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Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons
Walid Youssef Youssef Kamel,
Amr Mohammed Hilal Abdou,
Eman Mohammed Kamal Aboseif
Issue:
Volume 7, Issue 2, December 2019
Pages:
31-36
Received:
29 July 2019
Accepted:
3 September 2019
Published:
16 September 2019
DOI:
10.11648/j.ijacm.20190702.11
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Abstract: Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provides anaesthesia of the airway from the infraglottic area to the epiglottis. Additional topical application of local anesthetic to the oral, along with appropriate sedation, by fentayl and propofol provides satisfactory analgesia for endoscopic procedures The glossopharyngeal nerve (i.e., cranial nerve IX) supplies sensation to the posterior third of the tongue, the pharynx, and the superior surface of the epiglottism. Methods: The level of sedation was recorded using Ramsay sedation score. The time of the block, duration of the procedure were also recorded. Arterial blood gases (ABG) was withdrawn after the beginning of the procedure and by the end of the procedure and recorded, event of desaturation as well, The operator and the patients’ satisfaction were also assessed. After the end of the procedure the patients were admitted to recovery room till gag and cough reflexes regained and by the time the patients were reporting that they became no more feeling numbness, clear fluid were started. Results: The mean Duration of procedure, Time of block and Amount of sedation was 44.7±24.06 min, 15.2±3.05 min, and 18.9±10.2 ml respectively. tracheal biopsy was the most common procedure done (40%). In all the patients the Ventilation were Spontaneous and Stable all through the procedure. Arterial blood gases were normal in all the cases. no statistical significance between the depth of the sedation and patients satisfaction but there was statistical significance between the level of the sedation and the operator satisfaction. The mean recovery time from the end of the procedures till the patients fully awake, and hospital stay was 3.5±2.6 min, and 2.2±0.42 hr respectively. No Postoperative complications were recorded. 90% of the Patients were satisfied, while operator satisfaction was 60%. Conclusion: Airway block with sedation is a safe and reliable practice for high risks patients scheduled for interventional bronchoscopic procedures on a day case basis.
Abstract: Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provid...
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A Clinical Study of Comparison of Dexmedetomidine and Ketamine Versus Propofol and Ketamine for Procedural Sedation in Children Undergoing Device Closure
Sowmya Sree,
Somita Christopher,
Thota Venkata Sanjeev Gopal
Issue:
Volume 7, Issue 2, December 2019
Pages:
37-42
Received:
13 August 2019
Accepted:
4 September 2019
Published:
23 September 2019
DOI:
10.11648/j.ijacm.20190702.12
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Abstract: This prospective, randomized trial was done to compare the effects of Dexmedetomidine-Ketamine and Propofol-Ketamine combinations on hemodynamics, sedation level, and the recovery period in paediatric patients undergoing device closure in cardiac catheterization laboratory. Sixty children undergoing device closure were divided into two groups of thirty each. The Dexmedetomidine-Ketamine group (group I, n=31) received an infusion of 1microgram/kg of Inj Dexmedetomidine over 10 minutes and 1 mg/kg of Inj Ketamine IV as a bolus for induction. The patients then received an infusion of 0.5 microgram/kg/hour of Inj Dexmedetomidine. The Propofol - Ketamine group (group II, n=29) received 1 mg/kg of Inj Propofol and 1 mg/kg of Inj Ketamine as a bolus for induction. These patients then received an infusion of100 micorgram/kg/ min of Inj Propofol. Additional doses of Inj Ketamine, 0.5 mg/kg, were administered when a patient showed discomfort in both groups. Both groups had similar additional Ketamine consumption to maintain deep sedation. The recovery time was longer in group 1 than in group 2 (13 vs 5 minutes, respectively; p <0.01). So it was concluded that both Dexmedetomidine-Ketamine and Propofol-Ketamine combinations are safe and acceptable for sedation without any hemodynamic or respiratory effects for device closure in the cardiac catheterization laboratory in children.
Abstract: This prospective, randomized trial was done to compare the effects of Dexmedetomidine-Ketamine and Propofol-Ketamine combinations on hemodynamics, sedation level, and the recovery period in paediatric patients undergoing device closure in cardiac catheterization laboratory. Sixty children undergoing device closure were divided into two groups of th...
