With advances in technology, videoscopy and optic intubation have been gaining popularity, particularly in patients with difficult airways or as rescue devices in failed intubation attempts. Their routine use is, however, an uncommon occurrence. This review paper will summarise some of those newly developed devices currently available to assist tracheal intubation, their advantages, disadvantages when compared with the conventional laryngoscope and finally, evidence to support their use in both elective and emergency airway management.

Singapore Med J 2013; 54(2) : 75 O r i g i n a l A r tic le INTRODUCTIONPhantom limb complex is a term used to describe phantom limb sensations (PLS), phantom limb pain (PLP) and/or stump pain (SP).PLS is defined as any sensation, other than pain, in the absent limb. PLP is any painful sensation referred to the absent limb, while SP is pain localised in the stump. These elements often coexist in patients and may be difficult to differentiate.(1,2) Phantom limb complex, which is not an uncommon phenomenon, can be chronic and distressing to patients.Based on the current literature, the reported incidences of PLP vary from 47%-79%.

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Background: Pain occurring in the post-anaesthesia care unit (PACU) is common, distressing to patients and remains a management challenge for staff. This study aims to identify the factors affecting pain severity and delay in discharge of patients from the PACU. Methods: Data from 590 consecutive postoperative patients in the PACU was collected over one month in 2012 at the Singapore General Hospital. Patient demographics, surgical, intraoperative anaesthetic and recovery data were collected. The primary outcome measured was postoperative pain score and secondary outcome was a delay in discharge. Univariate and multivariate logistic regression were performed to determine preoperative and intraoperative variables that may be associated with pain and delayed discharge. Results: The majority (67.6%) of patients reported no to mild pain while 32.3% reported moderate to severe pain; 65.4% of patients had delayed discharge and 28.3% of these were a result of uncontrolled pain. Factors associated with moderate to severe postoperative pain included younger age, same day admissions, duration of operation >2 h, abdominal, upper limb and spine surgeries and use of general anaesthesia. Factors associated with delay in discharge included higher body mass index, abdominal, spine and superficial surgeries, use of general anaesthesia, moderate to severe pain score and use of nurse controlled analgesia. Conclusions: This study identifies predictive factors for postoperative pain and delay in discharge from the PACU. Knowledge of these factors may help in better clinical judgment for postoperative pain management and can lead to quality improvement measures for patient management and work flow in the PACU.

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