Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2009
Randomized Controlled TrialThe effect of nitroglycerin as an adjuvant to lidocaine in intravenous regional anesthesia.
The disadvantages of intravenous regional anesthesia (IVRA) include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of nitroglycerin (NTG) in quality improvement when added to lidocaine in IVRA. ⋯ The NTG adding to lidocaine in intravenous regional anesthesia shortens onset times of sensory and motor block and decreases the tourniquet and postoperative pain, without any side effect.
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Middle East J Anaesthesiol · Jun 2009
Randomized Controlled TrialIntravenous dexmedetomidine prolongs bupivacaine spinal analgesia.
The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha 2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. ⋯ Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability.
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Middle East J Anaesthesiol · Jun 2009
Patient survey of continuous interscalene analgesia at home after shoulder surgery.
The use of continuous peripheral nerve blocks at home (CPNBH) has improved patients' perioperative experience. In 30 months, 348 patients were sent home with interscalene CPNBH. ⋯ This survey shows that CPNBH results in low pain scores and a low incidence of side effects. Many patients commented positively on their overall impression of their anesthesia care, particularly the level of attention that they received. This highlights the low incidence of those complications and neural injury.
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Middle East J Anaesthesiol · Jun 2009
The impact of intraoperative transoesophageal echocardiography on decision-making during cardiac surgery.
Real time intraoperative transoesophageal echocardiograpgy (TOE) has an expanding role in peri-operative management and surgical decision making. ⋯ The impact of TOE in CABG procedures, while significantly less than that in non-CABG surgical procedures, remains substantial.
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Middle East J Anaesthesiol · Jun 2009
Case ReportsSudden cardiac arrest during cesarean section -- a possible case of amniotic fluid embolism.
Amniotic Fluid Embolism (AFE) is a rare obstetric catastrophe that occurs in approximately 1/50,000 pregnancies and has a mortality rate in excess of 80%. AFE is a condition that is poorly understood and often difficult to diagnose. We report a case of a healthy 27-yr-old gravid two, 35 wk gestation parturient with a previous Cesarean section two years previously, and presently admitted for emergent Cesarean section due to premature uterine contractions. ⋯ The post-mortem diagnosis of AFE is challenging to forensic investigators and pathologists and can be confirmed by histological confirmation of amniotic fluid contents in the pulmonary vasculature, although they may be difficult to identify. In recent years it has been suggested that AFE is an anaphylactoid reaction to fetal antigens and an elevated serum tryptase level is increasingly being used to support the diagnosis. Sudden onset of cardiovascular collapse and early signs of right heart strain and fulminant DIC supports the diagnosis of AFE in this case, although no fetal debri could be find in pathologic staining.