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Biomedical subjects

A A El-Dawlatly

Publications and source records attributed to A A El-Dawlatly.

7 recordsLinked to original sources
PubMed2004

Blood biochemistry following endoscopic third ventriculostomy.

BACKGROUND: Endoscopic third ventriculostomy (ETV) is now an accepted treatment for obstructive hydrocephalus. Anandh et al. have reported postoperative hyperkalemia following ETV. However, due to small sample size (20 patients), the authors could not confirm their hypothesis (8). Therefore, we have conducted the present study in order to investigate postoperative blood chemistry following ETV. PATIENTS AND METHODS: The computerized database and the medical records of 50 patients who underwent ETV under general anesthesia were studied. Blood chemistry for all patients was done preoperatively as well as for three consecutive days postoperatively. Preoperative and peak postoperative serum blood chemistry variables were compared by using Student's t-test for paired samples. A p value of < 0.05 was considered significant. RESULTS: Preoperative serum K+ concentration mean value was 4.8 +/- 0.7 mmol/l. In the consecutive two postoperative days serum K+ levels mean values were 4.4 +/- 0.8 and 4.3 +/- 0.8 mmol/l with significantly lower levels compared to preoperative values (p < 0.05). CONCLUSIONS: Although significantly lower K+ values have occurred in our series postoperatively, they were of no clinical significance. Moreover, our results were in contrast to Anandh et al. who used lactated Ringer's (LR) as irrigation fluid which led to postoperative hyperkalemia. We recommend the use of normal saline as irrigation fluid instead of LR.

Child↗
PubMed2004

Endoscopic third ventriculostomy: anesthetic implications.

Endoscopic third ventriculostomy (ETV) is one of the recent neurosurgical advances for the treatment of obstructive hydrocephalus. There has been number of publications, which have established the role of ETV in neurosurgical practice, particularly in hydrocephalus. ETV has developed into a therapeutic alternative to shunting for the management of patients with non-communicating hydrocephalus. This procedure requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation via neural structures to access the floor of the third ventricle. This discussion will focus on the anesthetic implications during ETV.

Anesthesia, General↗
PubMed2001

Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics.

BACKGROUND AND AIMS: Currently, few reports of the haemodynamic impact of intrapleural CO2 insufflation in the clinical setting are available. Therefore, we conducted the present study to compare the haemodynamic changes between right and left side thoracoscopic sympathectomy (TS) for treatment of palmar hyperhidrosis (PH) under general anaesthesia. MATERIALS AND METHODS: 20 adult patients (17 males) undergoing TS were randomly allocated to two groups (each 10); group A, right side and group B, left side TS procedures were performed under general anaesthesia with single-lumen endotracheal tube. Besides the routine monitoring of vital signs, non-invasive cardiac output monitor (NICO) was used to record the stroke volume (SV), cardiac output (CO) and cardiac index (CI). Intrapleural CO2 insufflation was used. Anaesthesia was maintained with 1 MAC sevoflurane in 50% nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Haemodynamic parameters were obtained every 3 min then averaged over the time of surgery at phases; I) after tracheal intubation, II) after CO2 insufflation and III) after CO2 deflation. RESULTS: The CO, CI and SV showed decreased trend in both groups during phase II compared to phase I with significant differences (P < 0.05). Comparing the CO and CI variables revealed lower values in group A compared to group B but with non-significant differences (P > 0.05). While the SV variable showed significant low value in group A compared to group B (P < 0.05). CONCLUSIONS: Compared to left side TS, direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO, CI and SV.

Adult↗
PubMed2000

The incidence of bradycardia during endoscopic third ventriculostomy.

UNLABELLED: The incidence of bradycardia during endoscopic third ventriculostomy (ETV) is unknown. In an attempt to determine that incidence, we studied 49 pediatric patients with obstructive hydrocephalus who underwent ETV during general anesthesia. The median age was 54.5 mo (range 1-108 mo) and the median weight was 12.2 kg (range 2.4-22 kg). The heart rate was measured continuously in which four stages were identified for data analysis. Stage A is the preoperative phase, stage B is 5 min before perforating the floor of the third ventricle, stage C during perforation, and stage D after perforating the floor of the third ventricle. Three readings were recorded at each stage, then averaged. The mean values of the heart rate at stages A, B, C, and D were 146 +/- 27, 151 +/- 26, 87 +/- 32, and 143 +/- 24 bpm respectively. A significant decrease in the heart rate was determined in stage C compared with stage B (P: < 0.05). The incidence of bradycardia was 41%. Alerting the surgeon to perforate the floor of the third ventricle or withdraw the scope away from it was sufficient to resolve the bradycardia. We concluded that serious bradycardia might occur during ETV, mostly because of mechanical factors and can be resolved without medications. IMPLICATIONS: The use of endoscopy for treating pediatric patients with increased intracranial pressure is a new surgical procedure. These patients require general anesthesia with continuous heart rate monitoring. We have observed a high incidence of decrease in heart rate. If a decrease in heart rate occurs, alerting the surgeon to speed the procedure would be an effective treatment.

Bradycardia↗
PubMed1999

Endoscopic third ventriculostomy: a study of intracranial pressure vs. haemodynamic changes.

Fourteen paediatric patients with obstructive hydrocephalus were studied. They underwent endoscopic third ventriculostomy under general anaesthesia. Their ages ranged from 1 to 144 weeks (mean 34+/-36 weeks) and weight from 2 to 22 kg (mean 10.2+/-5.4 kg). In an attempt to identify the possible mechanisms of the intraoperative haemodynamic changes associated with endoscopic third ventriculostomy, we studied the intracranial pressure measured in the third ventricle versus the haemodynamic changes. The intracranial pressure was measured using a pressure transducer attached at one end to the endoscope and the other end to the monitor. The mean third ventricle pressure value was 10.2 mmHg (+/-3.5). Bradycardia occurred in six (43%) of our patients. The mean value of the lowest heart rate reading intraoperatively was 81 beats/min (+/-31.8). Negative correlation was obtained between the intracranial pressure and the haemodynamic changes. Alerting the surgeon to perforate the floor of the third ventricle or withdraw the scope away from it was sufficient to resolve the bradycardia. We concluded that serious dysrhythmias might occur during endoscopic third ventriculostomy, the majority of which can be resolved without medications.

Endoscopes↗