Singap Med J
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Comparative Study
Ranitidine and sodium citrate as prophylaxis against acid aspiration syndrome in obstetric patients undergoing caesarean section.
The efficacy of a single oral dose of 0.3M of sodium citrate alone as a prophylaxis against acid aspiration syndrome in obstetric patients undergoing LSCS (elective and emergency) was compared with that of intravenous ranitidine. One group of patients was given 30 ml of 0.3M sodium citrate orally just before the induction of anaesthesia while the other group was given 50mg of ranitidine intravenously together with the 30ml of 0.3M sodium citrate. This was done for both the elective and the emergency groups of patients. ⋯ However, in the emergency group, those who were given sodium citrate alone tend to have a larger volume of gastric aspiration when compared with those given ranitidine together with the sodium citrate. There were significantly more patients with gastric aspirates of more than 25ml in the emergency group to which sodium citrate alone was given. It would appear that supplementing an intravenous dose of ranitidine with the oral dose of sodium citrate is useful in emergency LSCS as a prophylaxis against acid aspiration syndrome.
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Several lines of evidence suggest that, of the three main races of Singapore, peptic ulcers are more common among the Chinese and Indians when compared to the Malays. These include studies on hospital series of patients with or without appropriate control groups, studies on the incidence of surgery for perforated ulcer as well as mortality statistics. ⋯ The incidence of perforated ulcer in Singapore is increasing while ulcer mortality is declining. This is similar to the situation in Hong Kong but different from that in the western countries.
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Simultaneous metatarsophalangeal and interphalangeal dislocations of the big toe are rare injuries. Gangrene of the big toe following open dislocations was reported in a 20-year-old man.
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Case Reports
Nasal positive pressure ventilation in the treatment of chronic hypercapnic respiratory failure: a case report.
This paper describes the use of a nasal mask to deliver intermittent positive pressure ventilation to treat chronic respiratory failure in one patient with severe kyphoscoliosis. After two months of overnight nasal ventilation at home the patient achieved normal blood gases, showed improved inspiratory muscle strength, effort tolerance and was able to return to work. Intermittent nasal ventilation is a safe and effective ventilatory support modality for some patients with hypercapnic respiratory failure.
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Difficult intubation has been much discussed in the anaesthetic literature. The incidence of difficult intubation (11:560) was higher in obstetric patients (6:277) as compared to gynaecological patients (5:283) in our hospital. We tested the Mallampati's classification as a predictor of difficult intubation in 277 obstetric and 283 gynaecological patients. We recommend that Mallampati's classification can be used reliably (p less than 0.05) to predict difficult intubation in obstetric but not in gynaecological patients.