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Anis Baraka

Publications and source records attributed to Anis Baraka.

16 recordsLinked to original sources
PubMed2004

Remifentanil for modulation of hemodynamics in a patient undergoing laparoscopic resection of pheochromocytoma.

The present report monitors the hemodynamic fluctuations in a 63 year-old female patient undergoing laparoscopic resection of right adrenal pheochromocytoma during remifentanil-based anesthesia. Anesthesia was induced with lidocaine 1 mg x kg(-1), propofol 3.5 mg x kg(-1), and cisatracurium 0.2 mg(-1) x kg(-1) and a remifentanil infusion was started at a rate of 1 ug.kg (-1) x min(-1). Anesthesia was then maintained with remifentanil infusion (0.5 microg(-1) x kg(-1) x min), sevoflurane 1-2% (end-tidal) in a mixture of air/oxygen (3:1), and a continuous infusion of cisatracurium. There were no significant changes of BP and HR following tracheal intubation or surgical incision. However, creation of pneumoperitoneum as well as tumor manipulation resulted in a dramatic increase of systolic BP and pulmonary artery pressure, associated with a decrease in cardiac output. These hemodynamic changes were unresponsive to an increase in the remifentanil infusion rate up to 1.5 ug.kg(-1) x min(-1), but were controlled by increasing the concentration of sevoflurane up to 6%, and by a nitroglycerin (NTG) infusion. Ten min after removal of the tumor, and despite discontinuation of the NTG infusion as well as a reduction in the remifentanil infusion and sevoflurane concentration, the BP decreased down to 64/43 mmHg. In conclusion, the present report shows in a patient undergoing laparoscopic resection of adrenal pheochromocytoma that remifentanil does not prevent the severe hypertensive episodes associated with intraperitoneal carbon dioxide insufflation or tumor manipulation. However, it can be titrated to prevent the hemodynamic reflex response to tracheal intubation and surgical stimulation.

Adrenal Gland Neoplasms↗
PubMed2004

Alpha-stat vs. pH-stat strategy during hypothermic cardiopulmonary bypass.

There are two different strategies of acid-base regulation during hypothermis. The alpha-stat strategy of ectotherms maintains the temperature-uncorrected arterial PCO2 and pH at normothermic values (i.e., 40 mmHg and 7.4, respectively), irrespective of the body temperature. In contrast, the pH-stat of hibernators maintains the temperature-corrected pH and PCO2 at the normal values at the different body temperatures. Clinically, it appears that it is more physiological to use the alpha-stat strategy whenever tepid or moderate hypothermic CPB is used in order to maintain intracellular electrochemical neutrality, and to adopt the pH-stat strategy whenever deep hypothermic circulatory arrest is induced, in order to otimize brain protection.

Acid-Base Imbalance↗
PubMed2003

Multimodal spinal anesthesia.

BACKGROUND AND OBJECTIVES: Cystoscopy and extracorporeal shock wave lithotripsy (ESWL) are common urologic procedures in the treatment of ureteral calculi. Spinal anesthesia with local anesthetics is the anesthetic technique of choice for these procedures. Sufentanil and/or clonidine have been combined with local anesthetics to provide effective and safe neuroaxial anesthesia. Our objectives were to review the efficacy and safety of combining both sufentanil and clonidine with reduced doses of intrathecal lidocaine in patients undergoing cystoscopy and ESWL. METHODS: We reviewed the medical records of 12 patients who underwent such urologic procedures using an intrathecal mixture consisting of 20 mg of lidocaine, 10 micrograms of sufentanil, and 50 micrograms clonidine from May 1st, 1998 to December 31st, 1998. Patients' demographics, intraoperative analgesia and adverse side effects as well as recovery times were reviewed. RESULTS: All 12 patients tolerated their urologic treatments using this combination of drugs without requiring conversion to another anesthetic technique or significant supplementation with intravenous analgesics. Motor power returned to normal by the end of the procedure. The systolic blood pressure dropped 26 +/- 8% intra-operatively and 25 +/- 9% postoperatively. The incidences of other adverse side effects were low. Time spent in recovery area was short, 45 +/- 15 minutes (mean +/- standard deviation). CONCLUSIONS: Intrathecal admixtures of sufentanil 10 micrograms, clonidine 50 micrograms, and lidocaine 20 mg can provided effective and prolonged analgesia in patients undergoing cystoscopy and ESWL. Patients had recovery of their motor power in their lower extremities by the end of the procedure. No urinary retention was noted. Mild hypotension was the most common adverse side effect and was the main confounding factor for the prolongation of the discharge time.

