Mohamed Saleh

Use of biplane transesophageal echocardiography as the only imaging technique for percutaneous balloon mitral commissurotomy

Percutaneous balloon mitral commissurotomy with the Inoue technique was attempted in 9 patients with rheumatic mitral stenosis under the sole guidance of biplane transesophageal echocardiography and was completed in 8 patients. This preliminary experience points to the feasibility and relative safety of performing percutaneous balloon mitral commissurotomy under the sole guidance of biplane transesophageal echocardiography.

The effect of intrathecal compared with intravenous dexmedetomidine as an adjuvant to spinal bupivacaine anesthesia for cesarean section

Introduction The aim of this study was to evaluate the effect of intrathecal compared with intravenous dexmedetomidine as an adjuvant to spinal bupivacaine anesthesia for pregnant women undergoing cesarean section on intraoperative and postoperative analgesia with special emphasis on their sedative properties and on the neonatal outcome. Patients and methods A total of 105 women of ASA physical status I or II at term pregnancy were enrolled randomly into three groups. Patients in group I received spinal anesthesia with hyperbaric bupivacaine. In group II, 5 μg dexmedetomidine was added to bupivacaine. In group III, after administration of spinal anesthesia with bupivacaine and an intravenous infusion of 0.5 μg/kg/h dexmedetomidine throughout the surgery, the incidence of hypotension, bradycardia, the onset, and the duration of sensory and motor block and the postoperative pain score were assessed. Results No differences were observed in the rate of occurrence of hypotension and bradycardia between the three groups. The time to reach the peak sensory level was shorter in group II and group III with a longer duration compared with group I. The duration of motor block was shorter in group I compared with the two other groups with no significant difference between the three groups in the onset of motor block. The onset of postoperative pain was significantly earlier in group I, and more patients in group I needed supplementary analgesia. No significant difference was noted between the three groups regarding the Apgar score and the incidence of maternal side effects such as nausea, vomiting, and dryness of the mouth. Conclusion The use of intrathecal dexmedetomidine or intravenous dexmedetomidine as an adjuvant to spinal bupivacaine in women undergoing elective cesarean section improved the intraoperative condition and the quality of postoperative analgesia without neonatal or maternal side effects.

Left ventricular torsion assessed by two-dimensional echocardiography speckle tracking as a predictor of left ventricular remodeling and short-term outcome following primary percutaneous coronary intervention for acute myocardial infarction: A single-center experience.

Left ventricular (LV) torsion is a novel method to assess systolic LV function. This study aimed at exploring the utility of 2D speckle tracking–based assessment of left ventricular torsion in patients with acute myocardial infarction (AMI) undertaking primary percutaneous intervention (pPCI) in predicting left ventricular remodeling.

Management of uncontrolled hemorrhagic trauma: State of the art

Uncontrolled hemorrhagic trauma represents a challenge to the intensivist as it is a leading cause of potentially preventable death in trauma patients. Recently, damage control resuscitation and hemostatic resuscitation has become the standard of care for the management of these patients. The aim of this review is to highlight the pathophysiology of acute traumatic coagulopathy and the management of these challenging patients.

Central cord syndrome

Spinal cord injuries (SCIs) are classified as complete or incomplete injuries. Central cord syndrome (CCS) is the most common type of incomplete SCI. The syndrome mostly occurs in older individuals with underlying cervical spondylosis caused by a hyperextension injury. The neurological impairment is characterized by a disproportionate weakness of the upper extremities more than the lower extremities and may also include bladder dysfunction and varying degrees of sensory loss. The natural history of the syndrome varies, with some patients experiencing complete spontaneous recovery and others having persistent neurological deficits. The role of surgical intervention remains controversial. We present a case of an elderly patient with cervical spondylosis who underwent thoracolumbar spine fixation and was complicated by CCS mostly due to hyperextension injury during surgery.

Implementation of enhanced recovery after surgery in pediatric cardiac practice: a synopsis

Enhanced recovery after surgery is a multimodal, multidisciplinary, evidence-based approach, aiming to control postoperative pathophysiology and rehabilitation. The aim of this article is to review current literature in pediatric cardiac practice, implementing the ERAS approach, to identify peri-operative strategies that are associated with enhanced recovery after pediatric cardiac surgery.

Risk management and anesthesia

Risk management in Anesthesia is a crucial part of patient safety. Because anesthesia care is usually considered as facilitative rather than therapeutic, the outcome of anesthesia care has traditionally been measured in terms of the absence of ′complications′. Consequently, anesthetists have been at the forefront of clinical risk management. It can be described in five stages as follows: risk awareness, risk identification, risk assessment, risk management, and re-evaluation. By identifying the strong points and the weakest points in concurrent health systems; policies and procedures can be implanted in order to ensure effective risk control. If applied correctly and not limited to compelling statistics, risk management can be a powerful, highly beneficial aid to our practice.

Preoperative evaluation: impact on anesthetic management

Preoperative evaluation has a major impact on anesthetic management. Through a systematic approach of preoperative evaluation, involving history taking, physical examination, and preoperative investigation, the anesthetist could optimize patient′s medical condition, determine a proper perioperative risk, develop an appropriate perioperative anesthetic plan, and improve quality for perioperative care.

Anesthesia-related morbidity and mortality: where are we? A descriptive study

Background Safe anesthesia practice is by default the ultimate target for every anesthesiologist. Mortality and morbidity discussions constitute the most important method to address this issue, although a well-designed productive mortality and morbidity discussion is rare. In this study we tried to initiate a project of a systematic mortality and morbidity analysis that could easily gather data about the incident. These data were statistically analyzable and could finally address the problem. Materials and Methods A total of 56 mortality and morbidity reports from July 2009 to August 2012 were reviewed. These were analyzed using a self-constructed chart. This chart was designed to achieve the goal of addressing the problem. This chart also assessed the degree of attribution of the incident to anesthesia, anticipation of the incidents, and the contributing factors that led to this incident. Results Equal distribution of the three main categories of contributing factors (preoperative, intraoperative, and postoperative) was noticed, although 62% of the incidents could be easily gathered under a specific scenario of inappropriate preoperative management (20%) that led to improper choice of anesthesia (22%). Logically, this will lead to poor anticipation of intraoperative complications, followed by poor crisis management (14%) and finally insufficient postoperative management (6%). Hence, poor planning was responsible for 62% of the incidents. This result was supported by an almost similar percentage (65%) of unanticipated incidents. Moreover, 8% of the errors analyzed comprised system errors, which is a relatively high percentage. Conclusion Poor planning and nonanticipation of complications are the major problems that should be overcome by improving anesthesia planning. Also a stronger system is needed to minimize system errors.