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Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Abstract

Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy.

Material and methods: We reviewed the charts of all patients (179) undergoing laparoscopic sleeve gastrectomy from July 2012 to July 2013 at Wolfson Medical Center. Sugammadex 1.5-2 mg/kg (112 patients) or neostigmine 2.5 mg (67 patients) were used as reversal agents. Results were compared by the type of reversal agent employed. Compared parameters included demographic and anaesthetic data, residual curarization, oxyhemoglobin saturation (SpO2) in the recovery room (PACU), episodes of SpO2 lower than 90% in PACU, unexpected intensive care (ICU) admissions, incidence of atelectasis and pneumonia, re-intubation and duration of hospitalization.

Results: Obstructive sleep apnea syndrome (OSAS) was more frequent in the sugammadex group (19% vs. 8%; p = 0.026). Total intravenous anesthesia (TIVA) was more frequently associated with sugammadex (33% vs. 16%; p = 0.007). There were no differences in postoperative residual curarization, SpO2 < 90% episodes, reintubation, ICU admissions, pulmonary complications and duration of hospitalization.

Conclusion: With the inherent limitations of a retrospective study, the use of sugammadex following laparoscopic sleeve gastrectomy showed no advantage over neostigmine in terms of residual curarization and respiratory complications.

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Assessment of Respiratory Complications Associated with End Stage Renal Disease in Northern Saudi Arabia

Abstract

Background. The prevalence of End Stage Renal Disease (ESRD) is increasing in different parts of the Kingdom of Saudi Arabia (KSA), particularly Hail Region. Therefore, the aim of this study was to assess the respiratory complications that associated with ESRD.

Methods. In the present study, clinical, imaging and laboratory parameters were identified for 100 ESRD patients with ESRD who were referred to the Pulmonary Medicine Department at King Khalid Hospital.

Results. Pulmonary Edema, Pneumonia, and Pleural effusion were identified in 22%, 14%, and 16% of the referred ESRD patients, respectively.

Conclusion. Respiratory complications are common among ESRD patients in Hail Region.

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Acute Respiratory Distress Syndrome Caused by Methadone Syrup

Abstract

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

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Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study

response to medication with proved allergen or improved in allergic symptoms after antihistamine treatment Others Other complications that do not affect the cardiovascular system, for example, nausea, or vomiting, or both; or change in behavior Statistical analyses A sample size of at least 1,020 was calculated on the basis of an expected incidence of respiratory complications of 5.5% ± 1.4%, based on a previous study [ 15 ]. The chi-squared test was used to compare categorical data and multivariate logistic regression analysis

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Sever hepatitis induced by Epstein-Barr virus: case series

Abstract

Epstein-Barr virus (EBV) is a causative agent of infectious mononucleosis syndrome. This infection often resolves over a period of several months without outcomes, but may occasionally be complicated by a great variety of neurologic, hepatic, hematologic and respiratory complications. In the current report, we present the case histories of three patients with acute hepatitis following EBV infection when previously healthy. The patients showed fever, nausea, weakness, as well as yellowing of the skin, and then in the course of examination, sore throat. They were managed supportively and their clinical condition improved. Liver function tests such as ALT, AST, ALP, were undertaken and bilirubin were elevated. The serological tests for EBV infection were consistent with the acute phase of infection. The monospot test was also positive. The patients were managed supportively, and their critical condition was improved.

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Primary Repair of Cleft Lip and Nose in the Neonatal Period

Abstract

Facial cleft malformations belong to the most common problems of the congenital facial anomalies. At the Clinic of Plastic, Aestetic and Reconstructive Surgery at the Faculty Hospital in Banská Bystrica we have been performing primary cleft lip repairs during the first week of life of a newborn since 1995. During this life period the fetal healing still persists. Modern anesthetic techniques have considerably reduced respiratory complications after the lip closure. The adequate postoperative sedation together with monitoring of the pacient remarkably reduces the occurrence of wound dehiscence. The advantages of the neonatal cleft lip repair are the scarless healing, no negative effect on the growth of the middle thirt of the face, as well as the pschychosocial effect on the family and the fact that the ortodontic aparat has not been needed.

