ABSTRACT
Abstract Background Post-extubation laryngospasm is a dangerous complication that should be managed promptly. Standard measures were described for its management. We aimed to compare the efficacy of propofol (0.5 mg.kg-1) vs. lidocaine (1.5 mg.kg-1) for treatment of resistant post-extubation laryngospasm in the obstetric patients, after failure of the standard measures. Method This study was conducted over 2 years on all obstetric patients scheduled for cesarean delivery. Post-extubation laryngospasm was initially managed with a standard protocol (removal of offending stimulus, jaw thrust, positive pressure ventilation with 100% oxygen). When this protocol failed, the tested drug was the second line (lidocaine in the first year and propofol in the second year). Lastly, succinylcholine was used when the tested drug failed. Results In lidocaine group, 5% of parturients developed post-extubation laryngospasm, 31.9% of them were successfully treated via standard protocol, and 68.1% required lidocaine treatment. Among these, 65.6% of patients treated with lidocaine responded successfully and 34.4% required succinylcholine to relieve laryngospasm. In propofol group, 4.7% of parturients developed post-extubation laryngospasm, 30.1% of them were successfully treated via standard protocol, and 69.9% required propofol treatment. Among these, 82.8% of patients treated with propofol responded successfully and 17.2% required succinylcholine to relieve laryngospasm. Conclusion Small dose of propofol (0.5 mg.kg-1) is marginally more effective than lidocaine (1.5 mg.kg-1) for the treatment of resistant post-extubation laryngospasm in obstetric patients, after failure of standard measures and before the use of muscle relaxants.
Resumo Justificativa O laringoespasmo pós-extubação é uma complicação perigosa que deve ser prontamente tratada. Medidas padrão para o seu manejo foram descritas. O nosso objetivo foi comparar a eficácia de propofol (0,5 mg.kg-1) versus lidocaína (1,5 mg.kg-1) no tratamento de laringoespasmo resistente pós-extubação em pacientes obstétricas após falha das medidas padrão. Método Este estudo foi conduzido ao longo de dois anos em todas as pacientes obstétricas programadas para cesariana. O laringoespasmo pós-extubação foi inicialmente tratado com um protocolo padrão (remoção do estímulo ofensivo, protrusão mandibular, ventilação com pressão positiva com oxigênio a 100%). Ao constatar a falha desse protocolo, o fármaco testado foi a segunda opção (lidocaína no primeiro ano e propofol no segundo ano). Por fim, succinilcolina foi usada quando houve falha do fármaco testado. Resultados No grupo lidocaína, 5% das parturientes desenvolveram laringoespasmo pós-extubação, 31,9% delas foram tratadas com sucesso via protocolo padrão e 68,1% precisaram de tratamento com lidocaína, das quais, 65,6% responderam com sucesso ao tratamento com lidocaína e 34,4% precisaram de succinilcolina para alívio do laringoespasmo. No grupo propofol, 4,7% das parturientes desenvolveram laringoespasmo pós-extubação, 30,1% delas foram tratadas com sucesso via protocolo padrão e 69,9% precisaram de tratamento com propofol, das quais, 82,8% responderam com sucesso ao tratamento com propofol e 17,2% precisaram de succinilcolina para alívio do laringoespasmo. Conclusão Uma pequena dose de propofol (0,5 mg.kg-1) é marginalmente mais eficaz do que lidocaína (1,5 mg.kg-1) no tratamento de laringoespasmo resistente pós-extubação em pacientes obstétricas, após falha das medidas padrão e antes do uso de relaxantes musculares.
Subject(s)
Humans , Female , Adult , Propofol/administration & dosage , Cesarean Section , Laryngismus/etiology , Laryngismus/drug therapy , Airway Extubation/adverse effects , Hypnotics and Sedatives/administration & dosage , Anesthesia, Obstetrical , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Prospective StudiesABSTRACT
Introduction: Laparoscopic sleeve gastrectomy (LSG) as bariatric operation is gaining popularity nowadays. Many studies reported patient surgical outcome after LSG, however little is known about perioperative anesthesia-related complications. In this study we are reporting our experience in an university hospital with perioperative complications and adverse events in morbidly obese patients undergoing LSG. Methods: A prospective cohort study was conducted in Cairo university hospitals. All patients scheduled for LSG during a period of seven months were included. Anesthesia-related complications were reported as well as surgical outcomes. Major anesthesia complications were defined as: intraoperative or postoperative cardiac arrest, failed intubation, postoperative ventilation, and postoperative inotropic support. Possible risk factors for developing perioperative complications were also analyzed using univariate and multivariate analysis. Results: One hundred and fifty patients were included. Mean age was 33±6 years and mean Body mass index (BMI) was 48±6. No major anesthesia related complications were reported. We reported three cases (2%) of surgical anastomotic leakage and four cases (2.6%) of difficult intubation. Regarding minor complications, the most common were intraoperative and postoperative tachycardia (75%), increased plateau airway pressure (75%), and postoperative nausea and vomiting (60%). By multivariate analysis; independent risk factors for respiratory complications are BMI above 50 and STOP-BANG questionnaire score. Conclusion: LSG is done in our center with a low rate of major anesthesia-related complications. Difficult intubation is not common in morbid obese patients. Risk factors for pulmonary complications in this population were BMI above 50 and STOP-BANG questionnaire.
ABSTRACT
Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle. This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery. Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4. Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4. Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.
ABSTRACT
Cephalometry or skull measurement are used in pediatrics, forensic medicine, plastic surgery, oral surgery and diagnostic comprehension between patient and normal populations. Cephalic index is an important parameter for detecting the race and sex of an individual whose identity is unknown. The most important of cephalometric dimension are height and width of head which determine cephalic index. On the basis of cephalic index four head shapes are determined in international categories, that including dolichocephal, brachycephal, mesocephal and hyperbrachycephal. With noticing the lack of documented research about 14-18 years old girls and boys in this area, this study was planned for determining normal range of head shapes in 867girls and 960 boys in the age of 14-18 in fars-Iran. In regards of cephalic index our results showed that dominent type of head in girls was brachycephalic with 42.5 percent and in boys was hyperbrachycephalic with 34.3 percent, rare type of head shape in girls was dolicocephalic with 4.80 percent and in boys was 7.5 percent. There is significant difference between boys and girls cephalic index.
La cefalometría o medición del cráneo se utiliza en pediatría, medicina forense, cirugía plástica, cirugía oral, diagnóstico del paciente y el entendimiento de las poblaciones normales. El índice cefálico es un parámetro importante para la detección de la raza y el sexo de una persona cuya identidad se desconoce. Las dimensiones cefalométricas más importantes son la altura y peso de la cabeza que determinan el índice cefálico. En base al índice cefálico cuatro formas de la cabeza son clasificadas en categorías internacionales: dolicocefálica, braquicefálica, mesocefálica e hiperbraquicefálica. Debido a la falta de información sobre las niñas y niños de 14-18 años, en este ámbito, se planificó el presente estudio para la determinar el rango normal de la forma de la cabeza, en 867 niñas y 960 niños, de 14 al 8 años de edad en Fars, Irán. Los resultados mostraron que el tipo dominante de cabeza en las niñas fue braquicefálico (42,5 por ciento) y en niños fue hiperbraquicefálico (34,3 por ciento). El tipo de cabeza de forma dolicocefálico en niñas en un 4,80 por ciento y en niños en el 7,5 por ciento. Existen diferencias significativas entre el índice cefálico de niños y niñas.