Perioperative management of phaeochromocytoma with stress cardiomyopathy and aberrant vascular drainage.

The following case discusses the surgical considerations for a patient presenting with cardiogenic shock secondary to a phaeochromocytoma crisis with stress cardiomyopathy. The patient underwent an interval laparoscopic adrenalectomy. Pneumoperitoneum insufflation was performed at lower pressures; manipulation of the adrenal tumour was minimised, and the adrenal vein was ligated early.

Predictors and outcomes of withholding and withdrawal of life-sustaining treatments in intensive care units in Singapore: a multicentre observational study.

Background: Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches.

Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study.

Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year.

Trauma-induced coagulopathy: Mechanisms and clinical management.

Introduction: Trauma-induced coagulopathy (TIC) is a form of coagulopathy unique to trauma patients and is associated with increased mortality. The complexity and incomplete understanding of TIC have resulted in controversies regarding optimum management. This review aims to summarise the pathophysiology of TIC and appraise established and emerging advances in the management of TIC.

Comparing organ donation decisions for next-of-kin versus the self: results of a national survey.

Objectives: Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker's mindset. This focused on: (1) how decisions compare when made on behalf of a relative (vs the self); and (2) confidence in decisions made for family members.

Association between lung compliance phenotypes and mortality in COVID-19 patients with acute respiratory distress syndrome.

Introduction: Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS.

Methods: Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled.

Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore.

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected.

Lung ultrasound in a Singapore COVID-19 intensive care unit patient and a review of its potential clinical utility in pandemic.

Point-of-care bedside lung ultrasound is a diagnostic adjunct in the management of respiratory diseases. We describe the clinical progress and lung ultrasound findings of a Singaporean COVID-19 intensive care unit patient who was diagnosed with COVID-19 infection. The clinical course of one COVID-19 patient managed in the intensive care unit was traced.

Brain Death in Asia: Do Public Views Still Influence Organ Donation in the 21st Century?

Background: Historically, brain death legislation was adopted in Asia at a much later stage than it was in the West, with heated public debates surrounding these laws. In this study, we investigated whether the poor acceptance of brain death continues to the present day, focusing on the following: (1) what the Asian public understands brain death to be; (2) how views toward brain death are compared with those of cardiac death; and (3) the extent to which brain death perception contributes to the low rate of deceased organ donation that has been observed amongst Asians.

Methods: Using a door-to-door sampling strategy, we recruited 622 residents in Singapore between September 2016 and July 2017.

Direct and indirect low skill fibre-optic intubation: A randomised crossover manikin study of six supraglottic airway devices.

Background And Aims: Fibre-optic intubation (FOI) through supraglottic airway devices (SADs) is useful in the management of the difficult airway. We compared two methods of FOI through seven SADs in a randomised crossover manikin study to assess each device's performance and discuss implications on SAD selection.

Methods: Thirty anaesthetsiologists, 15 seniors and 15 juniors, each performed low skill FOI (LSFOI) with seven SADs using both 'direct' and 'indirect' methods.

Invasive Streptococcus Pneumoniae Infection Causing Cardioembolic Stroke: A Clinical Proximity to Austrian Syndrome.

Streptococcus pneumoniae (S. pneumoniae) is a significant human bacterial pathogen and the major cause of pneumonia. In the post-antibiotic era, S.

Anesthesia management for MitraClip device implantation.

Aims And Objectives: Percutaneous MitraClip implantation has been demonstrated as an alternative procedure in high-risk patients with symptomatic severe mitral regurgitation (MR) who are not suitable (or) denied mitral valve repair/replacement due to excessive co morbidity. The MitraClip implantation was performed under general anesthesia and with 3-dimensional transesophageal echocardiography (TEE) and fluoroscopic guidance.

Materials And Methods: Peri-operative patient data were extracted from the electronic and paper medical records of 21 patients who underwent MitraClip implantations.

Difficult intubation in a patient with vallecular cyst.

Although rare, vallecular cysts can have catastrophic consequences in an anaesthetised patient if airway management is inappropriate. We report a case of difficult intubation in a 46-year-old man with a vallecular cyst, and detail the methods and strategies for successful endotracheal tube insertion. Following a review of the current literature, we also discuss airway management options in adult patients with vallecular cysts.