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 10/2015; 23(2):129-30.
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    ABSTRACT: Submental intubation is an alternative to tracheostomy in patients requiring surgical access to both oral and nasal cavities. It is relatively safe, simple, and low morbidity procedure and requires only basic surgical equipment to perform. We successfully performed a submental intubation in a young patient with maxillofacial hypoplasia undergoing Le Fort I maxillary advancement without any intra- and post-operative complications.
    Middle East journal of anaesthesiology 06/2015; 23(2):257-259.
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    ABSTRACT: Background: Patients with atlanto axial dislocation (AAD) undergo stabilisation procedures under general anesthesia. Airway management in these patients is difficult as cervical spine movements during laryngoscopy can worsen spinal cord damage. Though multiple airway devices are used to intubate the trachea of these patients, there is no evidence of superiority of one technique over another. This retrospective study was designed to audit the practice of airway management during surgery for AAD over a 5 year period, starting from 2006 till 2011. Methods: Patients' demographics, airway intervention techniques, types of surgical procedures, postoperative neurological and respiratory deterioration were recorded from the case files. Association between the types of airway interventions and the postoperative neurological and respiratory deterioration were analysed. Results: One hundred and six patients underwent surgery for AAD during the study period. Sixty one percent of the patients were intubated with the help of a fiberoptic bronchoscope (FOB) and among them 15% received general anesthesia to facilitate FOB. Eighteen patients developed neurological deterioration and 15 patients developed respiratory weakness requiring ventilation postoperatively. Congenital AAD patients had higher chances for extubation at the end of surgery when intubated using FOB (p = 0.007). Among the AAD patients, female gender had significantly higher incidence of neurological deterioration compared to males. Conclusion: In the current audit, there was no correlation between the perioperative variables and postoperative respiratory and neurological deterioration. Most of the respiratory problems occurred between 2-5 postoperative days stressing the need for extended intensive postoperative monitoring of these patients.
    Middle East journal of anaesthesiology 06/2015; 23(2):163-170.
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    ABSTRACT: Background: Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation. Methods: Forty infants scheduled for Kasai procedure were randomly allocated into two groups (Doppler and clinical group). In Doppler group decided to provide VE (10-30 m1/kg of Hydroxyethyl starches HES) when the index stroke volume decreased by ≥ 15% from the baseline value, in clinical group, hemodynamic variables triggering colloid administration mean arterial blood pressure (MAP) less than 20% below baseline or central venous pressure (CVP) < 5 cmH2O in both groups: Ringer's acetate was infused at constant rate (6 m 1/kg/h). Standard and TED-derived data were recorded before and after VE. Follow up the postoperative outcome and hospital stay. Results: There were significantly lower mean volume of HES (42.85 ± 3.93 versus 84 ± 14.29 ml) and percent of infants required it (30% versus 90%) associated with earlier tolerance to oral feeding (2 ± 0.66 versus 3.4 ± 0.51), shorter hospital stay (5.30 ± 0.47 versus 6.7 ± [symbols: see text] days) and lower rate of chest infection (15% versus 30%) in Doppler group than clinical group. There was no difference between the two studied groups regarding heart rate, MAP. Conclusions: TED guided intraoperative fluid intake in infants undergoing Kasai operation optimize fluid consumption and improve outcome associated with shorter hospital stay.
    Middle East journal of anaesthesiology 06/2015; 23(2):205-211.
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    ABSTRACT: Pseudocholinesterase deficiency manifests as prolonged motor blockade after the administration of succinylcholine. A previously unknown homozygous form of the disease, became apparent during a lumbar laminectomy seriously limiting the ability to monitor motor evoked potentials and perform electromyelography (EMG). Moreover, concerns were raised as to how the enzyme deficiency would affect the metabolism of remifentanil and other esters during a total intravenous anesthetic. We present the perioperative management of the patient and a literature review of the syndrome. The patient provided written permission for the authors to publish this report. At our institution, IRB review and approval is not required for a single case report.
    Middle East journal of anaesthesiology 06/2015; 23(2):157-162.
