Publications by authors named "Kwok Hon Chan"

We report a case of large thyroid carcinoma with tracheal and esophageal invasion who presented with preoperative stridor scheduled for total thyroidectomy and segmental tracheal resection. Careful and comprehensive preoperative anesthetic planning was done. Extracorporeal circulation membrane oxygenation (ECMO) was set up and running prior to induction under local anesthesia, due to an increased international normalized ratio (INR) and fear of bleeding in the airway.

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Glutaric aciduria type 1 (GA1) is a rare, inherited mitochondrial disorder that results from deficiency of mitochondrial glutaryl-CoA dehydrogenase. Most patients develop neurological dysfunction early in life, which leads to severe disabilities. We present a 37-month-old girl with GA1 manifested as macrocephaly and hypotonia who received comprehensive dental restoration surgery under general anesthesia with sevoflurane.

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Background: Totally implantable access ports (TIAPs) are alternatives to central venous catheters for patients requiring chemotherapy. Since January 2003, we have used a central approach two-point incision technique to insert TIAPs. Following advances in ultrasound technique and clinical experience for tunneled dialysis catheter placement, we modified the central approach to a low-approach technique.

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Characteristic signs of malignant hyperthermia (MH) include unexplained tachycardia, increased end-tidal carbon dioxide (Etco₂) concentration, metabolic and respiratory acidosis, and an increase in body temperature above 38.8°C. We present the case of a patient with highly probable MH.

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Background: Examinations are necessary for assessment of student proficiency in medical education, but comparison of achievement across different cohorts in different tests is challenging. We applied psychometric test equating methods to compare student proficiency in two different examinations for a clinical anesthesiology course.

Methods: Each examination contained 50 multiple choice items and nine common items were identified from the two examinations (administered in 2011 and 2012).

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Background: Patient-controlled epidural analgesia (PCEA) is commonly used to relieve postoperative pain for upper abdominal surgeries. However, there is still a lack of studies exploring factors associated with PCEA consumption over time after upper abdominal surgery; our study intended to provide further elucidation about this issue.

Methods: This study retrospectively evaluated postoperative PCEA consumption over time after upper abdominal surgery.

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A vascular access with good function for drug delivery is the basis of chemotherapy. If there is any congenital or acquired vascular abnormality, procedurally related and late complications such as vessel rupture, malposition, and dysfunction of the catheter with ensuing thrombosis may occur, especially when it is undiagnosed or ignored. We describe a case of implantable central venous catheter (CVC) malposition and subsequent insertion of a Hickman catheter for stem cell transplantation after the diagnosis of persistent left superior vena cava (PLSVC) by radiologic image studies.

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As studies have pointed out, severity scores are imperfect at predicting individual clinical chance of survival. The clinical condition and pathophysiological status of these patients in the Intensive Care Unit might differ from or be more complicated than most predictive models account for. In addition, as the pathophysiological status changes over time, the likelihood of survival day by day will vary.

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Neutrophils play a critical role in acute and chronic inflammatory processes, including myocardial ischemia/reperfusion injury, sepsis, and adult respiratory distress syndrome. Binding of formyl peptide receptor 1 (FPR1) by N-formyl peptides can activate neutrophils and may represent a new therapeutic target in either sterile or septic inflammation. Propofol, a widely used i.

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Background: The Trendelenburg position has been suggested for right internal jugular vein (RIJV) catheterization. However, this position can sometimes be functionally intolerable for chronic kidney disease patients. We conducted an ultrasound study to further investigate the efficacy of the use of the Trendelenburg position during tunneled dialysis catheter insertion via the RIJV in chronic kidney disease patients.

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Background: Continuous passive motion after a major knee surgery optimizes functional prognosis, but causes severe pain. In this study, we assessed the effect of intravenous patient-controlled analgesia (IVPCA) on postoperative pain management in unilateral and bilateral total knee arthroplasty (TKA).

Methods: Data were collected retrospectively from a single medical center from March 2003 to October 2007.

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Background: Student examinations are an essential component of medical education and item analyses are important to assess test quality. Among miscellaneous psychometric theories used for test analyses, item response theory is more flexible and versatile than other theories. This study aimed to apply item response models to analyze an anesthesiology examination for medical and dental students.

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Objective: This study tested the hypothesis that adding tenoxicam (T) to intravenous patient-controlled analgesia (IV-PCA) with morphine (M) would improve postoperative pain relief and wound inflammatory responses compared with M alone after spine surgery.

