Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Oct 2008
ReviewChronic obstructive lung disease: perioperative management.
Inflammatory mediators play a major role in pulmonary and extra pulmonary manifestations of COPD. In the preoperative risk evaluation, composite scoring systems like ASA physical status are more efficacious than any single risk factor. ⋯ Preoperative optimization of respiratory status and use of postoperative lung expansion maneuvers are effective measures for prevention of PPCs. Lastly, anesthesiologists need to evolve strategies based on the pathophysiology of the disease to ensure that their patients receive optimal perioperative care.
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Middle East J Anaesthesiol · Oct 2008
Randomized Controlled Trial Comparative StudyFetal responses to epidural analgesia as evidenced by Doppler indices.
This study was designed to evaluate the maternal effects ofepidural analgesia by different local anesthetics and their impact on placental and fetal blood flow. ⋯ All local anesthetics produced excellent analgesia during labor. The Doppler indices were improved in the three groups with the best results in levobupivacaine group.
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Middle East J Anaesthesiol · Oct 2008
Randomized Controlled TrialEpidural ketamine for postoperative analgesia in the elderly.
We assessed the epidural use of ketamine in elderly patients undergoing major abdominal surgery. ⋯ Epidural ketamine, when compared to epidural morphine, appears to be associated with less sedation and a smaller risk of PONV, but necessitates more frequent or continuous administration to achieve comparable analgesia.
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Middle East J Anaesthesiol · Oct 2008
Randomized Controlled TrialTwo lung ventilation through single lumen tracheal tube in thoracoscopic thymectomy: a randomized clinical trial of efficacy and safety.
Video assisted thoracoscopic surgery (VATS) has been successfully used for thymectomy in myasthenia gravis (MG). Thoracoscopic thymectomy (TT) is usually done under general anesthesia with double lumen tubes (DLT). The aim of this study is evaluation of two lung ventilation through single lumen tubes (SLT) during TT. ⋯ SLT is safe in TT. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.
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Middle East J Anaesthesiol · Oct 2008
Randomized Controlled TrialUltrasound evaluation of the anatomical characteristics of the internal jugular vein and carotid artery--facilitation of internal jugular vein cannulation.
Literature review revealed major variations in the anatomic characteristics of the right internal jugular vein (IJV) and carotid artery (CA) by the use of the ultrasound machine. The purpose of this study is to examine the anatomical characteristics of the right IJV and CA and to evaluate the IJV cannulation outcomes by the standard ultrasound guided vs. ultrasound localized technique as suggested by Lin and colleagues. Additionally, the study assessed the impact of changing the ultrasound transducer direction on the location of right IJV relative to the CA METHODS: Patients (n = 100) were randomly assigned to either and ultrasound-guided or ultrasound-localized technique for IJV cannulation. The 'Site Rite' II ultrasound transducer was directed perpendicular to the floor at the apex of the clavicle-sternocleidomastoid triangle at the level of the cricoid cartilage with the head turned to contralateral side of cannulation and table tilted to 30 degrees in Trendelenburg position. Cannulation outcomes, including successful cannulation, access time, success time, and difficult cases were evaluated. Aborted difficult cases included prolonged procedural time exceeding four minutes and carotid puncture, and these were examined by technique, IJV size and its location relative to CA. The location of the IJV relative to CA was evaluated firstly with the ultrasound transducer directed perpendicular to the floor and secondly with the transducer directed perpendicular to the skin (Fig 1). ⋯ Findings of the study show that both ultrasound guided and ultrasound localized techniques yield similar cannulation outcomes. Additional to the anteraloteral position of the IJV relative to the CA, a small IJV size constitutes a powerful predictor for the incidence of prolonged procedure time and carotid puncture for IJV canulation. Finally, the transducer direction has a significant impact on the assessment of the location of the IJV relative to the CA.