Middle East Journal of Anesthesiology最新文献

Background: We conducted this prospective controlled observational study to compare the effect of ethnicity on the risk of postoperative nausea and vomiting (PONV) between moderate to high-risk African and non-African patients undergoing general anesthesia.

Methods: Using Apfel score risk factors and predicted length of surgery (>30 minutes), 89 moderate to high risk patients undergoing general anesthesia were recruited in a university hospital between March 2009 and November 2010. Thirty patients in the non-African group and 59 patients in the African group were allocated using an ethnicity self identification questionnaire. Intraoperative anesthesia was standardized. PONV was assessed at 0 minutes, 15 minutes, 90 minutes, 180 minutes, and 24 hours. Generalized linear mixed effects models was used to determine the effect of ethnicity on PONV.

Results: Despite similar Apfel scores, cumulative incidence of postoperative nausea was higher in the non-African group at 0 minutes (46.67% vs 22.03%, P = 0.019), 15 minutes (70% vs 23.73%, p<0.001) and 90 minutes (36.67% vs 16.95%, P = 0.04). The non-African group had more episodes of vomiting over 24 hours (13.33% vs 1.69%, P = 0.055). Non-Africans had a 25 times higher reported nausea incidence than Africans over 24 hours.

Conclusion: The incidence of PONV in non-Africans is significantly higher than in Africans. Non-African ethnicity is an independent risk factor for PONV. Current risk prediction models may be limited in multi-ethnic populations and further investigations are warranted to examine ethnicity as a risk factor.

Study Objective: To study the effects of circuit leak development over time and response during volume and pressure controlled ventilation using low flow in human patient simulator and to examine the minimum fresh gas flow needed to compensate for such a leak.Design/Setting: Prospective study using a patient Simulation Lab at Wayne State University.Measurements: A human patient simulator was endotracheally intubated. The endotrachealtube (ETT) was connected to the Datex-Ohmeda AS/3 Anesthesia machine. The tidal volume wasset to 500ml in the volume controlled trial and the pressure to 6cm H2O in the pressure controlledtrial. A hole was created in each experiment placed 10 cm after the inspiratory valve. Leaks weresimulated from holes using 4 different needle diameters: 25, 21, 18 and 16G. A series of data werecollected using fresh gas flow at 4 different flow rates (0.5, 1, 1.5 and 2 liters.min-1). Data wasmeasured at different time points (baseline, 1, 3 and 5 minutes) in the series of simulated leakingbreathing circuits.Results: Leak alarms were only detected with 16G hole at 5 minutes in the volume controlmode versus leaks at 3 minutes with 16G hole and at 5 minutes with 18G hole in the pressurecontrol mode.Conclusion: When a very low flow of 0.5 L/min is used, volume control is safer than pressure control modes.

Background: Fiberoptic bronchoscopes might be vital for the safe performance of difficultendotracheal intubations. However, many hospitals in low or middle-income countries are unableto afford the equipment. We describe the use of a flexible fiberoptic cystoscope, as an alternativeto a bronchoscope, for difficult nasoendotracheal intubation in patients with temporomandibular joint ankyloses.

Methods: Eight Jordanian patients (five females and three males) with severe restriction ofmouth opening, due to ankylosis of the temporomandibular joint, underwent awake nasoendotrachealintubation using a flexible fiberoptic cystoscope under local anesthesia.

Results: The procedure was successful and well tolerated in all eight patients.

Conclusion: A flexible cystoscope can be a successful alternative to a flexible bronchoscope,for difficult nasoendotracheal intubation in hospitals at rural areas in low-or middle-income countries with limited financial resources.

Healing hospitals have evolved into business companies (institutions). Therefore, the need arises to evaluate the care rendered not only for the sake of adequacy of healing among patients but also for the sake of self-promotions to ensure returning customers. This letter brings forth ourpost-hoc objective method that can be an answer and/or replacement to pre-hoc subjective scoring of services by Net Promoter Score® or The National Health Service Friends and Family Test. Both the abovementioned scores work on the flawed avenue based on the satisfaction perceivedimmediate post-care/service by consumers (employees or patients). The reason for this flaw is that these scores do NOT look into whether the scored satisfactions and consequent presumptions actually shape into direct reality for the evaluated institutions. Herein our SPQ: Self PromoterQuestionnaire or SPEC: Self Promotion Evaluator Collector comes in handy. This yet to be validated objective assessment of institutions definitely looks encouraging.

Objective: To evaluate the analgesic effect of preprocedural flurbiprofen axetil on rigidcystoscopy-associated pain for men.

Methods: Fifty-two men scheduled for cystoscopy were recruited in this study. The effectsof oxybuprocaine jelly alone or in combination with preprocedural flurbiprofen axetil, werecompared. The pain intensity was assessed using visual analogue scale (VAS) scores duringinjecting oxybuprocaine jelly into the urethra, during inserting rigid cystoscope into the urethra,during viewing inside the urinary bladder, at the first urination after cystoscopy and at the firsturination on the following morning at home.

Results: VAS scores with preprocedural flurbiprofen axetil were significantly lower ascompared with the control group at the time periods of inserting rigid cystoscope into the urethra,viewing inside the urinary bladder, the first urination after cystoscopy and at the first urination onthe following morning at home. No side effects associated with flurbiprofen axetil were observed.

Conclusion: Preprocedural flurbiprofen axetil can decrease cystoscopy-associated pain.

Context: Circumcision is one of the most common surgical procedures in pediatric males.Anesthesia is often the classic dorsal penile nerve block (DPNB), which is based on landmarkidentification and tactile feel of tissue resistance during needle advancement. However, thistechnique is associated with technical failures and vascular complications.

Objective: We used an ultrasound-guided in-plane technique to avoid injury of penilevascular and neural tissues during DPNB. The aims of this retrospective study were to compare thesuccess rate and efficacy of these two penile block techniques.

Methods: Male pediatric patients undergoing circumcision received general anesthesiabefore the penis and surrounding area were prepared with 0.5% chlorhexidine in 70% alcohol.Sixteen patients underwent classic DPNB, and 16 underwent the modified ultrasound-guided inplanetechnique. The ultrasound machine was adjusted to the musculoskeletal setting, and a linearultrasound probe with a frequency range of 5 to 10 MHz was placed transversely along the base of the penis, which received gentle traction.

Results: Though not statistically significant, patients who underwent the classic DPNB wereapproximately 1.8 times more likely to require rescue analgesia and approximately 2 times morelikely to have a complication than those in the ultrasound-guided group. Results also showed lowervolume requirements for local anesthetic and intraoperative narcotics, longer time until rescueanalgesic, and lower incidence of vomiting in the ultrasound-guided group than in the landmark-guided group.

Conclusions: The ultrasound-guided DPNB technique appears to offer advantages overclassic DPNB and warrants a prospective controlled trial to confirm these findings.