The purpose of the study is to find out the factors affecting the public speaking skills of 45th ... more The purpose of the study is to find out the factors affecting the public speaking skills of 45th cohort students majoring in high-quality English and make recommendations to improve and enhance the public speaking ability of EFL students from High-quality English Studies Program. The study participants included 86 high-quality English language third-year students. We used questionnaires to collect data and used SPSS statistical software to analyze data by descriptive statistical method. Research results show that students' ability to speak in public is affected by their lack of confidence in speaking. At the same time, the factors of the study program and the school environment also affect the students' public speaking skills. Based on the research results, the paper makes some pedagogical recommendations. Article visualizations:
Science and Technology Development Journal - Natural Sciences, 2021
As analyzing geomagnetic data at low latitude areas for instance the Mekong Delta (latitudes 11,0... more As analyzing geomagnetic data at low latitude areas for instance the Mekong Delta (latitudes 11,07o), significant problem is that both of the magnetization and ambient field are not vertical totally, making magnetic anomalies antisymmetrical and often skewed to the location of the sources. In this paper, two-dimensional continuous wavelet transform (2-D CWT), using Farshad-Sailhac complex wavelet function is studied and applied for reducing the magnetic anomaly to a symmetrical one - this located on the source of the anomaly, and then determining the position of the center of the object causing anomalies by wavelet transform modulus maxima (WTMM) method. Next, magnetic data is extracted in two perpendicular directions passing through the center of the source to perform one-dimensional continuous wavelet transform (1-D CWT) to estimate the shape, depth and size of the source. Then, using the Marquardt algorithm to solve the inverse problem by least-squares method to further identify ...
Nghiên cứu thành phần động vật đáy trong vịnh Quy nhơn được tiến hành tháng 8/2019 tại 30 vị trí.... more Nghiên cứu thành phần động vật đáy trong vịnh Quy nhơn được tiến hành tháng 8/2019 tại 30 vị trí. Kết quả xác định được 97 loài thuộc 77 giống, 57 họ, 31 bộ, 11 lớp, 5 nhóm: Thân mềm (Gastropoda, Bivalvia), Giáp xác (Crustacea), Dây sống (Chordata), Da gai (Echinodermata, Ophiuroidea), Giun nhiều tơ (Annelida). Trong đó nhóm Thân mềm Chân bụng (Gastropoda) có thành phần loài phong phú nhất (có 40 loài, chiếm 41,24%), Hai mảnh vỏ (Bivalvia) có 27 loài, chiếm 27,84% và Giáp xác (Crustacea) có 20 loài. Các nhóm khác có mức đa dạng thấp hơn. Chỉ số đa dạng sinh học ở vịnh quy nhơn được đánh giá là khá cao (H’ = 4,59). Mật độ trung bình cá thể (V=20,62 cá thể/m2). Sinh khối trung bình (W= 2,88g/m2).
Public reporting burden for this collection of information is estimated to average 1 hour per res... more Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition cause... more Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition caused by Gram-negative bacilli. Respiratory infections, including cough, shortness of breath, and chest pain and skin infection with eruptions, pustules and itchiness, are common complaints in the setting of late HIV infection. The variety of infections ranges from mild, self-limited viral, bacteremia and fungal infections to severe, life-threatening demanding urgent care and hospitalization. Varicella pneumonia, for instance, is the most severe complication of chickenpox in HIV infected adults, potentially refractory, fulminant respiratory failure can ensue. Patients with impaired immune status and chronic lung disease are at an increased risk. In the United States as well as in Vietnam, bacterial/viral pneumonia and skin infection are the two most common HIV-associated conditions. While globally the incidence of opportunistic infection has decreased since the introduction of highly active antiretroviral therapy during the last 3 decades, HIV-associated diseases remain a significant source of mortality, thus any manifestation must be taken seriously. This study will present the most common HIV-related pulmonary and skin infections and provide an overview of the epidemiology, characteristic clinical and chest radiograph findings, diagnosis, treatment, and prevention globally as well in Vietnam. Though the extensive efforts of the Vietnamese Govern-* Corresponding author. C. Gargiulo et al. 49 ment during last decade contributed to a valuable decrease, yet epidemic in Vietnam still remains high, ranking Vietnam 5 th in the SouthEast region. The second part of the study focuses on a unique and severe HIV case report of a 35-year-old man, with a rare form of pneumonia caused by Acitenobacter spp. concomitant with a prolonged and disseminating skin infection. The case has been treated with a combination of conventional anti-retroviral medication and autologous peripheral blood stem cells, the results showed that within 5 months there was an impressive amelioration of HIV viral activity together with a total recovery from pneumonia and skin infection.
