HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children.

patients with reperfusion injury after lung transplantation. J Thorac Cardiovasc Surg 2001; 121: 981-982. 3 Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT et al. Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension. Lancet 1991; 338: 1173-1174. 4 Haraldsson A, Kieler-Jensen N, Ricksten SE. The additive pulmonary vasodilatory effects of inhaled prostacyclin and inhaled milrinone in postcardiac surgical patients with pulmonary hypertension.

Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.

Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.