Middle East journal of anaesthesiology Impact Factor & Information

Publisher: Middle East Society of Anaesthesiologists; American University of Beirut Medical Center. Anesthesiology Dept

Journal description

The main objective of the journal is to act as a forum for publication, education, and exchange of opinions, and to promote research and publications of the Middle Eastern heritage of medicine and anesthesia.

Current impact factor: 0.00

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Additional details

5-year impact 0.00
Cited half-life 0.00
Immediacy index 0.00
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Website Middle East Journal of Anesthesiology website
Other titles Middle East journal of anaesthesiology, Middle East journal of anesthesiology
ISSN 0544-0440
OCLC 1778785
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • Middle East journal of anaesthesiology 10/2014; 22(6):627-8.
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    ABSTRACT: Identification of the cause of hypotension after induction of anesthesia is critical as treatment differs. We describe a case of anaphylaxis in a patient with severe cardiac disease, diagnosed by echocardiography and successfully treated with immediate cardiovascular resuscitation, epinephrine, vasopressors and antihistamines.
    Middle East journal of anaesthesiology 10/2014; 22(6):623-6.
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    ABSTRACT: Pressure support ventilation (PSV) is used to encourage spontaneous breathing and facilitate weaning. During PSV, duration of the breath is not set, but controlled by the patient, and influenced by some ventilator settings. There is no guarantee that the PS breathe will match start and end of patient's breathe. Indeed, patient-ventilator breath mismatching during PSV is the rule, not the exception. This bench study was conducted to investigate effects of varying PSV, patient's effort, and lung mechanics on trigger response time (TRT), and expiratory delay time (EDT). We used an electromechanical lung simulator (ASL 5000) to create different clinical scenarios. The simulator was set at 15 b/min and inspiratory time of 1 sec. In experiment I, we used 5, 10, 15, and 20 cmH2O of PS at each level of patient effort (Pmus) of 3, 6, and 10 cm H2O. In the second experiment, we set airway resistance (R) at 5, 10, and 20 cm H2O/L/s at each compliance (C) level of 30, 60, and 90 ml/cm H2O. For each combination of setting, we analyzed 5 consecutive breaths and calculated TRT and EDT. Mean values of TRT and EDT for each scenario were reported and compared for trends and statistical significance. At each given Pmus, increasing PS produced shorter TRT. This effect seems to plateau at higher PS levels. Significant change (p < 0.01) in EDT was noticed with increase in PS setting. Pmus alone did not affect trigger or cycle delay times. Increasing airway resistance caused an increase in TRT, expect when R5 was increased to R10 at compliance levels of 30 and 60 ml/ cm H2O. Similarly, increasing compliance significantly lengthened TRT. Higher R and C produced extended EDT, casing major expiratory asynchrony. This study delineates direction of effect for certain individual variables on patient-ventilator synchrony. Results of this study should help clinicians understand the complexity of synchrony issue.
    Middle East journal of anaesthesiology 10/2014; 22(6):573-82.
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    ABSTRACT: Ideal anesthetic technique for renal allograft recipients should provide hemodynamic stability, optimum graft reperfusion and adequate analgesia. Balanced anesthesia is preferred because renal nociception is conducted multi-segmentally and chronically ill ESRD patients have labile psychological profile. Present study compared the efficacy ofdexmedetomidine with fentanyl administered via intravenous and epidural route before induction of general anesthesia. Prospective, double blind randomized study, recruited sixty hemo-dynamically stable ESRD adults, 18-55 years, scheduled for elective live related renal transplantation. Patients randomly received intravenous dexmedetomidine 0.5 μg/kg followed by epidural dexmedetomidine 0.5 μg/kg alongwith 5 ml; 0.25% ropivacaine or intravenous fentanyl 1 μg/kg followed by epiduralfentanyl 1 μg/kg alongwith 5 ml; 0.25% ropivacaine. All patients received standardized general anaesthesia and continuous epidural ropivacaine 0.25%; 4-8 ml/hr. Preoperative sedation, peri-operative haemodynamics, end tidal anaesthetic agent requirement, peri-operative fluid requirement, need for vasopressors, blood loss and early graft function was assessed. 80% patients receiving intravenous dexmedetomidine did not require rescue midazolam for achieving satisfactory sedation before induction of general anaesthesia. Dexmedetomidine significantly reduced propofol and end tidal inhalational agents requirement and need for rescue analgesics. Early renal graft function (onset time of diuresis after declamping, 24 hours urine output and serum creatinine levels) was comparable. There were no adverse sequelae. Dexmedetomidine-based anaesthetic regimen versus fentanyl-based anaesthesia provided appropriate anxiolysis and analgesia for conducting invasive procedures and subsequent epidural administration of these agents reduced anaesthetic requirement and prolonged postoperative analgesia without compromising hemodynamics and respiratory parameters. Further dose finding studies can be conducted in kidney transplant recipients.