This paper presents a study of factors affecting time and cost overruns throughout life cycle of ... more This paper presents a study of factors affecting time and cost overruns throughout life cycle of construction projects. The issues of overrun in construction are very common worldwide including Malaysia. However, no researchers investigate this problem according to the phases of construction. Hence, this study is to classify the overrun factors into phases of project life cycle which include planning phase, design phase, construction phase and finishing phase. A total of 35 factors were identified based on previous studies involving a number of different countries. These factors were classified according to degree of occurrence of each phase. Based on this classification, it shows that most of the factors occurred in construction phase. This classification gives better understanding amongst construction practitioners.
A study was carried out to select the best method to estimate groundwater recharge in a hard rock... more A study was carried out to select the best method to estimate groundwater recharge in a hard rock terrain. Various standard empirical methods, soil-moisture balance method, water table fluctuation (WTF) method and commonly adopted norms set by Groundwater Estimation Committee (GEC), Govt of India were used to estimate recharge for the Munijhara watershed in the Nayagarh block of Orissa (India). The empirical formulae gave recharge rates ranging from 13 cm to 32 cm/year with average of 22.4 cm and standard deviation of 5.34, independent of other influencing factors like soil, topography and geology. The soil-moisture balance study indicated that recharge is more dependent on the continuous heavy rainfall total annual volume of rainfall. Recharge was limited at up to 10 mm per day, possibly due to presence of hard rock below the soil surface. The rise in water table depth was 3.45 m to 5.35 m with a mean rise of 4.5 m during the year 2006–2007. Annual groundwater recharge based on the...
ABSTRACT Photoinduced Anisotropy and All-Optical Poling are the result of two mechanisms, the ang... more ABSTRACT Photoinduced Anisotropy and All-Optical Poling are the result of two mechanisms, the angularly selective excitation of molecules (Angular Hole Burning) and the rotation of molecules during the excitationrelaxation cycle (Angular redistribution). In this ...
Comments and Corrections TABLE I CALCULATIONS OF Q-FACTORS FOR N = 3 AND N = 5 IN THE CASES OF TH... more Comments and Corrections TABLE I CALCULATIONS OF Q-FACTORS FOR N = 3 AND N = 5 IN THE CASES OF THREE DIFFERENT BIT RATES In these calculations the two photon absorption = 0:5 cm=GW has also been taken into account.
We propose a simple way to design a fully integrated and passive all-optical pulse reshaper in th... more We propose a simple way to design a fully integrated and passive all-optical pulse reshaper in the aim of reamplifying and reshaping (2R) regeneration of optical digital signals. The device could be achieved from a coupled microresonator structure with Kerr nonlinearity. By using time-domain simulation, we show that we can obtain a clear nonlinear power transfer that is capable of improving signal-to-noise ratio and reducing bit error rate for digital signals. The reshaping performances are estimated by calculating Q-factor enhancement. Since we take benefit from field enhancement at resonance, this integrated reshaper could be much smaller than other gates based on nonlinear fibers or waveguides.
Purpose of review Historically, ephedrine has been recommended as the best vasopressor in obstetr... more Purpose of review Historically, ephedrine has been recommended as the best vasopressor in obstetrics because animal studies showed it caused less reduction in uterine blood flow compared with α-agonists. Recent clinical evidence, however, suggests that this is not as important as initially thought. This review evaluates current data with a focus on spinal anesthesia for cesarean section. Recent findings Ephedrine and phenylephrine have been most investigated. Advantages of ephedrine include familiarity, long history and low propensity for uteroplacental vasoconstriction. Ephedrine, however, has limited efficacy, is difficult to titrate, causes maternal tachycardia and depresses fetal pH and base excess. Advantages of phenylephrine include high efficacy, ease of titration and the ability to use liberal doses to maintain maternal blood pressure near normal and then prevent nausea and vomiting without causing fetal acidosis. Phenylephrine, however, may decrease maternal heart rate and cardiac output and few data are available on its use in high-risk cases. Combination of a phenylephrine infusion and rapid crystalloid cohydration is the first method described that reliably prevents hypotension.
