Review Article
Consensus statement on Singapore integrated 24-hour activity guide for early childhood
Early childhood is a critical period for growth and development, setting the foundation for future and lifelong well-being.1 Adopting healthy lifestyle behaviours in early...
Letter to the Editor
Suboptimal adherence to medical therapy in patients undergoing lower limb angioplasty in Singapore
Dear Editor,
Chronic limb-threatening ischaemia (CLTI) is the advanced stage of peripheral arterial disease (PAD) and patients with this condition face a very high risk...
Commentary
Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside
Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example,...
Letter to the Editor
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...
Review Article
Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations
Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
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...
Letter to the Editor
Psychosocial impact and treatment trends of hidradenitis suppurativa in Singapore
Dear Editor,
Hidradenitis suppurativa (HS) is a common disease with a prevalence of about 1%.1 Patients commonly suffer from pain, disfigurement and psychosocial embarrassment, and...
Review Article
Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
The World Health Organization’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 provided guiding principles for national efforts in controlling...
Others
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...
Review Article
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...
Original Article
Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?
Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant...
Others
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%...
Others
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 (%...
Commentary
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...
Others
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...
Review Article
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...
Review Article
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....
Original Article
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...
Original Article
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...
Original Article
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,...
Editorial
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...
Review 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...
Original Article
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...
Original Article
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...
Others
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...
Others
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...
Original Article
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...
Review Article
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...
Others
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™)...
Original Article
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...
Others
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,...
Others
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...
Others
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...
Original Article
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...
Commentary
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...
Others
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...
Original Article
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...
Original Article
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...
Original Article
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...
Others
Acupuncture and Chronic Pain Management
Acupuncture is a component of the health care system of China that can be traced back for at least 2500 years. The general theory...
Others
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...
Original Article
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...
Review Article
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...
Others
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Original Article
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...
Review Article
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...
Others
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...
Others
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...
Others
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...
Original Article
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...
Others
Asthma Disease Management: A Provider’s Perspective
The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased...
Others
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...
Others
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...
Others
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...
Original Article
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...
Review Article
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...
Editorial
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...
Review Article
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...
Review Article
Laboratory Safety Aspects of SARS at Biosafety Level 2
In Singapore, the majority of patients suffering from the severe acute respiratory syndrome (SARS) were cared for at Tan Tock Seng Hospital. The dramatic...
Others
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...
Letter to the Editor
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...
Original Article
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...
Original Article
A Survey of Brain Death Certification – An Impetus for Standardisation and Improvement
Brain death is legally recognised in most developed countries. Certification is usually a prelude to either the withdrawal of cardiorespiratory life support or organ...
Original Article
Was it Easy to Use an Asthma Control Test (ACT) in Different Clinical Practice Settings in a Tertiary Hospital in Singapore?
In Singapore, asthma is a very common problem. It is estimated that 140,000 individuals in Singapore have current asthma, with a prevalence as high...
Original Article
Pain Prevalence in Singapore
Population studies on pain prevalence are useful in determining the impact that chronic pain has on the society. It draws the attention of healthcare...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
Dengue Knowledge, Attitudes, and Practices among Primary Care Physicians in Singapore
Dengue fever is the most common mosquito-borne viral illness worldwide and has reached hyperendemic proportions in the urban tropics and subtropics over the last...
Letter to the Editor
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...
Original Article
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...
Original Article
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...
Letter to the Editor
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,...