Singap Med J
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Randomized Controlled Trial Comparative Study
Comparison between use of neuromuscular blocking agent and placebo with the intubating laryngeal mask airway.
The intubating laryngeal mask airway (ILMA) is a specially-designed airway device that can be used for endotracheal intubation without direct laryngoscopy. The advantage of this device is that it allows blind endotracheal intubation with a predictably high success rate. The use of neuromuscular blocking agents in facilitating the use of the ILMA has been investigated in the Western population with a quoted successful intubation rate of 88-96 percent. This randomised, double-blind study aimed to see if the use of neuromuscular blocking agent is necessary for successful intubations. ⋯ The intubating laryngeal mask airway-assisted intubation yields a high success rate, which was similar between the paralysed and non-paralysed patients, with no statistical significance. However, the non-paralysed patients were prone to coughing and movements during intubation, requiring supplemental propofol.
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Cutaneous bruises are a common symptom and a sign of injury and blood coagulation disorders in childhood. A carefully-taken history, coupled with a thorough physical examination, would lead to the diagnosis, or guide the clinician to the necessary laboratory investigations. ⋯ The finding of an abnormal coagulation test does not exclude child abuse as it can be a consequence of maltreatment, or the two conditions may coexist. Whenever necessary, the opinion of a haematologist should be sought in order to obtain an accurate diagnosis, which is essential for subsequent management and the prevention of further injury in the case of child abuse.
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Controlled Clinical Trial
Fast-track method in cardiac surgery: evaluation of risks and benefits of continuous administration technique.
Fast-track is a method proposed to decrease medical costs through the reduction of patients' length of stay in the hospital. This study was carried out to assess the risks and benefits of conducting the fast-track method in cardiac anaesthesia and to evaluate the role of continuous infusion of short-acting anaesthetics in a successful fast-track protocol. ⋯ Continuous infusion of drugs in the fast-track method facilitates earlier extubation. It maintains continuous sedation and analgesia without increasing respiratory complications.
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Anaphylaxis during general anaesthesia is a major concern. Early recognition and management of anaphylaxis, as well as its future prevention, remain a challenge for the anaesthetists, while for the allergists, the elucidation of the causal agents may be difficult. We aimed to describe our experience in our drug allergy clinic. ⋯ NMBA was the commonest cause of anaphylaxis during general anaesthesia, occurring in 65% in our series.
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Placenta accreta occurs when the placenta is abnormally adherent to the uterus, often resulting in complications in the peripartum period such as severe haemorrhage, a possible need for caesarean hysterectomy, and even severe injuries to pelvic organs. There has been a gradual shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the main aim being to reduce pelvic injury and haemostasis with the aid of intervention radiology by means of insertion of occluding balloons into the internal iliac arteries. This strategy has previously been shown to reduce morbidity and mortality in carefully selected cases of placenta accreta. We review three cases of successful uterine conservation performed in our institution.