A sequential allocation study to determine the ED of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia.

Background: Intravenous regional anesthesia is an easy and reliable anesthetic technique, but its use is limited by tourniquet pain. Clonidine is effective in overcoming this shortcoming when used with intravenous regional anesthesia at a dose of 1 μg/kg. Dexmedetomidine has also been used successfully at a dose of 0.

Predictors of postoperative pain and analgesic requirements following abdominal hysterectomy: an observational study.

Purpose: A prospective observational study is conducted to identify independent predictors of pain and morphine consumption following abdominal hysterectomy.

Methods: Preoperative State Trait Anxiety Inventory (STAI), Numerical Rating Scales (NRS) for anxiety and pain expectations, thermal pain thresholds and pain scores at forearm and incision site, and pain scores generated from the insertion of an intravenous catheter were measured in female patients undergoing abdominal hysterectomy. Pearson correlations between the predictors and the two outcome measures postoperative pain scores and morphine consumption were studied and multiple regression analysis was conducted to identify independent predictors (primary outcome).

Setting practice standards for palliative care in Lebanon--recommendations of the Subcommittee on Practice --National Committee for Pain Control and Palliative Care.

Palliative care is in the early stages of development in Lebanon. The National Committee for Pain Control and Palliative Care (NCPCPC) was established under the Ministry of Public Health to work towards the development of palliative care. This paper summarizes the recommendations of the Subcommittee on Practice of the NCPCPC regarding hospital standards and provider competencies in palliative care.

A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery.

Background: Phenylephrine infusion is used to reduce hypotension during spinal anesthesia for cesarean delivery. A prophylactic fixed rate infusion regimen may not improve hemodynamic control; a variable rate regimen adjusted in response to changes in arterial blood pressure and heart rate may allow more accurate maintenance of baseline blood pressure. We hypothesized that a combination of crystalloid solution coload with a variable rate phenylephrine infusion and phenylephrine rescue boluses may be associated with fewer physician interventions needed to maintain maternal systolic blood pressure within 20% of baseline and greater hemodynamic stability than crystalloid solution coload with phenylephrine rescue boluses alone.

Use of noninvasive positive pressure ventilation in emergency departments of public and private hospitals in Lebanon.

Noninvasive positive pressure ventilation is increasingly being used in emergency departments across Europe and North America. To our knowledge, no similar data are available from other countries. The aim of this study is to describe the current use of noninvasive positive pressure ventilation in the emergency departments of Lebanese hospitals.

Effect of vitamin C on morphine use after laparoscopic cholecystectomy: a randomized controlled trial.

Purpose: We designed a randomized double-blind placebo-controlled trial to assess the role of a single prophylactic dose of vitamin C (2 g) po in reducing the consumption of opioids postoperatively in patients undergoing laparoscopic cholecystectomy.

Methods: Eighty adult patients were allocated to receive 2 g vitamin C po or placebo approximately one hour prior to induction of anesthesia. Following laparoscopic cholecystectomy, patients received morphine patient-controlled analgesia for 24 hr.

Subpleural block is less effective than thoracic epidural analgesia for post-thoracotomy pain: a randomised controlled study.

Context: Thoracic epidural and paravertebral blocks provide adequate analgesia for postoperative thoracotomy pain. Both procedures are usually performed percutaneously with considerable failure rates. A subpleural catheter placed in the space posterior to the parietal pleura and alongside the paravertebral area may provide superior postoperative pain relief.

Weaning from mechanical ventilation.

Purpose Of Review: Liberation from mechanical ventilation is a defining moment for intubated patients, and thus a critical clinical decision. Extubating the patient too early exposes the patient to extubation failure and reintubation. Waiting too long increases the complications of prolonged intubation.

Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients.

Context: Pain is a common complaint in oncology patients, and success in its treatment requires accurate assessment. Thus, assessment tools that are practical, culturally sensitive, and psychometrically sound are needed.

