants who scored the highest in the MCQ session. Certificates were given to all participants.
Overall, the Difficult Airway Workshop was a successful one. We wish to recruit more patients the next time for hands-on experience by the participants. On behalf of the Organising Committee, we thank all the participants, facilitators, medical attendants and nurses for their teamwork.
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Obstetric Anaesthesia Crisis Simulation Workshop
In conjunction with the Annual Scientific Congress of Anaesthesiology recently, the above workshop was held on 3rd April 2014, at Bronx 4, Berjaya Times Square Hotel & Convention Centre, Kuala Lumpur. It was jointly organised by Special Interest Group (SIG) Simulation and SIG Obstetric, College of Anaesthesiologists and Malaysian Society of Anaesthesiologists (MSA). Simulation courses have been conducted numerous times previously; however, this is the first time that it solely involved the obstetric field. The facilitators included Drs Mohd Rohisham Zainal Abidin, Thohiroh Abdul Razak, Nora Azura Dintan from SIG Obstetric and Drs Rajeswary Kanapathipillai, Rafidah Atan, Nor’azim Mohd Yunos and Noorulhana Sukarnakadi Hadzarami from SIG Simulation. In addition, Encik Mohamad Nor Mohd Ithnin from HKL also assisted. The response was overwhelming as there were 21 participants including 2 people who registered on the day itself. It was a good mix of participants, ranging from Anaesthetic Medical Officer (MO), Accident & Emergency MO, Anaesthetic specialists, as well as Obstetric Anaesthetic Subspecialty trainees.
The objective of this inaugural workshop was to highlight key issues required to optimise learning within a synthetic environment. In this workshop, participants were taught how to manage numerous obstetric anaesthesia crisis in the perioperative setting. After registration, there was a welcome speech followed by a lecture on Obstetric Crisis: An overview by the Chairperson himself, Dr Mohd Rohisham. Next, Dr Rajeswary gave a lecture on Human Performance Issues and Fixation Errors in Anaesthesia. Dr Rafidah then briefed participants on the workshop before everybody went for morning tea.
The first hands-on session kicked off after morning tea. The participants were divided into three smaller groups as there were three stations available. All stations were equipped with high end manikin which can mimic real life ‘signs of life’ (ie. Pupillary reaction, pulse, breath sounds etc). Various obstetric emergency scenarios using simulated patients were undertaken at each station. During each hands-on session, some participants took active role while the rest took the observer role. In the following station, the role was reversed. This was to ensure that all participants would have an opportunity to have at least one hands-on session. Each scenario lasted for an hour in which at the end of each session, a debriefing session to ascertain participants’ strengths as well as weaknesses was carried out. After the completion of the third and final hands on, an overall debriefing and Q&A session were held.
Overall, participants performed satisfactorily during the hands-on sessions and really enjoyed themselves. Although it was tiring for participants (as well as for the facilitators!) as it was a full one day course, nevertheless they have acquired invaluable skill and knowledge. The feedback were mostly positive and some of the suggestions included having a two-day workshop, more lectures, more obstetric emergency scenarios, changing the venue to a hospital and less expensive fee!
All these feedbacks were addressed adequately by the Chairperson. At the end of the workshop, a group photo session involving all the facilitators and participants took place. Before everyone went home, they were treated with afternoon tea.
For this opportunity, on behalf of the organisers, I would like to extend my highest appreciation to the College of Anaesthesiologists and MSA for organising this first ever obstetric crisis workshop. Kudos to all the facilitators who took part and gave their heart out in order to ensure the success of the workshop. Not to forget, Maycare & Laerdal for sponsoring this workshop. In addition, a special “thank you” to Dr R Raveenthiran, President- Elect, MSA and Professor Dr Chan Yoo Kuen for dropping by during the workshop and giving valuable feedback. To all participants, thank you as well for being sporting during the workshop.
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Difficult Paediatric Airway Workshop
The Paediatric Airway pre-congress worshop was held on the 3rd of April 2014, in the Clinical Skills Lab, Faculty of Medicine, UiTM Sungai Buloh. It was one of the workshops which was held in the outskirts of Kuala Lumpur, for the participating delegates to enjoy the serenity.
The workshop attracted 25 participants from all around the country. The format of the workshop was interesting; a combination of short interactive lectures in the morning and small group hands-on session in the afternoon.
The interactive lectures were really interactive as the participants bombarded the faculty with questions and queries regarding techniques and practices! Prof Dr Lucy Chan, Dr Ina Ismiarti, Dr Chris Acott, Dr Hamidah Ismail, Dr Vinodh Suppiah and Dr Tan Leng Zoo, had an enjoyable intellectual discussion with the participants.
The afternoon session had the participants on their feet most of the time. They had the best opportunity to fiddle around with the airway gadgets such as the fibre optic scope, videolaryngoscopes, emergency cricothyrotomy sets and supraglottic airway devices. The Paediatric Simulation session organised in the simulation lab certainly rekindled a lot of memories to the participants involved. With high fidelity simulation mannequin mimicking a threatened airway condition and a typical surgeon literally breathing down on your neck; it certainly stimulated the delegate’s six senses to manage the difficult airway scenario to their best!
The Difficult Paediatric Airway workshop certainly refreshed and updated the trainees, specialists and consultants’ knowledge on the latest regarding children’s difficult airway management. Those who completed this workshop, came out with No more fears!
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On the 1st and 2nd of March 2014, the Malaysian Society of Anaesthesiologists, in collaboration with Merck Sharpe & Dohme (MSD), organised the Networks in Anaesthesiology meeting at the Intercontinental Hotel, Kuala Lumpur. The event was attended by over 122 delegates from China, Singapore, Vietnam, Thailand, Brunei and Malaysia. It was also joined by an international panel of faculty from Netherlands, France, Denmark, Australia, and not forgetting our very own eminent clinicians from Malaysia.
The objectives of the event were as below:
The two-day programme comprised a mix of plenary lectures and concurrent workshops. The meeting started with an opening message of eliminating the barrier between the anaesthetist and the surgeon. The main message was that the partnership between both anaesthetist and surgeon is the key to ensure the best management for the patients. The meeting reinforced the importance of muscle relaxation in the management of general anaesthesia and the consequences of residual paralysis. New concepts in management of general anaesthesia namely the role of deep muscle relaxation to facilitate laparoscopic surgery were also shared.
The overall feedback from the participants who attended the symposium was that the event was a success and it served as a platform for anaesthetists across the region to share their practises and exchange their clinical experience with fellow colleagues.
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Annual Scientific Congress
3rd to 6th April 2014. The date for this year’s ASC… Wait a minute! “Did I just read ASC and not AGM? A typo perhaps?“– you may ask. You read me correct – ASC that is! Annual Scientific Congress!
This annual event is a major event in the Malaysian Society of Anaesthesiologists’ (MSA) and the College of Anaesthesiologists’ (CoA) calendar. We accomplished many firsts this year. 2014 - the Inaugural Year when we upgraded the event from a meeting to a congress reflecting the exponential multiplication of our members since the birth of our Society more than half a century ago. Berjaya Times Square Hotel and Convention Centre - exploring a new venue beyond our comfort zones with initial scepticism turning into a box-office success. Dare to Explore, Dare to Conquer – the motto of the Organising Committee spearheaded by Dr Raveenthiran Rasiah; advised by the Presidents of the MSA and the CoA, Dr Sushila Sivasubramaniam and Datin Dr V Sivasakthi respectively; we have a record of 875 participants for this Congress.
This was not all. We took our first baby step towards an environmental-friendly congress. Scientific posters were displayed electronically, bidding goodbye to mounted posters and saying hello to the ‘go green’ concept.
The Congress proper was preceded by five pre-congress workshops on 3rd April 2014 – the Obstetric Anaesthesia Crisis Simulation, Research for the Novice and the Ultrasound Life Support Workshop, all held at the Hotel; the Difficult Paediatric Airway Workshop in UiTM Sungai Buloh, and the Deep Block with Neuromuscular Blocking Agents Workshop in Hospital Kuala Lumpur. This year, we broke the track record by having the highest number of pre-congress workshops to date in the history of our meetings.
The Congress was opened by Datuk Dr Jeyaindran Tan Sri Sinnadurai, Deputy Director-General of Health, Malaysia, representing the Honourable Minister of Health, Datuk Seri Dr S Subramaniam. An anaesthesiology montage, a story of our secluded little world of anaesthesiology within a large scope of service, was launched at the ceremony. Dato’ Dr A Damodaran was conferred the MSA Honorary Membership for his extensive contributions in the field of anaesthesiology after a citation by Dato’ Dr Sylvian Das. Dr Abraham Philips and I were privileged to witness this Opening Ceremony as the Emcees of this event.
