Singap Med J
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Randomized Controlled Trial
Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy.
Sedation or anaesthesia is recommended for all patients undergoing bronchoscopy unless absolute contraindications exist. However, the widely used combination of propofol and opiates for moderate sedation (MS) in bronchoscopy results in a high incidence of hypoxaemia and a relatively high cough score during the procedure. In this study, we evaluated the efficacy and safety of target-controlled infusion (TCI) of propofol and remifentanil, together with the use of high frequency jet ventilation (HFJV), to achieve general anesthesia (GA) in diagnostic fibre-optic bronchoscopy. ⋯ GA, achieved via TCI-delivered propofol and remifentanil with HFJV, provides better conditions for diagnostic bronchoscopy - it decreases the occurrence of hypoxaemia, shortens the duration of bronchoscopy and increases patient satisfaction.
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Case Reports
Acute unilateral submandibular gland swelling associated with the laryngeal mask airway.
We describe a rare complication of acute unilateral submandibular gland swelling following the use of laryngeal mask airway (LMA) in two patients with otherwise uneventful perioperative airway management. This is likely to be a consequence of the pressure exerted by the airway cuff on the tissues within the submandibular triangle. ⋯ We discuss the presenting clinical features, pathophysiology and utilisation of ultrasonographic confirmation of sialadenopathy, and review the current anaesthetic literature to raise awareness of this unusual and under-reported complication of LMA. This complication can be mitigated by incorporating routine manometric checks and limiting intracuff pressures to < 60 cmH2O, potentially avoiding LMA insertions in patients with sialolithiasis and avoiding the use of nitrous oxide.
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For many decades, Wertheim's radical hysterectomy via laparotomy, also known as Wertheim's radical abdominal hysterectomy (RAH), has been the traditional surgical approach for operable stage IB cervical cancer. However, many established cancer centres worldwide have recently shown total laparoscopic Wertheim's radical hysterectomy (TLRH) to be a safe and feasible alternative to the conventional abdominal route for early cervical cancer management. This technique was introduced in Singapore in 2009. ⋯ The results of our study suggest that with appropriate patient selection and increased experience, TLRH can be a safe and effective procedure for the management of early cervical cancer in Singapore.