The purpose of this article is to quantify grades of obesity and their independent effects on perioperative adverse events in children having ambulatory minor non-airway surgery. Methods: After obtaining ethics committee approval, we selected every tenth child aged 2 to 16 years who was identified as having been a day case between January 2012 and December 2014. Weight groups were defined based on age-and genderspecific body mass index (BMI) cutoff points. A sample size of 1102 was calculated to demonstrate a threefold increase in the primary outcome measure, perioperative respiratory-airway adverse events, among obese children, with a power of 80% and an alpha error of 5%. Chi-squared and Fisher exact tests were used to compare proportions, and independent sample t tests were used to compare means. Results: Severely obese children had a significantly higher incidence of perioperative respiratory-airway adverse events when compared to normal-weight children despite no difference in respiratory and other comorbidity. Obese children had higher prevalence of overall medical comorbidities and obstructive sleep apnoea when compared to normal-weight children and there was no significant difference in the incidence of perioperative respiratory-airway adverse events and other outcome measures between obese and normal-weight children. Conclusions and recommendations: Severely obese children have a higher risk of perioperative respiratory-airway adverse events even during minor non-airway surgery despite absence of medical comorbidities. We recommend the use of age-and sex-specific BMI cutoffs or BMI percentile charts to identify children who are severely obese to anticipate and prevent major respiratory adverse events.

Background: The SingHealth Anaesthesiology Residency Programme (SHARP) is a 5-year postgraduate training programme in Singapore. Since its inauguration in 2011, SHARP has taken in the largest number of anaesthesia residents in Singapore. However, we noticed significant attrition over the years. As attrition is a costly and disruptive affair, both to the individual and the programme, we seek to investigate the prevalence of and reasons for separation, in order to determine ways to minimize attrition. Methods: An online anonymous survey was conducted among all residents who have separated from SHARP. The questionnaire comprised questions regarding demographic data, reasons behind separation, obstacles faced during residency, and potential ways to reduce attrition. Results: From 2011 to 2018, 22 out of 127 residents have separated from the programme, giving an overall attrition prevalence of 17%. Nineteen (86%) of the separated residents responded to our questionnaire. The most common reason for separation was due to difficulties in juggling childcare and training commitments. Of the residents who have separated, more than half of them would consider rejoining the programme if a less than full time (LTFT) option was available. Conclusion: One out of every six residents in the SHARP quits residency training. The reasons behind separation are often varied due to each resident’s unique social circumstances. An individualized training programme with a LTFT option that allows for flexibility may boost retention in the programme.

Securing a definitive airway in patients who require surgical fixation of complex maxillofacial fractures is an integral part of their perioperative management. For the ease of surgical access, an orotracheal tube is usually not preferred by surgeons. The presence of a base of skull or nasal bone fractures would also contraindicate nasotracheal intubation. Therefore, a tracheostomy may be the only option left to secure the airway in these patients who require surgical fixation. Submental intubation has been used as a safe and effective alternative method in patients who require intubation for maxillofacial reconstruction since it was first reported by Hernandez Altemir F in 1986. Many modifications to the original technique have been documented over the years, but there has been no consensus to support the use of a single method or device. In this case report, we described our experience with submental intubation using an LMAFastrach™ endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures. We conclude that the LMA-Fastrach™ ETT is a suitable device for submental intubation. This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma.

Background: With reports of higher mortality and complications occurring in patients with perioperative 2019 novel coronarvirus disease (COVID-19), most elective surgeries have been postponed. However, evidence regarding emergency surgeries in patients with COVID-19 remains scarce. We report the case of a patient with asymptomatic perioperative COVID-19, presenting with an acute abdomen requiring surgery. Case: A 25-year-old male, with a prior nasopharyngeal swab that was negative for SARS-CoV-2, presented with classical signs and symptoms of acute appendicitis. Clinical examination and investigations were not suggestive of COVID-19 infection. He underwent laparoscopic appendicectomy with infection control precautions. Postoperatively, he was found to be positive for SARS-CoV-2 but remained asymptomatic and had an uneventful recovery. Conclusion: In asymptomatic individuals with higher risks, negative test results should be viewed cautiously. The benefits of urgent surgical interventions must be weighed against the risks of complications due to perioperative COVID-19 in these patients.