PRABA THIAGARAJAN
I am a consultant anaesthetist working in Malaysia. I obtained my Fellowship FRCA in 1996 from RCOA.
My other email id is
tpraba15@gmail.com
Location Malaysia
Activity
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PRABA THIAGARAJAN made a comment
To my understanding Inclusive Pedagogies means engaging students in discussion during lecture and consider their view points as well. Making the lecture more interactive than one-way of delivering or teaching. I do learn a lot from my medical students.
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We have stopped using nitrous oxide since late 1997 onwards.
Using TIVA depends upon individual anaesthetists and their confidence level but it is in increasing trend.
Main barrier may be acquiring more TCI pumps and Remifentanil availability .
Even though alternative drugs available I generally prefer Remifentanil unless no other choice. Of course the... -
PRABA THIAGARAJAN made a comment
Nitrous oxide is not used in my place for many years now. We only use 20 ml Propofol and not much to nil wastage.
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PRABA THIAGARAJAN made a comment
looking forward
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PRABA THIAGARAJAN made a comment
What is the maximum BMI the present generation of TCI pumps accept.
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PRABA THIAGARAJAN made a comment
Fast waking up and less risk of cognitive disturbances. Can resume daily activities well and able to sleep like before surgery.
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I always feel outcome depends upon the fitness of the patient rather the chronological age. An active 80 years old is patient is better than a 50 years or even younger sedentary persons.
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PRABA THIAGARAJAN made a comment
With TCI pumps and BIS or any similar monitoring and by maintaining in the upper required range, I feel comfortable in using TIVA in the elderly.
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PRABA THIAGARAJAN made a comment
Is TIVA safe for fetus. Can it contribute to poor APGAR score.
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PRABA THIAGARAJAN made a comment
depends upon the period of gestation
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PRABA THIAGARAJAN made a comment
Very informative. Why procedural sedation is known as Monitored Anaesthetic Care specifically. Everything we do should be monitored whether it is GA,LA or Sedation. I always wonder about it.
Sedation using TCI pumps are much safer especially in elderly patients.
Sometimes out of interest I do use BIS to see the depth of sedation. -
very helpful information on recovery. Thanks.
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PRABA THIAGARAJAN replied to DR MUKESH VALECHA
yes. The only drawback is its price.
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PRABA THIAGARAJAN made a comment
Agreed. With constant practice can get familiar with when to decrease and stop the infusion. Mainly problem with Propofol especially with long duration surgeries but Remifentanil is quiet easy since its context sensitive half life is independent of duration of infusion.
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PRABA THIAGARAJAN made a comment
I think both controlling postop pain and PONV are very important. Patients should not be given a choice. Instead both problems must be addressed.
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Thanks Sir for the feedback.
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@MichaelIrwin Thanks Dr. for the feedback. Just would like to know is there any duration limit for Propofol infusion especially in Neurosurgery which sometimes can be very long.
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PRABA THIAGARAJAN made a comment
We normally give Celecoxib 200 mgm bd.
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PRABA THIAGARAJAN made a comment
I use IV Midazolam before I start Propofol TCI and I always run with Remifentanil. Sometimes yes Lidocaine. Approximately 20 minutes before switch off Remi will give longer acting analgesics like Morphine, Parecoxib or Paracetamol iv
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Some kind of monitoring is much better than none, even with all limitations. Also we should be able to easily set up the monitors and analyze them. Should not be time consuming. Above all the monitoring must be affordable especially the disposables.
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PRABA THIAGARAJAN made a comment
I don't do TIVA without BIS
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PRABA THIAGARAJAN made a comment
How about Dexmedetomidine. We use it for sedation procedures often since it has analgesic effect as well and for difficult airway management. I am also using Alfentanil when Remifentanil is out of stock .
