Biomedical subjects

E Nasser

Publications and source records attributed to E Nasser.

5 recordsLinked to original sources

PubMed2005

General anesthesia with remifentanil for Cesarean section in a patient with HELLP syndrome.

HELLP syndrome is a severe complication of pre-eclampsia characterised by hemolysis, elevated liver enzymes and a low platelet count. It is associated with an increased risk of adverse outcome for both the mother and the fetus. Patients with HELLP syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, intracerebral hemorrhage, eclamptic convulsions, disseminated intravascular coagulation, ruptured liver hematomas and acute renal failure. Perinatal mortality is equally high. Before delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems, if possible, and interruption of the pregnancy in the early phase of the accelerated disease progression. Definitive therapy is delivery. Parturients HELLP syndrome often require general anesthesia for Cesarean section delivery. The anesthetic technique is critical for these patients with a high risk of uncontrollable hypertension, bleeding and multiple organ failure. Remifentanil is increasingly used as a very short analgesic agent providing cardiovascular stability in high-risk patients. We report the management of a patient presenting in labor with HELLP syndrome, and describe the successful use of remifentanil as part of the anesthetic technique for her subsequent Cesarean section.

Adult↗

PubMed2003

Why a breast boost should remain a controversial aspect of routine breast conservation management in Australia and New Zealand in 2002.

Two randomized trials have recently shown a statistically significant improvement in local control when a boost is employed in the conservative treatment of early breast cancer. However, unresolved issues of cost effectiveness, potentially increased toxicity and the inability to automatically generalize these results to Australian and New Zealand practice remain. In view of these unresolved controversies, the St George and Wollongong hospitals breast boost trial (SGW trial) will continue to recruit.

Aged↗

PubMed1996

[Management of suspected heart injuries].

Penetrating cardiac injury has to be ruled out in any patients with penetrating thoracic injuries, even in those with no alterations in vital functions. Undelayed echocardiography should be performed to screen for the presence of pericardial effusion. The first case underlines the risk of cardiac tamponade if the diagnosis is missed. Echocardiography was not performed because no echocardiographist was present at the time, and a high suspicion of a neck vascular injury existed. Sudden deterioration due to the onset of acute tamponade was only reversed by an immediate pericardiocentesis followed by surgical haemostasis. The second patient, although stable, had a large echographic pericardial effusion. Emergent sternotomy revealed a large amount of blood in the pericardial space and two cardiac wounds with one on a coronary artery. Penetrating wounds in proximity to the heart, even in a stable patient, require aggressive attempts at ruling out a cardiac injury. Immediate echocardiography should be systematically performed to screen for pericardial fluid.

Adult↗

PubMed1996

[Intra-articular analgesia after arthroscopy of the knee].

In 33 patients the authors compared two protocols for postoperative analgesia after elective arthroscopy of the knee. One group (n = 11) received plain bupivacaine 0.25% by intra-articular administration. Another group (n = 11) received by the same route a mixture of bupivacaine 0.25% with fentanyl 50 micrograms. The last group (placebo group: n = 11) received the same volume of saline. The combination of bupivacaine with fentanyl reduced postoperative pain more effectively than plain bupivacaine and the analgesic effect was still present 9 hours after the arthroscopy.

Adolescent↗

PubMed1995

[Duplication of the vena cava].

Bilateral superior vena cava is a congenital anomaly of which the anaesthesiologist and intensivist should be aware in order to not mistake catheters placed in the left superior vena cava as being malpositioned outside of the venous circulation. These malpositions generally require catheter removal and reinsertion. This anomaly although rare is not-so-unusual. It is generally well tolerated.

Aged↗