Ann Acad Med Singap
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Continuous spinal anaesthesia is an established technique in which renewed interest has been generated by the availability of small bore catheters suitable for use in the subarachnoid space. Problems include technical difficulty, post dural puncture headache and maldistribution of local anaesthetic, the latter being implicated in the development of caudal equina lesions. Maldistribution of local anaesthetic may possibly be reduced by attempting to place the tip of the catheter at the apex of the lumbo-sacral curve and the use of local anaesthetic solution that is only marginally hyperbaric. This article is in the form of a short review together with an account of the authors' own studies of continuous spinal anaesthesia, conducted to assess the technique for peripheral vascular surgery.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialEpidural infusions of bupivacaine and fentanyl do not improve rehabilitation following one-stage bilateral total knee arthroplasty.
Epidural analgesia with local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopaedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were allocated to receive infusions of either continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. ⋯ Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Clinical TrialCombination of intramuscular Ketorolac and low dose epidural morphine for the relief of post-caesarean pain.
Epidural morphine produces profound analgesia but also causes many adverse effects in a dose-dependent manner. This double-blind, randomized, prospective study evaluated the analgesic efficacy and safety of low dose (2 mg) epidural morphine in combination with 30 mg intramuscular (IM) Ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic activity, in patients suffering pain after caesarean surgery. Ninety parturients who received epidural anaesthesia in the postoperative period were divided into 3 equal groups: group A received epidural morphine 2 mg plus IM placebo; group B received epidural morphine 2 mg plus IM Ketorolac 30 mg; and group C received epidural saline placebo plus IM Ketorolac 30 mg. ⋯ Results showed that group B had statistically significant superior pain relief to that of the other 2 groups. The incidence of adverse effects was similar between those of group A and B. We concluded that the addition of Ketorolac by IM administration enhanced the analgesic effect of low dose (2 mg) epidural morphine in the relief of post-caesarean pain without potentiating its adverse effects.
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Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle. In humans, MH is inherited in an autosomal dominant fashion; in swine, the principal model for MH, it is in a recessive fashion. Those with MH susceptibility usually are asymptomatic except in the presence of certain "triggering" anaesthetic agents such as isoflurane, enflurane and the muscle relaxant succinylcholine. ⋯ The pathophysiology of MH centres around a defect in calcium flux in skeletal muscle. A specific base pair change in the gene that codes for the ryanodine receptor calcium channel in muscle has been demonstrated in susceptible swine, but occurs rarely in humans. It is hoped that the understanding of the molecular genetics of MH will lead to a simpler diagnostic test than is currently available, and enhance our understanding of MH and its relation to other myopathies.
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Thyroid function and pubertal development of aborigines (Orang Asli) and Malays at different socioeconomic strata were assessed among 1136 subjects aged 7 years and above. Anthropometric measurements, goitre and pubertal staging were done. Serum thyroxine (T4), triiodothyronine (T3) and growth hormone were measured using radioimmunoassays (RIA) and serum thyroid stimulating hormone (TSH) by immunoradiometric assays (IRMA). ⋯ It was also a predictor for TSH levels in children but not in adults. Fasting serum growth hormone (GH) levels were significantly higher among less privileged groups and decreased according to social development. Serum growth hormone was negatively correlated with anthropometric indices and had a significant association with malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)