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Magnetic resonance imaging (MRI)-targeted transperineal prostate biopsy allows a more precise sampling of suggestive lesions. We describe a series of 10 cases for MRI-targeted transperineal prostate biopsy, of which 8 were successfully performed under ultrasound-guided caudal epidural anaesthesia. With the appropriate local anaesthetic volume and concentration, caudal epidural provides ideal conditions for this day case procedure.

Introduction The COVID-19 pandemic has presented a significant challenge for infection prevention and control during airway management in anaesthesia and critical care. The protective barrier enclosure has been described and studied particularly for perioperative anaesthesia use. The potential use of the protective barrier enclosure during cardiopulmonary resuscitation has been poorly explored in the current literature. This work aims to demonstrate the potential of protective barrier enclosure in limiting aerosol dispersion during cardiopulmonary resuscitation delivery. Methods A proof-of-concept simulation study was conducted to evaluate the protective properties of the protective barrier enclosure during cardiopulmonary resuscitation. Aerosol was simulated using a fluorescent dye trapped within the manikin. Three different methods of cardiopulmonary resuscitation delivery with a protective barrier enclosure applied over the manikin’s head were conducted. The first method simulated a chest compression only cardiopulmonary resuscitation, the second method also used chest compressions only, with a face mask fitted on the victim, while the third method, the victim was given chest compression and bag-valve-mask ventilation by two rescuers. Results In the first method, release of aerosol from the manikin’s mouth was observed during chest compression, while in second method, most of the aerosol was trapped within the face mask, with only minor leaking. However, when bag-valve-mask ventilation was delivered, the aerosol leaked out at high speed around the bag-valve-mask seal. No aerosol condensation was found outside of the protective barrier enclosure in all scenes. Conclusion Protective barrier enclosure may reduce aerosol exposure to the rescuers during out-of-hospital cardiac arrest.

The understanding of ergonomics is a vital competency for all peripheral nerve block operators. The essence of physical ergonomics for peripheral nerve block procedures can be summarised into three significant components: brain, musculoskeletal and needling. The first component includes strategies to optimise visuospatial neuroprocessing using equipment configuration. The second component reflects the careful planning of posture and position to improve procedural technique and reduce physical fatigue. The final component focuses on strategies to achieve needle beam alignment for optimal needle visualisation.

Introduction We conducted a single-centre, prospective randomised clinical trial to investigate the analgesic efficacy of transversus abdominis plane (TAP) block in adult patients undergoing laparoscopic appendicectomy. Methods Patients undergoing urgent laparoscopic appendicectomy under general anaesthesia alone (control group) and general anaesthesia supplemented by TAP block (TAP intervention group) were compared. All patients received a multimodal analgesia regime, which included postoperative morphine via a patient-controlled analgesia device. The primary endpoints were morphine consumption at 12 hours and 24 hours postoperatively. Secondary endpoints included pain scores, incidence of nausea and vomiting, and time to hospital discharge. A total of 58 patients were recruited, with 29 patients in each group. Results Mean postoperative morphine consumption at 12 hours (control group: 11.45 ± 7.64 mg, TAP intervention group: 9.79 ± 8.09 mg; p = 0.4264) and 24 hours (control group: 13.38 ± 8.72 mg, TAP intervention group: 11.31 ± 8.66 mg; p = 0.3686) for the control and TAP intervention groups were not statistically different. Secondary outcomes were also not different between the two groups. Length of stay in the post-anaesthesia care unit was significantly shorter for the TAP intervention group, with a trend toward faster hospital discharge being observed. Conclusion TAP block, a regional anaesthetic procedure performed immediately prior to skin incision for laparoscopic appendicectomy, did not significantly improve postoperative analgesia outcomes.

Advances in audio-visual information technology has allowed for effective self-directed learning and increase diversity of learning styles, the teaching of the psychomotor domain should also explore this type of technology. We attempted to explore the effectiveness of using educational home-made video in teaching basic emergency life support skills to a group of pre-clinical medical undergraduates. We developed five educational videos on themes of basic airway management (BAM), emergency extremity splinting (ES), defibrillation, cervical spine immobilization (CSI) and cardiopulmonary resuscitation (CPR). This paper emphasises on the accessibility of readily-available, affordable solutions for educators to create their own “educational home-made video”.

Background Airway management is an important part of the management of the critically ill and injured patients in the Emergency Department (ED). Numerous studies from developed countries have demonstrated the competency of emergency doctors in intubation. To date there have been no published data on intubations performed in EDs in Malaysia. Methods Data on intubations from 7 August 2007 till 28 August 2008 were prospectively collected. Results There were 228 intubations included in the study period. Cardiopulmonary arrest was the main indication for intubation (35.5%). The other indications were head injury (18.4%), respiratory failure (15.4%), polytrauma (9.6%) and cerebrovascular accident (7.0%). All of the 228 patients were successfully intubated. Rapid sequence intubation (RSI) was the most frequent method (49.6%) of intubation. A total of 223 (97.8%) intubations were done by ED personnel. In 79.8% of the cases, intubations were successfully performed on the first attempt. Midazolam was the most common induction agent used (97 patients), while suxamethonium was the muscle relaxant of choice (109 patients). There were 34 patients (14.9%) with 38 reported immediate complications. The most common complication was oesophageal intubation. Conclusion Emergency Department UKMMC personnel have a high competency level in intubation with an acceptable complication rate. RSI was the most common method for intubation.