Singap Med J
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Clinical Trial Controlled Clinical Trial
Morbidity from subarachnoid spinal anaesthesia--a prospective study on the post-operative morbidity from subarachnoid spinal anaesthesia.
A clinical survey was conducted on 274 patients who had surgery under subarachnoid spinal anaesthesia. The anaesthetic was performed with either a 23 gauge or 25 gauge needle. All patients were interviewed on the second and sixth post-operative days. ⋯ Backache was the most common complaint (20.5%). Using the finer needle did not reduce this aspect of morbidity. Post-dural puncture headache on the other hand was significantly reduced by the use of the finer 25 gauge needle (from 12.3% to 4.9%).
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The results of major surgery in 295 consecutive patients over the age of sixty years were analysed. In this series, 70% were electives and 30% emergency cases with a male preponderance of 3:2. The overall mortality was 11.2%. ⋯ Seventy percent (70%) of deaths after elective surgery followed palliative operations for advanced cancer. For elective surgery, complications of peptic ulcers were associated with a high mortality rate whereas deaths were fairly uniform in the emergency group. In general, concomitant medical diseases and postoperative complications were the major determinants of outcome of surgery in the elderly.
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This paper describes 19 consecutive episodes (18 patients) of status asthmaticus managed in a medical intensive care. Eleven patients required mechanical ventilatory support [MV] and 2 (11%) died. Most patients had acute respiratory acidosis although arterial blood gases alone could not predict the need for MV. ⋯ The most serious complication of MV was barotrauma. On follow up studies, two distinctive patterns of chronic asthma could be identified. One group of patients had highly labile pulmonary function with unpredictable and wide changes in peak flow rates while another group had poorly reversible obstruction.