INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

INTRODUCTIONIndirect laryngoscopes offer improved laryngeal view and higher success rates of intubation, particularly for difficult airways. We hypothesised that: (a) the time required for intubation, overall success rates and ease of intubation with indirect laryngoscopes would be better than with the Macintosh laryngoscope; and (b) novices may achieve higher success rates and intubate faster using indirect laryngoscopes.

METHODSIn a cross-sectional observational study, 13 novices and 13 skilled anaesthetists were recruited. Participants were compared when intubating a manikin simulating normal and difficult airway scenarios using the Macintosh laryngoscope, Pentax Airway Scope® (AWS), C-MAC[TM] and Bonfils intubation fibrescope.

RESULTSThere was no significant difference in intubation success rates between the groups. Skilled anaesthetists intubated faster than novices with Pentax AWS in the difficult airway scenario (22 s vs. 33 s, p = 0.047). The mean intubation times for C-MAC and Pentax AWS were shorter than for the Macintosh laryngoscope and Bonfils intubation fibrescope in both difficult (C-MAC: 24 s, Pentax AWS: 28 s, Macintosh: 80 s, Bonfils: 61 s; p < 0.001) and normal (C-MAC: 17 s, Pentax AWS: 19 s, Macintosh: 39 s, Bonfils: 38 s; p = 0.002) airway scenarios.

CONCLUSIONWe found that intubation success was more than 85% with all indirect laryngoscopes compared to 69% for the Macintosh laryngoscope. Both C-MAC and Pentax AWS achieved faster intubation times compared to the Macintosh laryngoscope and Bonfils intubation fibroscope for both airway scenarios. Skilled anaesthetists were 33% faster than novices when intubating a difficult airway using Pentax AWS.

Adult ; Anesthesia ; methods ; Anesthesiology ; education ; Cross-Sectional Studies ; Equipment Design ; Female ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopes ; Male ; Manikins ; Middle Aged ; Observer Variation ; Time Factors ; Treatment Outcome

INTRODUCTIONComplications occur in over 15% of central venous cannulations, often a result of anatomical variations. This study aimed to determine the anatomical variations of the internal jugular vein (IJV), demonstrate the likely success of cannulation and assess the risk of carotid artery (CA) injury when catheterising the IJV using the external landmarks technique at various degrees of head rotation in the local population.

METHODS100 elective cardiac surgical patients were prospectively enrolled. Simulated catheterisations were performed with patients placed in the Trendelenburg position. The standard landmark technique was used to identify anatomy. Simulations were done at six different degrees of rotation of the head: 0°, 30° and 60° for both right and left IJVs. Difficult catheterisation was defined as an IJV diameter < 7 mm.

RESULTSThere was no thrombosed or absent IJV in any patient. Catheterisation was potentially difficult in 15% of patients at 30° head rotation and more difficult for the left IJV than the right (20% vs. 10%; p < 0.05). The simulated needle hit the IJV in 82% of the attempts, but the needle was in the middle 80% of the vein only 70% of the time. Neck rotation increased the degree of overlap of the CA relative to the IJV from 20%-30% to 50%.

CONCLUSIONAnatomical variations play a significant role in determining the success of IJV catheterisation as well as the incidence of catheterisation-associated complications. This study emphasises the importance of using ultrasonography to guide IJV catheterisation, even in patients with seemingly normal neck anatomy.

Adult ; Aged ; Aged, 80 and over ; Carotid Artery Injuries ; epidemiology ; etiology ; prevention & control ; Catheterization, Central Venous ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Jugular Veins ; anatomy & histology ; Male ; Middle Aged ; Posture ; Prospective Studies ; Risk Factors ; Young Adult