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   2009| July-December  | Volume 3 | Issue 2  
    Online since November 27, 2009

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Neuroanesthesia management of neurosurgery of brain stem tumor requiring neurophysiology monitoring in an iMRI OT setting
Abdulrahman J Sabbagh, Mahmoud Al-Yamany, Reem F Bunyan, Mohamad SM Takrouri, Sabry Mohammed Radwan
July-December 2009, 3(2):91-93
DOI:10.4103/1658-354X.57877  PMID:20532111
This report describes a rare case of ventrally exophytic pontine glioma describing operative and neuroanesthesia management. The combination of intraoperative neuromonitoring was used. It constituted: Brain stem evoked responses/potentials, Motor EP: recording from cranial nerve supplied muscle, and Sensory EP: Medial/tibial. Excision of the tumor was done with intra-operative magnatic resonance imaging (iMRI), which is considered a new modality.
  7,038 807 -
Effect of fluid preloading on postoperative nausea and vomiting following laparoscopic cholecystectomy
Ahmed Turkistani, Khalid Abdullah, Essam Manaa, Bilal Delvi, Gamal Khairy, Badiah Abdulghani, Nancy Khalil, Fatma Damas, Abdelazeem El-Dawlatly
July-December 2009, 3(2):48-52
DOI:10.4103/1658-354X.57872  PMID:20532102
Background: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia. Different regimens have been described for the treatment of PONV with few that mention the prevention of it. Therefore, we conducted this study to compare the effect of preloading with either crystalloids or colloids on the incidence of PONV following laparoscopic cholecystectomy (LC), under general anesthesia. Materials and Methods: This study was carried out on 80 patients who underwent LC. The patients were divided into four groups (each 20 patients), to receive preloading of intravenous fluid, as follows: Group 1 received, 10 ml/kg of low-MW tetrastarch in saline (Voluven TM ), group 2 received, 10 ml/kg medium-MW pentastarch in saline (Pentaspan TM ), group 3, received 10 ml/kg of high-MW heta-starch in saline (Hespan TM ), and group 4, received 10 ml/kg Lactated Ringer's, and this was considered as the control group. All patients received the standard anesthetic technique. The incidence of PONV was recorded, two and 24 hours following surgery. The need for antiemetics and/or analgesics was recorded postoperatively. Results: The highest incidence of PONV was in group 3 (75% of the patients) compared to the other three groups. Also the same trend was found with regard to the number of patients who needed antiemetic therapy. It was the highest incidence in group 3 (70%), followed by group 2 (60%), and then group 1(35%), and the least one was in the control group (25%). Conclusion: Intravascular volume deficits may be a factor in PONV and preloading with crystalloids showed a lower incidence of PONV.
  4,491 719 2
Postoperative analgesia for gynecological laparoscopy
Ben Gibbison, Stephen Michael Kinsella
July-December 2009, 3(2):70-76
DOI:10.4103/1658-354X.57883  PMID:20532107
Gynecological laparoscopy is a commonly performed procedure. Providing anesthesia for this can present a challenge, particularly in the day surgery population. Poor analgesia, nausea, and vomiting can cause distress to the patient and increased cost for the health system, because of overnight admission. In this review we discuss anesthetic and analgesic techniques for day-case gynecological laparoscopy. The principles include multimodal analgesia, the use of the oral route wherever possible, and the contribution of the surgeon.
  3,965 471 3
Anesthesia for subglottic stenosis in pediatrics
Essam A Eid
July-December 2009, 3(2):77-82
DOI:10.4103/1658-354X.57882  PMID:20532108
Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofl uraneor propofol-based total intravenous anesthesia.
  3,870 438 3
Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery
Ahmed Metwally Khattab, Zeinab Ahmed El-Seify
July-December 2009, 3(2):61-66
DOI:10.4103/1658-354X.57878  PMID:20532105
Background and Objectives: The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation. Materials and Methods: Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 μg/ kg. The time of hospital discharge allowance was recorded. Results: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU ( P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM ( P< 0.05). Conclusion: Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.
  3,683 420 6
Taylor's approach in an ankylosing spondylitis patient posted for percutaneous nephrolithotomy: A challenge for anesthesiologists
Parul Jindal, Gaurav Chopra, Amit Chaudhary, Aslam Aziz Rizvi, JP Sharma
July-December 2009, 3(2):87-90
DOI:10.4103/1658-354X.57879  PMID:20532110
We describe a patient with long-standing ankylosing spondylitis who underwent percutaneous nephrolithotomy under spinal anesthesia. At preoperative assessment, it was considered that intubation of the trachea was likely to be difficult. Fiberoptic bronchoscopy was attempted, but without success. As the standard technique for spinal anesthesia failed, a variation of the paramedian approach in the lumbosacral approach, also known as Taylor's approach was successfully attempted. This resulted in adequate sensory and motor blockade for the surgical procedure. The patient did not require airway interventions, but equipment and aids to secure airway were available.
  3,542 309 3
Treatment of perioperative hypertension: Is clevidipine the answer?
