Ann Acad Med Singap
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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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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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The mechanism of anaesthesia is still a black box, although many investigators have been concerned about this theme since the 19th century. It is too complex to clarify the mode of anaesthetic action, as a variety of compounds have been adopted as anaesthetics. Hill coefficients calculated from the righting reflex dose-response curve in enflurane, isoflurane sevoflurane and halothane anaesthesia in a certain strain of mice were from 14 to 56. ⋯ It is suspected from Overton's experiment that the action site is not in the core of lipid bilayer but on the surface of membrane. It was demonstrated by 2 methodologies. Two-dimensional nuclear Overhauser effect spectrum in H1-NMR spectra of dipalmitoyl phosphatidylcholine (DPPC) vesicle membrane in the presence of methoxyflurane revealed from the existence of the cross-peak between the methoxy-proton and the choline methyl-proton that methoxyflurane molecule interacted only to the polar head of lipid membrane at lower temperatures.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Acad Med Singap · Jul 1994
Education of specialists in anaesthesia and intensive care in Europe--A Swedish perspective.
Sweden as well as most other countries in western Europe are parts of a common labour market where free movement of the labour force is encouraged. As in all recognised specialties of medicine, most national Anaesthesia societies or colleges have joined the Specialist Committee of the Union Européenne des Médicins Spécialistes (UEMS) as well as the European Board of Anaesthesiology in a joint European effort intended to promote the highest possible standard in the practice of Anaesthesia and Intensive Care throughout the European Union and the European Economic Space. ⋯ The European Academy of Anaesthesiology is working together with these organisations and is offering the specialist organisations or colleges in Europe to take part in their specialist examination, hospital recognition programme and in-training examinations. Our country, among others, has adopted the European Diploma of Anaesthesiology and Intensive Care as the national examination for future specialists in our discipline.
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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.