Biomedical subjects

Mostafa Somri

Publications and source records attributed to Mostafa Somri.

11 recordsLinked to original sources

PubMed2006

Delayed ventricular fibrillation following blunt chest trauma in a 4-year-old child.

A 4-year-old boy who was involved in a motor vehicle accident as a pedestrian and suffered blunt chest trauma was admitted to the emergency room. Unpredictable delayed ventricular fibrillation was diagnosed and treated successfully 2 h later. This case cannot be classified as commotio cordis as the ventricular fibrillation (VF) developed so long after the sustained chest injury. At the same time, other possible etiologies of VF such as cardiac pathology or electrolyte and metabolic disorders had been ruled out. Thus, an etiological link between the chest trauma and the subsequent VF could not be ruled out and is in fact plausible despite the late onset.

Accidents, Traffic↗

PubMed2006

The effects of droperidol in perforating keratoplasty.

PURPOSE: To evaluate the intraoperative and postoperative effects of droperidol administered with general anesthesia during perforating keratoplasty. METHODS: A prospective, randomized, double-masked clinical trial. Twenty-seven patients undergoing penetrating keratoplasty under general anesthesia were included. Patients were assigned randomly to two groups. Fifteen subjects received droperidol during induction of general anesthesia. Twelve control patients received general anesthesia without droperidol. RESULTS: Droperidol significantly reduced fellow eye intraocular pressure (p < 0.0001). Intraoperative anterior chamber depth was significantly deeper with droperidol (p = 0.0002). Iris bulging was observed in 25% of the control group and 0% with droperidol. There was significantly less postoperative nausea in the droperidol group (p = 0.038). There was less postoperative vomiting in the droperidol group, although the difference was not significant (p = 0.07). Postoperative wound gaping was observed in 2 patients; both of them did not receive droperidol. CONCLUSIONS: Droperidol effectively reduces intraoperative and postoperative complications in keratoplasty surgery.

Adjuvants, Anesthesia↗

PubMed2004

A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients.

BACKGROUND: The ProSeal Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) is a new laryngeal mask with a modified cuff designed to improve its seal and a drain tube for gastric tube placement. Similarly, the Laryngeal Tube Suction (LTS) (VBM Medizintechnik Gmbh, Sulz a.N, Germany) is a new laryngeal tube that also has an additional channel for gastric tube placement. This study compared the placement and functions of these two devices. METHODS: One hundred fifty patients undergoing general anesthesia for elective surgery were randomly allocated to the PLMA (n = 75) or LTS (n = 75). Oxygenation and ventilation, ease of insertion, fiberoptic view, oropharyngeal leak pressure, ventilatory data, ease of gastric tube insertion, and postoperative airway morbidity were determined. RESULTS: After successful insertion of the devices in 96% of patients with the PLMA and in 94.4% with the LTS it was possible to maintain oxygenation, ventilation, and respiratory mechanics during the entire duration of surgery. Successful first and second attempt insertion rates were 57 patients (76%) and 15 patients (20%), respectively, for the PLMA and 60 patients (80%) and 11 patients (14.6%), respectively, for the LTS. Airway placement was unsuccessful with the PLMA in three patients and with the LTS in four patients. Time to achieve an effective airway was 36 +/- 24 s with the PLMA versus 34 +/- 25 s with the LTS. Gastric tube insertion was possible in 97.3% of patients with the PLMA and in 96% with the LTS. CONCLUSIONS: With respect to both physiologic and clinical function, the PLMA and LTS are similar and either device can be used to establish a safe and effective airway in mechanically ventilated anesthetized adult patients.

Adult↗

PubMed2004

A new supraglottic airway, the Elisha Airway Device: a preliminary study.