Joseph D Tobias
July-December 2009, 3(2):45-47
DOI:10.4103/1658-354X.57871  PMID:20532101
  2,672 448 -
Pre-incisional infiltration of tonsils with dexamethasone dose not reduce posttonsillectomy vomiting and pain in children
Kamran Montazeri, Ahmad Okhovat, Azim Honarmand, Mohammad Reza Safavi, Leila Ashrafy
July-December 2009, 3(2):53-56
DOI:10.4103/1658-354X.57874  PMID:20532103
Background and Objective: Recently, dexamethasone has been found to have a prophylactic effect on postoperative vomiting and pain in children undergoing tonsillectomy. However, few studies have examined the preemptive analgesic effects of dexamethasone after tonsillectomy. The aim of this study was to evaluate the effect of pre-incisional infiltration of tonsils with dexamethasone on the incidence and severity of postoperative pain and vomiting in children undergoing tonsillectomy under general anesthesia. Materials and Methods: In a double blinded study, 62 patients were randomly allocated to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or an equivalent volume of saline at the peritonsillar region. All infiltrations were performed following the induction of general anesthesia and 5 minutes prior to the onset of surgery. Anesthetic agents, end-tidal carbon dioxide levels, and the administration of intravenous fluids were carefully regulated. Surgery was performed by one attending otolaryngologists using the same dissection and snare technique. The incidence of pain and vomiting, need for rescue antiemetics, and analgesic consumption were compared in both groups. Pain scores used included Children's Hospital Eastern Ontario Pain Scale, "faces", and a 0-10 visual analogue pain scale. Results: Demographics of dexamethasone and placebo groups were similar. No statistically significant difference was found between the dexamethasone and placebo groups in pain score, nausea, vomiting, irritability, or analgesic requirement postoperatively. Conclusion: Preincisional infiltration of the tonsils with dexamethasone play a limited role in the recovery phase from tonsillectomy, but further prospective, randomized studies are needed to support it.
  2,715 263 1
Perioperative blood pressure management with clevidipine during coiling of cerebral artery aneurysms
Thomas Meyer, Joseph D Tobias
July-December 2009, 3(2):83-86
DOI:10.4103/1658-354X.57880  PMID:20532109
The tight control of blood pressure (BP) is mandatory during cerebral aneurysm coiling to minimize abrupt changes in the transmural pressure across the aneurysm and thereby decrease the risk of rupture. Critical times during these procedures when significant BP changes may occur include anesthetic induction, endotracheal intubation, and emergence. Clevidipine is a recently introduced, rapidly acting dihydropyridine calcium channel antagonist. Its rapid metabolism by tissue and plasma esterases results in an effective half-life of 1 to 3 minutes. We present our preliminary experience with the use of clevidipine to control BP during the anesthetic care of three patients undergoing coiling of cerebral aneurysms in the interventional radiology suite.
  2,632 240 -
Preoperative oral dextromethorphan does not reduce pain or morphine consumption after open cholecystectomy
Hossein Mahmoodzadeh, Ali Movafegh, Noshin Mosavi Beigi
July-December 2009, 3(2):57-60
DOI:10.4103/1658-354X.57876  PMID:20532104
Background: Dextromethorphan, the D-isomer of the codeine analog levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate (NMDA) receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administered before tissue injury occurs, thus decreasing the subsequent sensation of pain. Materials and Methods: The study was conducted in the Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, between February 2005 and December 2006. In this study, 72 patients scheduled for elective cholesyctectomy were randomized into three groups to receive either oral dextromethorphan 45 mg (Group D45 = 24), dextromethorphan 90 mg (Group D90 = 24), or placebo (Group C, n = 24), as premedication, 120 minutes before surgery. A visual analog scale (VAS) for pain of each patient was measured at arrival in the ward and six and 24 hours after surgery. Results: The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption among the three groups. Conclusion: Dextromethorphan 45 mg and 90 mg, administrated orally, two hours before surgery, had no effect on postoperative morphine requirement and pain intensity.
  2,345 214 -
Criteria of acceptance in the Saudi program of anesthesia and intensive care
Jamal A.A Tashkandi
July-December 2009, 3(2):67-69
DOI:10.4103/1658-354X.57881  PMID:20532106
Background: The scientific congress of Anesthesia and Intensive Care of the Saudi Commission for Health Specialties aims to review and improve the guidelines for the selection process of trainees [1] , a selection process that is based on equal opportunity and upholds the principles of consistency, objectiveness, transparency, and procedural fairness. The study represents a step toward the goal of fostering quality patient care, by adopting a selection process that would result in graduating good, committed, and competent specialists. Materials and Methods: Reports of admission examinations in Jeddah, Riyadh, and the Eastern region have been collected, and they contain detailed lists of names, scores, and percentages of the criteria of admissions, that is, MB BS 25%, General Examination 50%, Interview 25%, and overall score of 100%. Results: Mean MB BS scores, average general examination scores, average interview scores, and average overall scores were not statistically different between candidates from different regions. The leading predictor was the 'Interview Score'. 49.5% of variation in the dependent variable (overall score) could be significantly explained (F = 69.4, P < 0.05) by the independent variable 'Interview Score'. The second predictor was the 'MBBS score'. Conclusion: The three components MB BS, General Examination, and Interview, were significant predictors of the overall score. The leading predictor was the 'Interview Score'. The author recommended that the selection process should be under continuous review. The general interview guide approach is recommended to ensure that the same general areas of information are collected from each interviewer. Questions of a personal or discriminatory nature should be avoided.
  2,017 209 -
Obituary - Omar Tawfik, MB Ch B, MsC, M.D - 1942-2009
Salah N El-Tallawy
July-December 2009, 3(2):94-94
  1,998 170 -
Obituary - Mahmoud Keilani, MB Ch B FRCA - 1939-2009
Mohamed Takrouri
July-December 2009, 3(2):94-94
  1,348 122 -