Adult↗
PubMed2003

Anesthetic management for a patient with myasthenia gravis undergoing coronary artery bypass graft.

PURPOSE: Report the clinical management of a patient having Myasthenia Gravis (MG), undergoing cardiopulmonary bypass (CPB). CLINICAL FEATURES: A 71-yr-old man having MG (Osserman IIB), was admitted for coronary artery bypass graft (CABG) under CPB. Optimization of the patient was achieved preoperatively. Thymectomy was done following midsternotomy. Continuous monitoring of the neuromuscular transmission (NMT) was maintained throughout the perioperative period. The hemodilutional effect of CPB was counteracted by the hypothermia resulting in maintenance of cisatracurium requirements at the same levels as the prebypass period. Extubation of the trachea was done after ensuring adequate recovery of the NMT and respiratory function. Oral myasthenic therapy was resumed following extubation. CONCLUSION: A myasthenic patient can safely undergo CPB provided adequate preoperative optimization is achieved. Continuous monitoring of the NMT must be throughout the perioperative period. Thymectomy is recommended in the myasthenic patient since it may improve the outcome. Extubation of the trachea is to be done after ensuring adequate NMT and respiratory function.

Aged↗
PubMed2002

Complicated negative pressure pulmonary oedema in a child with cerebral palsy.

A 3-year-old child with cerebral palsy developed postextubation upper airway obstruction secondary to laryngospasm and/or masseteric spasm,which may have been triggered by the muscular spasticity and the slow recovery from inhalational anaesthesia associated with cerebral palsy. This upper airway obstruction was followed by negative pressure pulmonary oedema. The patient improved on mechanical ventilation; however, his condition was complicated with the occurrence of bilateral pneumothoraces. After release of the pneumothoraces and reexpansion of the lungs, the child developed reexpansion pulmonary oedema, culminating in acute lung injury.

Cerebral Palsy↗
PubMedDate not supplied

Variable hemodynamic fluctuations during resection of multicentric extraadrenal pheochromocytomas.

PURPOSE: To report the perioperative management and the serious hemodynamic fluctuations during manipulation of an organ of Zuckerkandl tumour in a patient undergoing resection of multicentric extraadrenal pheochromocytomas. CLINICAL FINDINGS: A 28-yr-old man who had undergone at age 12 a laparotomy for excision of an extraadrenal pheochromocytoma complained of paroxysmal headache, occasional sweating and palpitations. The arterial blood pressure (BP) was 200/100 mmHg. A 24-hr-urine collection showed catecholamines 5076 microg x 24 hr(-1) (normal < 25 microg x 24 hr(-1)). Computed tomography of the abdomen revealed two retroperitoneal masses, one adjacent to the lower pole of the right kidney and a second larger mass located at the aortic bifurcation in the region of the organ of Zuckerkandl. The patient was scheduled for excision of multiple extraadrenal pheochromocytomas. He was prepared preoperatively for two weeks with prazosin 1 mg po q six hours and propranolol 10 mg tid. Manipulation of the infrarenal tumour was uneventful but manipulation of the Zuckerkandl tumour resulted in severe hypertensive episodes with BP ranging from 200/100 to 320/120 mmHg. Surgery was interrupted temporarily; the hypertensive crisis was controlled by the infusion of sodium nitroprusside and by iv phentolamine and esmolol. CONCLUSION: In a patient undergoing resection of recurrent multicentric extraadrenal pheochromoctyomas, severe hypertensive episodes occurred during manipulation of one tumour but not during manipulation of the other. This may be attributed to inadequate preparation of the patient, difficult surgical dissection of the large Zuckerkandl pheochromocytoma, and/or secondary to an excessive and different pattern of release of catecholamines during manipulation of the Zuckerkandl tumour.

Adult↗