Middle East journal of anaesthesiology (Middle East J Anesthesiol )

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


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.

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    Middle East Journal of Anesthesiology website
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    Middle East journal of anaesthesiology, Middle East journal of anesthesiology
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Magnesium sulphate (MgSO4), NMDA receptor antagonist, is known to reduce perioperative requirement of anesthetics and analgesics. However, no studies assessed the effect of MgSO4 on onset and recovery from spinal anesthesia. A prospective, randomised, double blind study was designed to assess the effect of intravenous (IV) MgSO4 on onset and recovery from spinal anesthesia and post operative analgesic requirement following below umbilical surgery. Sixty patients (ASA class I & II) were selected randomly and divided into two groups. Patients were given either MgSO4 50 mg kg(-1) in 10 mL within 10 min, followed by an infusion of MgSO4 10 mg kg(-1) hr(-1) IV in 4mL (MG group) for 12 hrs or normal saline in same volume and rate for 12 hrs as used in MG group (NS group). After initiating the infusion, spinal anesthesia was given with 0.5% bupivacaine (Hyperbaric) 2.5 mL at L3/4 or L4/5 space. Time taken for sensory block at the level of T-10 and motor block (modified Bromage Score-1) was noted. Postoperatively, time taken for recovery from spinal anesthesia, pain score and requirement of postoperative analgesic in 24 hours were observed and compared between the two groups. The first rescue analgesia was required after 334 +/- 202 min in MG group and after 233 +/- 141 min in NS group with significant difference (p < 0.05). The morphine required over 24 hours for analgesia was significantly less in MG group (3.99 +/- 1.25 mg) as compared to NS group (7.13 +/- 2.68 mg) (p < 0.000). Intravenous MgSO4 improves postoperative analgesia without affecting the onset and recovery from spinal anesthesia.
    Middle East journal of anaesthesiology 10/2013; 22(3):251-6.
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    ABSTRACT: Some anesthesiologists consider combined spinal epidural (CSE) analgesia as superior alternative to continuous labor epidural (CLE) analgesia. However, during CSE, even small doses of intrathecally administered local anesthetics with opioids induce almost instant analgesia that precludes the testing of epidural catheters as well as early appreciation of failed epidural catheters. To overcome the shortcomings of CSE analgesia, dural puncture epidural (DPE) analgesia had been devised. The goals for the present study were to test whether DPE technique would provide superior and safer labor analgesia as compared to CLE technique. 131 ASA Class I, II and III pregnant patients who requested labor epidural analgesia consented for their participation in this prospective randomized study. Group A patients received CLE analgesia for labor pain. Group B patients received DPE analgesia for labor pain. After exclusion of nineteen patients, final comparative data was available for 112 patients only [Group A (n = 63) versus Group B (n = 49)]. Per our analysis, the only positive aspect for DPE analgesia as compared to CLE analgesia was that patients who received DPE analgesia reported lower incidence for immediate failures of labor analgesia (P = 0.04). However, there was higher incidence of paresthesias while performing successful dural punctures (P < 0.0001). Pre-insertion epidural depth assessment with ultrasound (n = 112) correlated positively with the air-filled loss of resistance syringe technique (r = 0.88; P < 0.0001). DPE technique did not provide superior labor analgesia as compared to CLE technique. Technically, fewer immediate failures in labor analgesia but higher incidence of paresthesias were observed with DPE technique.
    Middle East journal of anaesthesiology 10/2013; 22(3):309-16.
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    ABSTRACT: Promoting clinical research is important considering the shortage of clinical investigators and the increasing need for large multicenter studies. Participation of clinical staff in research is crucial to achieve this goal. Our objective was to assess the research experience and interest of clinical staff working at a tertiary-care intensive care unit (ICU) and explore the perceived research barriers. A written survey was administered to 185 multidisciplinary ICU staff at a 900-bed tertiary-care academic hospital in Riyadh. It consisted of questions/statements on previous research experience, interests and barriers. Responses were either Yes/No answers or graded according to the 5-point Likert scale. Most (62.8%) staff responded (age = 33.9 +/- 7.2 years, 69.6% females, 76.0% nurses, 10.4% physicians, clinical experience = 7.6 +/- 6.8 years). Fifty (40%) respondents participated in clinical research (physicians 69.2%, nurses 37.9% and respiratory therapists 25%, p = 0.052 ), 42 (33.6%) of them in the current ICU but only 11.2% presented in-person their research projects at national/international meetings. Most respondents (86.2%) believed that participation in research would enhance their career. There was no differences in research tasks clinical staff were willing to perform except for writing manuscripts with physicians (69.2%) and respiratory therapists (58.3%) more willing than nurses (29.5%), p = 0.03. Perceived research barriers were lack of time (76.8%), of financial compensation (58.4%) and of encouragement (48.8%). The majority of clinical staff working at a tertiary-care ICU of an academic hospital was interested in conducting research but the lack of time, financial compensation and encouragement were perceived as significant barriers.
    Middle East journal of anaesthesiology 10/2013; 22(3):301-7.
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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.
  • Middle East journal of anaesthesiology 10/2013; 22(3):341.
