Value of echocardiography during acute exacerbations of chronic obstructive pulmonary diseas

This study was conducted in the general Intensive Care Unit [ICU], Faculty of Medicine El-Minya University Hospital, to evaluate the value of echocardiography in prediction of the need of mechanical ventilation during acute exacerbations of chronic obstructive pulmonary disease. It included sixty patients who were classified into two groups according to their outcome: Group [1]: included 34 patients, 22 males and 12 females, with a mean age +/- SD of 63 +/- 6.84 years, who required mechanical ventilation [MV] due to failure of conservative treatment Group [II]: included 26 patients, 24 males and 2 females, with a mean age +/- SD of 59.2 +/- 7.95 years, who did not need mechanical ventilation. Right ventricular [RV] end-diastolic and end-systolic dimensions were significantly higher, while E-wave velocity and E/A ratio of tricuspid Doppler flow signal were significantly lower in MV group than CT group. The following echocardiographic parameters had a strong diagnostic predictive value for the need of mechanical ventilation, as evidenced by the ROC curve analysis: RV end-diastolic and endsystolic dimensions, Pulmonary artery systolic pressure, and E/A ratio of Tricuspid Doppler flow signal. On the other hand, right ventricular ejection fraction, left ventricular dimensions and ejection fraction, and E/A ratio of mitral flow, did not have such diagnostic value. For RV end-diastolic dimension, a cut-off value of 27.35 mm had a sensitivity of 82.4% and a specificity of 70% for the diagnosis of the need of mechanical ventilation. For RV endsystolic dimension, a cut value of 21.75 mm had a sensitivity of 82.4% and a specificity of 62%. For pulmonary artery systolic pressure, a cut-off value of 36.6 mmHg had a sensitivity of 82.4% and a specificity of 70%. For E/A ratio of tricuspid flow, a cut value of 0.894 had a sensitivity of 94% and a specificity of 70%. We may conclude that, the following echocardiographic parameters have strong diagnostic predictive value and may be used for prediction of the need of mechanical ventilation during acute exacerbations of COPD: Right ventricular end diastolic and end systolic dimensions, E/A ratio of tricuspid Doppler flow signal and pulmonary artery systolic pressure

Prevention of postanesthetic shivering using nefopam and clonidine, a double-blind, placebo controlled study

Recovery from anesthesia is frequently accompanied by shivering [incidence up to 65 percent]. Post-anesthetic shivering [PAS] can exacerbate postoperative pain and also may induce many complications. Intraoperative hypothermia is the major risk factor from postanesthetic shivering, but shivering can occur in patients who are normothermic at the end of surgery. Various drugs and maneuvers were used to reduce or stop PAS. The aim of this study is to evaluate the effect of nefopam, and clonidine as inhibitors of PAS in comparison with placebo. Sixty patients of both sexes, ASA 1 and II. aged 17 to 60 years were scheduled for elective surgical procedures under general anesthesia. All patients received, midazolam [premedication] 0.04 mg/Kg. Then fentanyl [1 micro g/Kg], Thiopental [5mg/Kg] and atracurium [0.5 mg/Kg], endotracheal intubations, controlled ventilation with a mixture of isoflurane [1.1-2 percent] and N[2]O 60 percent in oxygen. End-tidal CO2 is kept at 30-35 mmHg. Warmed i.v. solutions were not used and patients were not actively warmed. Temperature was monitored by the use of nasopharyngeal thermocouple probe and temperature registered at 15 min, 30 min, and 60 min after exctubation. At the end of surgery, using a double-blind random protocol patients given either saline 0.9 percent [placebo], nefopam, 0.15 mg/Kg [nefopam group] or clonidine, 1.5 micro g/Kg [clonidine group]. Post anesthetic shivering [PAS] was assessed at 5 min.,15 min., 30 min and 60 min after extubation using 5-point scale. Recovery time, H.R. Mean arterial blood pressure and oxygen saturation are also assessed. The incidence of post-anesthetic shivering was lower in nefopam group [10 percent], and in clonidine group [20 percent]. than in placebo group which was about 75 percent. Recovery time was prolonged in clonidine group [12.2 min], than in nefopam group [7.9 min], while in placebo group it was 6 min Nefopam and clonidine are both effective for prevention of PAS but nefopam may be a better drug to use than clonidine

Effect of thiopental and succinylcholine on serum potassium concentration in children undergoing surgery

The effect of thiopental and succinylcholine on serum K[+] concentration in children undergoing surgery was studied in 90 medically free, children undergoing a variety of elective surgical procedures for which general anaesthesia was required. Patients were classified according to their ages into 3 groups each of them contains 30 patients. Furtherly, each group was divided according to the anaesthetic technique into 2 subgroups each contains 15 patients. This study was undertaken to compare the effect of thiopental without a muscle relaxant and the use of thiopental and succinylcholin on serum potassium concentrations in medically free children undergoing elective surgeries. It was found that, thiopental alone produces a significant decrease in serum K[+] levels in all groups of patients regardless their ages. And the use of thiopental before succinylcholine also produces a significant decrease in serum K[+] to a level below the control level in groups I and II, but in group III of patients there was non significant changes in serum K[+] after the use of thiopental and succinylcholine