    Middle East journal of anaesthesiology 10/2014; 22(6):549-57.
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    ABSTRACT: Unilateral spinal anesthesia is performed to provide restriction of sensory and motor block. The aim of this study was to compare unilateral and bilateral spinal anesthesia, with regard to limiting the nerve block exclusively to the area of surgery. This was a prospective, randomised, double-blind study, conducted in 40 consecutive outpatients scheduled for unilateral inguinal regional surgery. Patients in both groups received 0.5% hyperbaric bupivacaine 15 mg + morphine 0.1 mg. Patients in the unilateral group (Group U) were placed in the lateral decubitus position for 10 minutes (min) on their side to be operated, while patients in the bilateral group (Group B) were placed in the supine position. The pin-prick test was used to assess the times to reach L1, T12 and T10 sensory blocks and the times to reach motor block. In addition, the sensory and motor block recovery times were recorded using a modified Bromage scale. Furthermore, the duration of the operation and the times to first analgesic requirement were noted. There were significant differences between Group U and Group B in the times to reach L1, T12 and T10 dermatome levels of sensory block, and the times to reach motor block using the modified Bromage scale on three levels. However, there was no difference in the time to ambulation, the time to complete sensory regression and the time to first analgesic requirement. The time to reach sensory and motor blocks for unilateral spinal anesthesia could provide an advantage over bilateral spinal anesthesia in inguinal region operations.
    Middle East journal of anaesthesiology 10/2014; 22(6):591-6.
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    ABSTRACT: General anesthesia in patients with comorbid conditions may affect their intermediate or long-term outcomes. In this study, we evaluated the effects of provision of anesthesia on mortality in critical patients with comorbid conditions by retrospectively investigating one-year mortality in patients with ASA physical status more than III who underwent minor surgery for relative indications and nonfatal reasons. Data were collected during the period between January 2006 and December 2011. Eligible patients were those with ASA physical status more than III who underwent minor surgery under general anesthesia for relative indications and nonfatal reasons. Preoperative clinical information was collected from the patient's clinical charts. Comorbidity was quantified using the Charlson comorbidity index. All the patients were evaluated for in-hospital mortality and were followed-up for mortality at one-year. During the study period, 14, 979 patients underwent general anesthesia. Thirty six patients satisfied the eligibility for enrollment. Charlson comorbidity index of the patients ranged from one to five. No patients died during their hospital-stay; however, 4 patients were lost to follow up. Therefore, one-year mortality rates for each Charlson index category were 0%. The postoperative one-year mortality in patients with ASA physical status more than III undergoing minor surgery under general anesthesia for relative indications and nonfatal reasons was expected to be considerably small regardless of the Charlson index category.
    Middle East journal of anaesthesiology 10/2014; 22(6):597-602.
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    ABSTRACT: Although opioid-induced muscle rigidity occurs more commonly with large doses and rapid administration of the drugs, there is a number of cases reported, where muscle rigidity was experienced with lower doses of opioids. We present and discuss a case of muscle rigidity induced by an unusually low dose of fentanyl as primary agent during induction of anesthesia. A 79 year old male patient, scheduled for hernia repair, and with a preoperative physical examination of slight hand tremor, received a bolus of 100 mcg (1.2 mcg/kg) fentanyl as primary agent for induction. About 40 sec later he stopped responding, lost consciousness and developed neck and masseter muscle spasm with jaw closure and thoracoabdominal rigidity. Blood pressure was increased significantly. Ventilation was impossible. Rapid oxygen desaturation led us to proceed with IV propofol 150 mg and suxamethonium 100 mg. Opioid-induced muscle rigidity may cause life-threatening respiratory compromise and should be readily recognized and treated by anesthesiologists.
    Middle East journal of anaesthesiology 10/2014; 22(6):619-22.
  • Middle East journal of anaesthesiology 10/2014; 22(6):535-6.
  • Middle East journal of anaesthesiology 10/2014; 22(6):627-8.
  • Middle East journal of anaesthesiology 10/2014; 22(6):609-12.
