Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Oct 2012
ReviewLeft-to-right cardiac shunt: perioperative anesthetic considerations.
Congenital heart disease (CHD) affects roughly 8/1000 live births. Improvements in medical and surgical management in recent decades have resulted in significantly more children with left-to-right cardiac shunts surviving into adulthood. Surgical care of these patients for their original cardiac defect(s) or other non-cardiac medical conditions requires thorough understanding of cardiopulmonary changes and mastery of treatment options. ⋯ Cardiac defects with left-to-right shunt generally require surgical or trans-catheter repair at an early age. We review the current concepts and general principles of perioperative anesthetic management of CHD, including neuraxial anesthesia. Current techniques and unique pharmacodynamic and pharmacokinetic effects of some commonly used anesthetic agents in patients with left-to-right shunt are also reviewed.
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Middle East J Anaesthesiol · Oct 2012
ReviewPrevention and management of complications of regional orbital anesthesia.
The majority of ophthalmic procedures are performed under regional anesthesia, but the proximity of important structures such as the blood vessels, optic nerve and the brainstem lead to increased risks associated with these blocks. The most serious of these complications is brainstem anesthesia. ⋯ Procedural improvements include a close evaluation of the precise anatomy of the region, with particular attention to injection sites, depth of injection, position of the globe, and techniques to avoid nerve damage and accidental injection into surrounding structures, including blood vessels, globe and cerebrospinal fluid. This literature review emphasizes the importance of the prevention, recognition and management of these complications, which includes the extremely serious complication of brainstem anesthesia.
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Middle East J Anaesthesiol · Jun 2012
ReviewHyperparathyroidism, hypercalcemia and difficult laryngoscopy: a retrospective review.
The incidence of difficulty with intubation in the general population depends upon the definition used but results as high as 37% have been published. Endocrine disorders such as diabetes and hyperthyroidism have been linked to an increased incidence of difficult intubation via laryngoscopy. Hypercalcemia with resulting calcification has been demonstrated to result in neck pain, decreased cervical range of motion, and loss of skin and tendon compliance. We speculated that patients with hyperparathyroidism and resulting hypercalcemia would have an increased incidence of intubation difficulty via laryngoscopy. ⋯ To our knowledge, this is the first manuscript evaluating the impact of parathryoidectomy surgery and hypercalcemia on ease of intubation via laryngoscopy. Despite the fact that patients presenting for parathyroidecomy have many potential etiologies of increased difficulty with laryngoscopy, they do not appear to be at increased risk of laryngoscopy problems. The same is true of those patients presenting with hypercalcemia. Source(s) of support: There was no source of funding for this study. Presentation at a meeting: Society for Airway Management Annual Meeting 2009 Las Vegas NV and American Society of Anesthesiologists Annual Meeting 2010 San Diego, CA. Conflicting Interest (If present, give more details): With regard to conflict of interest, Dr. Arndt is a paid consultant for Cook Medical and receives royalties based on the sale of products that he invented.
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Middle East J Anaesthesiol · Oct 2011
Review Meta AnalysisEffect of prophylactic dexamethasone on nausea and vomiting after laparoscopic gynecological operation: meta-analysis.
Sex of female and laraproscopic surgery are both risk factors related to postoperative nausea and vomiting, and dexamethasone is used as anti-emetic in some operations. A meta-analysis of randomized trials was performed to determine the effect of prophylactic dexamethasone administration on postoperative nausea and vomiting, pain and complications in patients undergoing laparoscopic gynecological operation. ⋯ Prophylactic dexamethasone administration decreases the incidence of nausea and vomiting after laparoscopic gynecological operations during post-anesthesia care unit and within the first postoperative 24 hours. (286 words) Postoperative nausea and vomiting are the most common complications after anesthesia and surgery, and both sex of female and type of laparoscopic operation are risk factors. It is certain of a remarkably high incidence after laparoscopic gynecological surgery, which is reported as nearly 70% within the first postoperative 24 hours. It is very important to find an effective treatment to alleviate postoperative nausea and vomiting.