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ABSTRACT: PurposeEvaluate oxygen jet ventilation in a patient with tracheal stenosis undergoing stent insertion.
Clinical featuresManual intermittent low frequency oxygen jet ventilation was used during general anesthesia for fibreoptic bronchoscopy and
stent insertion in a patient with tracheal stenosis. Oxygen jets were delivered via a Sander’s injector adapted to the proximal
end of the endotracheal tube on one side, and open to room air on the other side. Adequate oxygenation and carbon dioxide
removal were ensured throughout the procedure.
ConclusionLow frequency jet ventilation in a patient with tracheal stenosis provided adequate ventilation as well as a nonobstructed
field during fibreoptic bronchoscopy and stent insertion.
ObjectifÉvaluer la ventilation en jet avec de l’oxygène chez un patient qui présente une sténose trachéale et qui doit subir la mise
en place d’un tuteur.
Éléments cliniquesLa ventilation en jet, manuelle et intermittente, avec de l’oxygène, a été utilisée pendant l’anesthésie générale pour la
fibroscopie et l’insertion d’un tuteur chez un sujet souffrant de sténose trachéale. L’oxygène a été administré par un injecteur
de Sander fixé à la partie proximale de la sonde endotrachéale, d’un côté, et ouvert à l’air ambiant, de l’autre côté. L’oxygénation
et l’élimination du gaz carbonique ont été adéquates pendant toute l’intervention.
ConclusionLa ventilation en jet à basse fréquence, utilisée dans un cas de sténose trachéale, a fourni une ventilation suffisante et
un champ libre pour la fibroscopie et l’insertion d’un tuteur.
Canadian Journal of Anaesthesia 04/2012; 48(7):701-704. · 2.35 Impact Factor
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Canadian Journal of Anaesthesia 04/2012; 52(8):884-885. · 2.35 Impact Factor
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ABSTRACT: In a prospective randomized double-blind study, we compared the effectiveness of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. Hundred ASA I and II patients scheduled for laparoscopic surgery were enrolled in the study and 84 patients completed it. Following induction of anesthesia, group I (n=42) received granisetron 1 mg and dexamethasone 8 mg, group II (n=42) received ondansetron 4 mg and dexamethasone 8 mg. Nausea and vomiting episodes, pain scores as well as side effects were recorded during the first hour and subsequently during the first 6 and 24 hours postoperatively. Satisfaction scores were obtained at discharge. There was no statistically significant difference between the 2 groups during the 1st 24 hours following surgery in regards to pain scores, satisfaction and side effects manifestations. At 0-1 hour interval, 100% of patients in group I and 97.6% in group II had no vomiting. Total response (no moderate or severe nausea and no rescue antiemetics) was 83.3% in group I and 80.95% in group II, and metoclopramide was used in 7.1% of patients in both groups. At 1-6 hours interval, 97.6% of patients in group I and 100% in group II had no vomiting. Total response was 92.8% in group I and 90.9% in group II, and metoclopramide was used in 4.76% of patients in group I and 2.38% in group II. At 6-24 hours no vomiting occurred in 97.6% of patients in group I and 100% in group II. Total response was 95.2% in both groups, and metoclopramide was used in 2.38% of patients in both groups. In conclusion, the combination of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg following induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.
Middle East journal of anaesthesiology 02/2010; 20(4):565-70.
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ABSTRACT: To investigate the efficacy of preoxygenation by eight deep breaths in 60 seconds with the Mapleson A (Magill) system, the circle anesthesia system, or the Mapleson D system at an oxygen flow of 5 L/min or 10 L/min.
Randomized, clinical study.
Operating room of a university hospital.
10 healthy volunteers.
Volunteers underwent 6 preoxygenation trials consisting of 8 deep breaths in 60 seconds using the Mapleson A, Mapleson D, and the circle anesthesia systems at an oxygen flow of 5 L/min and 10 L/min.
Fractional end-tidal oxygen concentration (F(ET)O(2)) was measured at 15-second intervals during preoxygenation.
