Middle East journal of anaesthesiology
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Sepsis and shock are severe conditions that, when together, may cause multiple organ failure. The anesthesiologist must be able to take a careful history and physical, as well as be aware that additional tests are necessary to assess the patient status, as preoperative systemic blood pressure is not indicative of adequate volume status. ⋯ Ketamine is notable for induction in these patients because it is less likely to decrease systemic vascular resistance too quickly. One must not take this lightly, as death may ensue if proper management is not taken.
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Middle East J Anaesthesiol · Feb 2007
Randomized Controlled Trial Comparative StudyCombined spinal-epidural analgesia in labor--comparison of sufentanil vs tramadol.
Combined spinal-epidural (CSE) analgesia is becoming increasingly used to provide pain relief during labor. It combines both the rapid onset of the spinal analgesia and the flexibility of the epidural catheter. Intrathecal sufentanil provides rapid-onset and profound analgesia during the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. The major concern of the anesthesiologist is to limit these side effects sources of discomfort to a parturient, by choosing the optimal dose of sufentanil or searching for an alternative. The purpose of this study is to compare tramadol and sufentanil used in CSE analgesia in terms of duration of analgesia and frequency of adverse maternal or fetal effects. ⋯ 2.5 micrograms of intrathecal sufentanil combined with 2.5 mg bupivacaine provides rapid-onset and profound analgesia during the first stage of labor without adverse maternal or fetal effects. 25 mg intrathecal tramadol with 2.5 mg bupivacaine had longer-lasting analgesia. The major side effect was vomiting.
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Middle East J Anaesthesiol · Feb 2007
Comparative StudyCombined regional-general anesthesia: evaluation of remifentanil based general anesthesia and postoperative epidural analgesia.
To evaluate whether remifentanil based general anesthesia combined with epidural analgesia for postoperative pain, has any advantages with respect to consumption of drugs, blood loss, quality of pain control, hemodynamic profile, in major abdominal surgery, as compared to other combined techniques. ⋯ The use of remifentanil based general anesthesia offers the advantage of non-accumulation of drugs and hemodynamic stability. Post-operative analgesia can be provided by epidural route which proved to be satisfactory in the remifentanil group. The effect on blood loss was not conclusive in this study.
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Middle East J Anaesthesiol · Feb 2007
Hemodynamic profile during laparoscopic cholecystectomy versus laparoscopic bariatric surgery: the impact of morbid obesity.
The present study investigated the hemodynamic profile using impedance cardiography (ICG) monitor during pneumoperitoneum for laparoscopic cholecystectomy versus bariatric surgery in order to determine the impact of body weight on hemodynamics. METHODS. 32 adult patients (two groups, each 16 patients) were studied. Group 1 (16 patients) scheduled to undergo laparoscopic cholecystectomy (lapchole) with body mass index (BMI) 28 +/- 5 kg/m2. ⋯ Cardiac index showed significant decreasing trend in morbid obese patients compared to nonobese, which may reflect the effect of body weight on hemodynamics. On the other hand other hemodynamic parameters was not altered by body weight. We believe that hemodynamics should be closely monitored during laparoscopic surgery with pneumoperitoneum.
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Middle East J Anaesthesiol · Oct 2006
Randomized Controlled TrialThe effect of positive pressure ventilatory patterns on post-bypass lung functions.
This study aimed at evaluating the effect of application of different patterns of positive ventilatory pressure either during or after cardiopulmonary bypass (CPB), on lung functions. ⋯ Maintenance of ventilatory parameters was achieved in all the positive pressure ventilatory methods applied, either being applied during or after CPB.