Biomedical subjects

W K Boey

Publications and source records attributed to W K Boey.

6 recordsLinked to original sources

PubMed1995

Challenges in ambulatory surgery: discharge criteria.

The weakest link in ambulatory surgery is often the discharge of patients. Protocols and guidelines are important for the safe discharge of patients. The patient who has recovered sufficiently for discharge is considered "home ready", is in the intermediate stage of recovery and is to continue the recovery at home under the supervision of a responsible adult. There are many tests of recovery but none suitable for routine clinical use. The mean hospital transfer rate for a multidisciplinary ambulatory centre is between 0.12% to 1.2%. Gynaecology and urology have the highest hospital transfer rate. Surgical causes of hospital transfer are three to five times greater than anaesthetic causes. Common anaesthetic reasons for hospital transfer were inadequate recovery, nausea and vomiting, hypotension and syncope. Surgical reasons for hospital transfer included bleeding, extensive surgery, perforated viscus and further treatment. The patient should be discharged by a physician after satisfying a checklist of "discharge criteria".

Adult↗

PubMed1991

Haemodynamic effects of ketanserin following coronary artery bypass grafting.

The haemodynamic effects of ketanserin were studied consecutively in seventeen patients in the intensive care unit following coronary artery bypass grafting. Hypertensive patients (Group 1, systolic blood pressure (SBP) greater than or equal to 150 mmHg following discontinuation of nitroprusside, n = 10) received intravenous ketanserin 10 mg and infusion of 0.1 mg.kg-1.hr-1 with additional boluses as required to maintain SBP less than or equal to 130 mmHg for one hour. Non-hypertensive patients (Group 2, SBP less than 150 mmHg, n = 7) received a 5 mg bolus and the same infusion. Ketanserin significantly decreased arterial blood pressure (P less than 0.001) in all patients in Group 1. Heart rate was decreased but not significantly. Cardiac index, systemic and pulmonary vascular resistance and pulmonary shunt fraction were not significantly altered from pre-ketanserin values when blood pressure was controlled with nitroprusside. Normotensive patients in Group 2 did not show any undesirable hypotension or significant haemodynamic changes. Mean nitroprusside dose requirements following ketanserin therapy were significantly reduced by 91.6% in Group 1 and 78.4% in Group 2 (P less than 0.05). Ketanserin is effective in treating hypertension following coronary artery bypass grafting with an advantage of lack of reflex tachycardia.

Adult↗

PubMed1991

Pain control.

There are two components to the perception of pain; the 'sensory' and the 'reactive'. Psychological factors control the latter. Pain research is rapidly advancing: the discovery of endorphins and opioid receptors, the appreciation of the psychological component of pain and the multidisciplinary approach to chronic pain are major advances. Pain can be classified as acute or chronic. Acute pain is easy to diagnose, the cause of pain obvious and the treatment logical, chronic pain has a greater psychological component, is difficult to diagnose and treatment is often empirical. Methods of pain control include drugs, injection techniques, electro stimulation, non invasive therapies, denervation procedures and palliative procedures. A multidisciplinary approach and a combination of methods is necessary to treat chronic pain. Spinal opioids, radiofrequency thermocoagulation, intrapleural bupivacaine, cryoanalgesia and patient controlled analgesia are recent advances in pain control. However, most pain can be controlled adequately with simple methods; what is essential is the interest and commitment of the physician towards achieving optimum therapeutics.

Acute Disease↗

PubMed1991

Comparison of propofol and thiopentone as induction agents for laparoscopy.

Fifty two patients for laparoscopy were randomly divided into two groups and induced with propofol 2 mgkg-1 or thiopentone 4 mgkg-1. The two groups were similar for race, age, weight, premedication and duration of operation. General anaesthesia with endotracheal intubation, nitrous oxide/oxygen with 0.5% halothane and muscle relaxation with suxamethonium was used throughout. Induction times were similar for both groups. The systolic, diastolic blood pressures and heart rates of both groups fell significantly from baseline values two minutes after induction. The fall in systolic blood pressure was greater with propofol (p less than 0.01). Following intubation the rise in systolic, diastolic blood pressures and heart rate above baseline values were greater with thiopentone (p less than 0.001 for all three variables). Discomfort on injection and involuntary movements were significantly more common with propofol. Laryngospasm was significantly more common with thiopentone. Patients given propofol could sit up unaided earlier after the anaesthesia (p less than 0.01). There was no difference in eye opening and orientation time.

Adult↗

PubMed1990

Comparison of propofol and thiopentone as anaesthetic agents for electroconvulsive therapy.

Propofol and thiopentone were compared as anaesthetic agents for electroconvulsive therapy in 31 patients on four occasions in a repeated measure crossover study. Discomfort on injection was significantly more common with propofol (51.6% of anaesthetics) compared to thiopentone (1.6% of anaesthetics). The duration of seizure was shorter with propofol in both treatments but there was significant drug-time interaction. Propofol gave a milder tonus and clonus during seizure when both treatments were considered together. The increase in systolic and diastolic arterial pressures and heart rate after treatment were significantly higher with thiopentone. Apnoea was significantly longer with propofol. The times to sitting up unaided and opening the eyes on command were the same for both drugs. The ability to walk 10 m 20 minutes after anaesthesia was significantly better with propofol (p less than 0.0001).

Anesthesia Recovery Period↗

PubMed1990

The role of protamine dose assay in reversal of heparin following extracorporeal circulation for open heart surgery.

The amount of protamine required for the neutralisation of heparin following cardiopulmonary bypass was determined by a Protamine Titration Assay using the principle of the dose--response curve and the patient's estimated blood volume. In 300 open heart surgery patients, infusion of the determined dose of protamine normalised the Activated Clotting Time (ACT) to baseline levels in 97% of these patients and produced adequate hemostasis. Our present study showed that the dose of protamine dropped to 75% of the dose calculated by conventional method of heparin to protamine ratio of 1:1. This had minimised the adverse effects of excessive protamine administration and optimised coagulation control after extracorporeal circulation.

Adolescent↗