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    ABSTRACT: To evaluate the incidence of residual curarization (RC) and related risk factors in the early and late postoperative periods in patients receiving general anesthesia with intermediate-acting muscle relaxants. Two-hundred and eight American Society of Anesthesiologists class I and II patients, aged 18-70 years, who underwent general anesthesia with intermediate-acting muscle relaxants, were included. Heart rate, blood pressure, oxygen saturation, tympanic temperature were recorded for each patient who was transported to the recovery room, every 10 minutes by a trained nurse. To define the efficacy of residual muscle relaxants, neuromuscular monitoring was performed, and Train of Four (TOF) ratios < 90% were regarded as RC whereas ratios ≥ 90% were considered as adequate neuromuscular recovery in early and late recovery periods. Age, duration of anesthesia, repeated doses, reversal and types of intermediate-acting neuromuscular blockers were evaluated as risk factors for RC. Logistic Regression Analysis was performed to define the risk factors for RC in early and late periods. The RC rate was 10.6% in the early recovery period, and short duration of anesthesia, repeated doses and lack of reversal use were the risk factors for RC. However, RC rate was 2.9% in the late recovery period, and the only risk factor was repeated doses. Reversal use was shown to reduce residual effects of intermediate-acting muscle relaxants in early recovery period, whereas risk of RC in 30 min in PACU was shown to increase with repeated doses of muscle relaxants.
    Middle East journal of anaesthesiology 10/2014; 22(6):583-90.
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    ABSTRACT: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia. A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer. Patients identified as receiving regional anesthesia were then matched for age, stage, estrogen receptor (ER) status, progesterone receptor status, and HER-2 expression with patients who received no regional anesthesia. Univariate (Pearson's χ2 test and odds ratio) and multivariate logistic analyses with backward stepwise regression were performed to determine factors associated with cancer recurrence. Between 1998 and 2007, 816 women underwent surgery for stage 0-III breast cancer at our institution. Forty-five patients developed tumors. Univariate analysis showed the use of regional anesthesia trended towards reduced cancer recurrence, but it did not achieve statistical significance (p = 0.06). Higher recurrence rates were associated with ER positive status (p = 0.003) and higher tumor stage (p < 0.0001). Age and HER-2 status were not associated with increased cancer recurrence (both p > 0.11). Multivariate analysis confirmed ER status and stage as independently influential (p = 0.002 and p < 0.0001 respectively). Although we found a trend towards reduced breast cancer recurrence with the use of regional anesthesia, univariate analysis did not reach statistical significance.
    Middle East journal of anaesthesiology 10/2014; 22(6):567-71.
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    ABSTRACT: With the general use of fast acting anesthetic agents, patients usually awaken quickly in the post operative period. However, sometimes recovery is protracted and the list of possible causes in long. Accurate diagnosis is key to institution of appropriate therapy.
    Middle East journal of anaesthesiology 10/2014; 22(6):537-48.
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    ABSTRACT: The most common peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and regional block (caudal block). Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this study is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery, and to evaluate the easiness of soft tissue puncture and ultrasonic appearance of two different needle types. Twenty two (22) pediatric patients (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz linear probe. An ultrasound-guided rectus sheath block in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). A 22 gauge short beveled sharp cutting needle 1.1 x 30 mm needle A (BD Insyte--W, Vialon material. Spain) was used in one side, and a Stimuplex A insulated Needle 22G 50mm (needle B) was used on the other side. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia were evaluated. Ultrasonograghic visualization of the posterior sheath was possible in all patients. Needle A scored 72.7% of excellent needle tip and shaft view (16 out of 22) compared to 63.63% for needle B (14 out of 22). None of the needles scored poor view. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one child who postoperatively requested morphine 0.1 mg/kg intravenously in recovery room. There were no complications. Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia in the lateral edge of the rectus muscle. Use of the sharp short beveled needle of 22 gauge intravenous (IV) cannula stylet provides easy, less traumatic skin and rectus muscle penetration and better needle visualization by the ultrasound.
    Middle East journal of anaesthesiology 10/2014; 22(6):559-66. DOI:10.1097/00003643-201406001-00379
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    ABSTRACT: Acquiring the necessary cognitive and psychomotor skills to perform ultrasound guided procedures may require initial training. Growing evidence shows that simulation can help in the acquisition of procedural skills. Commercially available phantoms are expensive, have non-tissue like haptics, are preformed with fixed targets and do not allow for additional targets to be imbedded. In this study we have described several new phantoms and animal models that are inexpensive, easy to assemble and allow a rapid change of targets. Such phantoms can provide an ideal initial learning opportunity in a zero-risk environment.
    Middle East journal of anaesthesiology 10/2014; 22(6):603-8.