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FLT-3 ITD Positive Acute Basophilic Leukemia with Rare Complex Karyotype Presenting with Acute Respiratory Failure: Case Report

Abstract

Background: Acute basophilic leukemia is a rare subtype of acute myeloid leukemia, as categorized by the 2008 World Health Organization classification of myeloid neoplasms. Acute basophilic leukemia diagnosis requires thorough morphological, cytochemical, immunophenotypic, molecular, and cytogenetic studies and exclusion of other hematological neoplasms associating basophilia. The disease course is defined by histamine driven, occasionally life-threatening respiratory, cardiovascular, cutaneous or digestive complications, as well as primary refractoriness to standard therapy. Clinical presentation: We herein report a case of a 63-year-old asthmatic female patient diagnosed with acute basophilic leukemia, associated with previously unpublished cytogenetic features and FLT-3 ITD mutation, pulmonary leukostasis and spontaneous pulmonary capillary leak syndrome, which worsened immediately following chemotherapy initiation. Respiratory complications were successfully managed, but recrudesced upon emergence of refractory disease and were ultimately fatal. We highlight the likelihood of pulmonary complications induced by basophil degranulation and tumor lysis in hypercellular acute basophilic leukemia and the potential benefit of histamine receptor blockade in this setting.

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Associative Tolerance of Intravenously Administered Lipid and Gestational Age in Preterm Infants Receiving Total Parenteral Nutrition

Associative Tolerance of Intravenously Administered Lipid and Gestational Age in Preterm Infants Receiving Total Parenteral Nutrition

Aim. The aim of this study is to investigate the effect of constant amount of lipid during total parenteral nutrition (TPN), by the evaluation of serum levels of: total cholesterol, triglycerides, free fatty acids, billirubin, AST, ALT, acid base status in the group of sick preterm infants.

Material and methods. The tolerance for intravenously administered lipid (IL), with a maximal daily dose of 2.5 gr/kg, in 20 sick preterm infants during total parenteral nutrition was analyzed by controlling the total serum lipid level; the total cholesterol; the serum triglycerides concentration; the free fatty acids levels; the lipoprotein electrophoresis; the bilirubin level (total, conjugated and unconjugated); ALT and AST; the blood hemoglobin; erythrocyte, leukocyte and reticulocyte count; hematocrit; and the acid base status in capillary, venous and arterial blood.

Results. A serum triglyceride concentration <1.5 mmol/l was found in 15 (75%) out of 20 triglyceride determinations, levels between 1.5-2.0 mmol/l were found in 3 (15%), and >2.0 mmol/l in 2 (10%). Hypertriglyceridemia >1.5 mmol/l was found in 4 patients with perinatal asphyxia and one with septicemia. There is a highly significant inverse correlation (p<0.001) between birth weight, gestational age and serum triglyceride level. The other analysis made for control of lipid tolerance were normal except the lower oxygen saturation levels such as pO2 and increased pCO2, derived from patients with RDSy. An important increase in body weight was signed: 24.948 gr/gr infused protein/24h, 45.528gr/418 KJ energy/24h, 22.078gr/kg body weight/24h.

Conclusion. Our study showed that the intake of 2.5 g/kg/day proteins and 2.5 g/kg/day IL can be tolerated without metabolic or respiratory complications, and can also prevent the development of negative nitrogen balance seen in the conventional management of delivering glucose alone.

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Ambulatory Anaesthesia/ Anestēzija Ambulatorajā Ķirurģija

Abstract

Ambulatory (outpatient) surgery refers to the admittance into hospital on the day of surgery of carefully selected and prepared patients for a planned surgical procedure and their discharge within hours. About 65% of all surgical procedures are performed on an outpatient basis. There are many benefits of ambulatory surgery: cost reduction up to 25-75%, efficiency, shorter waiting lists, lower cancellation rate, patient convenience, low morbidity/mortality, less infections and respiratory complications and less medication. All patients should follow a sequential pathway and be pre-assessed according to a set of ambulatory case criteria (health status, age, complexity of surgery, transport, and social support). An anaesthesia plan is developed by an anaesthesiologist, then accepted by the patient after discussion and documented. Anaesthetic management includes the usage of local anaesthetic or short-acting general anaesthetic drugs with fewer residual psychomotor effects and low incidence of postoperative malaise. Medical discharge criteria as well as the discharge organisation are also important. The readmission rate after outpatient surgery is about 1%. Nausea/vomiting, pain and operative site bleeding are the most common causes. Extended stay or inpatient facilities should be available for patients who cannot be discharged after a reasonable stay in the post-anaesthesia care unit areas

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Fading Sugammadex, or Just Cautiously (re) Considered?!

-Q.Drug -specific cyclodextrins. The future of rapid neuromuscular block reversal, Drugs Future. 2003; 23:347-354. 9. Ezri T, Evron S, Petrov Irina, Schlechter P, Berlovich Y, Shimonov M: Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy - the effect of reversal agents: sugammadex vs. neostigmine. J Crit Care Med. 2015;1(2):61-7. 10. Leykin Y, Pellis T, Lucca M, Lomangino G, Marzano B, Gullo A. The Pharmacodynamic effects of rocuronium when dosed according to real body weight or ideal body

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