Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Oct 2012
ReviewAids for facilitation of difficult tracheal intubation review and recent advances.
Management of difficult tracheal intubation has been facilitated by different techniques which include the use of stylets, introducers, intubating laryngeal mask airway, as well as by the development of special laryngoscope blades and fiberoptic laryngoscopes. The most recent advances for facilitation of difficult tracheal intubation is the introduction of the video-assisted laryngoscopes. The management of difficult tracheal intubation by video-assisted laryngoscopy can be further facilitated by using suspension laryngoscopy which frees the hands of the anesthesiologist to handle the insertion of the endotracheal tube with the aid of an endotracheal tube introducer, and a curved pipe stylet, under an umbrella of pharyngeal oxygen insufflation.
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Middle East J Anaesthesiol · Oct 2012
ReviewLeft-to-right cardiac shunt: perioperative anesthetic considerations.
Congenital heart disease (CHD) affects roughly 8/1000 live births. Improvements in medical and surgical management in recent decades have resulted in significantly more children with left-to-right cardiac shunts surviving into adulthood. Surgical care of these patients for their original cardiac defect(s) or other non-cardiac medical conditions requires thorough understanding of cardiopulmonary changes and mastery of treatment options. ⋯ Cardiac defects with left-to-right shunt generally require surgical or trans-catheter repair at an early age. We review the current concepts and general principles of perioperative anesthetic management of CHD, including neuraxial anesthesia. Current techniques and unique pharmacodynamic and pharmacokinetic effects of some commonly used anesthetic agents in patients with left-to-right shunt are also reviewed.
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Middle East J Anaesthesiol · Oct 2012
Randomized Controlled Trial Comparative StudyVideolaryngoscopic endotracheal intubation (GlideScope) of morbidly obese patients in semi-erect position: a comparison with rapid sequence induction in supine position.
In regards to peri-anesthetic morbidity considerations, morbidly obese patients often have full stomach for extended periods secondary to delayed gastric emptying. Additionally, they may have difficulty lying supine because of multiple reasons. ⋯ This is the first prospective study demonstrating endotracheal intubation with GlideScope in the semi-erect position as comparable to standard supine position intubation. Moreover, gravity-directed and aligned biomechanics in the semi-erect position may be ergonomically more efficient for intubating morbidly obese patients.
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Middle East J Anaesthesiol · Oct 2012
ReviewPrevention and management of complications of regional orbital anesthesia.
The majority of ophthalmic procedures are performed under regional anesthesia, but the proximity of important structures such as the blood vessels, optic nerve and the brainstem lead to increased risks associated with these blocks. The most serious of these complications is brainstem anesthesia. ⋯ Procedural improvements include a close evaluation of the precise anatomy of the region, with particular attention to injection sites, depth of injection, position of the globe, and techniques to avoid nerve damage and accidental injection into surrounding structures, including blood vessels, globe and cerebrospinal fluid. This literature review emphasizes the importance of the prevention, recognition and management of these complications, which includes the extremely serious complication of brainstem anesthesia.
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Middle East J Anaesthesiol · Oct 2012
Randomized Controlled Trial Comparative StudyTENS compared to opioids in postoperative analgesic therapy after major spinal surgery with regard to cognitive function.
Long-term use of opioids causes cognitive decline. Transcutaneous nerve stimulation (TENS) applied preincisionally and postoperatively reduces postoperative opioid requirement and provides sufficient analgesia after major spinal surgery. Aim of this study was to find out the impact of TENS compared to opioids, prescribed for postoperative analgesia on early postoperative cognitive function. ⋯ Augmentation of fatigue in early postoperative phase was less in patients treated with TENS than with opioids for analgesic therapy after major spinal surgery. Further investigations on the duration of opioid therapy when cognitive functions decline are necessary.