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    ABSTRACT: Recent research has shown that cerebrovascular complications following shoulder surgery performed in the beach chair position under general anesthesia arise secondary to cerebral ischemia. Appropriate management of cerebral oxygenation is thus one of the primary goals of anesthetic management during such procedures. The present report describes the case of a 65-year-old male patient, in which both bispectral index (BIS) and near-infrared spectroscopy (NIRS) were used to monitor cerebral oxygenation. During the positioning, we observed an increased suppression ratio (SR) while BIS and regional cerebral oxygen saturation (rSO2) were at adequate level. In view of the difference in blood pressure between the heart and the base of the brain, blood pressure was maintained to ensure adequate cerebral perfusion. Although intraoperative rSO2 was at or around the cut-off point (a 12% relative decrease from baseline), no marked decrease in BIS or further increase in the SR was observed. Monitoring of cerebral perfusion using combined BIS and NIRS optimized anesthetic management during the performance of arthroscopic shoulder surgery in the beach chair position.
    Middle East journal of anaesthesiology 10/2014; 22(6):613-7.
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    ABSTRACT: In this prospective, observational study, the rate of antibiotic resistance in cultures sampled from sepsis patients was determined in an intensive care unit of a low-middle income country. Critically ill patients suffering from bacterial sepsis were eligible for enrollment. Aside from demographic, disease-related and sepsis-specific parameters, the type of microbiological sample and cultured microorganism as well as the resistance pattern (extensively resistant bacteria, multi-drug resistant bacteria) were documented. Descriptive statistical methods, parametric and non-parametric tests were used. 215 sepsis patients were included. 193 ofthe 410 cultured organisms (47.1%) showed antibiotic resistance [extensively resistant bacteria, n = 90 (11%); multi-drug resistant bacteria, n = 103 (25.1%)]. 51.6% of the patients were infected by > or = 1 resistant bacteria. Bacteria with an exceptionally high rate of antibiotic resistance were Acinetobacter baumannii (90%), Enterobacter spp (60%) and coagulase-negative Staphylococci (60%). Patients infected with resistant bacteria more often received inadequate empirical antibiotic therapy (36.9 vs. 13.5%, p < 0.001), required mechanical ventilation (66.7 vs. 42.3%, p < 0.001) and renal replacement therapy (28.8 vs. 9.6%, p < 0.001) more frequently, and had a longer stay in the intensive care unit [5 (3-9.5) vs. 5 (2-8)%, p < 0.001] than patients with sepsis due to non-resistant bacteria. There was a trend towards a higher mortality in patients with resistant bacteria (43.2 vs. 31.7%, p = 0.09). Resistant bacteria were detected in up to 50% of microbiological samples from critically ill sepsis patients in the intensive care unit of a low-middle-income country. Antibiotic resistance appears to be a relevant problem of sepsis management in a resource-limited setting.
    Middle East journal of anaesthesiology 10/2013; 22(3):293-300.
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    ABSTRACT: Postoperative alopecia is an uncommon complication and its outcome is aesthetically drastic. Although its mechanism has not been clearly elucidated, a proposed risk factor is steep Trendelenburg positioning (30-40 degrees) that is frequently used during robotic gynecologic surgeries. We report a case of postoperative alopecia in 53-year-old female patient who had undergone robotic-assisted laparoscopic hysterectomy and bilateral salpingoophorectomy with sacrocolpopexy and cystoscopy. Prevention of alopecia with proper head positioning, avoidance of mechanical compression by rigid objects and maintenance of intraoperative hemodynamics is of utmost importance for anesthesiologists.
    Middle East journal of anaesthesiology 10/2013; 22(3):343-5.
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    ABSTRACT: As newer anesthesia ventilators are developed their capabilities are becoming more similar to intensive care unit (ICU) ventilators. However, in situations where there is severe decrease in lung compliance, an ICU ventilator may be superior in its ability to regulate inspiratory flow improving both ventilation and oxygenation. We present a case where an ICU ventilator was brought to the operating room and used in the treatment of ARDS post-cardiopulmonary bypass and ultimately allowed us to avoid extracorporeal membrane oxygenation (ECMO) therapy.
    Middle East journal of anaesthesiology 10/2013; 22(3):327-8.
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    ABSTRACT: Retrograde intubation is one of the methods used to maintain an airway in the event of a difficult intubation. Retrograde intubation has been successfully carried out on patient for whom intubation was not possible with a direct laryngoscope and fiber optic bronchoscope. The central venous catheter needle and guide wire are the materials that are the most practical to prepare and access for the retrograde intubation. To conclude, In conclusion, retrograde intubation may be good alternative to invasive airway management such as surgical tracheostomy for difficult or impossible intubations because it can be performed easily, quickly, and successfully.
    Middle East journal of anaesthesiology 10/2013; 22(3):333-6.