English has now become the most popular language in the world. In Vietnam, it has been more appre... more English has now become the most popular language in the world. In Vietnam, it has been more appreciated especially after the country joined WTO. Children learn the language even from kindergarten school. Recently, the government has decided English to be the only ...
I In nt tr ro od du uc ct ti io on n: : The aim of this study was to compare the postoperative an... more I In nt tr ro od du uc ct ti io on n: : The aim of this study was to compare the postoperative analgesic efficacy of epidural ropivacaine 0.15%, levobupivacaine 0.15% and ropivacaine 0.15% plus fentanyl 2 µg/ml, used with a patient-controlled epidural analgesia (PCEA) device after Caesarean section. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Sixty women undergoing elective Caesarean section under combined spinal-epidural anaesthesia were enrolled. Postoperatively, patients received PCEA with either ropivacaine or levobupivacaine 0.15% (basal rate 6 ml/h, bolus 5 ml/20 min), or ropivacaine 0.15% plus fentanyl 2 µg/ml (basal rate 6 ml/h, bolus 4 ml/20 min). Sympathetic and sensory level of analgesia, motor ability (Bromage 0-3), and pain scores at rest, movement and cough (VAS 0-10), haemodynamic parameters, oxygenation, side effects and total doses of local anaesthetic were documented every 6 h for 24 h. Patient satisfaction was assessed using a descriptive scale. R Re es su ul lt ts s: : No significant difference was observed in pain scores at all time intervals. A significantly higher sympathetic and sensory blockade occurred with levobupivacaine and ropivacaine 0.15% compared to ropivacaine 0.15% plus fentanyl, with no significant difference in total local analgesic consumption at 24 h (p = 0.08). Rescue analgesic requirements did not differ between the groups (p = 0.8) while patients' satisfaction was significantly higher in the ropivacaine 0.15% plus fentanyl group (p = 0.02). Haemodynamics, oxygenation, nausea, pruritus and numbness did not differ between the groups. C Co on nc cl lu us si io on ns s: : Dilute local anaesthetic solutions provided satisfactory postoperative analgesia after Caesarean section when used with a PCEA device. The combination of ropivacaine 0.15% with fentanyl 2 µg/ml appeared superior, since it provided higher patient satisfaction with statistically equal pain scores and local anaesthetic consumption.
The Limitations of Ropivacaine with Epinephrine as an Epidural Test Dose in Parturients. Warwick ... more The Limitations of Ropivacaine with Epinephrine as an Epidural Test Dose in Parturients. Warwick D. Ngan Kee, MBChB, MD, FANZCA,; Kim S. Khaw, MBBS, FRCA,; Bee B. Lee, MBBS, FANZCA,; Eliza LY Wong, RN and; Justina YW Liu, RN. ...
Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal... more Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal side effects. The aim of this study is to compare the effects of prehydration with crystalloid and prehydration with Hydroxyethyl starch on maternal blood pressure and neonatal outcome during cesarean section under spinal anesthesia. We enrolled 72 full term women weighting between 50 and 85 Kg, classified as ASA I, scheduled for elective caesarean section under spinal anesthesia. Participants were randomly allocated equally to one of crystalloid or Hydroxyethyl starch (Voluven) groups. After arrival in the operating room and intravenous (IV) access, 500 ml of ringer solution was infused within 10-15 min before the initiation of the spinal block in the crystalloid group, but in the Voluven group, 500 ml of 6% Hydroxyethyl starch solution was infused to the patients. Hypotension occurred in 47.2% of patients in crystalloid group and 25% of patients in Voluven group and the statistical difference between two groups was meaningful.(P = 0.008). The incidence of nausea was %41.6 (15 patients) in crystalloid group vs %22.2 (8 patients) in Voluven group. Apgar scores in newborns in both groups were above 8. As conclusion, prophylactic prehydration with Hydroxyethyl starch was more effective than prehydration with crystalloid in the prevention of hypotension during spinal anesthesia for elective caesarean section.
