Singap Med J
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To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients' knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting. ⋯ Despite the patients' poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance.
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Detailed anatomical knowledge of the suprascapular notch (SSN) is important for the management of entrapment neuropathy and interventional procedures. The objective of the present study was to collect data on the morphological features and anatomical variations of the SSN in an Indian population. ⋯ This study of the morphometrical characteristics and anatomical variations of SSN provides an anatomical database of SSN in the Indian context. This database will be of use in surgical procedures, as the information can be used to ensure adequate access to and complete decompression of the suprascapular nerve.
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Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis. ⋯ Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery.
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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.