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T Ezri

Publications and source records attributed to T Ezri.

At least 37 records · Page 2Linked to original sources
PubMed2001

The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.

IMPLICATIONS: In an earlier study we proposed the addition of a new airway class, zero (visualization of the epiglottis), to the four classes of the modified Mallampati classification. In this prospective study, 764 surgical patients were assessed with regard to their airway class (including class zero), laryngoscopy grade, and the effect of the airway class and other predictors on the laryngoscopy grade.

Adult↗
PubMed2001

Difficult airway in obstetric anesthesia: a review.

UNLABELLED: Failed intubation and ventilation are important causes of anesthetic-related maternal mortality. The purpose of this article is to review the complex issues in managing the difficult airway in obstetric patients. The importance of prompt and competent decision making in managing difficult airways, as well as a need for appropriate equipment is emphasized. Four case reports reinforce the importance of a systematic approach to management. The overall preference for regional rather than general anesthesia is strongly encouraged. The review also emphasizes the need for professional and experienced team cooperation between the obstetrician and the anesthesiologist for the successful management of these challenging cases. LEARNING OBJECTIVES: After completion of this article, the reader will be able to break down the complex issues in managing the difficult airway in the obstetric patient, outline the reasons for difficult intubations in pregnancy, and describe the evaluation used to predict a difficult intubation.

Adult↗
PubMed2001

Etiology and incidence of endotracheal intubation following spinal anesthesia for cesarean section.

BACKGROUND: The incidence of spinal failure necessitating general anesthesia and endotracheal intubation following spinal anesthesia for cesarean section is extremely low. Aspiration prophylaxis prior to spinal anesthesia is often recommended in case of spinal failure or excessive spinal block requiring the emergency administration of general anesthesia. OBJECTIVES: To determine the incidence of endotracheal intubation following spinal anesthesia for cesarean section. METHODS: We retrospectively reviewed the peri-operative course of parturients undergoing cesarean section under spinal anesthesia at our institution from February 1991 to December 1993. If spinal failure occurred, 10 ml of sodium bicarbonate was administered by mouth prior to induction of general anesthesia. RESULTS: Among the 743 cases that we reviewed, spinal failure occurred in 15 patients (2%) because of inadequate analgesia in 14 patients (1.9%) and unexpected prolonged surgery for hysterectomy in one patient (0.1%). No patient required intubation due to excessive spinal block. In none of the patients was a record of pulmonary aspiration identified. CONCLUSIONS: The extremely low incidence of spinal failure or excessive block necessitating endotracheal intubation suggests that routine aspiration prophylaxis may not be necessary prior to spinal anesthesia. However, these results should be confirmed by a prospective, controlled study on larger populations. An antacid should be readily available and administered whenever general anesthesia is required.

Adult↗
PubMed2000

Peripartum general anasthesia without tracheal intubation: incidence of aspiration pneumonia.

This study estimated the incidence of pulmonary aspiration during general anasthesia for obstetric procedures performed in the peripartum period (Caesarean sections were not studied). The records of 1870 patients anasthetised without tracheal intubation were reviewed retrospectively. The diagnosis of aspiration was based on the anasthetist's written remarks and the postoperative course. Eighty per cent of patients received ketamine and a benzodiazepine, and the remaining 20% received methohexital or thiopental and fentanyl. No cricoid pressure or tracheal intubation was performed. A single case of mild aspiration was detected in a woman anasthetised with methohexital (an incidence of 0.053%). These results suggest that the risk of aspiration during general anasthesia without tracheal intubation, during and immediately after delivery, may not be higher in obstetric patients in the peripartum period, as has been reported previously.

Adult↗
PubMed2000

Metoclopramide induced akathisia during cesarean section.

We report a case of akathisia developed after administration of 2.5 mg metoclopramide for treatment of nausea during cesarean section. The relevant literature as well as options for prevention and treatment of this phenomenon are reviewed.

Journal Article↗
PubMed2000

The onset time of rocuronium is slowed by esmolol and accelerated by ephedrine.