In a randomised, double-blind study, we investigated rapid extension of epidural analgesia to sur... more In a randomised, double-blind study, we investigated rapid extension of epidural analgesia to surgical anaesthesia for emergency Caesarean section. Parturients receiving epidural analgesia in labour who subsequently required Caesarean section were given a test dose of 3 ml lidocaine 2% with epinephrine 1 : 200 000, followed 3 min later by 12 ml lidocaine 2% with epinephrine 1 : 200 000 and fentanyl 75 microg, to which was added 1.2 ml sodium bicarbonate 8.4% (bicarbonate group; n = 20) or saline (saline group; n = 20). Mean (SD [range]) time to surgical anaesthesia was less in the bicarbonate group (5.2 (1.5) [2-8] min) than the saline group (9.7 (1.6) [6-12] min; mean difference 4.5 min (95% CI 3.5-5.5) min; p < 0.001). Maternal side-effects and neonatal outcome were similar between groups. We conclude that pH-adjusted lidocaine 2% with epinephrine and fentanyl is effective for rapidly establishing surgical anaesthesia in patients with a functioning epidural catheter for labour who require emergency Caesarean section.
In a randomised, double-blind study, we compared a combination of morphine and alfentanil with mo... more In a randomised, double-blind study, we compared a combination of morphine and alfentanil with morphine alone for patient-controlled analgesia (PCA) after Caesarean section under spinal anaesthesia. After surgery, patients were randomly allocated to receive PCA with a bolus dose of either morphine 0.75 mg plus alfentanil 0.125 mg (Group MA, n ¼ 40) or morphine 1.5 mg alone (Group M, n ¼ 37) with a lockout interval of 8 min and no hourly dose limit. Clinical assessments were made in the first 24 h, after which patients completed a written questionnaire. There were no differences between groups in PCA usage or visual analogue scale pain scores measured at 2, 4, 6 and 24 h. There was a low incidence of side-effects in both groups. In the questionnaire, patients in Group MA scored higher compared with Group M when asked to grade speed of onset and effectiveness of analgesia after a PCA bolus; there were no differences in grading for duration of analgesia or overall patient satisfaction. Addition of alfentanil to morphine may have advantages for PCA.
The purpose of the study is to find out the factors affecting the public speaking skills of 45th ... more The purpose of the study is to find out the factors affecting the public speaking skills of 45th cohort students majoring in high-quality English and make recommendations to improve and enhance the public speaking ability of EFL students from High-quality English Studies Program. The study participants included 86 high-quality English language third-year students. We used questionnaires to collect data and used SPSS statistical software to analyze data by descriptive statistical method. Research results show that students' ability to speak in public is affected by their lack of confidence in speaking. At the same time, the factors of the study program and the school environment also affect the students' public speaking skills. Based on the research results, the paper makes some pedagogical recommendations. Article visualizations:
Science and Technology Development Journal - Natural Sciences, 2021
As analyzing geomagnetic data at low latitude areas for instance the Mekong Delta (latitudes 11,0... more As analyzing geomagnetic data at low latitude areas for instance the Mekong Delta (latitudes 11,07o), significant problem is that both of the magnetization and ambient field are not vertical totally, making magnetic anomalies antisymmetrical and often skewed to the location of the sources. In this paper, two-dimensional continuous wavelet transform (2-D CWT), using Farshad-Sailhac complex wavelet function is studied and applied for reducing the magnetic anomaly to a symmetrical one - this located on the source of the anomaly, and then determining the position of the center of the object causing anomalies by wavelet transform modulus maxima (WTMM) method. Next, magnetic data is extracted in two perpendicular directions passing through the center of the source to perform one-dimensional continuous wavelet transform (1-D CWT) to estimate the shape, depth and size of the source. Then, using the Marquardt algorithm to solve the inverse problem by least-squares method to further identify ...