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Experience of Medial Column Bone Graft Combined with PHILOS Plate in the Treatment of Proximal Humeral Adductive Fracture in the Elderly
Gu Xiaopeng,
Lu Huan,
Wong Hongjun,
Wang Qijun,
Gu Yuequan
Issue:
Volume 7, Issue 2, December 2019
Pages:
43-46
Received:
29 August 2019
Accepted:
25 September 2019
Published:
10 October 2019
DOI:
10.11648/j.ijacm.20190702.13
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Abstract: To investigate the efficacy of medial column bone graft combined with PHILOS plate internal fixation for the treatment of proximal humeral adductal fractures in the elderly. The clinical data of 26 patients with proximal humeral adductal fractures were retrospectively analyzed. These patients were divided into bone graft group (14 cases, they were treated with medial column bone graft combined with PHILOS plate internal fixation) and no bone graft group (12 cases, they were treated with PHILOS plate internal fixation alone) according to whether or not the bone graft was performed. The indicators of operation time, fracture healing time, functional activity of shoulder joint and the angle loss of neck shaft angle were compared between the two groups. All patients were followed up for 12 to 23 months. There was a statistically significant difference between the two groups in the time of fracture healing, the degree of shoulder joint mobility (forward and uplift the arms) and the angle loss of neck shaft angle (P<0.05), however, there was no significant difference between the two groups in the operation time (P>0.05). Compared with no bone graft group, medial column bone graft combined with PHILOS plate has more satisfactory clinical results for the treatment of proximal humeral adduct fracture in elderly.
Abstract: To investigate the efficacy of medial column bone graft combined with PHILOS plate internal fixation for the treatment of proximal humeral adductal fractures in the elderly. The clinical data of 26 patients with proximal humeral adductal fractures were retrospectively analyzed. These patients were divided into bone graft group (14 cases, they were ...
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Fake Urine for Defeating Drug Test Results
Issue:
Volume 7, Issue 2, December 2019
Pages:
47-49
Received:
18 January 2019
Accepted:
25 February 2019
Published:
15 October 2019
DOI:
10.11648/j.ijacm.20190702.14
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Abstract: Illicit drug abuse is a serious public health issue in the USA. According to CDC more than 70,000 people had died from drug overdose in 2017 year. The death from cocaine and powerful synthetic opioids had increased about 113 percent each year since 2013 to 2016 across the United States. Drug overdose is currently the leading cause of death in the USA among people below age 50 during last five years. Despite expanding efforts to curb the drug abused or misused, the drug overdose death rates continue to rise. We have to do more to address this substance abuse and drug addiction in the United States. Drug users want to hide the substance abuse that would be revealed by their urine testing and, therefore, they are motivated to cheat and defeat drug screen process. Usage of synthetic urine or “fake urine” recently became very popular and common method for drug abusers to escape failing urine drug test. Health and Human Services (HHS) -certified laboratories lately observed significantly increased total numbers of invalid urine drug test results due to manipulations with synthetic (fake) urine by donors. Sale of synthetic urine is currently legal in most US states and appears to be on the rise now. Artificial urine is sophisticated fluid which is designed to cheat all aspects of drug testing process including validity. Banning synthetic urine to use and sale is very important step for reducing manipulations on drug testing system and preventing illicit drug abuse. But most important, it will help drug abusers to receive medical attention, treatment and crucial support. Artificial urine needs to be eliminated from the market. It is beneficial to diversify drug testing program and perform not only urine drug testing but oral fluid or hair analysis for some pre-employment drug testing plan.
Abstract: Illicit drug abuse is a serious public health issue in the USA. According to CDC more than 70,000 people had died from drug overdose in 2017 year. The death from cocaine and powerful synthetic opioids had increased about 113 percent each year since 2013 to 2016 across the United States. Drug overdose is currently the leading cause of death in the U...