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PRABA THIAGARAJAN made a comment
I always use BIS which is really helpful to guide the depth of anaesthesia . As mentioned the doses of both Propofol and Remifentanil will be different if we do not use muscle relaxants. They will definitely require higher doses. I don't use muscle relaxants much. All depends upon the type of surgical procedures and of course the surgeons. Some surgeons are...
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PRABA THIAGARAJAN made a comment
The model depends upon the drug. For Propofol I use Marsh (plasma) model.
For Remi I use Minto effect site model -
PRABA THIAGARAJAN made a comment
In inhalational anaesthesia also Propofol is commonly used as the induction agent followed by inhalational maintenance. Pure inhalational only anaesthesia is uncommon in our place. Also good to discuss the disadvantages as well. I prefer personally. Rapid awakening after anaesthesia is so good.
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PRABA THIAGARAJAN made a comment
Recently received an alert that NHS England has announced the decommissioning of desflurane by early 2024 with the support of RCOA and
the Association of Anaesthetists -
PRABA THIAGARAJAN made a comment
Safety concern with regards to long duration of Propofol infusion.
Medicolegal concerns
Surgeons acceptability especially slight delay in starting compared to traditional anaesthesia.Solution:
Needs adequate training.
Setting up a registry to look into the adverse effects of TIVA and all critical incidents reported honestly.
Seeking advice from... -
PRABA THIAGARAJAN made a comment
Agreed. Frequent users are normally used up with setting up of TIVA. My main concern which is not listed here is safety of Propofol infusion over longer duration. e.g. Propofol infusion syndrome. May I know any limitation for TIVA in view of duration with regards to Propofol. Is there a maximum duration. I am not worried much about Remifentanil since its...
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PRABA THIAGARAJAN made a comment
yes
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With regards to cost it should include also the cost of monitoring. BIS electrodes cost a lot. I feel comfortable to do TIVA only with BIS monitoring to maintain adequate plane of anaesthesia.
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PRABA THIAGARAJAN made a comment
I have done lots of TIVA . I normally prefer TIVA than inhalational anaesthesia. Also had conducted few workshops on TIVA. Most challenging for me is to make surgeons accept it. Looking forward to learn more.
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PRABA THIAGARAJAN made a comment
So much knowledge and practical needs acquired during this course. Thank you trainers . Really appreciate all your effort and time.
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PRABA THIAGARAJAN made a comment
It will be better the mother sits beside or at the foot end where the child can see her. May be the father or both could have accompanied the child. If one is sick or emotionally unstable other can take over. Taking care of a parent with too much of anxiety will distract the transferring team to monitor the child.
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PRABA THIAGARAJAN made a comment
We normally will not wait and transfer immediately if the mother and baby needs advanced care. Anytime the mother may turn critical and at that time she won't be able to withstand the transfer. In our country we have facilties to transfer the patient any time and not subjected to office hours only when lives are at risk.
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PRABA THIAGARAJAN made a comment
As an anaesthestist in Government hospital used to receive many maternal cases in very critical conditions from neighboring small facilities or maternal centers. Many are avoidable factors like attempting to deliver the high risk mother even though the facilities are not adequate especially without proper blood bank backup. This course is very much...
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PRABA THIAGARAJAN made a comment
Very good learning.
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PRABA THIAGARAJAN made a comment
Who bears the cost. Should be the patient is it. Any insurance covers the cost without any limits.
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PRABA THIAGARAJAN made a comment
This is not an urgent transfer since patient was in ICU for 20 days. If there is still time we can ask the referring hospital to send another set of the misplaced things to airport. First of all why the transfer bag was separated from the patient site since all the equipments are need for emergency for e.g. tracheostomy displacement or block with secretions.
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PRABA THIAGARAJAN made a comment
In Malaysia we have few hospitals which are totally paperless except for informed consents for various procedures which is done both electronically and manually for medicolegal purposed and Death certificates. We use THIS -Total Hospital Information Sistem which incorporates seven modules like Critical Care Information Sistem which covers Operating theaters...