Nghiên cứu thành phần động vật đáy trong vịnh Quy nhơn được tiến hành tháng 8/2019 tại 30 vị trí.... more Nghiên cứu thành phần động vật đáy trong vịnh Quy nhơn được tiến hành tháng 8/2019 tại 30 vị trí. Kết quả xác định được 97 loài thuộc 77 giống, 57 họ, 31 bộ, 11 lớp, 5 nhóm: Thân mềm (Gastropoda, Bivalvia), Giáp xác (Crustacea), Dây sống (Chordata), Da gai (Echinodermata, Ophiuroidea), Giun nhiều tơ (Annelida). Trong đó nhóm Thân mềm Chân bụng (Gastropoda) có thành phần loài phong phú nhất (có 40 loài, chiếm 41,24%), Hai mảnh vỏ (Bivalvia) có 27 loài, chiếm 27,84% và Giáp xác (Crustacea) có 20 loài. Các nhóm khác có mức đa dạng thấp hơn. Chỉ số đa dạng sinh học ở vịnh quy nhơn được đánh giá là khá cao (H’ = 4,59). Mật độ trung bình cá thể (V=20,62 cá thể/m2). Sinh khối trung bình (W= 2,88g/m2).
Public reporting burden for this collection of information is estimated to average 1 hour per res... more Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition cause... more Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition caused by Gram-negative bacilli. Respiratory infections, including cough, shortness of breath, and chest pain and skin infection with eruptions, pustules and itchiness, are common complaints in the setting of late HIV infection. The variety of infections ranges from mild, self-limited viral, bacteremia and fungal infections to severe, life-threatening demanding urgent care and hospitalization. Varicella pneumonia, for instance, is the most severe complication of chickenpox in HIV infected adults, potentially refractory, fulminant respiratory failure can ensue. Patients with impaired immune status and chronic lung disease are at an increased risk. In the United States as well as in Vietnam, bacterial/viral pneumonia and skin infection are the two most common HIV-associated conditions. While globally the incidence of opportunistic infection has decreased since the introduction of highly active antiretroviral therapy during the last 3 decades, HIV-associated diseases remain a significant source of mortality, thus any manifestation must be taken seriously. This study will present the most common HIV-related pulmonary and skin infections and provide an overview of the epidemiology, characteristic clinical and chest radiograph findings, diagnosis, treatment, and prevention globally as well in Vietnam. Though the extensive efforts of the Vietnamese Govern-* Corresponding author. C. Gargiulo et al. 49 ment during last decade contributed to a valuable decrease, yet epidemic in Vietnam still remains high, ranking Vietnam 5 th in the SouthEast region. The second part of the study focuses on a unique and severe HIV case report of a 35-year-old man, with a rare form of pneumonia caused by Acitenobacter spp. concomitant with a prolonged and disseminating skin infection. The case has been treated with a combination of conventional anti-retroviral medication and autologous peripheral blood stem cells, the results showed that within 5 months there was an impressive amelioration of HIV viral activity together with a total recovery from pneumonia and skin infection.
This paper presents a study of factors affecting time and cost overruns throughout life cycle of ... more This paper presents a study of factors affecting time and cost overruns throughout life cycle of construction projects. The issues of overrun in construction are very common worldwide including Malaysia. However, no researchers investigate this problem according to the phases of construction. Hence, this study is to classify the overrun factors into phases of project life cycle which include planning phase, design phase, construction phase and finishing phase. A total of 35 factors were identified based on previous studies involving a number of different countries. These factors were classified according to degree of occurrence of each phase. Based on this classification, it shows that most of the factors occurred in construction phase. This classification gives better understanding amongst construction practitioners.
A study was carried out to select the best method to estimate groundwater recharge in a hard rock... more A study was carried out to select the best method to estimate groundwater recharge in a hard rock terrain. Various standard empirical methods, soil-moisture balance method, water table fluctuation (WTF) method and commonly adopted norms set by Groundwater Estimation Committee (GEC), Govt of India were used to estimate recharge for the Munijhara watershed in the Nayagarh block of Orissa (India). The empirical formulae gave recharge rates ranging from 13 cm to 32 cm/year with average of 22.4 cm and standard deviation of 5.34, independent of other influencing factors like soil, topography and geology. The soil-moisture balance study indicated that recharge is more dependent on the continuous heavy rainfall total annual volume of rainfall. Recharge was limited at up to 10 mm per day, possibly due to presence of hard rock below the soil surface. The rise in water table depth was 3.45 m to 5.35 m with a mean rise of 4.5 m during the year 2006–2007. Annual groundwater recharge based on the...
