Congenital arhinia

Congenital arhinia is a rare condition described as the absence of the nose at birth. It is a lifethreatening condition if not managed properly. Due to its low incidence, not much is understood about the condition. We report a case of congenital arhinia diagnosed antenatally and managed in the Neonatal Intensive Care Unit [NICU]. The case was diagnosed at 27 weeks of gestation when fetal ultrasound revealed absence of nasal bones. At birth, the baby was in respiratory distress and required oral intubation followed by elective tracheostomy

trial to optimizing the values of positive end expiratory pressure to the dependent lung for patients undergoing video-assisted thoracic surgery during one-lung ventilation

This prospective, randomized, controlled study evaluated the effects on oxygenation by applying a selective and patient-specific value of positive end-expiratory pressure [PEEP] to the dependent lung during one-lung ventilation [OLV]. Forty patients undergoing video- assisted thoracic surgery for sympathectomy [VATS] under combined epidural general anesthesia were randomly allocated to receive the preventive application of PEEP, optimized on the best thoraco-pulmonary compliance [group PEEP, n=20], or zero PEEP [group ZEEP, n=20]. Mechanical ventilation was the same setting to all patients of both groups during two- and one-lung ventilation [FIO[2]= 0.5; VT=9 ml/kg, inspiratory: expiratory =1:1, inspiratory pause = 10%]. In this study the Lung-chest wall compliance decreased in both groups during one-lung ventilation, but patients of group PEEP had higher values than patients with no end-expiratory pressure [ZEEP] applied- group ZEEP [at 10minolv and 60 minolv, P<0.05]. During closed chest OLV, the PaO[2] / FiO[2] ratio was similar in the two study groups. After the start of VATS by 10 mm Pa[2]O/FiO[2] ratio was lower in group PEEP than in group ZEEP [P<0001], thereafter, the Pa[2]O/FiO[2] ratio significantly increase in the patients of group PEEP [P<0.0001] at 30 and 60 min after the start of VATS. No differences were reported between the two groups in the need for 100% oxygen ventilation [P=0.60] or re-inflation of the operated lung during VATS [P=0.78]. In conclusion, the selective application of PEEP to the dependent, non-operated lung increases the lung-chest wall compliance during one-lung ventilation, and could improve the patient oxygenation

Double-blind randomized controlled trial for co-administration of N-methyl D-aspartate receptor antagonists with intravenous patient controlled morphine for postoperative pain management

This double-blind randomized controlled trial evaluated the efficacy of co-administration of two N-methyl D-aspartate [NMDA] receptor antagonists: magnesium sulphate and ketamine hydrochloride with i.v. morphine patient controlled analgesia [IVPCA], as regard the improved analgesic efficacy and lower pain scores compared with morphine patient- controlled analgesia alone after elective thoracotomies. Seventy-five patients were all randomized allocated to receive, by patient controlled i.v. analgesia either morphine 0.4 mg/ml alone [group I], 0.4 morphine mg/ml with magnesium sulphate 30 mg/ml [group II], or morphine 0.4 mg/ml with ketamine hydrochloride 1 mg/ml [group III]. Postoperative analgesia was started when verbal rating scale was >/= 2. Patients were first given a standardized loading dose [0.05 mg/kg[-1]] of the study solution. They were then allowed to use bolus doses of this solution [0.0125 mg/kg[-1] with lockout interval 20 min without time limit or background infusion]. Pain scores, sedation, discomfort, cumulative morphine consumption and adverse effects were recorded up to 24 h after the start of patient-controlled analgesia. The level of discomfort, level of sedation and verbal rating scores decreased significantly with time in all groups [P<0.05]. Both verbal rating and discomfort scores were significantly lower in groups II and III at 15, 30 and 60 min compared with group I [P< 0.001]. Cumulative morphine consumption after 12 and 24 h was significantly higher in group I [median 29 and 50 mg, respectively] compared with group II [22 and 43 mg] and group III [23 and 44 mg]. In conclusions, the combination of NMDA receptor antagonists [magnesium sulphate or ketamine hydrochloride] and morphine delivered via IVPCA is safe and effective means of providing immediate postoperative analgesia, and significant lower morphine consumption with less side effects than morphine alone

Double-blind randomized comparison of epidural co-analgesics on the postoperative analgesic consumption

Pain mediators are responsible for the peripheral and central sensitization. Preempetive treatment will prevent the establishment of hypersensitivity by blocking the sensory input that induces the central sensitization. This prospective double blind study was carried out on 45 adult patients who underwent upper abdominal operations. All patients were assigned into 3 groups according to the drug injected epidurally. [Plain bupivacaine [group I], Ketamine + plain bupivacaine [group II]. and clonidine + plain bupivacaine [group III]],. 15 minutes before the general anesthesia. The purpose of this study was to evaluate and compare the effects of epidural ketamine and clonidine as co-analgesics on postoperative analgesic consumption for upper abdominal surgery Measurements for efficacy of preemptive analgesia evaluated by visual analogue scale [VAS] and Prince Henry score [PHS]. sedation score, mood state, cumulative postoperative analgesic consumption and the time of the first need of fentanyl Monitoring of vital signs and recording of possible side effects were performed on the postanesthesia care unit VAS was significantly less in group III at most times of measurements until 2 hr postoperatively. PHS showed less significant reading in groups I and III compared to group II at 15 min and 6 hr postoperatively. Sedation score was significantly higher in group III compared to group II, I and II at 15, 30 min. respectively. Mood score was significantly high in group II and III. No significant side effects and respiratory rate, oxygen saturation, and ECG were within normal range in the three groups. The total amount of fentanyl requirements in the first 24 hrs postoperatively was significantly less in group III compared to group I and II. The time of first need of fentanyl was't changed significantly between the three groups. In conclusion the preemptive analgesic effect of epidural clonidine combined with plain bupivacaine with lack of vcnak ventilatory effects makes clonidine a potenlially useful drug for the reduction of postoperative narcotic consumption or in other words for the postoperative pain management