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PRABA THIAGARAJAN made a comment
As the Engineer mentioned the extent of safety features we want to have decides the cost also. For e.g. if we want to get extra battery for the transport ventilator it is an optional purchase. Not standardized to include in the initial purchase even though we know that we need to keep extra battery for standby whatever the duration of transfer in view of...
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PRABA THIAGARAJAN replied to Fernah Peacey
This is really a big issue when certain drugs are only licensed for anaesthetist use.
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PRABA THIAGARAJAN made a comment
The information about dangerous drugs is very good and eye opening. Within the country should be ok if accompanied by anaesthetists since certain drugs for only anaesthetist use. In my country (Malaysia) there are very strict penalties for dangerous drugs
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PRABA THIAGARAJAN made a comment
Is there a separate bag for the different drugs both for emergency and the extra infusions the patient is on. We do have separate box carrying the drugs which needs to prepared just before the transfer.
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PRABA THIAGARAJAN made a comment
very good info. Every hospital administrator should read
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PRABA THIAGARAJAN made a comment
I always worry of medico-legal implications. With all the efforts taken by us for safe transfer we often get criticism and sometimes even scolding by certain authorities.
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PRABA THIAGARAJAN made a comment
I call the receiving hospital quiet frequently to check the progress of the patient and also to provide any additional information needed like culture reports which are received after transferring the patient
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PRABA THIAGARAJAN made a comment
Strictly following SOPs might help to discipline ourselves and to prevent adverse incidents. How ever some times SOPs need to be modified according to the situation we are in and the clinical condition of the patient.
Simulation based training will definitely help -
PRABA THIAGARAJAN made a comment
very often involved in this type of transfer. Most of the mistakes like ETT disconnection have been noted by co-learners. Definitely there is lack of manpower. Three is not enough.
We use the modular type of monitor. So we just remove the monitoring module to transport monitor which eliminates the need for recalibration of various monitoring parameters and... -
PRABA THIAGARAJAN made a comment
Same practice in our place.
Also good to ask about the investigations done so far and the results especially the culture reports and treatment on or already given like antibiotics
We also electronically transfer our radiology images and others -
PRABA THIAGARAJAN made a comment
Oxygen cylinder getting emptied and lack of oxygen supply
Battery ran out with long journey with spare battery not available -both ventilator and various syringe pumps.
Adequacy of iv fluids
Different sizes of BP cuff is essential to cover different patients
Different sizes of pulse oximetry probe and also different type like ear lobe oximeter probe are... -
PRABA THIAGARAJAN made a comment
looking forward
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PRABA THIAGARAJAN made a comment
Documentation is a must. How ever it can be quiet difficult at times of critical transfers where the patient needs more attention and close monitoring. Electronic documentation is much easier than manual documentation. Having CCTV surveillance is much preferred since we can get all crucial information when needed. Good WIFI service is preferred for...
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PRABA THIAGARAJAN made a comment
This was the most important concern during the recent covid pandemic.
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PRABA THIAGARAJAN made a comment
Also frequent tracheostomy suction will help to prevent any mucus plug causing obstruction and increasing the pressures activating the alarms.
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PRABA THIAGARAJAN made a comment
I feel patient must be at least stabilized before the transfer to some degree for him to withstand the journey. In my place commonly the expert physician in the receiving hospital will give us instructions with regards to the management and even visit the patient in the primary hospital and they don't like to compromise the patient due to the transfer if the...
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PRABA THIAGARAJAN made a comment
I feel in this scenario it would have been safer if the patient is intubated and supported fully with sedation and analgesics . Being diabetic this patient can develop both DKA or hypoglycemia and needs frequent blood sugar monitoring and may need insulin infusion. Totally agreed with all the comments from our trainer. Difficult to point out one best answer...
