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
Randomized Controlled TrialAnalgesic requirements for patients undergoing lower extremity orthopedic surgery--the effect of combined spinal and epidural magnesium.
Polypharmacological approach is the most common practice to treat perioperative pain, as no single agent has yet been identified to specifically inhibit nociception without associated side effects. Opioids such as Fentanyl is commonly added to local anesthetics to produce spinal and epidural anesthesia. However, significant adverse effects, such as pruritus, respiratory depression, hemodynamic instability and occasionally severe nausea and vomiting, may limit their use. Our present study was designed to assess the effectiveness of using combined intrathecal and epidural magnesium (Mg) in reducing intra-and postoperative analgesic requirements and improving the quality of analgesia. ⋯ For lower extremity orthopedic procedure, supplementation of spinal anesthesia with combined intrathecally injected and epidurally infused Mg, considerably reduced the perioperative analgesic requirements without any side effects.
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Middle East J Anaesthesiol · Jun 2008
Case ReportsAnesthetic management of a patient with myotonic dystrophy for laparoscopic cholecystectomy--a case report.
Myotonic dystrophy (MD) is rare disease that offers challenges to anesthesiologists. We report a case of adult patient with myotonic dystrophy who underwent laparoscopic cholecystectomy. A 48-year-old male patient, known case of MD, was presented for laparoscopic cholecystectomy. ⋯ To the best of our knowledge, this is the first case report in a patient with MD who underwent laparoscopic cholecystectomy under thoracic epidural analgesia. Myotonic dystrophy (M) is rare disease and represents challenges to anesthesiologists. We report a case of adult patient with myotonic dystrophy who underwent laparoscopic cholecystectomy.
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Middle East J Anaesthesiol · Jun 2008
Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy--a case report.
Patients with peripartum cardiomyopathy may require analgesia/anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. ⋯ She was scheduled for emergency cesarean section becaue of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.