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    ABSTRACT: Introduction: The aim of the current study was to compare block of the sciatic nerve through the anterior approach by two methods, namely, the nerve-stimulator guided and ultrasound-guided, with or without nerve stimulation, with regard to the ease of performance, reliability and safety of this approach. Patients and methods: 36 adult patients were randomly allocated equally into one of 2 main groups: "Nerve Stimulator-Guided Group (NSG)" where the nerve was located by nerve stimulator only and "Ultrasound guided group (USG)" where the sciatic nerves were blocked by a stimulated needle under guidance of the ultrasound. Assessment of performing each technique, sensory and motor blockades, occurrence of acute systemic toxicity and haematoma formation were compared. Results: Only one-third of the sciatic nerves could be visualized by US. This did not affect the block execution time but caused less number of needle passes in a statistically significant value. Sensory and motor block showed significant differences between the 2 groups. Criteria of acute systemic toxicity and occurrence of hematoma were not reported in both groups. Conclusion: Results of the current study showed that the addition of ultrasound to nerve stimulator in the anterior approach to the sciatic nerve block added only little to the ease of performance, reliability and safety. This was because only one-third of the nerves could be seen. More practice, better machines and new blocking techniques may be needed to overcome the problem of anisotropy of the nerve.
    Middle East journal of anaesthesiology 06/2015; 23(2):185-191.
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    ABSTRACT: In patients undergoing spine surgery postoperative pain management can often be complicated with side effects associated with high dose narcotic such as respiratory depression and those associated with non-steroidal anti-inflammatory drugs such as interference with bone healing process. Local anesthetics can help in both decreasing postoperative pain and minimizing side effects associated with systematically administered analgesics. This report describes the use of preoperative ultrasound guided dorsal ramus nerve block to reduce postoperative pain in six patients undergoing lumbar spine surgery under general anesthesia.
    Middle East journal of anaesthesiology 06/2015; 23(2):251-256.
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    ABSTRACT: Purpose: Lumbar laminectomy is a commonly performed procedure in neurosurgical and orthopedic practice. Postoperative pain reliefhelps in early mobilization, initiation of physiotherapy, provides satisfaction to the patients and plays an important role in reducing the morbidity and mortality. This prospective study investigated the simple technique of instillation of wound with bupivacaine and leaving a contact time of 60 seconds on postoperative pain following lumbar laminectomy. Methods: 32 ASA I and II patients scheduled for laminectomy were randomly allocated to receive either 20 ml of normal saline (group I) or 0.25% of bupivacaine (group II) into the wound after securing hemostasis. After a dwell time of 60sec the wound was closed in layers without mopping or suctioning. After extubation, the pain scores were evaluated by visual analog scale at every 4 hrs. for 24hrs and also the time for first demand of analgesia, number of analgesic demands and the total amount of analgesia consumed were noted by an independent observer.. Results: The median duration of analgesia in group I was 8.8 [5-11] and in group II 13 [8.5-16] hrs. with a p = 0.04. The number of demands and the amount of analgesia consumed was also statistically significant. Conclusion: Wound instillation technique is simple, safe and effective in management of acute pain management after lumbar laminectomy and can be used as one among the multimodal armamentarium in pain management.
    Middle East journal of anaesthesiology 06/2015; 23(2):193-198.

  • Middle East journal of anaesthesiology 06/2015; 23(2):261-262.
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    ABSTRACT: The future appears bright for the use of simulation in medical education. Medical, nursing, and allied healthcare students trained through simulation have opportunities to practice hands on techniques, teamwork, and communication through trial and error in a safe environment before working with live patients. The cost of high-fidelity simulation will continue to make its use prohibitive and challenging for some programs though the use of low-fidelity simulation, standardized patients, and role-playing continues to have measureable qualitative value. Cost center sharing is one way for programs on a tight budget who desire high-fidelity simulation to access this valuable skills-building, outcome-improving medical education adjunct tool.
    Middle East journal of anaesthesiology 06/2015; 23(2):247-250.
