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  Citation statistics : Table of Contents
   2015| September-December  | Volume 9 | Issue 3  
    Online since December 29, 2015

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Conservative management of a case of transesophageal echocardiogram-induced esophageal perforation
Mostafa ElAdawy, Deirdre Timon
September-December 2015, 9(3):49-53
Esophageal injury or perforation is a rare but life threatening complication of transesophageal echocardiography (TEE). Most of the patients manifest symptoms within 24 hours of the procedure and upper esophagus is the most common site of injury. Incidence of esophageal perforation is relatively rare, in a large series of 10,000 cases of TEE, the incidence of esophageal perforation was reported in 3 cases (0.03%) and in another study it was found to be 1 in 5,000 TEEs, 0.02%. This is a case report that highlights a case of esophageal perforation and false passage discovered accidentally 24 hours postoperatively, in contrast to most of the previous esophageal perforation case reports, a conservative management was undertaken successfully since the discovery of the complication until the full recovery and the discharge of the patient from the cardiac ICU, a follow up upper gastrointestinal endoscopy and CT chest showed progressive resolution of the hematoma surrounding the esophagus, healing of the false passage and recovery of the mediastinal gas locules.
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Anaesthetic management of primary repair of complete right bronchial rupture following blunt chest trauma
Santosh , Saiyed Anjum, Meena Reema, Chand Kishan Vyas
September-December 2015, 9(3):46-48
Tracheobronchial injury is a rare incidence after blunt trauma injury. Isolated complete bronchial tear is very rare. If it is not managed properly and timely, it can lead to significant morbidity and mortality. Clinical manifestations of tracheobronchial injury include persistent pneumothorax, subcutaneous emphysema, pneumomediastinum and respiratory insufficiency. Anaesthesiologists face challenges while securing the airway, controlling oxygenation, managing one-lung ventilation and maintaining anaesthesia during airway surgery. The preferred airway management technique is to intubate the healthy bronchus with a single-lumen or double-lumen endotracheal tube. We report successful anaesthetic management of complete traumatic rupture of the right main bronchus at the carina in adult male patients by using a left-sided double-lumen endotracheal tube. After induction, right thoracotomy was performed and bronchial transection was repaired successfully. Early correct diagnosis and proper repair can lead to excellent outcome.
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Anesthesia for high-risk patients undergoing percutaneous mitral valve repair with the MitraClip system in the catheterization laboratory
Rabie Soliman, Reda Abuel Atta
September-December 2015, 9(3):33-38
Background MitraClip system implantation is a new technique for high-risk patients with severe mitral regurgitation and patients risky for surgical repair or replacement of mitral valve through cardiopulmonary bypass. Aim The aim of this study was to evaluate the anesthetic experience in high-risk patients undergoing MitraClip implantation. Setting Madinah Cardiac Center, Saudi Arabia. Patients and methods The study included 34 patients scheduled for MitraClip implantations in the catheterization laboratory. An arterial line and a central venous line were inserted before induction. Epinephrine was started before induction and milrinone infusion was started after induction. The anesthetic technique for induction and maintenance was the same for all patients. Monitors included the heart rate, the arterial blood pressure, the central venous pressure, arterial blood gases, the temperature, and the urine output. Results All patients were hemodynamically stable intraoperatively and postoperatively. The intervention was successful in 33 cases and aborted in one case because of severe posteromedial leaflet tethering. Epinephrine and milrinone were weaned, and all patients were extubated, except for one mortality case that happened within the first 8 h postoperatively. Conclusion Percutaneous mitral valve repair with MitraClip implantation is a successful alternative in high-risk patients with symptomatic severe mitral regurgitation. Proper preoperative evaluation of the patients by an anesthetist and a cardiologist is very important. Starting epinephrine before anesthetic induction and milrinone infusion after induction resulted in a decreased pulmonary artery pressure, an increased ejection fraction, and maintained the arterial blood pressure during the procedure.
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The dual mode of ventilation 'pressure-controlled ventilation-volume guaranteed' does not provide anymore benefit in obese anesthetized patients
Mohamed A El-Ramely, Ahmed Abdelaal Ahmed Mahmoud, Mohamed M Abdelhaq
September-December 2015, 9(3):39-45
Background Ventilatory strategies aim at the prevention of atelectasis and the improvement of oxygenation, but yet none is optimal. On comparing pressure-controlled ventilation (PCV) with volume-controlled ventilation (VCV) with the same tidal volume and inspiratory time, PCV tends to produce higher mean airway pressures, and thereby improves oxygenation. However, volume-targeted ventilators (VTV) allow to set the tidal volume directly. In order to deliver that volume. We compared PCV and pressure-controlled ventilation volume guaranteed (PCV-VG) with regard to the airway pressures produced when aiming to achieve the same tidal volume. Patients and methods Thirty obese ASA I-III patients scheduled for abdominal surgery were ventilated with PCV for 45 min; then, the PCV-VG mode was applied to all patients with the same parameters, targeting the same tidal volume of conventional PCV during the first phase. The plateau pressure and the mean airway pressure were recorded and compared between both modes. Vital signs, EtCO 2 , SpO 2 , arterial blood gases, and the oxygenation index were compared. Results No difference was observed between both modes of ventilation in terms of the plateau airway pressure (34.2 ΁ 1.8 vs. 34.1 ΁ 2.9 cmH 2 O, P = 0.484) and the mean airway pressure (13.4 ΁ 1.6 vs. 13.2 ΁ 1.8 cmH 2 O, P = 0.326). No significant difference was observed between PCV and PCV-VG with regard to the hemodynamics, EtCO 2 , and SpO 2 . No significant change was observed in the arterial blood gas analysis including pH (7.39 ΁ 0.3 versus 7.4 ΁ 0.2 with P value 0.204), PaCO 2 (30.8e 0.204) change in 0.2 with P value 0.06), PaO 2 (155.8 0.06)) change in0.2 with blood P value 0.316) and oxygenation index (4.34 oxygenation index.2 with bP value 0.176). Conclusion No significant difference was observed between both modes of ventilation (PCV vs. PCV-VG) in obese patients.
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