Use of dexmedetomidine as the main anesthetic agent in patients with laryngo-tracheomalacia. A case report

The successful use of Dexmedetomidine as the main anesthetic agent for three pediatric patients with tracheomalacia presenting for different kinds of urgent operations is described. Patients were kept spontaneously breathing without intubation during their whole procedures. Surgical conditions were adequate, and hemodynamic and respiratory profiles were within baseline limits

Surgical emphysema after tonsillectomy in Jordan University Hospital

We report a case of a twenty-year old female patient who got subcutaneous emphysema following tonsillectomy. The patient had general anesthesia, intubation and ventilation air bubbles were noticed intraoperatively by the surgeon; then the patient developed surgical emphysema involving the face, neck and upper chest. Clinical and radiological assessment revealed a previous surgery in emphysema which extend to the anterior mediastinum and anterior chest wall and bilateral axillae with air in the retro peritoneal cavity. Management and follow-up where discussed, and to the best of our knowledge, our case is the first to be published from Jordan

Discomfort, Awareness and Recall in the intensive care - still a problem?

During surgery, anesthetists take extra care to prevent patient awareness done mainly under general anesthesia either by using inhalational or intravenous medications. However, patients in the ICU mainly those on ventilatory support with intubation and sedation, pass through lot of psychological stress and frustration. Most of the times this stress phenomenon is not documented in the general intensive care. This is the first report in our general ICU. Aim of this Study: Assessment of this stress phenomenon in order to avoid it in future, and to elicit proper consensus regarding its existence and offer methods of re-solution. Seventy patients aged [20-60] years were interviewed one day after discharge from the ICU, about their memory of events during their stay. Patients with head injury, CNS infection and those who were disoriented at the time of interview were excluded from the study. The remaining 55 patients were oriented as to place and time. Intravenous morphine was used for analgesia as required, while sedation was achieved using midazolam and morphine infusions in appropriate doses as decided by the attending doctors and nurses, to achieve appropriate Ramsay sedation score. Questions asked were patient's memory of events and their distressing experiences regarding pain, anxiety, dreams, fear, noises, and other discomforts. The same questions were repeated 5 days later. The sample of patients were representative of our regular ICU admissions in their age group, APACHE II score and duration of stay. The most distressing experiences recalled were: Anxiety [68%], discomfort from endotracheal tube [60%], fear [54%], pain [52%], discomfort from N/G tube [48%], difficulty in communicating [33%], dreams and hallucinations [31%], discomfort from physiotherapy [24%], noise [15%], insomnia [13%], thirst [10%], muscle paralysis [100%], some of these like anxiety, fear, dreams, hallucinations and insomnia had continued since discharge in 6% of patients. None of the studied experiences correlated with age, sex or with the APACHE II score. On interviewing the patient 5 days later, there were no significant changes in their responses. Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness. More work is still needed i.e. using sedation measuring systems, to improve our sedation and analgesia in the ICU

Anesthesia apparatus: cuff mate-2, endotracheal cuff inflator and pressure monitor

A digital endotracheal cuff inflator and pressure monitor were tested under clinical conditions on 150 patients in the intensive care Patients were either intubated with endotracheal tubes or had tracheostomies, and were spontaneously breathing or artificially ventilated. Patients were divided into three groups. Group A had the endotracheal tube or tracheostomy cuff inflated randomly by a syringe and tested later by the Cuff Mate. Group B had the cuffs inflated by a syringe till air leak just disappeared on a hand-bagged positive pressure inspiration. Group C had the cuff inflated by the Cuff Mate till air leak just disappeared on a hand bagged positive pressure inspiration. In all three groups, cuff pressure measurement and inflation were done using the Cuff Mate. Higher mean tracheal cuff pressures were recorded in Group A, in comparison with the other two groups, while smaller differences were observed between Group B and C. Using the Cuff Mate to inflate cuffs till no air leak, in addition to simultaneous monitoring of the cuff pressure to prevent excessive cuff pressure, decreases the ischemic damage that is caused by over inflated cuffs. Cuff pressures should be kept below that causing obstruction to the tracheal mucosal blood flow so as to avoid prolonged over inflated cuffs in intensive care patients

Near drowning: a report of 4 cases and review of literature

Four near drowning patients were admitted to intensive care unit [ICU] at Jordan University Hospital [JUH] during the last 3 years [1986-1989]. Their ages ranged between 1-17 years [mean 9 years], 3 were males and one was a female. They were managed in the ICU by hyperventilation, PEEP, muscle paralysis, thiopentone coma and steroids, with monitoring of arterial blood gases and central venous pressure. All recovered completely except one who had neurological deficit. None of the victims had received medical resuscitation at the site of the accident prior to admission, they all arrived by public transport, first aid was performed at the emergency room at our hospital. We believe that first aid at the site of drowning is vital for avoiding the effects of hypoxia

Clinical assessment of propofol anaesthesia in short gynecological surgical procedures: a comparative study with thiopentone

75 patients mean age 24.9 SD 8 years of ASA grade 1, were included in the study from patients who were to undergo minor gynaecological procedures. They were divided into two groups : Group A received propofol and group B received thiopentone for induction of anaesthesia. Blood pressure was recorded before induction, 2 minutes after induction and at three minutes intervals thenceforth recordings. Also respiratory rate was recorded by visual observation. The induction dose and time taken, unwanted events and subjective assessment of quality of induction were recorded, as were the presence and duration of apnoea. Maintenance doses and timing, untoward events such as movement, and a subjective assessment of control of depth of anaesthesia were noted by the anaesthetist. The duration of surgery was recorded together with the time from start of induction to the end of surgery [the anaesthetic time]. Recovery time was measured from the time of closure of nitrous oxide to the time the patient took to recognize the time, date and place which meant complete orientation. Any side effect during recovery were noted as well. And any changes of the cardiovascular system and airway and respiratory system stability were noted. Propofol took longer to render patient asleep, gave more incidence of pain on injection and the patient moved In response to surgical stimulation. On the other hand the patients blood pressure was more stable with less changes

effect of midazolam and succinylcholine on systemic blood pressure and intraocular pressure

The effects of midazolam in a dose of 2.0-0.25 mg/kg body weight followed by succinylcholine in a dose of 1-1.5 mg/kg body weight, were studied during the induction of anaesthesia in 30 patients undergoing non-ophthalmic surgery. There was an increase in the studied parameters one minute after induction. Values started to decline after three minutes, and five minutes after induction the systolic blood pressure and intraocular pressure were both well below their initial values