At an oxygen flow of 10 L/min, mean F(ET)O(2) values at 60 seconds of preoxygenation were comparable among the Mapleson A, Mapleson D, and the circle anesthesia systems (87 +/- 2.1%, 87 +/- 1.6%, 87 +/- 1.6%, respectively). Using an oxygen flow of 5 L/min, mean F(ET)O(2) values at 60 seconds were similar among the Mapleson A, Mapleson D, and circle anesthesia systems (74 +/- 4.1%, 75 +/- 2.6%, 74 +/- 4.4%, respectively); however, they were significantly lower than the corresponding values achieved at an oxygen flow of 10 L/min.
The 8-deep-breaths in 60 seconds technique at an oxygen flow of 10 L/min can achieve adequate preoxygenation with the Mapleson A (Magill), Mapleson D, and circle anesthesia systems. Suboptimal preoxygenation is obtained with the three systems when the oxygen flow used is 5 L/min.
Journal of clinical anesthesia 12/2009; 21(8):574-8. · 1.32 Impact Factor
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Vanda G Yazbek-Karam,
Roula W Haswani,
Hoda S Karam,
Walid M Haddad,
Pierre S Youssef,
Boutros F Hachem,
Fouad T Atik,
Simon J Rassi,
Joseph N Yammine, Anis S Baraka,
Marie T Aouad
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ABSTRACT: A reusable Robertshaw red rubber double-lumen endotracheal tube (DLT) was placed to facilitate lung isolation for thoracoscopy in a 49-year-old atopic patient. In spite of its smooth insertion, it was then not possible to remove the DLT. Direct laryngoscopy showed severe laryngeal edema. After 48 hours of medical treatment with steroids, the trachea was extubated. The laryngeal edema could have been the result of physical and chemical irritation by the reusable rubber DLT itself, or from the substances formed during repeated cleaning and sterilization of the DLT. Atopic patients who are prone to developing latex allergy are also more liable to develop severe reactions to chemical, mechanical, and physical irritation from reusable red rubber DLTs or from the chemical solution used for its cleaning and sterilization.
Journal of clinical anesthesia 11/2009; 21(7):514-6. · 1.32 Impact Factor
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Middle East journal of anaesthesiology 07/2009; 20(2):289-90.
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ABSTRACT: Hypotension after spinal anesthesia for cesarean delivery is common. Previous studies have demonstrated that a crystalloid fluid "coload" (rapid administration of a fluid bolus starting at the time of intrathecal injection) is superior to the conventional crystalloid preload (fluid administered before the intrathecal injection) for preventing hypotension. Colloid preload provides a sustained increase in central blood volume. We hypothesized that, in contrast to crystalloid, a colloid preload may be more effective than colloid coload for reducing the incidence of spinal anesthesia-induced hypotension.
In this double-blind study, 178 patients were randomly assigned to receive a preload of 500 mL of hydroxyethyl starch over a period of 15-20 min before initiation of spinal anesthesia (n = 90) or an identical fluid bolus of hydroxyethyl starch starting at the time of identification of cerebrospinal fluid (n = 88). Vasopressors (ephedrine or phenylephrine) were administered if systolic arterial blood pressure decreased less than 80% of the baseline pressure and <100 mm Hg, or with smaller decreases in blood pressure if accompanied by nausea, vomiting, or dizziness. The primary outcome was the incidence of hypotension (defined as the administration of at least one dose of vasopressor).
There was no significant difference between the groups in the incidence of hypotension (68% in preload group and 75% in coload group, 95% confidence interval of difference -6%-20%; P = 0.28), doses of ephedrine and phenylephrine, and number of vasopressor unit doses. The incidence of severe hypotension (systolic blood pressure <80 mm Hg) was 16% in the preload group and 22% in the coload group (P = 0.30). There were no differences in the incidence of nausea and/or vomiting, or neonatal outcome between the groups.
There was no difference in the incidence of hypotension in women who received colloid administration before the initiation of spinal anesthesia compared with at the time of initiation of anesthesia. Both modalities are inefficient as single interventions to prevent hypotension.
Anesthesia and analgesia 07/2009; 109(4):1219-24. · 3.08 Impact Factor
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Pediatric Anesthesia 11/2008; 18(10):1002-3. · 2.10 Impact Factor
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ABSTRACT: The intubating laryngeal mask airway (ILMA) is used in the management of difficult intubation. Usually, a silicone wire-reinforced tube is inserted for tracheal intubation. Because the silicone wire-reinforced tube is expensive, alternatives, such as polyvinyl chloride (PVC) and posterior beveled Parker tubes, are worth considering. We compared the blind intubation success rates among the silicone wire-reinforced tube, the Parker tube, and the PVC tube, and identified laryngeal structures preventing tracheal intubations through the ILMA.