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Adhesive Intestinal Obstruction in Children: A 10-Year Experience in a Teaching Hospital in Enugu, Nigeria
Chukwubuike Kevin Emeka,
Nduagubam Obinna Chukwuebuka,
Eze Thaddeus Chikaodili
Issue:
Volume 7, Issue 2, December 2019
Pages:
50-54
Received:
1 November 2019
Accepted:
22 November 2019
Published:
2 December 2019
DOI:
10.11648/j.ijacm.20190702.15
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Abstract: Background: Following an injury, the peritoneum tries to repair itself through biochemical and cellular responses. These responses result in the formation of adhesions that may cause bowel obstruction. Methodology: This was a retrospective review of children who presented, to our pediatric surgery unit, with adhesive intestinal obstruction (AIO) between January 2008 and December 2017. The patients were reviewed for age at diagnosis of AIO, gender, age at initial surgery, time interval from the initial surgery to the development of AIO, type of initial surgery, duration of symptoms before presentation, treatment and outcome. Result: Thirty four children were admitted with AIO. There were 24 males and 10 females with 36 episodes of bowel obstructions. The mean age of the patients at diagnosis of AIO was 81.5 months (range: 12 - 168) whereas the mean age of the patients at initial surgery was 59.7 months (range: 1 - 144). The mean interval between the initial surgery and onset of AIO was 23.2 months (range: 11-48). Majority of the patients (44.1%) developed AIO within 12 months after their initial surgery. Laparotomy for typhoid intestinal perforation was the most common initial procedure that led to AIO. Non-operative treatment was successful in twenty three patients (67.6%) while ten patients (29.5%) had surgery. One patient (2.9%) was discharged against medical advice. There was no mortality. Conclusion: AIO is uncommon in children. In this series, laparotomy for typhoid intestinal obstruction was the most common operation leading to AIO. Non-operative treatment was effective in two-third of our patients.
Abstract: Background: Following an injury, the peritoneum tries to repair itself through biochemical and cellular responses. These responses result in the formation of adhesions that may cause bowel obstruction. Methodology: This was a retrospective review of children who presented, to our pediatric surgery unit, with adhesive intestinal obstruction (AIO) be...
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Evaluation of the Relevance and the Cost of Prescribing Preoperative Paraclinical Examinations at the Sourô Sanou Teaching Hospital in Bobo Dioulasso
Guibla Ismael,
Traoré Ibrahim Alain,
Ki Bertille,
Ilboudo Charles
Issue:
Volume 7, Issue 2, December 2019
Pages:
55-59
Received:
23 October 2019
Accepted:
14 November 2019
Published:
31 December 2019
DOI:
10.11648/j.ijacm.20190702.16
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Abstract: The pre-anesthetic consultation is an important step before any surgical procedure. It may include paraclinical examinations in addition to the clinical examination. The objective of this study was to evaluate the relevance and the cost of prescribing preoperative checkups by Sourô Sanou Teaching Hospital (CHUSS) surgeons. It was a prospective cross-sectional study from March to August 2016. All preoperative examinations were analyzed according to the formal recommendations of experts from the French Society of Anesthesia- intensive Care Medicine. The medico-economic impact of the implementation of the recommendations was also analyzed. A total of 2603 pre-operative checkups prescribed in 400 patients were analyzed. The mean age of the patients was 28.59 years with a sex ratio of 0.83. Intermediate surgical risk (59.7%) was the most observed. The majority of patients were ASA 1 and 2 (99%). The most popular checkups were CBC (99%) followed by blood glucose (96.7%) and serum creatinine (92.7%). We found that 5.6% of the checkups were abnormal. Of the checkups prescribed, 74.6% did not comply with international recommendations. The CBC prescription had a high compliance rate (69.2%). The lowest compliance rates were: blood glucose (1.5%), renal function, and coagulation profile (17%). The cost generated by the excess prescription of preoperative examinations was estimated at 5484, 01 US dollar for all patients (13,715 US dollar/ patient on average). The preoperative checkups performed as part of a planned surgery are mostly inadequate with a real medico-economic impact.
Abstract: The pre-anesthetic consultation is an important step before any surgical procedure. It may include paraclinical examinations in addition to the clinical examination. The objective of this study was to evaluate the relevance and the cost of prescribing preoperative checkups by Sourô Sanou Teaching Hospital (CHUSS) surgeons. It was a prospective cros...
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