Migraineurs had no impaired attentional or working-memory functioning in the 2 days after an attack. They did show impairments in the processing of global visual features compared with controls, both between and immediately after an attack.

Introduction: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. Methods: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30–60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). Results: Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of <60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4–18] vs 4 days [range 2–8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis. Conclusion: PACU delirium is common in elderly patients with risks factors presenting for major surgery. Keywords: Geriatrics, major non-cardiac surgery, postoperative delirium

Introduction: Post-anaesthesia care unit (PACU) delirium affects 5%–45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable but it remains under-recognised due to a lack of awareness for its diagnosis. Nursing Delirium Screening Scale (Nu-DESC) has been validated in diagnosing PACU delirium but is not routine locally. This study aim was to use the Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. Methods: With IRB approval and informed consent, we conducted an audit of eligible patients undergoing major surgery in three major public hospitals in Singapore over one week. Patients were assessed for delirium 30–60 minutes following their arrival in the PACU using the Nu-DESC with a score of ≥ 2 as indicative of delirium. Results: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%) and 9/146 (6.2%) in patients over 65 years old. PACU delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic Regression analysis showed that the use of BIS (p < 0.001) and the presence of malignancy (p<0.001) were significantly associated with a higher incidence of PACU delirium. Conclusion: In this first local study, the incidence of PACU delirium was 3.8%, with the incidence increasing to 6.2% in those older than 65 years old. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long term morbidities and mortality of PACU delirium.

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Transmission of severe acute respiratory syndrome coronavirus 2, leading to coronavirus disease (COVID-19) is thought to occur primarily through respiratory droplets, while airborne transmission may occur with the generation of aerosols. Upper gastrointestinal endoscopy is deemed a potentially infectious aerosol-generating procedure; consequently, healthcare workers present at the premises are at a high risk, particularly because of the physical proximity to the patients.Various professional guidelines [1] recommend multi-pronged strategies for the use of endoscopes in the management of patients with COVID-19. This include deferring non-essential endoscopy, appropriate use of personal protective equipment (PPE), standard infection control practices, strict isolation precautions in negative-pressure rooms, and adequate disinfection protocols.After obtaining written informed consent, we describe the management of a 30-yearold man who had a history of thalassemia intermedia and presented with a 1-day history of fever, sore throat, and myalgia. A positive nasopharyngeal swab test confirmed COVID-19.On day 3, the patient developed productive cough. On day 7, he developed acute cholangitis. Imaging showed choledocholithiasis, likely a pigment stone secondary to chronic hemolysis. On day 18, in view of recurrent abdominal pain and worsening derangement of liver enzymes despite antibiotics, endoscopic retrograde cholangiopancreatography (ERCP) was performed instead of waiting for COVID-19 clearance, as was initially planned. As the patient was clinically stable with adequate oxygen saturation on room air, the procedure was performed under sedation.To reduce the risk of contamination, we used a barrier enclosure during the procedure. The barrier enclosure was a transparent acrylic trapezoidal box placed over the patient's head and upper torso during ERCP (Fig. 1A). It measured 60 × 55 × 61 cm (Fig. 1B).The patient was initially placed in a supine position in the box, and lignocaine was sprayed to anesthetize the pharynx. The patient was then turned to a prone position in the box, and a nasal cannula was applied. Sedation was induced with titrated boluses of midazolam, fentanyl, and propofol.Similar boxes, conceptualized for use with intubation, have garnered much interest in recent months. Kearsley [2] highlighted concerns regarding the use, while others speculated on the physics and virulence of droplets and aerosols in infection transmission [3], thus questioning the utility of such an enclosure.The patient coughed when lignocaine was sprayed into the pharynx and gagged slight-