Objectives: The purpose of this study was to evaluate the psychometric properties and cultural sensitivity of the Arabic Brief Pain Inventory (BPI) in a Lebanese sample of cancer patients.

Femoral vein cannulation performed by residents: a comparison between ultrasound-guided and landmark technique in infants and children undergoing cardiac surgery.

Background: Percutaneous cannulation of the femoral vein, in the pediatric age group, can be technically challenging, especially when performed by residents in training. We examined whether the use of real-time ultrasound guidance is superior to a landmark technique for femoral vein catheterization in children undergoing heart surgery.

Methods: Patients were prospectively randomized into 2 groups.

The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial.

Background: Ultrasound-guided transversus abdominis plane block is an effective method of providing pain relief after cesarean delivery. Neuraxial morphine is currently the "gold standard" treatment for pain after cesarean delivery. In this study we tested the hypothesis that subarachnoid morphine would provide more prolonged and superior analgesia than would transversus abdominis plane block in patients undergoing elective cesarean delivery.

Excellent intubating conditions with remifentanil-propofol and either low-dose rocuronium or succinylcholine.

Purpose: The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg .

A comparison of a silicone wire-reinforced tube with the Parker and polyvinyl chloride tubes for tracheal intubation through an intubating laryngeal mask airway in patients with normal airways undergoing general anesthesia.

Background: The intubating laryngeal mask airway (ILMA) is used in the management of difficult intubation. Usually, a silicone wire-reinforced tube is inserted for tracheal intubation. Because the silicone wire-reinforced tube is expensive, alternatives, such as polyvinyl chloride (PVC) and posterior beveled Parker tubes, are worth considering.

Recurrent postoperative aspiration following jugular foramen tumor resection.

We report a 38 year old male patient who underwent a craniotomy for jugular foramen tumor resection. In the postoperative care unit, the patient developed aspiration accompanied with oxyhemoglobin desaturation. Subsequently, he had several episodes of recurrent aspiration which were attributed to cranial nerves (IX, X) palsy as a complication of the surgery at the jugular foramen.

A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia.

Background: Emergence agitation in children after sevoflurane is common. Different drugs have been used to decrease its occurrence with variable efficacy. The authors compared the incidence and severity of emergence agitation in children who received a single dose of propofol at the end of strabismus surgery versus children who received saline.

Noninvasive bilevel positive airway pressure for preoxygenation of the critically ill morbidly obese patient.

Purpose: We describe the use of noninvasive bilevel positive airway pressure (BiPAP) in a critically ill, hypoxemic and morbidly obese patient for preoxygenation prior to rapid sequence induction of anesthesia.

Clinical Features: A critically ill morbidly obese patient (body mass index: 49 kg.m(-2)) was scheduled for urgent laparoscopic cholecystectomy.

Phantom limb syndrome: a review.

Phantom limb syndrome is a condition in which patients experience sensations, whether painful or otherwise, in a limb that does not exist. It has been reported to occur in 80-100% of amputees, and typically has a chronic course, often resistant to treatment. Risk factors include the presence of preoperative pain, traumatic amputation, and the type of anesthetic procedure used during amputation.

A randomized, placebo-controlled trial of bupropion sustained release in chronic low back pain.

Unlabelled: Clinical trials of the efficacy of antidepressant drugs in patients with chronic low back pain have had mixed results, possibly because of the different mechanisms of action of the drugs that have been studied. Because bupropion has a mechanism of action that differs from other antidepressants and has shown efficacy in neuropathic pain, a randomized, placebo-controlled, 2-period crossover trial was conducted to evaluate its efficacy in subjects with chronic low back pain. The primary efficacy variable was mean daily diary pain intensity ratings, and secondary pain intensity and relief outcomes included weekly pain intensity ratings, the McGill Pain Questionnaire (MPQ) Present Pain Intensity scale, pain relief ratings, and satisfaction with pain relief ratings.