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Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

Dear Editor, Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...

Periodontal disease and systemic health: An update for medical practitioners

Care for the oral cavity lies in the intersection of dentistry and medicine. As the oral cavity serves as an entry to the gastrointestinal...

Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

Dear Editor, The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...

Sedation in gastrointestinal endoscopy in Singapore

Dear Editor, I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...

Non-anaesthesiologists administering propofol in the Singapore context

Dear Editor, Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...

Sedation by non-anaesthesiologists in gastrointestinal endoscopy

Dear Editor, We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...

Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring

The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are...

An Overview of Anaesthetic Issues in Phaeochromocytoma

New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the...

Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol

The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500%...

Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report

Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (%...

Management Training in Critical Care Medicine

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...

Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...

Critical Care Medicine in the Western Pacific Region

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Critical Care—The Worldwide Perspective

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Predictors of Long-term Outcome in Severe Head Injury

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only...

Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...

Intensivists for the Intensive Care Unit—Do They Make a Difference?

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...

Recurrent Gigantic Pyogenic Granuloma Disturbing Speech and Mastication: A Case Report and Literature Review

Pyogenic granulomas are common benign fibrovascular growths of the oral cavity that are non-neoplastic in nature. They may also present as skin lesions. This article...

Epidural Analgesia in Obstetrics

Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types...

An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking

In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural...

Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

A Case Report of a Vital Replanted Tooth with Unfavourable Extra-alveolar Condition: A 10-Year Follow-up

Tooth avulsion, frequently of the maxillary central incisors, occurs most often in children from 7 to 9 years of age, when the periodontium surrounding...

Odontoameloblastoma: Report of a Case

Ameloblastoma is a benign but locally invasive tumour that affects the jaws. Although it is commonly regarded as a homogeneous group of tumours, detailed...

Oral Manifestations of Schimmelpenning Syndrome: Case Report and Review of Literature

Schimmelpenning syndrome (SS) is characterised by specific skin manifestations, skeletal defects, and central nervous system abnormalities, such as mental deficiency and seizures. Happle has...

Alveolar Bone Grafts: The Surgical/Orthodontic Management of the Cleft Maxilla

Secondary alveolar bone grafting, which was pioneered in Europe, was reported in the German literature at the beginning of this century. However, it was...

Pathogenesis and Morphogenesis of Craniofacial Developmental Anomalies

The current explosion of molecular biology encompassing genetics, morphogenesis, teratogenesis and pharmacogenomics for targeted drug therapy is about to have a profound impact upon...

A Review of Common Mucocutaneous Disorders Affecting the Mouth and Lips

Most of the mucocutaneous diseases are confined to the stratified squamous epithelia and thus may involve oral, genital and other mucosae and skin. Most...

Oral Rehabilitation Using Dental Implants and Guided Bone Regeneration

Form follows function and adaptation to physiologic demands dictates skeletal form. In the oro-facial region, tooth loss leads to atrophy of the alveolar arches...

Reconstruction of Cranial Bone Defects Using Alloplastic Implants Produced from a Stereolithographically-generated Cranial Model

Cranial bone defects can be a result of trauma, congenital defects, infection or iatrogenically induced by surgery. Even for patients with sufficient hair to...

A 5-Year Survey of Oral Biopsies in an Oral Surgical Unit in Singapore: 1993-1997

There are a variety of pathological conditions that present in the oral cavity. While clinical and radiographic examination will suggest a provisional diagnosis, histological...

The Role of Multiple Segment Osteotomies in Orthognathic Surgery

Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to...

Sutures, Growth Plates and the Craniofacial Base—Experimental Studies in the Toothless (tl-Osteopetrotic) Rat

Craniofacial development is a complex multidimensional process that depends in large part on growth in the cranial base at several growth centres posteriorly and...

Surface Laser Scanning of the Cleft Palate Deformity —Validation of the Method

Cleft palate morphology and palatal dimensional changes due to growth and treatment have been analysed by numerous quantitative techniques. Many of these methods, however,...

Intraoral Mandibular Distraction: Indications, Technique and Long-term Results

Distraction osteogenesis is rapidly becoming a mainstream treatment modality for the early management of the patient with mandibular hypoplasia. Following early clinical experience with...

Aetiology and Distribution of Mandibular Fractures in the National University Hospital, Singapore

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken...

A Duty of Quality

The process of delivery of health care is complex and includes aspects which concern the clinician, the patient and the treatment process itself. Training...

The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus

A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed...

Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report

A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...

Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...

Controversies in Anaesthesia—Designer Drugs

The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of...

Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report

A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™)...

Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit

Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with...

Perioperative Wheezing—A Report of Three Cases

Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration,...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...

Case Reports: The Use of Intermaxillary Screws to Achieve Intermaxillary Fixation in the Treatment of Mandibular Fractures

The mandible is a unique bone in the human skeleton and occupies a prominent position in the craniofacial region. Traumatic injury to the face,...

A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma

Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in...

Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery

Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes...

Transurethral Surgery and the Adductor Spasm

Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of...

Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia

Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes. This article is available only as...

Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium

Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous...

The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury

Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...

Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation

Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised...

A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix

Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many. This article...

Oral Manifestations of Human Immunodeficiency Virus (HIV)-infected Patients in Singapore

The spread of human immunodeficiency virus (HIV) disease has pursued a relentless course since it was first recognised in the early 1980s and if...

Evaluation of Problem-based Learning: A Lecturer’s Perspective

In the last decades, the exponential growth in the sophistication of the medical/dental knowledge and technologies has made the current dental curriculum more cramped...