Sixty-three adult patients were randomized into three groups: Group I (n = 20) silicone wire-reinforced tube, Group II (n = 21) Parker tube, and Group III (n = 22) PVC tube. Demographic and clinical continuous data were compared with the analysis of variance with the Scheffé test for post hoc analysis. Frequencies and percentages were compared with the chi(2) test.
Tracheal intubation was successful from the first attempt in 18 of 20 patients in Group I (silicone wire-reinforced tube), which was significantly higher than the success rate in either Group II (12 of 22 patients) (Parker tube) or Group III (10 of 21 patients) (PVC tube). With clockwise or anticlockwise rotation of the tracheal tube, the number of successful intubations did not change in Group I, but it increased to 19 of 22 patients in Group II and to 12 of 21 patients in Group III. The rate of successful intubation between patients in Group I (90%) and Group II (86%) was not significantly different after manipulation of the tracheal tube (P = 0.72). However, the rate of successful tracheal intubations in patients of Group III (57%) was significantly lower in comparison to patients in both Group I (P = 0.02) and Group II (P = 0.03). In 3 of the 22 patients of Group II and in 9 of the 21 patients of Group III in whom blind intubation was not possible, the obstruction was due to the epiglottis tubercule.
Manipulation improved the success rate of intubation with the Parker tube through the ILMA rendering it a possible alternative to the silicone wire-reinforced tube.
Anesthesia and analgesia 10/2008; 107(3):994-7. · 3.08 Impact Factor
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Pediatric Anesthesia 08/2008; 18(7):673-5. · 2.10 Impact Factor
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ABSTRACT: We report a 38 year old male patient who underwent a craniotomy for jugular foramen tumor resection. In the postoperative care unit, the patient developed aspiration accompanied with oxyhemoglobin desaturation. Subsequently, he had several episodes of recurrent aspiration which were attributed to cranial nerves (IX, X) palsy as a complication of the surgery at the jugular foramen. It is suggested that aspiration prophylactic measures should be taken and early assessment of lower cranial nerves function should be done prior to tracheal extubation to decrease post-operative aspiration in patients undergoing base of skull surgery.
Middle East journal of anaesthesiology 06/2008; 19(5):1179-84.
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ABSTRACT: Laryngospasm is a common complication in pediatric anesthesia. In the majority of cases, laryngospasm is self-limiting. However, sometimes laryngospasm persists and if not appropriately treated, it may result in serious complications that may be life-threatening. The present review discusses laryngospasm with the emphasis on the different prevention and treatment modalities.
Pediatric Anesthesia 05/2008; 18(4):281-8. · 2.10 Impact Factor
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Anesthesia and analgesia 03/2008; 106(2):672; author reply 672-3. · 3.08 Impact Factor
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Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):863-6. · 1.64 Impact Factor
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ABSTRACT: We describe the use of noninvasive bilevel positive airway pressure (BiPAP) in a critically ill, hypoxemic and morbidly obese patient for preoxygenation prior to rapid sequence induction of anesthesia.
A critically ill morbidly obese patient (body mass index: 49 kg.m(-2)) was scheduled for urgent laparoscopic cholecystectomy. Preoxygenation with 5 L.min(-1) oxygen flow resulted in a moderate increase in oxygen saturation (SpO2) from 79% to 90%. Prior to rapid sequence induction of anesthesia, a trial of noninvasive BiPAP with oxygen delivery at 5 L.min(-1) increased his SpO2 to 95% initially, with full saturation of 99% achieved when oxygen flow was increased to 10 L.min(-1). Bilevel positive airway pressure with an inspiratory and expiratory pressures of 17 cm H2O and 7 cm H2O, respectively, was applied using a full face mask to achieve a tidal volume of 8 mL.kg(-1). Rapid sequence induction proceeded uneventfully.
Prior to rapid sequence induction of anesthesia in patients with respiratory compromise secondary to factors which reduce FRC, noninvasive BiPAP in combination with supplemental oxygen may be indicated whenever traditional preoxygenation does not provide adequate oxyhemoglobin saturation. Improved oxygenation is most likely attributable to improved ventilation and alveolar recruitment.
