Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2010
Case ReportsUse of dexmedetomidine as the main anesthetic agent in patients with laryngo-tracheomalacia--a case report.
The successful use of Dexmedetomidine as the main anesthetic agent for three pediatric patients with tracheomalacia presenting for different kinds of urgent operations is described. Patients were kept spontaneously breathing without intubation during their whole procedures. Surgical conditions were adequate, and hemodynamic and respiratory profiles were within baseline limits.
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Middle East J Anaesthesiol · Feb 2010
Randomized Controlled Trial Comparative StudyEpidural analgesia during labor--0.5% lidocaine with fentanyl vs. 0.08% ropivacaine with fentanyl.
Although lidocaine is a cheap and globally available local anesthetic, yet it is not a popular drug for labor analgesia. This is claimed to its higher intensity of motor block, possibility of transient neurological symptoms (TNS) and its placental transfer with probable drawbacks on fetal well-being. However, these effects could be concentration dependent and, the evidence linking them to lidocaine is still lacking. This study was designed to evaluate the efficacy and safety of 0.5% epidural lidocaine plus fentanyl during labor. ⋯ Dilute epidural lidocaine (0.5%) with fentanyl effectively and safely initiates epidural analgesia clinically indistinguishable from 0.08% epidural ropivacaine with fentanyl. Although it induces significant motor block compared to ropivacaine, it still preserves maternal ability to move satisfactorily in bed. Whether further reduction in lidocaine concentration could trim down the motor block, remains to be investigated.
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Middle East J Anaesthesiol · Feb 2010
Association between factors predicting and assessing the airway and use of intubating laryngeal mask airway.
The Intubating Laryngeal Mask Airway FastrachTM (ILMA) has been used with success in difficult intubation cases. The purpose of this study is to evaluate the effect of mouth opening, Mallampati classification, thyromental distance and Cormack-Lehane Grade, on the ease of ILMA use. ⋯ Success rates in insertion of ILMA and in blind intubation were 100% and 92.6% respectively. No difference was found between Cormack-Lehane Grade I-II and II-IV or Mallampati classification and number of ILMA insertion attempts or IDG. There was also no correlation between mouth opening, or thyromental distance and number of ILMA insertion attempts or IDG. It is concluded that easiness of ILMA use is irrelevant to mouth opening, thyromental distance, Mallampati classification or Cormack-Lehane Grade.
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Middle East J Anaesthesiol · Oct 2009
Randomized Controlled TrialIntraoperative minimal acute normovolemic hemodilution in patients undergoing coronary artery bypass surgery.
Efficacy of minimal acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion during cardiovascular surgery remains controversial. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. Our objective was to evaluate the impact of minimal ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass (CPB). ⋯ Minimal ANH is safe and cost effective and its routine use in eligible patients is therefore justified. Intraoperative autologous blood donation in CABG surgery decreased perioperative allogeneic blood requirement. However, the removal and reinfusion of about one unit autologous blood had no effect on postoperative bleeding or platelet count.
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Middle East J Anaesthesiol · Oct 2009
The 'best fit' endotracheal tube in children --comparison of four formulae.
Uncuffed endotracheal tubes are still being recommended by most pediatric of anesthetists at our Institutes. Different algorithms and formulae have been proposed to choose the best-fitting size of the tracheal tube. The most widely accepted is related to the age of the child [inner diameter [ID] in mm = (age in yr/4) + 4; the second is a body, length-related formula (ID in mm = 2 + height in cm/30); the third, a multivariate formula (ID in mm = 2.44 + age in yr x 0.1 + height in cm x 0.02 + weight in kg x 0.016]5; the fourth, the width of the 5th fingernail is used for ID prediction of the ETT (ID in mm = maximum width of the 5th fingernail). The primary endpoint of this prospective study was to compare the size of the 'best fit' tracheal tube with the size predicted using each of the above mentioned formulae. ⋯ The age-based and 5th fingernail width-based predictions of ETT size are more accurate than length-based and multivariate-based formulae in terms of mean value and case matching.