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  • ISSN: 2333-6641
    Volume 2, Issue 3
    July-September 2014
    Research Article
    Wael Abu Dayyih1*, Dania El Tannir1, Eyad Mallah1, Mohammad Hamad2, Nasir Idkaidek3, Riad Awad1, Abdel Fatah Salem4 and Tawfiq Arafat1
    Background: Since 1940, pethidine became the most widely used opioid for labor analgesia. However, pethidine administration may cause fetal distress especially if delivery occurred in a short time after administration and due to genetic variations between populations. Therefore,the aim of this study was to develop a validated and sensitive method for determination of pethidine in plasmafollowed by determination of plasma pethidine level in Jordanian women at different times duringand after labor and in the neonatal cord just after delivery.
    Methods: Liquid Chromatography tandem mass spectrometry was developed to measure pethidine levels in plasma. Fifteen pregnant females agreed to enroll in the study and each signed an informed consent. All pregnant females received a single intravenous dose of 50 mg pethidine followed by withdrawing of blood samples at certain time points for the measurement of pethidine levels. In addition, umbilical cord was collected for the same purpose.
    Results: Due to fetal distress, three out of fifteen subjects (20%) dropped out of the study following pethidine administration and went through Caesarian section. Two of the three withdrawn cases had high maternal pethidine plasma levels. A negative correlation was found between pethidine bioavailability in the newborn and the dose-delivery duration (p<0.01). In addition, there was a negative correlation between maternal’s pethidine concentration and Apgar score (p<0.05).
    Conclusion: The present study showed that single intravenous dose during labor cannot be considered safe in Jordanian population without an extensive study with larger sample size regarding pethidine route of administration and its metabolism.
    Case Report
    Nobuhito Kamekura*, Makiko Shibuya and Toshiaki Fujisawa
    Abstract: We report the successful management of Total Intravenous Anesthesia (TIVA) for a narcoleptic patient using propofol and remifentanil under Bispectral Index (BIS) monitoring. A 63-year-old woman with narcolepsy required oral surgery under general anesthesia. On the morning of the day of operation, she took methylphenidate and modafinilfor control of narcolepsy. Anesthesia was induced with continuous infusion of remifentanil and propofol, and maintained with remifentanil and propofol under BIS monitoring. Anesthesia, which lasted almost 4.5 h, was uneventful, with neither significant change in hemodynamics nor delayed emergence from anesthesia. In our patient, symptoms of narcolepsy were well controlled. In such patients, habitual central nervous system stimulants should be continued before anesthesia, and short-acting anesthetic drugs are desirable for general anesthesia.
    Masashi Ishikawa*and Atsuhiro Sakamoto
    Abstract: Intraoperative acute descending aortic dissection is a rare and potentially fatal complication of open cardiac surgery. We report the case of a 62-year-old female who developed this condition during surgery includingmitral valvuloplasty, tricuspid valvuloplasty and the MAZE procedure. After induction of general anesthesia, baseline Transesophageal Echocardiography (TEE) examination revealed a normal ascending and descending aorta. At the time of weaning off cardiopulmonary bypass, we decided to use intra-aortic balloon pumping (IABP) because of insufficient left ventricular output. TEE examination of the descending aorta at this time revealed descending aortic dissection, which extended from just beyond the left subclavian artery to above the celiac artery (DeBakey IIIb type). We decided to adopt a conservative approach because the dissection did not compromise circulation in the branch arteries; we also avoided using IABP.TEE is commonly used intraoperatively and is considered the modality of choice to diagnose this complication and direct the surgeon to the extent of the dissection.TEE is also useful for determining the therapeutic strategy for acute descending aortic dissection.This case highlights the importance of maintaining a high level of suspicion of intraoperative descending aortic dissection and its prompt diagnosis using TEE.
    Review Article
    José M Beleña1* and Mónica Nuñez2
    Abstract: Laparoscopic surgery is a very common and widely established technique. Benefits include decreased postoperative pain, improved patient satisfaction (including cosmetic results), reduced hospital stays and fewer postoperative complications compared with open techniques. The range of surgical techniques is increasing in complexity and about the kind of patients undergoing these procedures (pluripathological patients, associating co-morbidity). Number of emergency operations performed laparoscopically has been increased as well.
    Complications of laparoscopic surgery are mainly divided into three groups: complications derived from pneumoperitoneum, complications caused by the operative procedure and postoperative complications.
    Apart from the alterations caused by the pneumoperitoneum (raised intra-abdominal pressure and physiological effects especially within cardiovascular and respiratory systems), which have significant effects on the patient, especially if they are elderly or have associated morbidity, it may cause some complications such as severe hypercarbia, cardio-pulmonary compromise, air embolism or gas migration (subcutaneous emphysema, pneumomediastinum and pneumothorax.
    Complications of the operative procedure can be grouped into two categories: complications of access and complications of technique.
    Complications of access or trocar entry include: hollow or solid viscus perforation, abdominal wall or major vessel injury, incisional hernia and peritoneal tumor cell implantation.
    In case of complications derived from the surgical technique, we can include: hemorrhage, vascular injury, retroperitoneal hematoma, bile leak, bile duct injury, bile peritonitis (with or without a bile duct injury). Postoperative complications include: intestinal perforation, bile leak, retroperitoneal hematoma, pancreatitis, subhepatic abscess and postoperative air embolism. This review discusses the complications that can occur in the postoperative period.
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