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    ABSTRACT: Background: Increases in myocardial blood flow preserve myocardial oxygenation during moderate acute normovolemic hemodilution. Hypocapnic alkalosis (HA) is known to cause coronary vasoconstriction and increase hemoglobin-oxygen affinity. We evaluated whether these effects would compromise myocardial oxygenation during hemodilution. Methods: Eighteen anesthetized dogs were studied. Myocardial blood flow (MBF) was measured with radioactive microspheres. Arterial and coronary sinus samples were analyzed for oxygen content and plasma lactate. Myocardial oxygen supply, oxygen uptake, and lactate uptake were calculated. HA (PaCO2, 23 ± 2 (SD); pHa, 7.56 ± 0.03) was induced by removal of dead space tubing at baseline (n = 8) and during hemodilution (n = 10), with hematocrit at 43 ± 4% and 19 ± 2%, respectively. Results: Hemodilution during normocapnia caused decreases in arterial oxygen content (19.9 ± 2.4 to 9.3 ± 1.2 ml/100; P < 0.05) and the coronary arteriovenous 02 difference (13.0 ± 3.0 to 6.4 ± 0.9 ml/100ml; P < 0.05). MBF increased (52 ± 12 to 111 ± 36 ml/min/100g; P < 0.05) to maintain myocardial oxygen supply and oxygen uptake. Myocardial lactate uptake increased (31 ± 19 to 68 ± 35 µeq/min/100g; P < 0.05). At normal hematocrit, HA decreased MBF (57 ± 18 to 45 ± 10 ml/min/100; P < 0.05), implying vasoconstriction, accompanied by decreased myocardial oxygen supply. These myocardial effects of HA were not apparent during hemodilution. HA did not alter myocardial lactate uptake during hemodilution. Conclusion: When HA was induced during hemodilution, its ability to cause coronary vasoconstriction was lost, and myocardial oxygenation remained well preserved.
    Middle East journal of anaesthesiology 06/2015; 23(2):225-233.
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    ABSTRACT: Objective: Block of the sciatic nerve at the popliteal fossa can be performed using the ultrasound machine; it may be proximally or distally to the bifurcation of the sciatic nerve using lateral, medial, or posterior approaches. It is frequently used for surgeries below the knee specially the foot and ankle operations. Purpose: This study compares one and two injections of the sciatic nerve in the popliteal fossa with ultrasound-guided block in foot or ankle surgeries. Methods: Forty patients received ultrasound-guided sciatic nerve block with the nerve stimulator, using the posterior approach. The patients were enrolled into two groups (20 patients each), group 1: received one injection at 2 cm cephalad to the bifurcation of the sciatic nerve, and group 2: received two injections caudate to the sciatic bifurcation; one for tibial nerve and the other for common peroneal nerve. All patients received 20 ml of levobupivacaine 0.5%. The block performance time, block efficacy, success rate, complications and patient’s satisfaction were evaluated. Results: Block the tibial and common peroneal nerves separately (two injections) distal to the point of bifurcation of the sciatic nerve has a significantly (P<0.05) faster time to complete sensory block of tibial and common peroneal nerves compared to a pre-bifurcation sciatic nerve block (one injection). The complete motor block, block time performance, success rate and patient’s satisfaction were not significantly different between groups (P>0.05). Conclusion: The block of tibial and common peroneal nerves separately distal to the sciatic nerve bifurcation is superior to single injection block of sciatic nerve above the bifurcation in the popliteal fossa as regard complete sensory block time.
    Middle East journal of anaesthesiology 06/2015; 23(2):171-176.
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    ABSTRACT: Background: The present study aimed to evaluate the effects of listening to the mother's heartbeat and womb sounds on the depth of anaesthesia in children. Methods: The present study included 40 children scheduled for minor surgery under general anaesthesia, with an American Society of Anaesthesiologists (ASA) status of 1 to 2. Anaesthesia was induced with sevoflurane, and maintained with sevoflurane and oxygen in nitrous oxide. Patients were randomly divided into two groups. The children in Group I were made to listen to recordings of their mothers' heartbeat and womb sounds via earphones during anaesthesia induction, while those in Group II were made to listen to ambient noise via earphones. The music was turned off when the inhalational anaesthetics were discontinued. Intraoperative monitoring included electrocardiogram (ECG) recordings, heart rate (HR), oxygen saturation, non-invasive systolic blood pressure (SBP) and diastolic blood pressure (DBP), bispectral index system (BIS), end-tidal (ET) sevoflurane, ET N2O, ET CO2, and SaO2. Results: In Group I, there was a significant decrease in bispectral index (BIS) values over time (p < 0.05). Although blood pressure and heart rate were lower in Group I, no significant differences between the groups were detected. While the duration of extubation was shorter in Group I, overall, there was no significant difference between the groups. Conclusion: We found that children exposed to recordings of their mothers' heartbeat and womb sounds in addition to music had lower BIS values under anaesthesia, which indicates deeper anaesthesia levels.