Intravenous Regional Anaesthesia Using Lignocaine and Tramadol

Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the...

Catheter-related Infection: Diagnosis, Prevention and Treatment

Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem. This article is...

Book Review

This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions...

Intra-abdominal Hypertension—Implications for the Intensive Care Physician

Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...

Anaemia in the Critically Ill—The Optimal Haematocrit

The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported...

Quality of Life in Long-Term Survivors of Intensive Care

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying...

Limitation of Life Support in the Critically Ill: The Hong Kong Perspective

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly...

Simulation-based Training at the University of Pittsburgh

In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred...

Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock

Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of...

Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume

The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored...

Case Report: Catheter-Related Epidural Abscess

Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to...

A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery

Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of...

Subdural Block—From a Spinal? A Case Report

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...

Problems Related to Epidural Analgesia for Postoperative Pain Control

Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...

Clinical Update on Managing the Obstructed Airway

Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...

Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report

Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems...

Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...

A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital

Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and...

Craniofacial Anomalies: Clinical and Molecular Perspectives

Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia,...

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...

Ensuring safe sedation during gastroendoscopy

Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...

Case Report of a Dermoid Cyst at the Floor of the Mouth

A 19-year-old Indian male with a past history of “Ludwig’s angina” was seen at the Accident and Emergency Department of National University Hospital complaining...

Difficulties in Diagnosing Lesions in the Floor of the Mouth – Report of Two Rare Cases

The floor of the mouth takes form as early as in the fourth week of gestation with the downward growth and subsequent degeneration of...

Spontaneous Bone Regeneration after Mandible Resection in a Case of Ameloblastoma – A Case Report

Ameloblastoma is a true neoplasm of enamel organ type tissue which does not undergo differentiation to the point of enamel organ. This type of...

Clinico-Pathological Conference 2002

Six patients with unusual presentations of head and neck disease were presented for diagnosis by discussants at the conference. Images were accompanied by brief...

The Role of Internet and Personal Digital Assistant in Oral and Maxillofacial Pathology

The Internet is a global network of networks that connect computers all over the world, so that anyone from any point in the network...

Bisphosphonates – A Word of Caution

Bisphosphonates are commonly prescribed for the treatment (and prevention) of postmenopausal and corticosteroid induced osteoporosis, Paget’s disease, hypercalcemia associated with malignancy and osteolysis (and...

Low Frequency of Anti-Endomysial Antibodies in Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis (RAS) is a common condition of the oral mucosa of unknown aetiology. Several predisposing factors have been suggested including haematinic deficiencies,...

Oral Lesions and Conditions Associated with Human Immunodeficiency Virus Infection in 1000 South Indian Patients

Human immunodeficiency virus (HIV) infection is a major global health problem. It is estimated that the number of people living with HIV infection in...

Epidemiology of Betel Quid Usage

Betel quid/areca nut use has been common in South and Southeast Asia and the Asia Pacific region for a long time and is common...

Oral Mucosal Immunology: An Overview

The primary function of the immune system of the mouth is to protect the teeth, jaws, gingivae and the rest of the oral mucosa...

Oral & Maxillofacial Pathology and Medicine – A Dental Specialty Issue Whose Time Has Come?

The practice of Dentistry in Singapore has advanced rapidly, with the development and recognition of several specialty practices, coupled with the support of established...

Marijuana in Pregnancy

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...

Spectrum of Dentofacial Deformities: A Retrospective Survey

Deformity refers to distortion of any part of the body. The term dentofacial is related to the dental arches and their effects on facial...

Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context

Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...

An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics

Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion...

The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation

The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style...

Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations

Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are...

Effect of Orthognathic Surgery on the Posterior Airway Space (PAS)

During the growth and development of a person, the facial structures are primarily dependent on the genetic makeup and secondarily on the environmental factors....

Airway and Craniofacial Changes With Mandibular Advancement Device in Chinese With Obstructive Sleep Apnoea

The mandibular advancement device (MAD) consists of upper and lower splints attached to the teeth and postures the mandible forward. The rationale for use...

A Brief History of the Chapter of Dental Surgeons

The idea of having an Academy of Medicine in Singapore was first proposed by some 20 medical specialists on 19 July 1957 and was...

Reply from Author: Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank Dr Nicholas Chua et al for their interest in our review article. We agree and appreciate the experience and comments by the...

Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank the authors for a comprehensive review on the role of interventional pain therapies used in cancer pain as well as a informative...

Enlargement of the Right Maxilla – Report of an Unusual Peripheral Osteoma

Osteomas are benign, slow-growing tumours of the bone which may be classified as solitary or multiple. Multiple osteomas are mainly associated with Gardner’s syndrome...

Recommendations for standards of neuromuscular monitoring during anaesthesia

Dear Editor, We presented recommendations for neuromuscular monitoring during anaesthesia, which were approved by the Council of the College of Anaesthesiologists, Singapore in September 2019...

Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force

Studies show that the incidence of chronic pain is approximately 18% in Australia and developed countries in Europe. In Asia, data from Hong Kong...

The Use of Complementary and Alternative Medicine in Chronic Pain Patients in Singapore: A Single-Centre Study

Chronic pain is a prevalent disease that is often diffi cult to manage. According to a World Health Organisation survey, the worldwide prevalence of...

Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography

A significant proportion of patients with underlying obstructive sleepapnoea (OSA) remain undiagnosed when they present for surgery. Epidemiologic data have placed the prevalence in the...

A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients

Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range,...

Precautions When Providing Dental Care During Coronavirus Disease 2019 (COVID-19) Pandemic

Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization...