Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialSubcutaneous infusion of ketamine and morphine for relief of postoperative pain: a double-blind comparative study.
Low dose ketamine by subcutaneous infusion (0.1 mg.kg-1.h-1) was compared in a double-blind fashion with a similar infusion of morphine (0.03 mg.kg-1.h-1) for postoperative analgesia in 60 ASA-I adults after major abdominal surgery. Pain was assessed using visual analogue scales and sedation was graded on a four-point rank drowsiness score. Cardiovascular and respiratory parameters were also recorded. ⋯ Both tidal and minute volume parameters improved better with ketamine (P < 0.001); patients were more awake and alert as evidenced by the drowsiness score (P < 0.001). Nine out of 30 patients who received morphine required catheterisation for urinary retention (P < 0.05). The study revealed higher analgesic efficacy of a low dose subcutaneous infusion of ketamine with lesser sedation and fewer side effects.
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Respiratory catastrophes are the most common cause of anaesthesia-related brain deaths and death. If an airway is recognised to be difficult, endotracheal tube (ETT) intubation should be performed awake. Awake intubation demands proper preparation of the patient. ⋯ If at any point mask ventilation becomes impossible and the patient still cannot be intubated, then transtracheal jet ventilation (TTJV) through a percutaneous IV catheter should be instituted. Once life-sustaining gas exchange is again effected by TTJV, then the patient should either be awakened, a semi-elective tracheostomy or cricothyroidotomy performed or the patient intubated with a special ETT intubation technique. An intubated patient with a known difficult airway should be extubated over a jet stylet.
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Ann Acad Med Singap · Jul 1994
Case ReportsRepeat epidural caesarean section in a patient with cerebral arteriovenous malformation.
Following a previous uneventful pregnancy and caesarean section, a 27-year-old woman with an untreated cerebral arteriovenous malformation presented again with a second pregnancy. While the cerebral haemodynamics during labour and delivery remain unclear, it is best to avoid Valsalva manoeuvres in women with cerebrovascular disease, and therefore caesarean section is usually the preferred method of delivery. ⋯ In the absence of decreased intracranial compliance, epidural anaesthesia is recommended because it avoids the haemodynamic stresses of laryngoscopy and rapid sequence intubation. The anaesthetic management of cerebral arteriovenous malformation in pregnancy is summarised.
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The American Board of Anesthesiology (ABA) has been in existence since 1937 for the purpose of advancing the practice of anaesthesiology in the United States. It is a credentialling organization which requires anaesthesiology residency training, medical licensure, and successful completion of written and oral examinations in order for an individual physician to be granted a diploma. Residency training requires four years and must culminate with a satisfactory certificate of clinical competence. ⋯ The ABA also issues subspecialty certificates in critical care medicine and pain management. There is a voluntary mechanism for diplomates to demonstrate continuing qualifications. This is accomplished by peer review and a written examination.
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Ann Acad Med Singap · Jul 1994
Specialist training and certification process for anaesthesiologist in Japan.
Anaesthesiology is the first medical specialty in Japan to be legislated for training and certification by the Ministry of Health and Welfare. The Japanese Society of Anaesthesiologists (JSA) is the regulating body since 1960. Consultants or independent specialists in anaesthesiology are known as Diplomates of the Board of JSA. ⋯ This national examination system has a written, oral, on-site evaluation and demonstration of research by credit accumulation. Presently, 34% of post-anaesthesia trainees are Diplomates and this is an increasing trend. Recertification is mandatory with continued medical education as the Diplomate status is valid for 5 years only.