We describe the Elisha Airway Device (EAD), a new reusable supraglottic ventilatory device. Its uniqueness consists of its ability to combine three functions in a single device: ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion. This study was performed in 70 ASA status I-II, Mallampati class I-II patients undergoing elective knee arthroscopy and receiving general anesthesia with mechanical ventilation. Anesthesia was induced with fentanyl and propofol and was maintained with isoflurane in N20/oxygen. Neuromuscular blockade was achieved with vecuronium. Blind insertion of the device was successful in 96% of patients, with a mean insertion time of 20 +/- 4 s. In these patients it was possible to maintain oxygenation and ventilation throughout the surgical procedure. Gastric tube insertion was successful in all cases. Endotracheal intubation via the EAD was attempted in 20 patients. Blind intubation was possible during the first and second attempts in 15 and 2 patients, respectively. Fiberoptic intubation was then successful in two of the remaining three patients. The EAD is a new alternative in the evolution of supraglottic ventilatory devices; however, further clinical studies are necessary to evaluate its efficacy.

Adult↗

PubMed2003

The effectiveness and safety of spinal anaesthesia in the pyloromyotomy procedure.

BACKGROUND: Hypertrophic pyloric stenosis is a relatively common disorder of the gastrointestinal tract in infancy, causing projectile vomiting and metabolic abnormalities. Surgical management in the form of pyloromyotomy under general anaesthesia has been reported as safe for relieving the obstructed bowel. A number of studies have demonstrated the advantages of spinal anaesthesia over general anaesthesia in high risk infants undergoing minor infraumbilical surgery. The purpose of this study was to evaluate spinal anaesthesia as an alternative option to general anaesthesia in infants undergoing pyloromyotomy. METHODS: Twenty-five infants undergoing pyloromyotomy under spinal anaesthesia were studied. Haemodynamic and respiratory parameters were noted before performing the spinal block, 5 min after the spinal block, and every 10 min after performing the spinal block; for a total period of 30 min. The spinal block was performed using spinal isobaric bupivacaine 0.5%, 0.8 mg.kg-1. Blood pressure, heart rate, respiratory rate and oxygen saturation values were recorded. RESULTS: The sensory levels achieved ranged between T3-T5 thoracic segments within 6-8 min and were sufficient to perform surgery in 23 cases. There were no statistically significant differences in the oxygen saturation, systolic blood pressure and respiratory rate compared with before the spinal block and after 5, 10, 20 and 30 min. CONCLUSIONS: This study proposes that spinal anaesthesia is an alternative option to general anaesthesia in infants undergoing pyloromyotomy, and should be considered in infants undergoing pyloromyotomy.

Anesthesia, General↗

PubMed2003

Postdural puncture headache: an imaging-guided management protocol.

IMPLICATIONS: We propose an imaging-based algorithm for the management of headache caused by the inadvertent puncture of dura that occurs sporadically during epidural analgesia. Its implementation can identify those postdural puncture headache cases that cannot benefit from epidural blood patches, and their unnecessary application can consequently be avoided.

Adult↗

PubMed2003

An evaluation of the Laryngeal Tube during general anesthesia using mechanical ventilation.

UNLABELLED: The Laryngeal Tube is a new supraglottic ventilatory device for airway management. It has been developed to secure a patent airway during either spontaneous or mechanical ventilation. In this study, we sought to determine the effectiveness of the Laryngeal Tube for primary airway management during routine surgery with mechanical ventilation. One-hundred-seventy-five subjects classified as ASA physical status I and II, scheduled for elective surgery, were included in the study. After the induction of general anesthesia and insertion of a Size 4 Laryngeal Tube, measurements of oxygen saturation, end-tidal CO(2) and isoflurane concentration, and breath-by-breath spirometry data were obtained every 5 min throughout surgery. The lungs were ventilated with volume-controlled mechanical ventilation. The number of attempts taken to insert the Laryngeal Tube and the insertion time were recorded. In 96.6% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics by using mechanical ventilation throughout the surgical procedure. The results of this study suggest that the Laryngeal Tube is an effective and safe airway device for airway management in mechanically ventilated patients during elective surgery. IMPLICATIONS: In 96.6% of patients intubated with the Laryngeal Tube, it was possible to maintain oxygenation, ventilation, and respiratory mechanics during mechanical ventilation.

Adolescent↗

PubMed2002

Effect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block.