Canadian Journal of Anaesthesia 10/2007; 54(9):744-7. · 2.35 Impact Factor
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ABSTRACT: Propofol is well-known for its pain on injection. Premixture with lidocaine or pretreatment with remifentanil reduces injection pain. A multimodal approach might offer additional mitigation of propofol injection pain.
In a randomized, prospective, double-blind study of 156 patients, we compared the incidence and severity of propofol pain among three groups. Patients in the lidocaine group (n = 54) received 2% lidocaine premixed with propofol (40 mg lidocaine in 180 mg propofol). Patients in the remifentanil group (n = 50), received pretreatment with remifentanil 2 microg x kg(-1) IV over 30 s. Patients in the combination group (n = 52) received both lidocaine and remifentanil.
A significant decrease in the overall incidence of propofol pain at induction was achieved in the combination group (9.6%) compared with that in the remifentanil group (36%) and the lidocaine group (35%) (P = 0.003). The incidence of severe and moderate pain was also significantly different in the combination group (0%), compared with that in the remifentanil (18%) and lidocaine groups (12.9%) (P < 0.02). Similar, statistically significant differences among the three groups were achieved concerning recalled pain in the postanesthesia care unit.
The combination of two different analgesic modalities, remifentanil and lidocaine completely abolishes moderate and severe pain associated with propofol injection, and significantly reduces the incidence of mild pain when compared with each drug used alone.
Anesthesia and analgesia 07/2007; 104(6):1540-4, table of contents. · 3.08 Impact Factor
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ABSTRACT: We compared the efficacy of granisetron and ondansetron for the prevention of subarachnoid morphine-induced pruritus after cesarean delivery.
The incidence of pruritus was assessed in parturients who were randomly allocated into Group G (granisetron 3 mg IV, n = 45), Group O (ondansetron 8 mg IV, n = 42), and Group S (saline IV, n = 42).
The incidence of pruritus was not significantly different among the 3 groups (86.6% in Group S, 83.3% in Group O, and 88% in the Group G).
Neither prophylactic ondansetron nor granisetron reduced the incidence of subarachnoid morphine-induced pruritus when compared with the saline group.
Anesthesia and analgesia 03/2007; 104(2):421-4. · 3.08 Impact Factor
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Anesthesia and analgesia 02/2007; 104(1):214; author reply 214-5. · 3.08 Impact Factor
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ABSTRACT: To determine whether two vs 10 mL of saline injected into the epidural space affects the subsequent spread and quality of epidural analgesia in parturients.
Randomized, double-blinded, placebo-controlled study.
Delivery room.
105 ASA physical status I and II parturients requesting epidural analgesia.
After identification of the epidural space by the loss-of-resistance technique using normal saline, two mL of saline was then injected into the epidural space in the 2-mL group (n = 53) and 10 mL in the 10-mL group (n = 52). Five minutes after the test dose, patients received 10 mL of bupivacaine (0.1%) with fentanyl two microg mL(-1).
25 minutes after the initial bolus of bupivacaine and fentanyl, spread of block, subsequent pain relief, and influence of the volume of the injected saline on the ease of epidural catheter insertion and on the incidence of blood vessel trauma and paresthesia were evaluated.
The total number of dermatomes blocked for cold and pinprick sensation in the 10-mL group was significantly more than in the 2-mL group (19 [6-29] vs 15 [4-27] for cold sensation, P = 0.000; and 15 [3-29] vs 11.5 [3-26] for pinprick sensation, P = 0.001). However, the visual analog pain scale and need for supplemental analgesia were similar between the two groups. The epidural catheter was easily inserted in 94.2% of the 2-mL group and 100% of the 10-mL group. The incidence of blood vessel trauma was low and the incidence of paresthesia was high without any significant difference between the two groups.
10 mL saline was associated with a higher total number of dermatomes blocked for both cold and pinprick sensation than the two mL saline. However, the pain relief was adequate in both groups, and two mL saline was as effective as the 10 mL in the ease of catheter insertion and prevention of intravascular cannulation.
Journal of Clinical Anesthesia 01/2007; 18(8):575-9. · 1.21 Impact Factor
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Anesthesiology 07/2006; 104(6):1352-3. · 5.36 Impact Factor
