Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2013
Case ReportsUse of airway exchange catheter for bronchoscopy of a patient with Down's syndrome.
Tracheobronchial injuries (TBI) are highly fatal, and early diagnosis and repair are crucial for survival. The anesthesiologist and the surgeon must secure the integrity and patency of the airway for these cases. These injuries remain infrequent, and are becoming less fatal due to the availability of the resources necessary to achieve a secure airway, and thus some of them can be managed conservatively. We report an unusual case of upper airway compromise and extensive subcutaneous emphysema due to traumatic bronchial rupture and its conservative repair in a patient with Down's syndrome.
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Middle East J Anaesthesiol · Jun 2013
Randomized Controlled TrialSuccess of ultrasound guided popliteal sciatic nerve catheters is not influenced by nerve stimulation.
There is debate as to whether nerve stimulation (NS) is required to place peripheral nerve catheters when using ultrasound (US) guidance. There is conflicting evidence for whether stimulating catheters improve postoperative analgesia compared to non-stimulating catheters. The use of US in combination with NS has been shown to be superior to NS alone in terms of popliteal nerve blockade. Given the previously published reports, we hypothesized that there is improvement in sensory and motor blockade for stimulating popliteal perineural catheters placed under US guidance when NS is used. ⋯ We have found that the addition of NS provides no benefit over US alone. US alone was associated with a significantly shorter block performance time. US+NS showed no significant difference in pain control, patient satisfaction, or block success.
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Middle East J Anaesthesiol · Jun 2013
Use of the bilateral BIS monitor as an indicator of cerebral vasospasm in ICU patients.
Earlier diagnosis of cerebral vasospasm and delayed cerebral ischemia (DCI) and treatment has the potential to decrease post-bleed morbidity after subarachnoid hemorrhage (SAH). Previous studies have shown that electroencephalogram (EEG) can detect blood flow changes associated with DCI sooner than other modalities potentially leading to earlier diagnosis. However, continual monitoring with raw EEG requires significant expertise and effort, and may be difficult due to the intermittent need for MRI studies in these patients. Here we describe a series of patients with subarachnoid hemorrhage in the Neurosurgical ICU who underwent monitoring with the Bilateral Bispectral Index (BIS) monitor.
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Middle East J Anaesthesiol · Jun 2013
Comparative StudyEffects of liberal vs. conventional volume regimen on pulmonary function in posterior scoliosis surgery.
We observed an increased rate of pulmonary complications (hypoxemia, pulmonary edema, re-intubation) in some patients after posterior spinal fusion, though standardized intraoperative volume regimens for major surgery were used. Therefore, we focused on the effects of two different standardized fluid regimens (liberal vs. conventional) as well as on two different types of postoperative pain management (thoracic epidural catheter vs. intravenous analgesia) concerning pulmonary function in patients undergoing posterior spinal fusion. ⋯ The combination of a more restrictive fluid management (better pulmonary oxygen uptake and ventilation, less pulmonary edema) and a thoracic epidural catheter (sympatholysis, pain management) in posterior spinal fusion may be advantageous as both factors can improve pulmonary outcome.
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Middle East J Anaesthesiol · Jun 2013
Case ReportsIncidental finding of foreign bodies during nasal intubation in a mentally challenged patient.
Nasal foreign bodies are frequently encountered among children and mentally challenged patients. They are often asymptomatic and may remain undetected for years. We are presenting a case of an incidental finding of foreign bodies during nasal intubation in a mentally challenged patient.