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PRABA THIAGARAJAN made a comment
Nicely outlined the problems which is commonly encountered. Thanks
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PRABA THIAGARAJAN made a comment
When I started working in UK as a overseas trainee very long time back I found the system in UK was very much well organized and efficient. I helped up with many transfer as an anesthetist. The transfers were well organized except one issue. After handing over the patient to the receiving hospital myself and my staff were actually stranded there with no...
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PRABA THIAGARAJAN replied to Peter Farkas
very comforting and reassuring . Great teacher
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PRABA THIAGARAJAN made a comment
Most common are intra hospital transfers. For e.g. moving critically ill patients on multiple organ support from ICU to Radiology for imaging services, or emergency surgeries to operating rooms or a collapsed or bleeding mother from labor room to OT. The preparations are same and sometimes need urgent transfer with ongoing resuscitations. I find it very...
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PRABA THIAGARAJAN made a comment
In Malaysia our transfer rates and purposes are same as UK. But our transfer are mostly by Road Ambulance services. In fact road transport is faster here and the distance is not very far and also good high ways. Not much by aircrafts. Occasionally Army help us. East Malaysia we use more aviation help. We don’t have dedicated team. Mostly arranged by sending...
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PRABA THIAGARAJAN made a comment
Transferring very ill patients even between different departments in the same hospital like ICU and Radiology itself is very challenging and is extremely stressful when we think about inter hospitals transfer and it is not uncommon for patients to deteriorate and even suffer from cardiac arrest during transfer. Need to consider so many things like drugs,...
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PRABA THIAGARAJAN made a comment
Last time I paid for permanent access for the perioperative medicine course but later got disappointed because I could only access the version which I took but not newer updated Perioperative medicine course
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PRABA THIAGARAJAN made a comment
Very good initiative by Futurelearn team and I am grateful to Futurelearn for all these excellent courses. Very useful for my career. I used to get very frightened whenever I need to transfer critically ill patients and always used tp pray for the safe journey both for patient and the staff during my early years of working in UK earlier and later in my...
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PRABA THIAGARAJAN made a comment
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PRABA THIAGARAJAN made a comment
Merah Biru Hijau Putih
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PRABA THIAGARAJAN made a comment
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PRABA THIAGARAJAN made a comment
Betul
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PRABA THIAGARAJAN made a comment
Not bad my score. Lookin to lern or refine my Malay language proficiency
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PRABA THIAGARAJAN made a comment
Hi everyone. As a doctor an anesthesiologist I want to get more information in general about food and medicine. Also looking forward to involve in all discussions which I find more valuable part of these courses and I learn a lot from the discussions and feedback as well from different parts of the world. Truly borderless involvement. Thanks Futurelearn Learn...
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Simplified excellent easy to understand presentation
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Thank you Sir. That is very nice.
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PRABA THIAGARAJAN made a comment
It is really very hurting feeling even as a professional when confirming brain death or death by neurological criteria and more difficult when breaking the news to his or her loving family members. Sometimes even though I was their consultant involved in their care, I used to get involved personally with the patient and their family and that's why it hurts...
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very comprehensive and easy to understand
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Excellent presentation by Prof.Hannah. Simplified a difficult topic. Thanks
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PRABA THIAGARAJAN made a comment
I don't think so the opt out system will be ever possible in our place.
Very impressed with the way UK deals with this important issue. -
Very impressive. Hope we can establish similar models in my place.
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PRABA THIAGARAJAN made a comment
In my long experience of working in ICU this is what I mean breaking bad news to family is the most difficult part even though we prepare them and update them from beginning. At the final moments it is difficult to control their emotions. It is when we loose some potential donors. This is most common in our region.
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PRABA THIAGARAJAN made a comment
With regards to donating and receiving organs. the issues depends upon multiple factors and that is quite complicated in most of the places and countries. There are many issues such as family, ethics, religious, culture, community , financial ( for eg the cost of post transplant immunosuppression and complications) and medical facilities etc.
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very impressive and more regulated steps.
