Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialOpioid sparing effect of epidural levobupivacaine on postoperative pain treatment in major spinal surgery.
Continuous epidural administration of a local anesthetic drug for postoperative pain treatment of patients, who undergo a fusion operation of lumbar vertebrae is limited by the suction of wound drainage. The effect of the single epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure was examined on the postoperative demand for piritramide. ⋯ The epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure effects opioid sparing in the pain treatment of patients undergoing posterior interbody fusion of two or three vertebrae.
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Middle East J Anaesthesiol · Feb 2008
Comparative Study Clinical TrialPost-thoracotomy pain and pulmonary function--comparison of intermittent intercostal bupivacaine vs intravenous pethidine.
In a prospective, observer-blind study, 50 patients scheduled for posterolateral thoracotomy were investigated to compare the effects of intermittent intercostal extrapleural bupivacaine (n = 25) and intravenous pethidine (n = 25) on post-thoracotomy pain and pulmonary function. The severity of chest pain (objectified by the use 5-point scale of Prince Henry) and changes in spirometric values [forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and FEV1/FVC] were monitored during the first three postoperative days. Because intravenous pethidine was used to supplement pain relief in the patients who received intercostal analgesia, total pethidine used was compared to that administered to patients in the intravenous pethidine group. ⋯ Intermittent intercostal nerve block with bupivacaine appears to be a promising, safe and reliable technique in the management of post-thoracotomy pain. Use of intercostal bupivacaine could significantly reduce or even eliminate the postoperative need for systemic narcotics.
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialEffect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding.
Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index (BIS) monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevoflurane administered while providing an adequate anesthesia. ⋯ Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption.
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Middle East J Anaesthesiol · Feb 2008
Case ReportsSurgical removal of a looped and knotted epidural catheter in a postpartum patient--a case report.
We report a case of unsuccessful removal of an epidural catheter in a postpartum patient following a labour epidural analgesia, which ultimately required surgical intervention and fenestration ligamentum flavum to remove the epidural catheter. A 26 year old, requested an epidural analgesia for her labour pain. The epidural catheter was inserted under aseptic technique, and she was comfortable throughout her labour and had a normal vaginal delivery 4 hours later. ⋯ Surgical removal was the option, patient and partner were informed and consented, a neurosurgeon was consulted. Through a small incision (1 inch) a fenestration of ligamentum flavum was performed and a knotted and looped epidural catheter was removed. Patient was discharged next day, and in the follow up and subsequent visits patient remained well with no other complaints.