ABSTRACT Photoinduced Anisotropy and All-Optical Poling are the result of two mechanisms, the ang... more ABSTRACT Photoinduced Anisotropy and All-Optical Poling are the result of two mechanisms, the angularly selective excitation of molecules (Angular Hole Burning) and the rotation of molecules during the excitationrelaxation cycle (Angular redistribution). In this ...
Comments and Corrections TABLE I CALCULATIONS OF Q-FACTORS FOR N = 3 AND N = 5 IN THE CASES OF TH... more Comments and Corrections TABLE I CALCULATIONS OF Q-FACTORS FOR N = 3 AND N = 5 IN THE CASES OF THREE DIFFERENT BIT RATES In these calculations the two photon absorption = 0:5 cm=GW has also been taken into account.
We propose a simple way to design a fully integrated and passive all-optical pulse reshaper in th... more We propose a simple way to design a fully integrated and passive all-optical pulse reshaper in the aim of reamplifying and reshaping (2R) regeneration of optical digital signals. The device could be achieved from a coupled microresonator structure with Kerr nonlinearity. By using time-domain simulation, we show that we can obtain a clear nonlinear power transfer that is capable of improving signal-to-noise ratio and reducing bit error rate for digital signals. The reshaping performances are estimated by calculating Q-factor enhancement. Since we take benefit from field enhancement at resonance, this integrated reshaper could be much smaller than other gates based on nonlinear fibers or waveguides.
Purpose of review Historically, ephedrine has been recommended as the best vasopressor in obstetr... more Purpose of review Historically, ephedrine has been recommended as the best vasopressor in obstetrics because animal studies showed it caused less reduction in uterine blood flow compared with α-agonists. Recent clinical evidence, however, suggests that this is not as important as initially thought. This review evaluates current data with a focus on spinal anesthesia for cesarean section. Recent findings Ephedrine and phenylephrine have been most investigated. Advantages of ephedrine include familiarity, long history and low propensity for uteroplacental vasoconstriction. Ephedrine, however, has limited efficacy, is difficult to titrate, causes maternal tachycardia and depresses fetal pH and base excess. Advantages of phenylephrine include high efficacy, ease of titration and the ability to use liberal doses to maintain maternal blood pressure near normal and then prevent nausea and vomiting without causing fetal acidosis. Phenylephrine, however, may decrease maternal heart rate and cardiac output and few data are available on its use in high-risk cases. Combination of a phenylephrine infusion and rapid crystalloid cohydration is the first method described that reliably prevents hypotension.
English has now become the most popular language in the world. In Vietnam, it has been more appre... more English has now become the most popular language in the world. In Vietnam, it has been more appreciated especially after the country joined WTO. Children learn the language even from kindergarten school. Recently, the government has decided English to be the only ...
I In nt tr ro od du uc ct ti io on n: : The aim of this study was to compare the postoperative an... more I In nt tr ro od du uc ct ti io on n: : The aim of this study was to compare the postoperative analgesic efficacy of epidural ropivacaine 0.15%, levobupivacaine 0.15% and ropivacaine 0.15% plus fentanyl 2 µg/ml, used with a patient-controlled epidural analgesia (PCEA) device after Caesarean section. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Sixty women undergoing elective Caesarean section under combined spinal-epidural anaesthesia were enrolled. Postoperatively, patients received PCEA with either ropivacaine or levobupivacaine 0.15% (basal rate 6 ml/h, bolus 5 ml/20 min), or ropivacaine 0.15% plus fentanyl 2 µg/ml (basal rate 6 ml/h, bolus 4 ml/20 min). Sympathetic and sensory level of analgesia, motor ability (Bromage 0-3), and pain scores at rest, movement and cough (VAS 0-10), haemodynamic parameters, oxygenation, side effects and total doses of local anaesthetic were documented every 6 h for 24 h. Patient satisfaction was assessed using a descriptive scale. R Re es su ul lt ts s: : No significant difference was observed in pain scores at all time intervals. A significantly higher sympathetic and sensory blockade occurred with levobupivacaine and ropivacaine 0.15% compared to ropivacaine 0.15% plus fentanyl, with no significant difference in total local analgesic consumption at 24 h (p = 0.08). Rescue analgesic requirements did not differ between the groups (p = 0.8) while patients' satisfaction was significantly higher in the ropivacaine 0.15% plus fentanyl group (p = 0.02). Haemodynamics, oxygenation, nausea, pruritus and numbness did not differ between the groups. C Co on nc cl lu us si io on ns s: : Dilute local anaesthetic solutions provided satisfactory postoperative analgesia after Caesarean section when used with a PCEA device. The combination of ropivacaine 0.15% with fentanyl 2 µg/ml appeared superior, since it provided higher patient satisfaction with statistically equal pain scores and local anaesthetic consumption.