The theme “Bridging the Gap: Evidence Meets Experience” was apt in this era of evidence-based medicine uniting clinical practice with research studies. The emphasis on research was highlighted in the first keynote lecture delivered by Professor Neville Gibbs entitled Evidence-Based Practice In Anaesthesia. The Scientific Committee led by Dr Ina Ismiarti Shariffuddin convened an outstanding educational programme over this three-day Congress consisting of five plenaries, thirteen symposia and four concurrent workshops, summoning some of the brightest minds in the field of Anaesthesiology from around the globe.
The ‘Meet-the-Professor’ Session was introduced this year as an informative session to facilitate anaesthesiologistsin- training by revealing tips and tricks on how to handle examinations and perhaps, the examiners. The two daily sessions were among the most popular sessions despite being held in the very early morning of the Congress.
The MSA and CoA Annual General Meeting was held with the election of new Office Bearers and the change of guards. Professor Dr Chan Yoo Kuen signed off as the Chairman of the MSA and Dr Mohamed Namazie Ibrahim was elected for the next quadrinium.
All work and no play, makes an anaesthesiologist dull! The ASC besides being a meeting point for professionals to learn, impart knowledge, and explore common interest; also offered the opportunity to catch up and mingle with peers in a social environment. The Congress Gala Night with a “Black and White” theme was an evening of unforgettable fun and exhilaration, and was graced by the presence of Datuk Seri Dr Noor Hisham Abdullah, the Director-General of Health Malaysia. Dr Roopak Singh Raghbir Singh was the Emcee for the evening.
We were mesmerised by the absolutely amazing voice of Adibah Noor, a talented artiste, singer and performer as she sang with passion to the crowd, and the spectacular performance by Dr Jason Leong, a doctor turned standup comedian.
The very best of the best of those who went all out in the name of research were rewarded and awarded that night. There were 38 abstracts submitted for both oral and poster presentations. Dr Rahmat A H from Hospital Sultanah Aminah, Johor Bharu, bagged the MSA-AstraZeneca Award for his presentation on “Don’t Worry, Block Deeply! A Randomized Controlled Trial Comparing Deep Block Reversal By Sugammadex And Moderate-Block Reversal By Neostigmine”. The MSA Award went to Dr E Kamaruzaman of Universiti Kebangsaan Malaysia for his presentation on “Comparing the Efficacy of Granisetron and Ketamine for the Prevention of Shivering in Patients Undergoing Spinal Anaesthesia”. The poster awards went to:
The Congress ended with a sumptuous lunch on 6th April 2014. We would like to say a ‘big thank you’ to the support from the biomedical industries and the congress secretariat.
More than half a century of glory saw the elevation of our status from a meeting to a congress. As pioneers of change, this congress was redesigned to undergo a metamorphosis towards the betterment of the society - a major breakthrough in the history of the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists. We came a long way from the initial gathering of a few members more than five decades ago, to the amalgamation of knowledge and expertise at international level today. We are proud to be members of the Malaysian Society of Anaesthesiologists and for those who have yet to join this big family of anaesthesiologists, what are you waiting for? Join us now to create history of tomorrow. See you next year in Penang for the ASC 2015, to be held in conjunction with the Congress of the Asian Society of Paediatric Anaesthesiologists (ASPA) in Malaysia.
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Deep Block with Neuromuscular Blocking Agents
The Pre-Congress Workshops for the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists Annual Scientific Congress 2014 were held on 3rd April 2014. There were five Pre-Congress Workshops in total.
Hospital Kuala Lumpur hosted the “Deep Block with Neuromuscular Blocking Agents” Pre-Congress Workshop, in collaboration with Merck Sharp & Dohme. This workshop featured eminent speaker, Associate Professor Dr Nolan McDonnell, an obstetric anaesthesiologist from King Edward Memorial Hospital for Women in Perth, Western Australia. The aim of this one-day workshop was to focus on the concept of deep neuromuscular blockade in facilitating optimal surgical conditions, assimilating theoretical knowledge with clinical practice and coupling deep neuromuscular paralysis with fast, predictable and complete reversal.
More than 20 participants attended this workshop. The morning began with an icebreaking session by Datin Dr V Sivasakthi, President of the College of Anaesthesiologists, Academy of Medicine of Malaysia; Head of Anaesthesiology and Intensive Care Services in the country, also the Head of the Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur.
