Middle East journal of anaesthesiology (Middle East J Anesthesiol)

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

Impact Factor Rankings

Additional details

5-year impact 0.00
Cited half-life 0.00
Immediacy index 0.00
Eigenfactor 0.00
Article influence 0.00
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


  • No preview · Article · Oct 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology

  • No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Perioperative pain control in the setting of gastrointestinal surgery presents unique challenges for the clinician, including the incidence of ileus and its potential exacerbation by analgesics, large incisions, patient characteristics and a wide variety of other factors. At the same time, optimizing postoperative pain control is of key significance in this patient population and has implications for both medical and surgical outcomes, length of hospital stay and associated costs and risks of developing chronic postsurgical pain. Data from recent clinical trials and other studies have highlighted the impact of specific surgical and anesthetic techniques on post-operative pain for several types of abdominal surgeries, including pancreatoduodenectomy, hepatectomy, gastric bypass, cholecystectomy, colectomy, and appendectomy. The management of pain may be optimized through the multidisciplinary and concerted efforts between clinicians involved in the perioperative care of patients undergoing gastrointestinal surgery.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Preoperative evaluation of surgical patients is important, as perioperative complications are associated with increased mortality. Specialties including anesthesiology, internal medicine, cardiology, and surgery are involved in the evaluation and management of these patients. This institutional study investigated the residents' knowledge of the 2007 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on perioperative evaluation of patients undergoing non-cardiac surgery. Methods: This pilot study used a web-based survey questionnaire to assess resident's knowledge of the 2007 ACC/AHA guidelines through individual steps and corresponding branch point(s) in twelve clinical scenarios. Additionally, residents were asked if they were aware of, or if they had received lectures on ACC/AHA guidelines. Staff anesthesiologists with training in cardiac and intensive care medicine validated the scenarios. Results: A total of 104 resident participants were surveyed including 35 anesthesiology residents, 41 internal medicine residents, 20 surgery residents, and 8 cardiology fellows. Awareness of the 2007 ACC/AHA guidelines by specialty was: anesthesiology (85%), internal medicine (97.6%), cardiology (100%), and surgery (70%). Only 54.3% of anesthesiology, 31.7% of internal medicine, 100% of cardiology, and 10% of surgery residents stated they received lectures. The overall mean score achieved on the eleven scenarios was 50.4% for anesthesiology, 47.0% for internal medicine, 55.7% for cardiology, and 42.3% for surgery. Conclusions: Although the majority of residents were aware of the 2007 ACC/AHA guidelines, fewer received lectures and regardless of specialty, implementation of these guidelines was poor. There exists significant room for improvement in the understanding of preoperative assessment of non-cardiac surgery patients.
    No preview · Article · Jun 2015 · Middle East journal of anaesthesiology