Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2009
Randomized Controlled Trial Comparative StudyAttenuation of hemodynamic responses following laryngoscopy and tracheal intubation -- comparative assessment of clonidine and gabapentin premedication.
The present study was conducted to compare the effect of clonidine and gabapentin premedication in modifying the hyperdynamic response following laryngoscopy and tracheal intubation. ⋯ The data propose that both clonidine and gabapentin have effective role in blunting hyperdynamic responses after laryngoscopy, more so with gabapentin.
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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.
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Middle East J Anaesthesiol · Jun 2009
Case ReportsUneventful epidural analgesia in a patient with severe thrombocytopenia.
Epidural analgesia is the most effective method for analgesia in labor. It has, however, contraindications and carries many serious side effects. Though coagulopathy is an absolute contraindication for epidural and axial blocks, yet there are no absolute limits for platelet counts that stand in the way of providing epidural analgesia. In a patient who is writhing in pain due to severe uterine contractions, and in whom there exists a recent normal platelet screening and no history of bleeding disorders, it is internationally acceptable between anesthetists to provide epidural analgesia without waiting for a new platelet screening.