Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2008
Case ReportsTransient severe left ventricular diastolic dysfunction during intraoperative transesophageal echocardiography--a case report.
A 55-year-old man with significant lesion of left anterior descending artery and left ventricular systolic dysfunction, became candidate for coronary artery bypass grafts surgery. Intraoperative transesophageal echocardiography (TEE) was done for evaluation of severity of mitral regurgitation. ⋯ After restoring blood pressure to 110/60 mmHg, LV diastolic pattern returned to baseline pattern. The decreased coronary perfusion pressure and its effect on diastolic function may be responsible for this pattern of diastolic dysfunction.
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Middle East J Anaesthesiol · Feb 2008
Case ReportsSurgical removal of a looped and knotted epidural catheter in a postpartum patient--a case report.
We report a case of unsuccessful removal of an epidural catheter in a postpartum patient following a labour epidural analgesia, which ultimately required surgical intervention and fenestration ligamentum flavum to remove the epidural catheter. A 26 year old, requested an epidural analgesia for her labour pain. The epidural catheter was inserted under aseptic technique, and she was comfortable throughout her labour and had a normal vaginal delivery 4 hours later. ⋯ Surgical removal was the option, patient and partner were informed and consented, a neurosurgeon was consulted. Through a small incision (1 inch) a fenestration of ligamentum flavum was performed and a knotted and looped epidural catheter was removed. Patient was discharged next day, and in the follow up and subsequent visits patient remained well with no other complaints.
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialCaffeine in children with obstructive sleep apnea.
Children with obstructive sleep apnea (OSA) have a higher rate of adverse post-extubation respiratory events, such as laryngospasm, upper airway obstruction, apnea, desaturation and/or need for re-intubation. They are overly sensitive to sedatives and narcotics. Although the etiology of OSA is primarily obstruction (mechanical or neuromuscular), a central element may contribute to OSA. Caffeine citrate has been shown to be effective in treating apnea of prematurity. This study evaluated whether the administration of caffeine benzoate to children with OSA decreases the number of children who experience adverse post-extubation respiratory events. ⋯ In children with OSA scheduled for T&A, administration of caffeine benzoate, 20 mg/kg IV, decreased the number of children who developed adverse post-extubation respiratory events and decreased the overall incidence of adverse post-extubation respiratory events. PACU duration, hospital discharge time and postoperative delirium did not differ between groups.
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Middle East J Anaesthesiol · Feb 2008
Randomized Controlled TrialEffect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding.
Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index (BIS) monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevoflurane administered while providing an adequate anesthesia. ⋯ Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption.