Biomedical subjects

T K Tan

Publications and source records attributed to T K Tan.

14 recordsLinked to original sources

PubMed1998

Epidural analgesia in obstetrics.

An ideal analgesic for labour would preferably be non-invasive, as effective as spinals and epidurals without their attendant complications and is safe to mother and child and should not complicate the labour process. Analgesia for labouring women ranges from the use of opioid injections to invasive methods, chiefly epidural injections. Each has its advantages and drawbacks. This article provides a review of analgesic methods and techniques for labouring women. It focuses mainly on the role of epidurals, how it is utilised by anaesthetists and the differing methods of drug delivery through the epidural route. It discusses various concoctions of local anaesthetics and adjuvants used. The epidural route is probably the most effective and most commonly used invasive route for achieving analgesia during labour. Local anaesthetics of varying concentrations are administered as intermittent boluses or as a continuous infusion. Adjuvant drugs are able to enhance the quality and duration of the analgesia. Opioids including fentanyl and sufentanil, and clonidine are discussed. The use of patient-controlled epidural analgesia and combined spinal-epidural analgesia are reviewed. Ambulatory or mobile epidurals are increasingly popular. They are known to improve maternal satisfaction because of preservation of motor power. Ambulation may help with cervical dilatation and engagement, and abolition of backpain, among other advantages. This article describes the methods of establishing mobile epidurals and offers guidelines on safe ambulation and contraindications to its use.

Adjuvants, Anesthesia↗

PubMed1997

Interhospital and intrahospital transfer of the critically ill patient.

AIM: This paper highlights hazards involved in moving critically ill patients between locations, discusses minimalisation of risks involved and the advantages of specialist teams. METHOD: This is a systematic review. RESULTS AND CONCLUSIONS: Critically ill patients are moved within the hospital because of the need for surgical procedures or to have fixed facilities investigations performed. Interhospital movement of patients is necessary for specialised care available elsewhere. This has increased with centralisation of specialist services. This paper adopts a practical approach to the transfer process. It establishes the goals of conducting a safe transfer, highlights the deleterious effects of moving an ill patient, the risks and pitfalls of a transfer, and how to minimise them. Attention is drawn to the need for proper resuscitation and stabilisation of a patient before transport. The quality and outcome of the transfer depend on the experience of the transferring team and on adequate monitoring facilities. The benefits of a specialist transfer team is suggested.

Critical Illness↗

PubMed1995

Allergens of Bipolaris species.

Skin prick tests done previously revealed a significantly higher percentage of sensitization to an extract of Bipolaris sp. among atopic individuals (34/147, 23.1%) compared to non-atopic individuals. Bipolaris-specific IgE levels were quantified in sera from a representative group of 38 individuals using the Fluorescence Allergosorbent Test (FAST). Result obtained by FAST were found to be comparable to the skin prick test results (r2 = 0.60, p < 0.001 for IgE levels vs wheal sizes; r2 = 0.44, p < 0.001 for IgE levels vs erythema sizes). Characterisation of the extract's allergenic component by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) showed 28 protein bands with molecular weights (MW) ranging from 11 kDa to above 100 kDa. Immunoblotting with sera of 10 Bipolaris-sensitive (skin prick test, 3 +) individuals showed that Bipolaris spore extract contained at least 4 IgE binding proteins (MW 11-13 kDa, 16-17 kDa, 20-22 kDa and 36 kDa). All 10 sera reacted to the protein at MW 20-22 kDa, 2 sera with MW 11-13 kDa, 3 sera with 16-17 kDa and 6 sera with 36 kDa. This study has thus demonstrated that spores of Bipolaris sp. contain allergenic components which may elicit IgE-mediated reactions.

Allergens↗

PubMed1994

House dust mite allergen levels in a Singapore hospital.