BACKGROUND: Both caudal epidural and ilioinguinal/iliohypogastric nerve blocks have been used to provide effective intra- and postoperative analgesia. Stress response hormone levels can be used as an objective method to assess the analgesic efficacy of the anaesthetic techniques used in infraumbilical surgery in children. In this study, we compared catecholamine blood levels in children undergoing these two different supplementary analgesic/anaesthetic techniques. METHODS: Thirty male paediatric patients undergoing orchidopexy, ASA I, received inhalation general anaesthesia, and were randomly allocated to one of two groups: a caudal group (n = 15) and an ilioinguinal/iliohypogastric nerve block group (n = 15). Plasma epinephrine and norepinephrine concentrations were measured at the induction time, at the end of surgery, and in the postanaesthesia care unit. Postoperative pain score was also assessed in the postanaesthesia care unit. RESULTS: In both groups, there was a substantial decrease in the catecholamine blood levels; however, there were significantly higher levels of epinephrine in the ilioinguinal group at the end of surgery (P = 0.008) and in the recovery room (P = 0.02) and a significant higher level of norpinephrine in the recovery room (P = 0.008). CONCLUSIONS: The result of this study revealed that caudal epidural block was more effective than ilioinguinal block in suppressing the stress response as reflected in epinephrine and norepinephrine blood levels in orchidopexy patients.

Anesthesia, Caudal↗

PubMed2002

Simple on-line endotracheal cuff pressure relief valve.

Ischemic injury of the tracheal mucosa in the endotracheally intubated patient is directly proportional to the tracheal tube cuff pressure. At a cuff pressure of 30 cm H2O, the tracheal mucosal blood flow becomes partially obstructed, and at a pressure of 45 cm H2O, the obstruction to the tracheal mucosal blood becomes total, leading to tracheal mucosal damage and subsequent complications. In our institute, we have developed a simple and very inexpensive method to gauge the cuff pressure. We use a regular 20-mL syringe attached in line with the connector of the endotracheal tube cuff. In this manner, we monitored the intracuff pressure in 120 patients who underwent ear or neck surgery. The syringe was connected to the tube cuff and inflated with 15 mL of air. The syringe was left constantly connected to the cuff. In addition, the cuff pressure was measured with the Mallinckrodt Hi-Lo aneroid pressure gauge at the beginning of surgery and hourly thereafter for the duration of surgery. At the same time, a check for leakage around the cuff was made by auscultation with a stethoscope above the sternal notch. Multiple comparisons between the repetitive intracuff pressure measurements revealed that there were no significant differences in the intracuff pressure values measured at the different times of surgery. These results indicate that there was an adequate venting of the excess intracuff pressure and also that there was no leakage around the cuff.

Adult↗

PubMedDate not supplied

Flexible fiberoptic bronchoscopy through the laryngeal mask airway in a small, premature neonate.

The laryngeal mask airway (LMA) was introduced as a supraglottic device in anesthesia for routine use in the normal adult and pediatric population. Because the distal end of properly placed LMA faces the laryngeal inlet, this device can be used as a guide to flexible fiberoptic bronchoscopy (FFB) performance. In this clinical case, we present a small premature neonate with severe congenital biphasic stridor. FFB was performed successfully through the LMA while maintaining a patent airway during general anesthesia and permitting spontaneous respiration, as well as allowing assisted ventilation when necessary. An immediately subglottic intramural mass was revealed and tracheostomy was performed.

Anesthesia, General↗

PubMedDate not supplied

Bee stings of children: when to perform endotracheal intubation?

Hymenoptera stings account for more deaths in United States that any other envenomation. Oropharyngeal stings, although rare, may produce life-threatening airway obstruction by way of localized swelling. We present 4 cases of bee stings in children that necessitated tracheal intubation and mechanical ventilation. Two children had breathing difficulties at admission; the other 2 presented with minimal symptoms but were preventively intubated and mechanically ventilated. Orofacial bee sting victims should be given parenteral treatment with epinephrine, steroids, antihistamines, and inhalational bronchodilators even when they initially present with minimal symptoms, with general anaphylaxis management in large envenomations, as well as immediate endotracheal intubation and mechanical ventilation for at least 24 hours in patients with signs of airway compromise.

Airway Obstruction↗