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Organ donation awareness campaign is happening in my country as well quiet frequently especially in malls and hospital lobbies. The main problems we face here is family issues. When a person pledges the organs it goes into our registry but the problem is that when the potential donors die due to some reasons, his or her family abruptly refuses to donate their...
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PRABA THIAGARAJAN made a comment
I am a consultant anaesthetist and critical care physician. I am also involved in teaching medical students as an Associate Professor and I would like to update my knowledge on this most essential topic so that I can teach my students appropriately and create better awareness besides incorporating the information into my clinical practice
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PRABA THIAGARAJAN made a comment
Eagerly waiting for this course and looking forward to go through
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PRABA THIAGARAJAN made a comment
My name is Praba and I am from Malaysia. I just want to know how basic English is taught at elementary level
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PRABA THIAGARAJAN made a comment
Just interested to see how English is taught at elementary level
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PRABA THIAGARAJAN made a comment
Great . Everything in a simple way explained
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PRABA THIAGARAJAN made a comment
Very very informative presentation with regards to the COVID 19. More practical aspects
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PRABA THIAGARAJAN made a comment
Thanks Dr. Graham Nimmo for the orientation. Looking forward
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PRABA THIAGARAJAN made a comment
I am really happy to see how expert our mentors are and looking forward to learn from them. Thanks to all our mentors. I am actually teaching medical undergraduates and postgraduates.
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PRABA THIAGARAJAN made a comment
Looking to learn more and get new ideas with regards to online teaching and more ways to make students interested. Normally they show more interest when I share my clinical experience and conduct online quizzes.
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PRABA THIAGARAJAN made a comment
I am teaching medical undergraduates and postgraduates. The main challenge I have is teaching clinical aspects. Any amount of simulation based teaching using manikins can’t replace actual patient interactions. Also it is difficult to pick up communication skills with manikins for e. g. taking informed consents. Teaching theory it is ok.
Assessment and... -
PRABA THIAGARAJAN made a comment
Thanks to the whole team. I am grateful to you all for educating us
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PRABA THIAGARAJAN made a comment
Great and Excellent course. Detailed recapture of Airway management. Learned a lot about human factors and ergonomics, team work, equipments and methods available, DAS guidelines with detailed explanation, situations of difficult airway and global anaesthetic practice especially in Kenya and other countries with limited resources. I wish I can go and help...
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PRABA THIAGARAJAN made a comment
Yes. Agreed100%
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PRABA THIAGARAJAN made a comment
Due to lack of knowledge, they just do sedation with atropine, ketamine, and diazepam. And if fairly– that’s the literal they can do,
May I know why use atropine as sedation -
PRABA THIAGARAJAN made a comment
Frequent training is important and we conduct at least once a year an airway workshop where most of the companies selling airway products and drugs take part and sponsor hugely. The Government policies and Ministry of health should address these problems by allocating adequate funds not only for the big city hospitals but for the whole country. The effort...
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PRABA THIAGARAJAN made a comment
With life style habits and fast food chains, coming across obese patients for surgery are common. Government policies should address these issues in prevention. Morbid obesity is a nightmare for both anaesthetists and surgeons. Whenever possible regional techniques are superior. For total abdominal hysterectomy I would have considered regional techniques if...
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PRABA THIAGARAJAN made a comment
Simple. concise and informative
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PRABA THIAGARAJAN made a comment
Yes. Few times. Managed with second generation with Ryle's tube aspiration and proceeded with surgery. Sometimes woke up patient and after discussing with obstetric team and patient proceeded under spinal one or two hours later if the indications for LSCS are other than maternal and foetal life threatening for e.g. severe PIH or impending Eclampsia, postdated...
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PRABA THIAGARAJAN made a comment
I still remember my days at St. Michael's Hospital in Bristol nearly two decades ago as trainee in Obstetric anaesthesia. Some were very stressful memories. All the points with regards to obstetrics anaesthesia are true. For an overseas trainee like me the stress was much higher. Different population and culture. There was not much airway aids were available....