House dust mite allergens constitute one of the most important allergens in house dust. In this study, the levels of two common dust mite allergens, Der p I and Der f I, in a general hospital in Singapore were evaluated. Our results showed that these allergens were detected in 42/74 (or 57%) of the dust samples. Der p I was found to be the predominant allergen detected (p < 0.001). The allergen levels were, however, low with only 1/74 having a Der p I concentration above 2 micrograms g-1 dust. None of the samples had Der f I concentrations above this level. Of the various niches studied (mattresses, pillows, sofas, carpets, blinds and floors), the blinds and floors had the lowest concentration of allergen (p < 0.05). These low levels in the hospital compared to homes were attributed to the vigorous cleaning schedule in the hospital, the use of plastic to encased mattresses and pillows, vinyl covered sofas and vinyl lined floors. These practices may be adopted in the home as a means to reduce mite allergen exposure.

Air Conditioning↗

PubMed1993

General anaesthesia vs sedation for minor gynaecological procedures--a comparative study.

Sedation using combined intravenous midazolam and fentanyl is a popular technique for minor gynaecological procedures. However, it is fraught with inconsistency in efficacy and has a greater tendency to perioperative oxygen desaturation. Fifty female ASA I patients scheduled for minor gynaecological procedures were given intravenous midazolam and fentanyl before surgery started. Intraoperative excessive movement that interfered with surgery and failure to maintain a patient airway were noted. Perioperative oxygen saturation was monitored with the pulse oximeter. In another group of 50 female ASA I patients, intravenous thiopentone was given and anaesthesia maintained with 67% nitrous oxide in 33% oxygen and 0.5% of isoflurane via a face mask. Results showed that 10% of the sedated patients had excessive movements that interfered with surgery, of which 6% needed a general anaesthetic. Twenty-two percent of the sedated patients needed maintenance of airway perioperatively. Perioperative oxygen desaturation was profound in incidence and degree in the sedated patients whereas no patient who received general anaesthesia desaturated. The perioperative incidence of desaturation in the sedated patients was 46%. Intraoperatively, 28% (p < 0.001) of the sedated patients had oxygen saturation in the range of 85 to 90% and 18% of them (p < 0.01) had oxygen saturation of less than 85%. Postoperatively 8% of the sedated patients had oxygen saturation of 85 to 90%. We conclude that general anaesthesia is more efficacious and safer than sedation in patients scheduled for minor gynaecological procedures. The same minimum standard of monitoring applied to general anaesthesia should be used for sedated patients.

Adolescent↗

PubMed1993

Cancer: To tell or not to tell?

After a patient is diagnosed with a malignant illness, the physician is often left with the dilemma of how to communicate the diagnosis to the patient and the family. In the West, it is often the consensus that the patient be told. This is not necessarily true elsewhere, eg in Japan, the patient is often not told. A questionnaire survey was done to study how Singapore doctors feel about revealing the diagnosis of cancer to the patient. 90.4% of respondents will reveal the diagnosis to the family, while only 43.6% will inform the patient. The possible reasons are discussed.

Attitude of Health Personnel↗

PubMed1993

Dysphagia and chronic schizophrenia: a case report.

It is known that dysphagia in schizophrenia could result from acute or tardive dystonic reactions or parkinsonism as a result of neuroleptics. This case illustrates that dysphagia may be inherent in schizophrenia itself and not necessarily be due to neuroleptics.

Airway Obstruction↗

PubMed1992

Protoplast fusion of beta-glucosidase-producing Aspergillus niger strains.

Protoplast fusion, induced by polyethylene glycol and Ca2+, was carried out between two auxotrophic strains of Aspergillus niger. The fusion frequency ranged from 6.2 x 10(-2) - 9.1 x 10(-2). After induced haploidization of a diploid, various segregants showing combinations of the parental genetic markers were isolated. Unlike diploids, haploid segregants exhibited greater variations in their morphology and beta-glucosidase activities. One segregant showed a 2.5-fold increase in beta-glucosidase activity over those of the parents. Thus, this method appears promising for creating new recombinant strains of A. niger with improved beta-glucosidase activities.

Aspergillus niger↗

PubMed1991