Associate Professor Dr Nolan McDonnell discussed the applications of neuromuscular blockade in modern day anaesthesia and addressed issues pertaining postoperative curarisation. His points were further strengthened by real-time communications with our invited surgeons during live demonstrations of an orthopaedic and a laparoscopic procedure from the operating theatre.
Mr Manmohan Singh Sarjit Singh, an Orthopaedic Surgeon, and Mr Tikfu Gee, a surgeon specialising in Advanced Minimally Invasive and Bariatric Surgery, spoke on their perspectives of deep neuromuscular paralysis on their surgical experience thus far.
This workshop set the pace for networking between enthusiastic participants with skilled experts in their own field; and between anaesthesiologists with surgeons. This was without doubt, a rewarding and valuable experience, a day we gained deeper insight into the world of neuromuscular blocking agents with a whole new concept.
It was all in all, a successful workshop and the ultimate goals of this workshop were attained.
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Hi Fellow Collegians
Time has really flown and six months have passed so fast. Let us look at some of the activities that have occurred.
The MSA / CoA Annual Scientific Congress was held on 3rd to 6th April 2014, at Berjaya Times Square, Kuala Lumpur. It was a sensational event attended by almost 900 participants. The College AGM was held on 5th April and attended by 31 members. Many topics were covered and discussed.
CPD for Members: The Council of the Academy of Medicine of Malaysia has done a trial run amongst the members of the College of Surgeons, in December 2013. The Academy Council at its meeting on 8th February 2014, has directed that the Colleges look at the CPD credit points system which has been set up and to provide feedback. The College has nominated an overall administrator as well as evaluators for the subspecialties/specialty. We were requested to provide a calendar of events being planned and organised for this year and subsequent years. Therefore, it will be good if organisers of future events will email to us the planned dates and the programme so that our administrator can get this calendar going.
Consent Guidelines. The Malaysian Medical Council has uploaded the finalized Consent Guidelines on the MMC website. There was some unhappiness about certain sections in the guidelines. It was proposed that the College and the Malaysian Society of Anaesthesiologists could sent a joint letter to the MMC on this matter.
Duration of Post Qualification Experience: The College has decided on twelve months for the duration of post qualification experience for Anaesthesia and this decision has been conveyed to the Chairman of the Specialty Subcommittee for Anaesthesiology of the National Specialist Register.
Fee Schedule. The Minister of Health has announced in early March 2014 of the increase of 14.4% across board to the existing fees; this increase was gazetted in December 2013.
Field of Practice: It was highlighted that paediatric anaesthesia, cardiothoracic anaesthesia, obstetric anaesthesia, neuroanaesthesia and pain medicine will be deemed as Fields of Practice. At a recent Academy Council meeting, it was highlighted that each specialist can have one base specialty and one subspecialty only in the NSR. Therefore, as many of our specialists do cases from the above mentioned areas, it was decided that these areas should not be converted to subspecialties and remain as areas of interest. Private hospitals should privilege these specialists if necessary.
ANZCA ASM and RACS Annual Scientific Congress was held in Singapore from the 5th to the 9th of May 2014.
The CoA was invited to take part in the induction ceremony for new ANZCA fellows. It was also an opportunity to renew ties with Dr Ellen O’Sullivan who is the President of the Ireland College of Anaesthetists. We had a fruitful discussion and it has been decided to hold a preparatory course for the Primary exam in Anaesthesia in October 2014. The course will be held in Hospital Kuala Lumpur and I am now in the process of collecting names. Please send names via email to email@example.com. Please pass the word around to your friends as well. It is of note that the Ministry of Health is endorsing this alternative pathway to produce more specialists in the future. Do not miss this opportunity!
Finally, two Guidelines were launched. The first was on Preoperative Assessment and the second was on Monitoring Guidelines. A huge vote of thanks to both the editors and their members, for their dedication and hard work. Make sure you get your copies and reference these guidelines during your practice.
What is coming up, you may ask!
2014 International Congress of Pathology & Laboratory Medicine (ICPaLM) and 48th Malaysia-Singapore Congress of Medicine
26th to 28th August 2014, Shangri-La Hotel, Kuala Lumpur
Ambulatory Care Conference
4th to 5th September, Medical Academies of Malaysia Building, Kuala Lumpur
Dr Sivasakthi V
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