Middle East journal of anaesthesiology
-
Middle East J Anaesthesiol · Oct 2011
Randomized Controlled TrialEvaluation of an intraoperative algorithm based on near-infrared refracted spectroscopy monitoring, in the intraoperative decision for shunt placement, in patients undergoing carotid endarterectomy.
We evaluated whether the use of an intraoperative algorithm based on cerebral oximetry with near-infrared refracted spectroscopy (NIRS) monitoring, could aid in the intraoperative decision for shunt placement, in patients undergoing carotid endarterectomy (CEA). ⋯ The use of a specific algorithm based on NIRS monitoring, in patients undergoing CEA, may aid in the intraoperative decision for shunt placement.
-
Middle East J Anaesthesiol · Oct 2011
Randomized Controlled TrialProspective, randomized study to assess the role of dexmedetomidine in patients with supratentorial tumors undergoing craniotomy under general anaesthesia.
Preliminary data on the perioperative use of dexmedetomidine in patients undergoing craniotomy for brain tumor under general anaesthesia indicate that the intraoperative administration of dexmedetomidine is opioid-sparing, results in less need for antihypertensive medication, and may offer greater hemodynamic stability at incision and emergence. Dexmedetomidine, alpha 2 adrenoceptor agonist used as adjuvant to anaesthetic agents. Relatively recent studies have shown that dexmedetomidine is able to decrease circulating plasma norepinephrine and epinephrine concentration in approximately 50%, decreases brain blood flow by directly acting on post-synaptic alpha 2 receptors, decreases CSF pressure without ischemic suffering and effectively decrease brain metabolism and intracranial pressure and also, able to decrease injury caused by focal ischemia. ⋯ Continuous intraoperative infusion of dexmedetomidine during craniotomy for supratentorial tumors under general anaesthesia maintained the haemodynamic stability, reduced sevoflurane and fentanyl requirements, decreased intracranial pressure, and improved significantly the outcomes.
-
Middle East J Anaesthesiol · Oct 2011
Randomized Controlled Trial Comparative StudyComparison between two phenylephrine infusion rates with moderate co-loading for the prevention of spinal anaeshtesia-induced hypotension during elective caesarean section.
Phenylephrine induces maternal bradycardia in 50% of mothers when used for prevention and treatment of spinal anaesthesia-induced hypotension during caesarean delivery. Rapid fluid administration immediately after initiation of the spinal block (co-loading) may have a vasopressor sparing effect. The aim of this study was to evaluate the hypothesis that when using rapid crystalloid co-loading, an infusion of 50 mcg/minute of PE could be as effective as 100 mcg/minute in preventing maternal hypotension but with minimal maternal bradycardia and an acceptable fetal outcome. ⋯ In combination with rapid co-loading, an infusion rate of 50 microg/min of PE is as adequate as 100 microg/min in prevention of spinal anaesthesia-induced hypotension during elective caesarean section. Both infusions are associated with a similar neonatal outcome. PE infusion of 50 microg/min is associated with significantly less maternal bradycardia than 100 microg/min.
-
Middle East J Anaesthesiol · Oct 2011
Case Reports"Crime scene investigation" at an anesthetic cocktail party with atrioventricular dissociation.
A healthy 21-year-old female patient received midazolam, propofol, fentanyl, rocuronium, nitrous oxide in oxygen, ranitidine, diclofenac, neostigmine and glycopyrrolate during the anesthetic process for elective knee arthroscopy and developed a complete AV dissociation with a P-wave frequency of 40 and a "small" QRS-complex frequency of 55 beats/min. Based on this typical case of poly-pragmatic anesthetic drug administration causing a complete atrioventricular dissociation in a young healthy patient we will discuss the possible pharmacodynamic mechanisms of all used drugs with regard to the cardiac conduction system.