Ann Acad Med Singap
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In recent years tremendous progress has been made in our understanding of peripheral, spinal cord and brain mechanisms involved in acute pain and in the neurophysiologic description of nociceptive pathways, receptors and mediators. Great strides have been made in our knowledge of pharmacokinetics and pharmacodynamics of drugs used to treat pain. However, in spite of unprecedented interest in pain and its management, most patients undergoing surgery still receive treatments that have changed little in the past decades. ⋯ Various combinations of the above are also possible. However, it is increasingly recognised that the solution to the problem of inadequate pain relief on surgical wards lies not so much in the development of new drugs and new techniques but in the development of a formal organisation for better use of existing drugs and techniques. A simple, low-cost organisation model for acute pain services (APS) is described.
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Ann Acad Med Singap · Nov 1994
Case ReportsHigh resolution computed tomography of the temporal bone: preliminary experience.
High Resolution Computed Tomography (HRCT) can demonstrate the detailed anatomy and pathology of the temporal bone and is fast becoming an important imaging modality in the diagnosis and preoperative management of our local patients with temporal bone diseases. We present our experience in the usage of HRCT in temporal bone lesions in Tan Tock Seng Hospital, using 8 cases as illustration. ⋯ We also give an overview of those clinical conditions whereby HRCT can provide information which will help surgeons in the management of their patients. These clinical conditions are hearing loss, external auditory canal atresia, middle ear inflammation/cholesteatoma, temporal bone trauma, pulsatile tinnitus and vascular tympanic membrane.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialEpidural infusions of bupivacaine and fentanyl do not improve rehabilitation following one-stage bilateral total knee arthroplasty.
Epidural analgesia with local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopaedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were allocated to receive infusions of either continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. ⋯ Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.
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The development of new non-depolarizing neuromuscular blocking drugs starting with the introduction of the intermediate-acting agents atracurium and vecuronium has made it possible to avoid the use of succinylcholine for elective cases. Recently 4 new drugs have become available; the short-acting mivacurium, the intermediate-acting rocuronium and the 2 long-acting drugs doxacurium and pipecuronium. The pharmacokinetic and pharmacodynamic profile of these drugs are reviewed in this paper.
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Extracorporeal life support (ECLS), which is prolonged cardiopulmonary bypass with an artificial membrane lung, is one of the most efficient life support means for patients with severe cardiopulmonary failure. Its practice will become much simpler, safer and popular in the near future. In this article, the history of ECLS and the acronyms related to it, together with its present status in the world are introduced. ⋯ Heparin-bonded hollow-fibre lungs made of non-microporous membrane are recommended for prolonged cardiopulmonary bypass to prevent gas embolism and fluid leakage from the artificial lungs. Several special clinical cases where patients were saved from moribund cardiopulmonary failure, such as severe barotrauma after excessive ventilator therapy and prolonged cardiac standstill after myocardial infarction, are described to explain the life-support effects and indications of ECLS. Research on ECLS, now taking place, such as the use of an intravenacaval oxygenator, manually operated cardiopulmonary bypass system for emergency resuscitation and transportation of the patient, as well as respiratory care of a premature newborn in artificial amnion fluid, is also introduced.