Administration of ephedrine prior to rocuronium decreases the onset time of neuromuscular blockade from rocuronium by 26%. This effect was attributed to a increased cardiac output. If so, beta adrenergic-blocking drugs, which decrease cardiac output, should prolong the onset time of rocuronium. In a double-blind study, 60 patients were randomly assigned to three groups (n = 20) to receive either 70 microg. kg(-1) of ephedrine, 0.5 mg. kg(-1) esmolol or placebo, 30 s before induction of anesthesia. Onset time of rocuronium was defined as the time from the end of its injection to disappearance of all four twitches of the train-of-four. The onset time of rocuronium was significantly shorter after ephedrine (22%) and longer after esmolol (26%), as compared to placebo. No differences were observed among the three groups with regard to heart rate, systolic, diastolic or mean blood pressure. We concluded that a dose of 0.5 mg. kg(-1) of esmolol significantly prolongs the onset time of rocuronium with minimal hemodynamic changes.

Adolescent↗
PubMed1999

Use of cuffed oropharyngeal vs laryngeal mask airway in elderly patients.

PURPOSE: This study was designed to compare the new cuffed oropharyngeal airway (COPA) to the laryngeal mask airway (LMA) in elderly patients. METHODS: In a randomized, controlled study, 80 patients, age > or = 65, ASA I-III, undergoing urology procedures, were managed with either COPA or LMA. Propofol requirements for insertion of the devices, ease of insertion and removal, airway manipulations, mean arterial pressure, heart rate, P(ET)CO2, SpO2, peak inspiratory pressure, selection of the appropriate size of the device and leaks, fibreoptic visualization of larynx and complications were studied. RESULTS: There were more airway manipulations in the COPA group than in the LMA group (40% and 5% respectively) whereas P(ET)CO2 was higher in the LMA group (P < 0.05). In 60% of COPA patients the vocal cords could not be visualized but ventilation was adequate in all but two cases. Postoperative sore throat occurred in 20% of patients with LMA vs 10% with COPA). Bloody secretions on the device were present in two patients managed with LMA. CONCLUSION: In elderly patients COPA required more airway manipulations than the LMA. Laryngeal mask airway caused more sore throats, but was better for fibreoptic visualisation of the larynx. Both are excellent options when intubation is not indicated/desired.

Aged↗
PubMed1998

Oral clonidine premedication does not prolong analgesia after herniorrhaphy under subarachnoid anesthesia.

STUDY OBJECTIVE: To determine the effect of oral clonidine premedication on duration of sensory and motor block, postoperative analgesia, hemodynamic stability, sedation, and respiratory parameters after subarachnoid anesthesia (SA). DESIGN: Prospective, double blind, randomized, placebo-controlled study. PATIENTS: 80 ASA physical status I patients were randomized into four equal groups to receive oral premedication with either clonidine 5 mcg/kg (C5), clonidine 2.5 mcg/kg (C2.5), diazepam 100 mcg/kg (D), or placebo (PL). MEASUREMENTS AND MAIN RESULTS: The following parameters were measured: duration of motor and sensory block, requirement for postoperative analgesia; systolic (SBP), diastolic (DBP), and mean (MBP) blood pressures; heart rate (HR); sedation and anxiolysis scales; respiratory rate (RR); oxyhemoglobin saturation; and complications. (1) The duration of sensory and motor block did not differ significantly among the groups. (2) There were no differences in the time to first request for analgesia and in requirements for analgesia in the first 24 postoperative hours. (3) Clonidine premedication before SA did not produce episodes of significant hypotension. HR did not differ significantly among the groups. Baseline SBP was significantly higher (p = 0.037) in group PL than in groups C5 and C2.5. Three minutes after SA significant decrease in the following parameters was observed: SBP in group PL compared with the other three groups (p = 0.004), DBP in group PL vs. groups C5 and C2.5 (p = 0.002), and MBP in group PL vs. groups C5 and C2.5 (p = 0.003). (4) Sedation and anxiolysis were more pronounced (p = 0.0001) in groups C5 and C2.5 than in groups D and PL and in group C5 than in group C2.5. (5) RR was significantly lower (p = 0.0024) in group C5 than in groups D and PL. (6) Complications consisted of three episodes (15%) of bradycardia in the C5 group and two of bradypnea (10%) in the same group. CONCLUSIONS: In healthy patients, premedication with oral clonidine provided useful sedation and anxiolysis and stable hemodynamics, without prolongation of sensory and motor block. Side effects occurred only with clonidine 5 mcg/kg. Thus, a dose of 2.5 mcg/kg is recommended.

Administration, Oral↗