[Show abstract][Hide abstract] ABSTRACT: Fusion of the jaws in the neonate is a very rare congential anomaly which may be associated with other congenital defects such as aglossia, facial hemiatrophy or retrognathia. Ventilatory management for surgical separation of the fused jaws presents severe problems. In a recent case of a neonate with almost completely fused jaws requiring general anasthesia, we used subanasthetic doses of ketamine in combination with un insufflation technique. It took 45 minutes to reach the surgical stage of anasthesia due to misplacement of the nasotracheal tube through an unsuspected cleft palate towards a gap between the jaws, a previously unreported combination of complications.
[Show abstract][Hide abstract] ABSTRACT: Dexmedetomidine is a potent new alpha-2 adrenoceptor agonist with an alpha-2 to alpha- ratio more than 7 times that of clonidine. Its potent sedative, analgesic and sympatholytic effects blunt the cardiovascular responses (hypertension, tachycardia) without unexpected toxicity. Many reports confirmed its pharmacological properties if given by infusion. Recent report confirmed favorable non-depressant effect on respiration and blood gases.
ICU patients at King Khalid University Hospital.
Open label clinical evaluation on ten surgical patient ASA I class received dexmeditomidine infusion to the sedative effect level of Ramsy scale of 3 for ventilated patients and 2 for spontaneously breathing patient. The clinical observation and analgesic requirement as well as the hemodynamic parameters and hemoglobin oxygen saturation were observed for the period of ventilation and weaning till discharge from the ICU. These records were subjected to paired t test for values measured at preinfusion period compared to 10 minutes and 6 hours measurement after infusion.
The study confirmed the previous findings of previous reports regarding the cardiovascular stability and non depressive effect on respiration. It also confirmed the sparing effect on the use of analgesics which indicates its analgesic effect. The sedation quality is unique in that the patient is easily arousable. This was reported favorably by the nursing staff. Bradycardia was observed in one patient who was treated effectively by stopping the infusion.
We concluded that dexmedetomidine is useful sedative agent with analgesic properties which reduce the analgesic requirement of the patient. The patient were ventilated, weaned, then breathed spontaneously in a satisfactory manner.
Middle East journal of anaesthesiology 11/2002; 16(6):587-95.
[Show abstract][Hide abstract] ABSTRACT: Gynecological admissions to the surgical intensive care unit vary from the obstetrical cases. Pregnant women are of prime age and can tolerate the pregnancy and delivery well. There are certain rare conditions or complications, which make the pregnant women's life pass through a critical time. These are dealt with in a high dependency area, which is short of the intensive care unit. In King Khalid University Hospital there is no such arrangement, so the mildly affected and critically ill patients together are cared for in the surgical intensive care unit. The objective of this study is to study the gynecological and obstetrical conditions requiring intensive care admission in King Khalid University Hospital, surgical intensive care unit.
All obstetrical and gynecological patients who were admitted to the surgical intensive care unit were included. The demographic particulars, reason for admission, the course of the surgical intensive care unit stay and outcome were studied.
During the study period of 3 years, there were 83, (100%) obstetrical and gynecological admissions to the surgical intensive care unit. Two (2%) cases were due to anesthesia complications. The majority of causes of admissions were due to obstetrical (n=63, 76%) complications or combination of medical and surgical conditions. Gynecological admissions comprised only 18 (22%) cases. There was no mortality in the group studied.
Management of major obstetrical emergencies and gynaecological patients require an understanding of medical conditions' influence on the patients, and the physiological changes of normal and abnormal pregnancies. Intensive care unit management is an essential part in raising the level of patient care; health personnel training and continuing health care education may be improved.
Saudi medical journal 12/2001; 22(11):980-3. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this review is to establish a framework about the educational activities of the Cardiopulmonary Resuscitation (CPR) National Committee of the Saudi Heart Association (SHA) and determine if it has had any effect on the survival rate in daily hospital work. Further, the review puts forward recommendations regarding the key to success for future implementations and improvement in the outcome of heart attacks in the Kingdom of Saudi Arabia (KSA). Cardiopulmonary resuscitation (CPR) was introduced into the Kingdom of Saudi Arabia in the 1980s. The birth of CPR in the Kingdom was conducted by the American Heart Association (AHA) provision of the first instructor course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) in the spring of 1984. This educational activity was initiated by the Postgraduate Center of the College of Medicine and currently is a function of the Saudi Heart Association (SHA). The National Heart Center (NHC) continually expands its activities. The number of courses organized, conducted, and reported herein totaled 459 for providers and instructors in BCLS and ACLS. This resulted in certification of 916 and 204 instructors in basic and advanced CPR respectively. There were 80 centers established in the Kingdom over the span of 15 years. They all provide BCLS courses; only 13 provide ACLS courses. The SHA issued a total of 84,659 certificates.
Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 09/1999; 14(3):180-5.
