Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Oct 2001
Review Case ReportsPerioperative considerations for the patient on herbal medicines.
Herbal medicines have enormous presence in the United States health care system. There is an increasing trend towards reimbursement of herbal medicines by insurance companies, which further encourage their utilization. Herbs are listed under the "supplement" category by the Food and Drug Administration. ⋯ While such an action holds some promise in the elective setting, emergency care should be based on a thorough drug-intake history from the patient or a relative, if possible. Medical research and medical literature in general has not addressed this new group of health supplements, despite the fact that many of these herbs have the potential to cause serious health problems and drug interations. There is a need to conduct scientific clinical trials to study the anesthetic drug responses to commonly used neutraceutical agents.
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Middle East J Anaesthesiol · Oct 2001
GuidelineAn advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.
The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. ⋯ Common or controversial medications (epineprine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.
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Middle East J Anaesthesiol · Jun 2001
Case ReportsCerebrospinal fluid cutaneous fistula after labour epidural analgesia.
We report a case of cerebrospinal fluid cutaneous fistula in a previously healthy patient who had seemingly uneventful lumbar epidural analgesia for labour.
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Post operative nausea and vomiting (PONV) remains an unpleasant and persistent problem for patients undergoing surgery. In fact PONV are among the most important factors contributing to delay in discharge of patients and an increase in unanticipated admissions after ambulatory surgery. Anesthesia providers are most often blamed for PONV, sometimes rightfully so, many times wrongly so. ⋯ Although PONV may be unavoidable in some patients for reasons we do not fully understand, there are risk factors that can be identified. As anesthesiologists it is essential for us to understand the mechanisms involved in nausea and vomiting and the available perioperative treatment options. We must do whatever we can to prevent and treat PONV and improve patient outcome for both medical and economic reasons.
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Middle East J Anaesthesiol · Jun 2001
Comparative StudyParavertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair.
One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. ⋯ The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.