Demographic profile and extent of healthcare resource utilisation of patients with severe traumatic brain injury: still a major public health problem.

Introduction: Trauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause.

Methods: This study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011.

Results: A total of 780 TBI patients were admitted during the study period; 365 (46.

Postoperative permanent pressure alopecia.

A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient.

Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring.

Background: During spinal surgery, intraoperative monitoring of motor-evoked potentials (MEPs) is a useful means of assessing the intraoperative integrity of corticospinal pathways. However, MEPs are known to be particularly sensitive to the suppressive effects of inhalational halogenated anesthetic agents.

Objective: To investigate the effects of increasing end-tidal concentrations of desflurane and sevoflurane anesthesia in a background of propofol and remifentanil with multipulse cortical stimulation on intraoperative monitoring of MEPs.

Cerebral ischaemia in pituitary disorders--more common than previously thought: two case reports and literature review.

Vasospasm and consequent cerebral ischaemia in aneurysmal subarachnoid haemorrhage are well-described. The development of cerebral ischaemia following pituitary tumour surgery is under-appreciated, and can be attributed to mainly cerebral vasospasm or internal carotid artery compression. We report on two patients with pituitary tumours who developed delayed cerebral ischaemia after transsphenoidal and transcranial pituitary macroadenoma decompression.

Management plan to reduce risks in perioperative care of patients with obstructive sleep apnoea averts the need for presurgical polysomnography.

Introduction: Obstructive sleep apnoea (OSA) is associated with increased perioperative morbidity and mortality. Patients at risk of OSA as determined by pre-anaesthesia screening based on the American Society of Anesthesiologists checklist were divided into 2 groups for comparison: (i) those who proceeded to elective surgery under a risk management protocol without undergoing formal polysomnography preoperatively and; (ii) those who underwent polysomnography and any subsequent OSA treatment as required before elective surgery. We hypothesised that it is clinically safe and acceptable for patients identified on screening as OSA at-risk to proceed for elective surgery without delay for polysomnography, with no increase in postoperative complications if managed on a perioperative risk reduction protocol.

Anesthesia for cerebral revascularization for adult moyamoya syndrome associated with sickle cell disease.

We report the anesthetic management of an adult patient undergoing cerebral revascularization surgery for moyamoya syndrome complicating sickle-cell disease (SCD). We present a 25 year-old male of African ethnicity with homozygous SCD who was experiencing worsening ischemic neurologic symptoms culminating in intraventricular hemorrhage from rupture of moyamoya vessels. Despite an extracranial-intracranial superficial temporal artery-middle cerebral artery bypass that was angiographically patent postoperatively, he subsequently required an intracranial omental transplant to improve cerebral blood flow to the anterior cerebral artery territory.

Case series: monocular visual loss associated with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms.

Purpose: To describe variations in the presentation of monocular visual loss associated with intracranial aneurysm rupture. The clinical course, possible etiologies and management of visual loss in three patients are described.

Clinical Features: The first patient developed Terson's syndrome (vitreal hemorrhage associated with raised intracranial pressure secondary to subarachnoid hemorrhage).