Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2008
Clinical TrialTracheostomy under jet-ventilation--an alternative approach to ventilating patients undergoing surgically created or percutaneous dilational tracheostomy.
In a prospective observational study we compared the results of 297 elective tracheostomies under jet-ventilation with regard to its complication rate and practicability. Of those, 156 patients underwent surgically created tracheostomy (SCT) and 141 patients percutaneous dilational tracheostomy (PDT). Initially, in 159 patients jet-ventilation was performed using a jet-cannula inserted intratracheally through the cricothyroid membrane. ⋯ The bronchoscope-guided gas stream, when compared to jet-cannula inserted intratracheally, offered more space for tracheostomy and safety for the patient. The permanent danger of mishappenings and dislocation involved with the jet-cannula could be avoided, since the bronchoscope was operating on under direct visualization. Under these circumstances, PDT is an acceptable approach to inserting a tracheostomy tube under jet-ventilation via bronchoscope, particularly for the management of difficult airway in critically ill patients.
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialThe effect of intravenous nitroglycerine on blood pressure during intubation.
Hypertension is one of the most frequent complication during laryngoscopy and intubation; thus in the premedication or induction stages, many drugs have been used to control this hypertension. Nitroglycerine is one of the drugs thought to be effective and the purpose of this study is to appraise this deliberation. ⋯ Injection of 2 microg/kg nitroglycerine immediately after anesthetic induction is effective in preventing the unwanted increase in the blood pressure, and as a result, complications following this response in patients with ischemic heart disease would be reduced.
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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.
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialCaffeine in children with obstructive sleep apnea.
Children with obstructive sleep apnea (OSA) have a higher rate of adverse post-extubation respiratory events, such as laryngospasm, upper airway obstruction, apnea, desaturation and/or need for re-intubation. They are overly sensitive to sedatives and narcotics. Although the etiology of OSA is primarily obstruction (mechanical or neuromuscular), a central element may contribute to OSA. Caffeine citrate has been shown to be effective in treating apnea of prematurity. This study evaluated whether the administration of caffeine benzoate to children with OSA decreases the number of children who experience adverse post-extubation respiratory events. ⋯ In children with OSA scheduled for T&A, administration of caffeine benzoate, 20 mg/kg IV, decreased the number of children who developed adverse post-extubation respiratory events and decreased the overall incidence of adverse post-extubation respiratory events. PACU duration, hospital discharge time and postoperative delirium did not differ between groups.
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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.