Singap Med J
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Randomized Controlled Trial Clinical Trial
Patient-controlled epidural analgesia after thoracic and upper abdominal surgery using sufentanil with and without bupivacaine 0.125%.
Epidural sufentanil can relieve postoperative pain after thoracic and upper abdominal surgery but it has some unwanted side effects. Patient-controlled epidural analgesia (PCEA) allows patients to titrate and reduce their analgesic requirements. ⋯ The PCEA demand-only programme using sufentanil 1 microg/ml with and without bupivacaine 0.125% was satisfactory after thoracotomy and upper abdominal surgery in our patient population. The addition of bupivacaine to sufentanil did not significantly reduce the amount of sufentanil required, the pain scores or the side effects.
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A survey was carried out among primary school teachers in the district of Kota Bharu, Malaysia to assess the level of knowledge on asthma and its management. Our findings revealed that primary school teachers were less informed about the management and treatment of asthma. ⋯ It is important that teachers should be able to recognise symptoms of an asthmatic attack or take the necessary precautions to avoid such an attack. Many teachers agreed on the need to have an asthma education programme in their teaching curriculum.
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This is a three-year retrospective review of 96 cases of paracetamol ingestions seen by KK Children's Emergency Department. Paracetamol is the commonest substance (23%) involved in childhood poisonings. ⋯ These older children ingested higher doses of paracetamol (average dose of 233 mg/kg) and had potentially serious serum paracetamol levels. There was no significant morbidity and no mortality in this series.
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Ketamine, a dissociative anaesthetic in use since 1970, produces prominent psychoactive effects in humans. Its non-medical use has raised concerns in many countries, including Singapore. This paper narrates the psychedelic and psychotic effects of ketamine in two ketamine dependent patients who have presented to the psychiatric service. ⋯ However, breaking the ongoing addiction cycle seemed more difficult. The neuro-pharmacological mechanisms of these phenomena are largely due to its complex multi-receptors actions, notably through the excitatory amino acids through mainly the N-methy-D-aspartate (NMDA) receptors. The detection of ketamine abuse requires a high index of suspicion and needs to be considered when there is an acute presentation with multi-modal hallucinations and psychosis.
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Gabapentin was approved for use in the USA in 1994 as an add-on drug in adults who have partial seizures either alone or with secondary generalised seizures. Its use has been expanded to include treatment for other conditions such as neuropathic pain and paraesthesiae. Gabapentin was prescribed for our patient who had persistent left-sided hemi-paraesthesiae consequential of a previous thalamic infarct. ⋯ Skin biopsy revealed histological features of cutaneous leukocytoclastic vasculitis. This rash completely resolved with withdrawal of gabapentin and steroidal treatment. This cutaneous adverse reaction to gabapentin has not been reported in the medical literature.