Design: Randomized, prospective, double-blind, controlled study.

Subjects: Ninety-four patients eligible for elective spine surgery.

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Background: Low central venous pressure (CVP) produced by fluid restriction has been applied to liver transplant recipients in order to decrease blood loss. However, CVP is not reliable for monitoring intravascular volume and ventricular filling. In addition, doubts remain over the association between fluid restriction and acute kidney injury (AKI).

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The left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that helps in maintaining the pumping ability of a failing heart. Thromboembolism poses a significant risk during and after LVAD implantation. It occurs in up to 35% of patients with adverse sequelae.

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We previously demonstrated that intrathecal IL-1β caused thermal hyperalgesia in rats. This study was conducted to examine the effects and cellular mechanisms of glial inhibitors on IL-1β-induced nociception in rats. The effects of minocycline (20 μg), fluorocitrate (1 nmol), and SB203580 (5 μg) on IL-1β (100 ng) treatment in rats were measured by nociceptive behaviors, western blotting of p38 mitogen-activated protein kinase (MAPK) and inducible nitric oxide synthase (iNOS) expression, cerebrospinal fluid nitric oxide (NO) levels, and immunohistochemical analyses.

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A 75-year-old man underwent low anterior resection for sigmoid colon cancer under general anesthesia. Comprehensive preoperative surveys showed normal cardiopulmonary functions. In spite of adequate fluid administration, persistent intraoperative hypotension required vasopressors to maintain an acceptable blood pressure.

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Plasma-containing products are given during the pre-anhepatic stage of liver transplant surgery to correct abnormal thromboelastogram (TEG) values and prevent blood loss due to coagulation defects. However, evidence suggests that abnormal TEG results do not always predict bleeding. We questioned what effect using higher TEG values to initiate treatment would have on blood loss.

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Article Synopsis
  • Methylmalonic acidemia (MMA) is a rare genetic metabolic disorder that can lead to severe neurological and kidney issues.
  • A unique case is described where a 13-month-old boy with MMA experienced life-threatening hyperkalemia (high potassium levels) and arrhythmia during anesthesia for a port-a-cath insertion.
  • After urgent medical intervention, the patient fully recovered neurologically within a week, highlighting the need to consider hyperkalemia when treating MMA patients with specific heart rhythm problems.
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Background: Droperidol is commonly added to intravenous patient-controlled analgesia (IVPCA) regimens as an antiemetic agent. Although some studies have demonstrated its safety and efficacy, it is not clear whether adding droperidol to IVPCA infusate without an extra loading dose can effectively reduce the incidence and severity of postoperative nausea and vomiting (PONV) in real-life clinical settings.

Methods: Patients receiving IVPCA in this retrospective survey were classified into two groups based on their IVPCA regimens.

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Study Objective: To explore the influence of shoulder roll height on internal jugular vein (IJV) diameter and IJV/common carotid artery (CCA) overlap.

Design: Cross-sectional study.

Setting: University-affiliated hospital.

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Background: Valid and reliable measures based on health behavior theory, such as multiattribute utility decision theory, are essential to elucidate complex relationships between psychological factors and labor pain. In this study we aimed to use Rasch analysis to simplify a previously developed 20-item multidimensional questionnaire on attitude toward labor epidural analgesia using multiattribute utility theory.

Methods: The Rasch analysis was performed to condense item selection categories, to exclude misfit items and persons, and to generate a unidimensional attitude toward labor epidural analgesia (ATLEA) score.

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We present a case of post-operative iatrogenic quadriplegia, which occurred after subtotal parathyroidectomy. This patient was on long-term hemodialysis for 7 years. The need of prolonged neck extension for this procedure was probably the main risk factor for the spinal cord injury.

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Background: Test evaluation in a clinical curriculum is important for medical education. To identify examinee ability and appropriateness of the test content, this study used the Rasch model to analyze an examination in anesthesiology for medical students.

Methods: Fifty items were administered to 119 fifth- and sixth-year medical students in the exam.

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Cerebral oximetry is a noninvasive bedside monitor for cerebral oxygen saturation (rSO(2)). A patient with a thoracic aneurysm underwent combined surgical and endovascular repair. A sudden decrease in right rSO(2) led to the finding of acute innominate artery dissection.

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