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Comparison between the Clinical Assessment, Peripheral Nerve Stimulation (PNS), and Acceleromyography (AMG) to Reverse Neuromuscular Blockade

Authors: Iyad Abbas Salman --- Mortada A. Jubara
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 146-152
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND:Traditionally, most of anesthesiologists in Iraq evaluate the degree of neuromuscular blockade during and after anesthesia using clinical criteria alone, which are inaccurate to assess adequate recovery from neuromuscular block (NMB) which is essential for the patient to have full control of pharyngeal and respiratory muscles. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio > 0.4. The time gap between losses of visual fade by using a PNS until objective TOF ratio has returned to > 0.90 can be considered “the potentially unsafe period of recovery.” OBJECTIVE: To compare between assessment of subjective clinical, subjective TOF by peripheral nerve stimulation (PNS), and objective TOF by acceleromyography (AMG) before reversal of neuromuscular blockadePATIENT AND METHOD: A prospective clinical trial of one hundred females who underwent caesarian section under general anesthesia. Standard anesthesia was conducted for all patients. Giving of neuromuscular reversal was decided by the anesthesia care providers depending on clinical criteria, at that time, TOF measured by 2 ways, 1st: counting the twitches visually (principal of PNS), and 2nd: the device showing the TOF reading objectively (principal of AMG).RESULT: Comparisons between subjective criteria and objective AMG T4T1 ratios revealed no statistical significance (P > 0.05) in all comparisons (except that with the moving limb and lift the head). The association and consistency of subjective criteria and visual PNS was insignificant differences in all comparisons. There was wide discrepancy between objective reading and the visual PNS. CONCLUSION: The moving limbs and sustained lift head 5 seconds clinical criteria were correlated to TOF. Other criteria (protruding tongue, respiratory effort, and swallowing reflex) were not correlated to TOF. Objective AMG more sensitive to detect the fourth twitch than the subjective PNS. KEY WORDS: train of four (TOF), peripheral nerve stimulator (PNS).


Article
A Comparison of Using Ketamine Versus Combination of Ketamine and Thiopentone in Short Painful Procedures in Pediatrics

Authors: Iyad Abbas Salman --- Saba J. AL-Wardi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 1 Pages: 103-109
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications.OBJECTIVE: To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone".PATIENTS AND METHOD: THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded. RESULTS:It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.CONCLUSION: The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental.KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.

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