    Middle East journal of anaesthesiology 06/2015; 23(2):241-246.
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    ABSTRACT: Background: Major liver resection is associated with haemodynamic, hepatic and renal changes as a result of the procedure. Aim: To compare Desflurane (D) versus Sevoflurane (S) on hepatic, renal functions, haemodynamics and perioperative course for cirrhotic patients undergoing major liver resection. Patients and Methods: A prospective randomized control study with 50 patients (Child A) (D, n=25 and S, n=25). End tidal D or S adjusted with Entropy (40-60). Haemodynamics monitored with invasive blood pressure and trans-oesophageal Doppler (TED). Liver and kidney function tests, blood Glutathione-S-transferase (GST), urinary microalbuminuria (Microalb) were assayed. Extubation time and anaesthetic consumption were recorded. Results: Systemic vascular resistance (SVR) post-resection and stroke volume of D vs S were 835.04±12.02vs778.16±11.97dyn.sec.cm-5, P<0.01, and 85.72±2.95vs76.16±6.52 ml, P<0.01 respectively. Doppler corrected flow time (FTc) between groups were comparable (P>0.05). No difference post-operatively regarding hepatic and renal functions, and urine Microalb (14.76±3.95vs14.24±8.65 µg/ml, P=0.78), but a statistically difference was foundwith GST (0.046±0.003vs0.043±0.002 IU/ml, P<0.01).Despite a higher D consumption (73±17 vs 64±22 ml, P=0.102), cost in Egyptian pounds (LE) was lower with D (141.14 ± 32.90 vs 320.60 ± 114.01, LE, P<0.01). Extubation time and ICU stay with D vS (4.52±2 vs 7.72±2 min, P <0.01) and (1.40 ± 0.50 vs 1.64 ± 0.48, days P=0.09) respectively. Conclusion: Neither D nor S were clinically superior to the other with respect to liver and kidneys functions, but D was found to preserve better the haemodynamic parameters and enhance recovery at a lower cost.
    Middle East journal of anaesthesiology 06/2015; 23(2):213-223.
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    ABSTRACT: Background: This study was conducted to determine if intravenous dexamethasone combined with caudal block was able to prolong post-operative analgesia in pediatric daycare surgeries. Methods: Sixty four ASA I or II children aged 3 to 10 year old scheduled for daycare open unilateral herniotomy received general anesthesia and caudal block using 0.25% levobupivacaine 0.75 mg.kg(-1) with suppository paracetamol 30 mg.kg(-1). After anesthesia induction, they were randomized to receive either intravenous dexamethasone 0.5 mg.kg(-1) (Group I) or same volume intravenous normal saline (Group II). Postoperatively, pain scores were assessed using Wong- Baker faces scale. At home, their parents assessed and recorded the pain scores, time to first oral paracetamol served and frequency of paracetamol given in two consecutive days post surgery. On the third postoperative day, these information were gathered from the parents via a phone call. Results: There were statistically significant differences between Group I and Group II in the median time to first paracetamol (800 vs 520 min, p = 0.01), mean pain scores postoperative day 1 (1.9 ± 2.0 vs 3.5 ± 2.2, p = 0.05), mean pain score-postoperative day 2 (0.8 ± 1.6 vs 2.3 ± 2.0, p = 0.03) and mean frequencies of paracetamol given on postoperative day 2 (0.3 ± 0.8 vs 1.1 ± 1.0, p = 0.02). Conclusion: A single intravenous dexamethasone dose when combined with caudal block reduces postoperative pain, decreases paracetamol requirement and prolongs analgesic duration in children after open herniotomy.
    Middle East journal of anaesthesiology 06/2015; 23(2):177-183.