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    ABSTRACT: To compare adequacy of peri-partum pain management with or without neuraxial opioids in patients on buprenorphine maintenance therapy (BMT). After institutional review board approval for the study protocol, retrospective peripartum anesthesia/analgesia data of BMT patients for five-year period were accessed and analyzed. Out of reviewed 51 patient charts, nineteen patients were found eligible for final comparative analysis. The daily amounts of peri-partum rescue analgesics with vs without neuraxial opioids were equianalgesic doses of parenteral hydromorphone (10.7 +/- 13.8 mg vs 2.6 +/- 0.7 mg, P = 0.45 for vaginal delivery; 16.4 +/- 21.1 mg vs 5.3 +/- 3.6 mg, P = 0.42 for elective cesarean section (CS)), oral ibuprofen (1.1 +/- 0.5g vs 0.8 +/- 0.4g, P = 0.37 for vaginal delivery; 1.1 +/- 0.2g vs 1.6 +/- 0.6g, P = 0.29 for elective CS), and acetaminophen (0.2 +/- 0.4g vs 0 +/- 0g, P = 0.56 for vaginal delivery; 0.3 +/- 0.3g vs 0.2 +/- 0.2g, P = 0.81 for elective CS). In the patients who underwent emergent CS after failed labor (all had received epidural opioids), there was clinical trend for higher daily amounts ofperi-partum rescue analgesics (parenteral hydromorphone 35.6 +/- 37.5 mg; oral ibuprofen 1.2 +/- 0.4g; oral acetaminophen 1.2 +/- 0.5g), when compared with vaginal delivery patients or elective CS patients who all had received neuraxial opioids. As the study was underpowered (n = 19), future adequately powered studies are required to conclude for-or-against the use ofneuraxial opioids in BMT patients; and pro-nociceptive activation by neuraxial opioids may be worth investigating to improve our understanding of peripartum pain management of BMT patients.
    Middle East journal of anaesthesiology 10/2013; 22(3):273-81.
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    ABSTRACT: Many physicians have experienced or will experience patient who acts threateningly towards them at least once in their careers. However, there have been no studies to gauge the incidence rate and severity of patients' and/or patients' families' violence towards pain physicians. This nationwide survey was completed to evaluate the incidence of death/bodily harm threats (DBHTs) against pain physicians. A questionnaire along with online assent form was uploaded on SurveyMonkey Online Portal. The uploaded survey web-link was sent to pain fellowship programs in the United States so that pain physicians and pain fellows can respond to this survey. The respondents were expected to anonymously complete the survey containing various questions relating to confrontational patients' experiences, how these experiences affected them, how those situations were handled, and how the respondents would act differently in the future secondary to their victimization by the confrontational patients. The response rate to the nationwide survey was extremely low (5.2% of anticipated numbers), most likely secondary to underreporting. Out of total 26 respondents across the United States, seven respondents reported receiving DBHTs (incidence of 27%). The median number of absolute DBHTs received in lifetime by these seven respondents was three (range being 1 to 21-30). There is minimal/underreported but definite risk of DBHTs for pain practitioners and the improved reporting, awareness and discussions can help pain physician community to formulate efficacious strategies to the prevention and management of future DBHTs.
    Middle East journal of anaesthesiology 10/2013; 22(3):317-26.
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    ABSTRACT: We report a case in which the use of benzocaine spray to facilitate awake fiber optic intubation (FOI) in a patient with a difficult airway caused methemoglobinemia intraoperatively. Local benzocaine was sprayed to numb the patient's airway for a total time of one second, fifteen minutes later SpO2 decreased to 85% on the pulse oximeter. Arterial blood gas (ABG) showed a MetHb of 24.6% of total Hemoglobin. The patient was successfully treated with methylene blue intravenously and recovered uneventfully. Small amounts of local benzocaine sprayed to numb the airway can cause significant methemoglobinemia that requires immediate recognition and appropriate management.
    Middle East journal of anaesthesiology 10/2013; 22(3):337-40.
  • Middle East journal of anaesthesiology 10/2013; 22(3):245-50.
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    ABSTRACT: There is no consensus on the optimal local anesthetic agent to initiate labor analgesia for patients in active labor. Currently used local anesthetic agents for initiating labor analgesia include 0.25% bupivacaine, 0.5% bupivacaine, 0.2% ropivacaine without or with various types and doses of opioids. All these agents are administered in incremental doses and are relatively "slow onset" in initiation of labor analgesia. We used 0.5% lidocaine 10 ml as the loading dose given as an epidural bolus to initiate epidural analgesia for patients in early stages of labor. We included 32 cases (16 in Lidocaine group and 16 in Bupivacaine group). We found that 0.5% lidocaine is fast-onset, very effective and safe in initiating epidural analgesia for early stage labor.
    Middle East journal of anaesthesiology 10/2013; 22(3):257-61.
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    ABSTRACT: General anesthesia (GA) is considered the gold standard for external dacryocystorhinostomy (DCR) surgery. There are few reports about laryngeal mask airway (LMA) use in DCR surgery. The aim of this study was to compare the use of endotracheal intubation (ETT) vs LMA for airway management during DCR surgery. Ninety patients were randomized to two groups. In the group C, ETT and in the group L, classic LMA was used to maintain and protect the airway during the procedure. Hemodynamic data before, after intubation or LMA insertion and after skin incisions were recorded. Coughing and straining at the end of anesthesia and postoperative nausea and vomiting (PONV) were recorded. In the group L, the mean arterial pressure and the heart rate after LMA insertion and after the skin incisions were significantly lower than the group C (p < 0.05). Furthermore, incidence of coughing, straining at the end of anesthesia and PONV was lower in the group L than the group C (p < 0.05). LMA can be used in external DCR, to decrease the hemodynamic changes, to decrease coughing, straining at the end of anesthesia and the incidence of PONV.
    Middle East journal of anaesthesiology 10/2013; 22(3):283-8.
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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.
  • Middle East journal of anaesthesiology 10/2013; 22(3):329-31.
  • Middle East journal of anaesthesiology 06/2013; 22(2):213-5.
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    ABSTRACT: The authors present a case of unusual rise in inspired carbon dioxide due to misplaced absorbent canister.
    Middle East journal of anaesthesiology 06/2013; 22(2):237-8.