Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2008
Randomized Controlled TrialEffects of butorphanol and fentanyl on cerebral pressures and cardiovascular hemodynamics during tunneling phase for ventriculoperitoneal shunt insertion.
Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. ⋯ Butorphanol must be used with caution in neurosurgical patients. The ventricular end of the shunt catheter should preferably be put before the tunneling phase to avoid rise in intracranial pressure.
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Middle East J Anaesthesiol · Jun 2008
Review Case ReportsTachyphylaxis to cisatracurium--case reports and literature review.
Nondepolarizing neuromuscular blocking agents (NNMBAs) are commonly used in the intensive care unit (ICU), mainly to facilitate mechanical ventilation in critically ill patients who are not responding to sedatives and analgesics alone. Tachyphylaxis, also referred to as resistance, may develop during long-term infusion of NNMBAs. Several case reports of tachyphylaxis to NNMBAs have been reported. ⋯ Tachyphylaxis to NNMBAs is associated with adverse outcomes including inadequate ventilation, increased risk of dose-dependent side effects, and increased drug costs. Patients who develop tachyphylaxis to one NNMBA should be treated with another NNMBA if neuromuscular blockade (NMB) is still indicated. We report three cases of tachyphylaxis to cisatracurium in a surgical intensive care unit (SICU): one in patient with acute respiratory distress syndrome (ARDS) and the other two with traumatic brain injury (TBI).
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Middle East J Anaesthesiol · Jun 2008
Assessment of perioperative transfusion therapy and complications in sickle cell disease patients undergoing surgery.
Perioperative blood transfusion is usually given to sickle cell disease patients to reduce or prevent perioperative morbidity. Assessment of such a practice was the subject of our study. ⋯ Exchange transfusion does not prevent perioperative complications of sickle cell disease patients. HBSS > 40% carries a higher risk of postoperative complications.