Introduction: Giving two intravenous anaesthetic agents simultaneously generally results in an additive effect. The aim of this study was to investigate the interaction between propofoland thiopental when given to patients who have had sedative premedication. Methods: Fifty patients were admitted into the study. All patients received oral midazolam 3.75mg and intravenous fentanyl 100mg before induction of anaesthesia. Twenty patients received an infusion of their propofol or thiopental while 30 patients received an infusion of an admixture of both drugs. Results: The interaction between propofol and thiopental was additive. The average dose at loss of the eyelash reflex for propofol and thiopental was 0.71mg kg-1 and 1.54mg kg-1 respectively. Premedication decreased the induction dose by 38.2%. Conclusion: Propofol and thiopental interact in an additive fashion when given at induction of anaesthesia

Introduction: The aims of this randomised study were to compare the induction characteristics of sevoflurane using vital capacity breath technique to that of tidal breathingtechnique in adults undergoing day-care surgery., and to compare patients' acceptance of these two techniques. Methods: Sixty ASA I and II adult patients undergoing day-care surgery were randomly allocated to receive either the vital capacity breath or tidal breathing technique for induction of anaesthesia with 7.5% sevoflurane in nitrous oxide and oxygen. Haemodynamic changes, induction characteristics and patients' acceptance were compared. Results: The mean time for induction was significantly faster with the vital capacity breath technique. There were no significant differences in haemodynamic changes and oxygenation during induction between these two groups. There was a significant increase in incidence of exictatory movement in patients receiving the tidal breathing technique. Either technique was found to be acceptable by most of the patients studied. Conclusion: The vital capacity breath technique appears to be better tolerated with shorter onset time and less movement during induction of anaesthesia. As it is well accepted by the patients and has a stable haemodynamic profile, its use should be encouraged.

INTRODUCTIONTreatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.

MATERIALS AND METHODSPatients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.

RESULTSThere were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.

CONCLUSIONFebrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.

Candidiasis ; epidemiology ; Chemotherapy-Induced Febrile Neutropenia ; epidemiology ; microbiology ; Child ; Cohort Studies ; Escherichia coli Infections ; epidemiology ; Gram-Negative Bacterial Infections ; epidemiology ; Gram-Positive Bacterial Infections ; epidemiology ; Humans ; Influenza, Human ; epidemiology ; Klebsiella Infections ; epidemiology ; Mycoses ; epidemiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Pseudomonas Infections ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Staphylococcal Infections ; epidemiology ; Virus Diseases ; epidemiology