Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2005
Randomized Controlled TrialInfusion and bolus administration of cisatracurium--effects on histamine release.
The purpose of this study is to evaluate the usefulness of Cisatracurium Besilat (CB), and the method of its administration during laparotomies on adult patients, to determine whether CB caused cutaneous, systemic or chemical evidence of histamine release. This study was conducted as a randomized, double-blind clinical trial on 38 patients (ASA I-II). After a standard anesthetic induction with fentanyl and propofol, patients received an i.v. bolus CB (0.15 mg/kg in Group A (n=20) or Group B (n=18). ⋯ There was no consistent correlation between hemodynamic changes, cutaneous manifestations and histamine concentrations. We conclude that CB does not cause systemic or cutaneous histamine release. The infusion method of cisatracurium has a stable level of curarization without side effect and there were no significant recovery time differences between the groups.
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Auto-positive end expiratory pressure (auto-PEEP) is a physiologic event that is common to mechanically ventilated patients. Auto-PEEP is commonly found in acute severe asthma, chronic obstructive pulmonary disease, or patients receiving inverse ratio ventilation. Factors predisposing to auto-PEEP include a reduction in expiratory time by increasing the respiratory rate, tidal volume or inspiratory time. ⋯ The work of breathing can be decreased by providing external PEEP to 75-80% of auto-PEEP in patients who are spontaneously breathing during mechanical ventilation but there is no evidence such external PEEP would be useful during controlled mechanical ventilation when there is no patient inspiratory effort. Ventilator setting should aim for a prolonged expiratory time by reducing the respiratory rate rather than increasing inspiratory flow. Routine monitoring for auto-PEEP in patients receiving controlled ventilation is recommended.
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Middle East J Anaesthesiol · Jun 2005
Clinical TrialPresurgical caudal block attenuates stress response in children.
Our aim was to determine if the anesthesia technique for pain relief in children affects the stress response after minor surgery. A rise in blood glucose reflects stress-related effects in children who do not receive glucose perioperatively. ⋯ Presurgical caudal analgesia attenuates the stress response of anesthesia and surgery and decreases postoperative narcotic use while narcotics prolong PACU and discharge times.
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Middle East J Anaesthesiol · Jun 2005
Clinical TrialMuallem endo-tracheal tube introducer: (METTI)--an aid for the difficult airway.
This is a brief report evaluating a new single use endotracheal tube introducer (METTI) which has a soft curved atraumatic tip. The introducer was tried in 44 patients, whose direct laryngoscopic view was simulated to Cormack IIIb score, and in six patients with real Cormack III score. The overall success rate of railroading of the tracheal tube over the introducer was 94% from the first attempt.
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Middle East J Anaesthesiol · Jun 2005
Case ReportsManagement of difficult intubation in a patient with ankylosing spondylitis--a case report.
We describe a case of difficult intubation in a patient suffering from ankylosing spondylitis undergoing total hip replacement surgery. The anesthetic management of 42 year old patient with difficult airway is discussed. Failure of epidural anesthesia procedure necessitated general anesthesia. ⋯ Cricoarytenoid cartilages involvement may result in upper airway compromise. Furthermore cervical spine vertebrae are prone to fractures, especially on hyperextension and may lead to spinal cord transection and quadriplegia. In this case report we describe the airway management of such patient with fixed rigidity of cervical spine and thoracolumbar kyphosis.