[Show abstract][Hide abstract] ABSTRACT: We describe a retrospective analysis of critical incident reports in two teaching hospitals. We included significant observations, involving unsafe practices during cardio-pulmonary resuscitation intensive care management and during anesthesia. Of the 143 critical incidents reported, 87% did not lead to negative out-come, out of these 13% were reports on deaths of patient resuscitated by CPR team or emergency department, underwent surgery, and or managed in the intensive care unit. Human errors and lack of communications were common factors for the majority of the incidents. Wrong drug labeling and irresponsible behavior were the most frequent among the human errors. The analysis aimed to regularize the method of reporting and also to determine the causes of complications, offer solutions and prevent occurrence of such incidents in the future.
Middle East journal of anaesthesiology 11/1998; 14(6):425-32.
[Show abstract][Hide abstract] ABSTRACT: Every year over 2 million pilgrims (Hajjis) gather from different countries to perform the sacred ritual, the fifth pillar of Islam, Hajj. Several nationalities from different climates come to Saudi Arabia which is located in a subtropical area with a hot and humid climate during the long summer season. This undertaking is characterised by several days of continuous physical, spiritual, and emotional exertion following their homeland. Several factors predispose them to heat exhaustion, such as the hot climate, excessive physical exercise, lack of acclimatisation, overcrowding, illiteracy, old age, diseases, and over zealous performance of Hajj during the peak sunshine hours. Several thousands of pilgrims suffer from heat exhaustion which is a minor form of heat illness that can easily be detected and treated. Patients are usually discharged having fully recovered, but if heat exhaustion is not treated immediately, it may result in heat stroke with serious sequelae. Cases that need further observation and management are admitted to hospital, particularly those who have associated medical disorders. This study was designed to investigate the role of pulse oximetry in detecting hypoxaemia in patients suffering from heat exhaustion. One hundred fifty-five patients from 26 different countries were enrolled in this study. Their ages ranged from 18 to 83 years. There were 51 (33%), 48 (31%), and 56 (36%) from Asia, the Middle East and Africa, respectively. One hundred thirty-four patients (86.5%) showed a form of hypoxia which necessitated O2 administration. Mild hypoxia (91-94% O2 saturation) was detected in 81 patients (52.3%) and moderate to severe hypoxia (< 90% O2 saturation) was detected in 53 (34.2%) patients.
[Show abstract][Hide abstract] ABSTRACT: The laryngeal mask airway (LMA) has been newly introduced to anaesthesia practice as an alternative to the endotracheal tube (ETT) or face mask for airway management. It is capable of providing a rapid and easily achieved patent airway that permits positive pressure ventilation within confined limits. In this study, we aim to evaluate the role of the LMA in cardiopulmonary resuscitation (CPR) in 20 patients as an alternative to tracheal intubation. Study parameters included measurement of oxygen saturation by a pulse oximeter and end-tidal carbon dioxide level (ETCO2) using the Fenem CO2 analyser. Five of these 20 cases were resuscitated using endotracheal tubes as a control group. Seven cases were resuscitated using LMA only and eight cases were resuscitated using LMA initially followed by ETT for long term ventilation. In the LMA groups I and III, 12 patients had LMA inserted at the first attempt and three at a second attempt. We concluded that LMA is a good alternative to ETT, although it may not protect against aspiration. We recommend it to be included in CPR chart cards and all medical doctors, nurses and paramedical staff should learn how to use it.
[Show abstract][Hide abstract] ABSTRACT: We describe the successful management of a 28-year-old female with Wilson's disease who developed gestational pre-eclamptic hypertension (GPH) during pregnancy and who required an urgent cesarean delivery. We discuss the rationale of using magnesium sulphate prior to induction and the importance of adequate monitoring is selecting an anesthetic technique based on the pathophysiology of the disease.
Middle East journal of anaesthesiology 03/1992; 11(4):391-7.
[Show abstract][Hide abstract] ABSTRACT: During pilgrimage season (Hajj) in Saudi Arabia 34 patients with heat stroke (HS) were centrally cannulated to assess their state of hydration and fluid requirement during cooling period. Central venous pressure (C.V.P.) measurements indicated that most victims of heat stroke had normal C.V.P. on arrival at heat stroke centres and may not be fluid depleted. Twenty-two patients (64.7%) had normal or above normal C.V.P. Twelve patients (35.3%) had zero or below zero C.V.P. Six patients (17.6%) had above 10 cmH2O (range 10-26 cmH2O) and could have developed acute congestive heat failure and pulmonary edema if they had been transfused at the standard recommended rate of 3-4 litres of fluid during an average cooling time of 1 h as has been practiced in the heat stroke centres to date. This study also showed that heat stroke patients should not be briskly transfused because the heart may be affected by heat stroke per se and an unmonitored challenge by brisk i.v. therapy during cooling (which on its own increases preload on the heart due to peripheral vasoconstriction) can lead to acute overload problems. An average of 1 litre of normal saline or Ringer's lactate (crystalloids) was sufficient to normalize C.V.P. during the cooling period and to restore an optimal state of hydration without predisposing to congestive cardiac failure and pulmonary edema--the potential to develop disastrous adult respiratory distress syndrome and disseminated intravascular coagulopathy.