Middle East Journal of Anesthesiology最新文献

Background: Preoxygenation before anesthetic induction is a widely accepted maneuver toincrease oxygen reserves and delay desaturation during apnea. There is limited data regarding theuse of the NuMask® in the perioperative setting, and no data as to its efficacy in achieving maximalpreoxygenation. We hypothesize that the NuMask® may be a useful alternative to the face mask inachieving maximal preoxygenation.Methods: After IRB approval, the NuMask® was compared with the classic face maskwith respect to achieving maximal pre-oxygenation in 30 healthy volunteers using tidal volumebreathing. All volunteers were tested for three periods of 5 minutes intervals and the followingparameters were recorded every 30 seconds: inspired, and end-tidal oxygen concentration and endtidalcarbon dioxide concentration.Results: The mean ETO2 of ≥90% was achieved with both masks at 3.5 minutes (SD =1.62 and 1.98 for facemask and NuMask® respectively) and thereafter the ETO2 remained above90%. There were no statistical differences noted in FiO2 and ETO2 between the face mask and theNuMask® in the same time periods. ETCO2 values were also not statistically different between thetwo masks.Conclusions: The study showed that the NuMask® is as effective as the classic face mask inachieving maximal pre-oxygenation during tidal volume breathing.Introduction

Introduction: Hepatic ischemia-reperfusion (I/R) injury is commonly observed in severesepsis, hemorrhagic shock, liver transplantation, hepatic resection, and major trauma. Ketaminesuppresses the production of cytokines, such as IL-6 and TNF-α, via NF-κB inhibition. Weinvestigated the anti-inflammatory effects of ketamine in liver I/R injury.

Materials and methods: Female Wistar-Albino rats (n = 18), weighing 150-200g, weredivided into three groups (n = 6 each). Group I underwent reperfusion for 4h following 30 minof ischemia. Group II received 2.5 mg/kg ketamine IM following 30 min of ischemia and 4h ofreperfusion and Group III received 10 mg/kg ketamine IM following 30 min of ischemia and 4h ofreperfusion. Blood samples were obtained before and after ischemia and reperfusion. MDA, AST,ALT, TNF-α, IL-1β, IL-6, and NO levels were determined. Liver tissue samples were evaluatedhistologically.

Results: Increased TNF-α, IL-1β, and IL-6 levels were observed in all groups post-ischemiaversus pre-ischemia (p <0.05). The TNF-α, IL-1β, and IL-6 levels in Group III increased less thanthey did in Groups I and II (p <0.05). Higher MDA, NO, AST, and ALT levels were found duringthe ischemia and reperfusion periods compared with during the pre-ischemia period in all groups (p<0.05). The MDA, NO, AST, and ALT levels of rats that received ketamine increased less than didthose of Group I (p <0.05). Significantly less injury was observed in the histopathological analysisof livers of rats administered ketamine (p <0.05).

Conclusions: Ketamine showed a dose-dependent anti-inflammatory effect in I/R injury inthe liver when administered after ischemia.

Ludwig’s angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, securing the airway, and formal surgical drainage of the infection. Awake fiberoptic intubation under topical anesthesia may be the preferred method to secure the airway. Flexible nasotracheal intubation requires skill and experience. When fiberoptic bronchoscopy is not feasible, not available, or has failed, an elective awake cricothyrotomy and tracheostomy are the options. Furthermore, the introduction of newer advanced airway techniques, such as video-assissted laryngoscopy, may allow the clinician additional flexibility in nonsurgical airway management. We present a recent case of a patient with Ludwig’s angina, successfully managed at our hospital, with a brief review of airway management options.

Background: Background: The nature of massive mass gathering during Hajj was expected to provide achallenging and stimulating working experience for anesthesiology training program residents. Annew rotation arrangement was reached between the Ministry of Health and the Saudi Commissionof Health Specialties to recruit anesthesia resident to provide critical care services during the Hajjseasons in 1434 and 1435.

Objectives: This study aimed to explore the perspectives of anesthesia residents on theirexperience working among critical care teams during Hajj seasons in 1434H and 1435H at variouslocations of Makkah city and Al-Mashaer.

Subjects and methods: This cross-sectional study was conducted using a self-administeredquestionnaire distributed to all residents (n = 35) enrolled in anesthesia residency training programof the SCFHS and participated in critical care areas as locum during the Hajj seasons of 1434H and1435H. Data was analyzed by using the statistical package of social science.

Results: The mean score of residents agreement on being treated with respect from bothnurses and administration was the highest among the surveyed item (6.13 and 6.22 respectively). Itwas observed that, satisfaction of the residents with the direct observations and feedback providedto them (p = 0.01), the adequacy of the services components (p = 0.01) being treated with respectby the senior doctors and nurses (p = 0.03, p = 0.002) was significantly increased in the year 1435compared to that of the year 1434. The satisfaction was generally higher in Makkah hospitals whencompared to that of Al-Mashaer (Arafat and Menna) hospitals although this difference was of no statistical significance.

