Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2009
Patient survey of continuous interscalene analgesia at home after shoulder surgery.
The use of continuous peripheral nerve blocks at home (CPNBH) has improved patients' perioperative experience. In 30 months, 348 patients were sent home with interscalene CPNBH. ⋯ This survey shows that CPNBH results in low pain scores and a low incidence of side effects. Many patients commented positively on their overall impression of their anesthesia care, particularly the level of attention that they received. This highlights the low incidence of those complications and neural injury.
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Middle East J Anaesthesiol · Jun 2009
Case ReportsSudden cardiac arrest during cesarean section -- a possible case of amniotic fluid embolism.
Amniotic Fluid Embolism (AFE) is a rare obstetric catastrophe that occurs in approximately 1/50,000 pregnancies and has a mortality rate in excess of 80%. AFE is a condition that is poorly understood and often difficult to diagnose. We report a case of a healthy 27-yr-old gravid two, 35 wk gestation parturient with a previous Cesarean section two years previously, and presently admitted for emergent Cesarean section due to premature uterine contractions. ⋯ The post-mortem diagnosis of AFE is challenging to forensic investigators and pathologists and can be confirmed by histological confirmation of amniotic fluid contents in the pulmonary vasculature, although they may be difficult to identify. In recent years it has been suggested that AFE is an anaphylactoid reaction to fetal antigens and an elevated serum tryptase level is increasingly being used to support the diagnosis. Sudden onset of cardiovascular collapse and early signs of right heart strain and fulminant DIC supports the diagnosis of AFE in this case, although no fetal debri could be find in pathologic staining.
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Middle East J Anaesthesiol · Jun 2009
Case ReportsPerioperative care of a child with Ullrich congenital muscular dystrophy.
Ullrich congential muscular dystrophy (UCMD) is a severe form of congenital muscular dystrophy manifesting axial muscle contractures and distal joint hyperlaxity. Severe hypotonia and associated respiratory failure may occur early in the disease process. ⋯ Anesthetic care implications included the need for a rapid airway control to limit the risks of aspiration due to the intra-abdominal process, choice of neuromuscular blocking agent for rapid sequence intubation, associated airway issues related to micrognathia and limited mouth opening, and the potential for involvement of the cardiovascular and respiratory systems. The perioperative management of patients with UCMD is discussed including the use of propofol and remifentanil for rapid sequence intubation to avoid the need for neuromuscular blocking agents.
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Middle East J Anaesthesiol · Jun 2009
The impact of intraoperative transoesophageal echocardiography on decision-making during cardiac surgery.
Real time intraoperative transoesophageal echocardiograpgy (TOE) has an expanding role in peri-operative management and surgical decision making. ⋯ The impact of TOE in CABG procedures, while significantly less than that in non-CABG surgical procedures, remains substantial.