The Limitations of Ropivacaine with Epinephrine as an Epidural Test Dose in Parturients. Warwick ... more The Limitations of Ropivacaine with Epinephrine as an Epidural Test Dose in Parturients. Warwick D. Ngan Kee, MBChB, MD, FANZCA,; Kim S. Khaw, MBBS, FRCA,; Bee B. Lee, MBBS, FANZCA,; Eliza LY Wong, RN and; Justina YW Liu, RN. ...
Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal... more Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal side effects. The aim of this study is to compare the effects of prehydration with crystalloid and prehydration with Hydroxyethyl starch on maternal blood pressure and neonatal outcome during cesarean section under spinal anesthesia. We enrolled 72 full term women weighting between 50 and 85 Kg, classified as ASA I, scheduled for elective caesarean section under spinal anesthesia. Participants were randomly allocated equally to one of crystalloid or Hydroxyethyl starch (Voluven) groups. After arrival in the operating room and intravenous (IV) access, 500 ml of ringer solution was infused within 10-15 min before the initiation of the spinal block in the crystalloid group, but in the Voluven group, 500 ml of 6% Hydroxyethyl starch solution was infused to the patients. Hypotension occurred in 47.2% of patients in crystalloid group and 25% of patients in Voluven group and the statistical difference between two groups was meaningful.(P = 0.008). The incidence of nausea was %41.6 (15 patients) in crystalloid group vs %22.2 (8 patients) in Voluven group. Apgar scores in newborns in both groups were above 8. As conclusion, prophylactic prehydration with Hydroxyethyl starch was more effective than prehydration with crystalloid in the prevention of hypotension during spinal anesthesia for elective caesarean section.
In a randomised, double-blind study, we investigated rapid extension of epidural analgesia to sur... more In a randomised, double-blind study, we investigated rapid extension of epidural analgesia to surgical anaesthesia for emergency Caesarean section. Parturients receiving epidural analgesia in labour who subsequently required Caesarean section were given a test dose of 3 ml lidocaine 2% with epinephrine 1 : 200 000, followed 3 min later by 12 ml lidocaine 2% with epinephrine 1 : 200 000 and fentanyl 75 microg, to which was added 1.2 ml sodium bicarbonate 8.4% (bicarbonate group; n = 20) or saline (saline group; n = 20). Mean (SD [range]) time to surgical anaesthesia was less in the bicarbonate group (5.2 (1.5) [2-8] min) than the saline group (9.7 (1.6) [6-12] min; mean difference 4.5 min (95% CI 3.5-5.5) min; p < 0.001). Maternal side-effects and neonatal outcome were similar between groups. We conclude that pH-adjusted lidocaine 2% with epinephrine and fentanyl is effective for rapidly establishing surgical anaesthesia in patients with a functioning epidural catheter for labour who require emergency Caesarean section.
In a randomised, double-blind study, we compared a combination of morphine and alfentanil with mo... more In a randomised, double-blind study, we compared a combination of morphine and alfentanil with morphine alone for patient-controlled analgesia (PCA) after Caesarean section under spinal anaesthesia. After surgery, patients were randomly allocated to receive PCA with a bolus dose of either morphine 0.75 mg plus alfentanil 0.125 mg (Group MA, n ¼ 40) or morphine 1.5 mg alone (Group M, n ¼ 37) with a lockout interval of 8 min and no hourly dose limit. Clinical assessments were made in the first 24 h, after which patients completed a written questionnaire. There were no differences between groups in PCA usage or visual analogue scale pain scores measured at 2, 4, 6 and 24 h. There was a low incidence of side-effects in both groups. In the questionnaire, patients in Group MA scored higher compared with Group M when asked to grade speed of onset and effectiveness of analgesia after a PCA bolus; there were no differences in grading for duration of analgesia or overall patient satisfaction. Addition of alfentanil to morphine may have advantages for PCA.
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