Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Oct 2006
Case ReportsParadoxical vocal cord motion: a postoperative dilemma--a case report.
Paradoxical vocal cord motion (PVCM) is a dysfunction more often seen by otolaryngologists, but of which the anesthesiologist must also be aware of in order to prevent inappropriate invasive airway interventions. For the anesthesiologist, PVCM is most often seen as inspiratory stridor during the postoperative recovery period. Unfortunately, inspiratory stridor can also be a sentinel of impending respiratory failure, and so it is crucial that the serious etiologies be efficiently ruled out. Presented is a case of postoperative PVCM, diagnosed by direct fiberoptic examination, in which timely recognition of this benign, psychogenic postoperative complication resulted in effective and appropriate noninvasive management.
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Middle East J Anaesthesiol · Oct 2006
Randomized Controlled Trial Comparative StudyThe impact of operative fluids on the prevention of postoperative anesthetic complications in ambulatory surgery--high dose vs low dose.
Adequate control of postoperative (postop.) nausea, vomiting, dizziness and thirst, and early return to normal activity are important anesthetic goals in the context of ambulatory surgery. This study, investigated the impact of different preoperative fluid therapies or regimens on preventing postop. nausea, vomiting, dizziness and thirst. ⋯ We conclude that preoperative high dose hydration (20 ml/kg bolus) can efficiently decrease the incidence of postop. thirst and vomiting within the first 60 minutes, it was superior to low dose hydration and therefore, we recommend it in ambulatory surgeries.
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Middle East J Anaesthesiol · Oct 2006
Comparative StudyPostoperative cognitive dysfunction in adult and elderly patients--general anesthesia vs subarachnoid or epidural analgesia.
This study compared the effect of general anesthesia or regional vertebral analgesia (subarachnoid or epidural) on postoperative cognitive function in 60 young adult (group A) and 60 elderly (group E) patients undergoing orthopedic and urologic surgery. Wechsler Adult Intelligence Scale-Revised for cognitive functions assessment was done preoperatively, and postoperatively; one day and three days after surgery. Variations in heart rate, blood pressure, arterial oxygen and carbon dioxide tensions, and pH as well as serum bicarbonate, sodium and potassium levels, were assessed at the same time intervals. ⋯ Moreover, significantly better WAIS-R Scores were found in the elderly group one and three days after spinal anesthesia than after general anesthesia. The results indicate that general anesthesia poses a significant risk for the occurrence of early postoperative cognitive dysfunction in elderly patients that can persist for 3 day after surgery. Regional vertebral analgesia is advantageous over general anesthesia for elderly patients in terms of a better postoperative neuropsychological functioning.
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Middle East J Anaesthesiol · Oct 2006
Case ReportsParadoxical vocal cord motion: an alarming stridor for a benign condition--case reports.
Paradoxical vocal cord motion presents a challenge to medical practitioners in various specialties. Physicians in general and anesthesiologists should suspect this condition in a patient presenting with stridor or a history of choking or asthma not responding to medical treatment. Women are usually more affected than men and more often there is history of anxiety and/or a precipitating factor such as cough or hyperventilation. ⋯ The etiology varies from organic causes such as brainstem compression or lower motor neuron injury to non-organic causes such as malingering or conversion disorders. The pathophysiology is believed to be accentuation of the glottic closure reflex. Many modalities of treatment are available ranging from sedation, voice therapy and breathing exercises to Heliox administration, Botulinum toxin type A injection, intubation and at times tracheostomy.
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Middle East J Anaesthesiol · Oct 2006
Randomized Controlled TrialEvaluation of remifentanil in endoscopic retrograde cholangio-pancreatography.
Endoscopic retrogade cholangio-pancreatography (ERCP) is a painful procedure that requires transient analgesia and conscious sedation. Remifentanil an ultrashort, very potent narcotic, is eliminated by plasma esterases, and does not interfere with liver function. It does not accumulate and is free of residual depression. Our aim is to find out if remifentanil can provide safe and effective sedation in ERCP, without undue technical difficulty secondary to sphincter spasm. ⋯ We recommend remifentanil in ERCP. Vigilance, however, must be exercised in titration and supervision of patients.