Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1994
ReviewPharmacotherapy for cancer pain: an anaesthesiologist's viewpoint.
Cancer pain is prevalent and undertreated despite the availability of therapeutic options that, taken together are highly effective, economical and safe. Improved understanding of the pharmacology of chronically-administered opioids has resulted in reduced concerns about addiction and an increased emphasis on their use. The anaesthetist may play a pivotal role in cancer pain management by the provision of nerve blocks and other interventions, but, to be a truly effective consultant, must also be expert in all aspects of pharmacotherapy. A rationale for the development of pharmacologic expertise together with a review of assessment and pharmacologic management of cancer pain are provided.
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Magnetic resonance imaging (MRI) has become an increasingly popular non-invasive radiological diagnostic procedure, with several distinct advantages over computerised tomography (CT). The images are produced using a strong (1.5-Tesla) magnetic field and radiofrequency (RF) pulses. Due to the effects of the strong magnetic field, certain groups of patients with implanted ferromagnetic objects and women in their first trimester of pregnancy are precluded from undergoing MRI. ⋯ The problems related to anaesthesia in MRI include the constant presence of a strong magnetic field, the RF pulses and their effect on the anaesthesia machine, monitoring devices, magnetically coded material, and loose ferromagnetic objects. In this article, the current availability of MRI-compatible anaesthesia machine, various monitoring devices, and safe conduct of anaesthesia during MRI for patients of all ages are discussed. In addition, the implications of the strong magnetic field on patient resuscitation inside the MRI suite and the recommended procedure for a successful outcome are outlined.
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Considerable advances have been achieved in developing new techniques and equipment for the assessment of neuromuscular transmission during anaesthesia. This paper is a review of the methods currently used in research as well as in daily clinical practice. ⋯ The clinical evaluation of the responses to nerve stimulation, and which stimulation patterns to prefer during onset, maintenance and recovery of neuromuscular block are dealt with, as well as possible errors to be encountered. Arguments are given for routine use of neuromuscular monitoring in the clinical setting, and situations where monitoring of neuromuscular function are of particular importance are noted.
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Ann Acad Med Singap · Jul 1994
Septic shock in a surgical intensive care--validation of multiorgan and APACHE II scores in predicting outcome.
We analysed retrospectively the records of 353 admissions to the National University Hospital's Surgical Intensive Care Unit over a one-year period and found 25 patients with septicaemic shock requiring vasoactive therapy. The mortality rate was 68%. ⋯ Only the APACHE II was a significant predictor of outcome, the rest having poor predictive ability. We conclude that the present scoring systems are too inaccurate for us to base important clinical decisions on.
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Ann Acad Med Singap · Jul 1994
Case ReportsRepeat epidural caesarean section in a patient with cerebral arteriovenous malformation.
Following a previous uneventful pregnancy and caesarean section, a 27-year-old woman with an untreated cerebral arteriovenous malformation presented again with a second pregnancy. While the cerebral haemodynamics during labour and delivery remain unclear, it is best to avoid Valsalva manoeuvres in women with cerebrovascular disease, and therefore caesarean section is usually the preferred method of delivery. ⋯ In the absence of decreased intracranial compliance, epidural anaesthesia is recommended because it avoids the haemodynamic stresses of laryngoscopy and rapid sequence intubation. The anaesthetic management of cerebral arteriovenous malformation in pregnancy is summarised.