Conclusion: Hajj critical care rotations in 1434 and 1435 were well perceived by anesthesiaresidents. They found them useful as they give them the chance to gain self-confidence andexperience the provision of healthcare services for mass gathering sessions.

Objective: To evaluate the effectiveness of inducing acute hypertension during laparoscopicovarian cystectomy on postoperative nalbuphine analgesic requirements.

Methods: The total dose of nalbuphine used in the hypertension group was significantly lowerthan that in the control group (p <0.001). The VAS score was significantly lower in the hypertensiongroup on arrival to PACU and during the period between 1 and 6 hours postoperatively.

Results: The total dose of nalbuphine used in the hypertension group was significantly lowerthan that in the control group (p <0.001). The VAS score was significantly lower in the hypertensiongroup on arrival to PACU and during the period between 1 and 6 hours postoperatively.

Conclusion: This study demonstrates that pharmacologically induced mild acuteintraoperative hypertension significantly reduces postoperative nalbuphine consumption and painscores following laparoscopic ovarian cystectomy. Trial registration in Pan African Clinical TrialRegistry: identification number for the registry is PACTR201508001247179.

Abstract: The design of the endotracheal tube might be an important factor in the incidence of injurious complications during nasotracheal intubation.

Aim of the work: Primary aim: to compare the parker flex tip (PFT) and the preformed nasal(PNT) tubes regarding the ease of insertion during nasotracheal intubation in children undergoingadenotonsillectomy. Secondary aim: to verify the incidence of traumatic complications of bothtypes of tubes during nasotracheal intubation in children undergoing adenotonsillectomy.

Patients and methods: 100 patients aged between 4 and 10 years ASA physical status I-IIscheduled for adenotonsillectomy were divided into two groups; Group PFT: Patients were nasallyintubated using the parker flex-tip endotracheal tube, Group PNT: Patients were nasally intubatedusing the preformed nasal tube. Ease of insertion of the ETT, degree of trauma and the time ofintubation was measured.

Results: ETT was easily inserted without any resistance in 24% of patients of the PFT groupversus 12% of patients in the PNT group. ETT could not be passed through the right or left nostrilsin 20% of patients of the PNT group relative to only 4% of patients of the PFT group. Incidence oftrauma to the nasal mucosa was significantly higher in patients of the PNT group than patients ofthe PFT group. Duration of intubation was statistically significantly longer among patients of thePNT group than patients of the PFT group.

Conclusions: It seems that the flexible tapered tip of the PFT tube has led to easierinsertion through the nasal passages as well as less trauma to the nasal mucosa in children havingnasopharyngeal pathology in the form of adenoids. At the same time, the duration of intubation wasless in the PFT group relative to the control group in spite of the more familiarity of the investigatorwith the standard portex tube.

Background: Postoperative pain management is a critical concern in pediatric surgery. Acetaminophen is the safest and most widely used analgesic in children. The present study compared the analgesic efficacy of intravenous (IV) and rectal acetaminophen versus placebo in children undergoing inguinal herniorrhaphy.

Methods: A total of 120 children, who were candidate for elective surgical repair of unilateral inguinal hernia, were enrolled and randomly allocated to four groups of 30 patients each to receive IV acetaminophen, acetaminophen suppository, IV placebo, and placebo suppository during surgery. Postoperative pain scores, measured on the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, were recorded and compared.

Results: The four groups had no significant differences in the mean age, weight, length of stay in the recovery room, and duration of operation. The frequency of postoperative vomiting was significantly lower in the IV and rectal acetaminophen groups compared to the two placebo groups (P = 0.04). The mean pain scores of the two acetaminophen groups were similar during the first two hours after surgery. These scores were significantly lower than the scores of the placebo groups. However, the four groups were not significantly different in terms of pain scores at the fourth, sixth, and 12th postoperative hours. During the first hour after surgery, IV acetaminophen had the largest analgesic effect. Moreover, among all four groups, the IV acetaminophen group had the highest sedation level in the recovery room.

Conclusion: Both IV and rectal acetaminophen were more effective than placebo in pain relief after inguinal hernia repair in children. They were also associated with lower frequencies of postoperative vomiting. The greatest analgesic efficacy of both forms was observed during the first two hours after surgery.

Skin reactions following the application of electrocardiography (ECG) electrodes have been reported in adults and children, and are postulated to result from contact with the conductive gel or adhesive used on the electrodes. Although contact dermatitis is the usual cause of such reactions, contact depigmentation or hypopigmentation may also occur. We report a case of hypopigmentation in a healthy boy following continuous electrocardiography monitoring during general anesthesia for dental rehabilitation.