Anesthesia for thoracic surgery: a survey of middle eastern practice

The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern [ME] region. A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic- anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation [OLV], anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Volume-controlled ventilation was favored over pressure-controlled ventilation [62% vs 38% of respondents, P < 0.05]; 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube [DLT] as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker [BB] in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques [P < 0.05]. Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice

Effect of bispectral index [BIS] monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding

Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index [BIS] monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevofLurane administered while providing an adequate anesthesia. Thirty morbidly obese ASA I and II patients undergoing laparoscopic gastric banding [LAGB] procedures were studied. In the first group [15 patients], patients were anesthetized without the use of BIS [non BIS or control group], and sevoflurane being administered according to standard clinical practice [control group]. In the second group [15 patients], sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min prior to the end of surgery [BIS group]. Recovery times were recorded. Time to extubation was also noted, as well as the time to achieve a modified Aldrete score of 9 were evaluated subsequently at 10-min intervals until 3 h after surgery by nurses who had no knowledge of the study. Sevoflurane consumption was calculated using the vaporizer weighing method. Awakening and extubation times were significantly shorter in the BIS group [P <0.05]. In the BIS [vs. non BIS] group, there were no significant differences observed in the time to obtain an Aldrete score of 9. The sevoflurane consumption and cost in the BIS group were lower than in the non BIS group [P <0.05]. Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption

Effect of hydroxyurea in children with sickle cell disease in Saudi Arabia

The objective of this study is to demonstrate the effects of hydroxyurea in children with sickle cell disease at Madina Maternity and Children's Hospital and to evaluate its short term safety. This was a retrospective review over two years period from 2004 - 2006. The inclusion criteria were: Children with sickle cell disease who had three or more attacks of painful crisis per year Children with sickle cell disease who had two or more episodes of acute chest syndrome per year. The dose range of Hydroxyurea was 15 - 30 mg/kg/day. The clinical episodes and the laboratory investigations were monitored monthly. The total patients included initially were 14; 4 patients were excluded because of poor compliance to treatment. 10 patients were eligible for the study. 6 were male and 4 were female. 8 patients were Saudi and 2 patients were non Saudis. The age range was 5 - 15 years. The attacks of painful crisis and acute chest syndrome were significantly reduced after Hydroxyurea treatment, also laboratory investigation showed significant increase in MCV and Hemoglobin F values after Hydroxyurea. We conclude that Hydroxyurea is effective in children with sickle cell disease and had no major short term adverse effect. However long terms follow up is required to evaluate long term adverse effect