Archives of Anesthesia and Critical Care

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

2024-06-29T15:54:49+00:00

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia

Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level.

Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless."

Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.

A Non-Inferiority Study of the Speed and Success of Nasotracheal Intubation in Maxillofacial Surgeries Using Macintosh Direct Laryngoscope versus Sanyar® Video Laryngoscope

2024-06-29T15:55:29+00:00

Background: The recently developed blade design of the Sanyar® video laryngoscope yields an exceptionally precise visualization of the larynx, thereby easing the process of tracheal intubation.

Objectives: A non-inferiority clinical investigation, to assess the efficacy of the Sanyar® as compared to the Macintosh® direct laryngoscope for nasotracheal intubation in the context of maxillofacial surgeries.

Methods: 78 patients for maxillofacial surgery were divided randomly into two groups and intubated through the nose using either the Sanyar® or Macintosh® laryngoscope after anesthesia was induced. The study measured intubation time and secondary objectives included success rate, attempts, and hemodynamic changes in two groups.

Results: 40 eligible patients in the Sanyar® and 38 in the Macintosh® group were involved. Of all, 42(53.8%) were men and 36(46.2%) were women. The average age of patients in the Sanyar® and Mackintosh groups was (31.62±13.41) and (30.81±10.89), respectively. 39(98%) of the Sanyar® group and 33(86%) of the Macintosh® group had successful laryngoscopy and intubation, with a P-value<0.034. Sanyar® group had a significantly shorter intubation time than Macintosh® (P-value<0.001). Hemodynamic changes before and after laryngoscopy and intubation had no significant differences between the two groups.

Conclusion: The Sanyar® video laryngoscope reduced the time of nasal tracheal intubation in maxillofacial surgery compared to direct laryngoscopy and improved the success rate of the first intubation attempt.

Comparing the Ease of Endotracheal Intubation with and without an Intubation Box in COVID-19 Patients

2024-06-29T15:56:06+00:00

Background: Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients.

Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups.

Results: The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032).

Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility.

Comparative Study of the Preemptive Dexmedetomidine Versus Ondansetron Effect in Post-Operative Nausea and Vomiting after Middle Ear Surgery

2024-06-29T15:56:48+00:00

Background: Nausea and vomiting after operation has high prevalence and cause adverse effect. The aim of this study was to compare the effect of dexmedetomidine with ondansetron in prevention of post-operative nausea and vomiting (PONV) after middle ear surgery under general anesthesia.and saliva gas in traumatic patients under mechanical ventilation.

Methods: This in this double-blinded clinical trial study, one hundred and sixty-two patients undergoing middle ear surgery under general anesthesia were randomly divided into three groups of 55 each: ondansetron (O), dexmedetomidine (D) and control (C). Group O received 0.1 mg/kg of ondansetron, Group D received 1 μg/kg/min of dexmedetomidine and Group C received 10 cc of normal saline 15 to 20 minutes before surgical incision. After that, the patients were examined in post-anesthesia care unit (PACU) and up to 24 hours after the operation in terms of PONV and other study variables.

Results: The severity of nausea after operation based on VAS (visual analog scale) was significantly different between Group O (2.2±0.7) and Group D (3.9± 0.7) and Group C (5.15±1.3) (P= 0.04). The incidence of vomiting in the first 24h postoperatively was 14.8% in Group O, 46.3% in Group D and 88.8% in Group C (P= 0.003).

Conclusion: Our study showed that ondansetron was better than dexmedetomidine for prevention of PONV after middle ear surgery.

Investigating the Role of Dexmedetomidine and Propofol on Fertility Rate in IVF Candidate Patients

2024-06-29T15:57:19+00:00

Background: One of the most important treatments used in women with infertility is IVF, and improving its results can affect the success of assisted reproductive techniques. It was previously shown that anesthetics can enter the follicular fluid (FF), so there is concern about the accumulation of anesthetics in the FF and their negative effects on fertilization and fetal growth under general anesthesia. The use of drugs that have both analgesic and sedative effects but do not have hemodynamic side effects is of particular importance and dexmedetomidine is one of the drugs introduced in this field. On the other hand, the use of sedatives such as midazolam and propofol may cause hemodynamic disturbances and severe hypotension in these patients, which limits the use of such drugs. Accordingly, and considering the importance of the issue, in this study, we decided to evaluate and compare the effect of propofol and dexmedetomidine on fertility in IVF candidates.

Methods: In this clinical trial study, 78 infertile patients who underwent IVF were randomly examined. After dividing the patients into two groups receiving dexmedetomidine and propofol or standard recording doses, the fertility rate of the patients in the two groups was evaluated using chi-square and Fisher tests at a significance level of 0.05.

Results: The use of dexmedetomidine for (P = 0.0348) Pressure_After_Dia, HR_Before (P = 0.0204), Injection_Time (P =0.000) and Recovery Time (P =0.000) indices caused a significant increase compared to the propofol group.

Conclusion: The results of the present study did not show a significant difference in the use of these two drugs on fertility.

The Effect of Deferoxamine and Vitamin C Supplementation on Ferritin and CRP Levels in COVID-19 Patients

2024-06-29T15:57:52+00:00

Background: Today, the COVID19 pandemic is one of the most important health system challenges in the world, which doesn’t have specific treatment yet. It includes a wide range of respiratory and non-respiratory signs and symptoms, that lead to hospitalization and intensive care units.

Methods: In this study, 78 patients in two groups of 39 patients were included. The case group included 39 COVID19 patients who had specified sign in CT scans and factors of viral infection, high serum ferritin, increased inflammatory factor in the blood. There were two intervention groups (receiving deferoxamine and vitamin C) and the control group (receiving only official protocol drugs of the country). All patients were admitted to the ICU of Shohada-e-Tajrish Hospital and underwent complete cardiorespiratory monitoring. All changes in Spo2, hemodynamics, serum ferritin and CRP were recorded before the study.

Results: This study presented that improved patient had lower ferritin levels than those who were still ill. In addition, prescribing deferoxamine as an adjunct to vitamin C can prevent cytokine storms that was effective for improving the patients with COVID19.

Conclusion: In conclusion. According to the role of deferoxamine and vitamin C in significantly reducing inflammatory factors of ferritin and CRP, they can be used as an adjunctive therapy in patients with COVID19.

Comparison of Analgesia Produced by preoperative Ultrasound-guided Femoral Nerve Blocks and Postoperative Intravenous Administration of Opioids in Patients Undergoing Hip Replacement Surgery

2024-06-29T15:59:14+00:00

Background: Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery.

Methods: This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia.

Results: After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group.

Conclusion: The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.

Intraoperative Administration of Diphenhydramine Attenuates Postoperative Catheter Related Bladder Discomfort in Patient Following Percutaneous Nephrolithotomy

2024-06-29T16:00:12+00:00

Background: We intend to evaluate the effect of intraoperative diphenhydramine administration on incidence and severity of catheter related bladder discomfort (CRBD) and pain after percutaneous nephrolithotomy.

Methods: In a double blind randomized clinical trial, adult male patients undergoing percutaneous nephrolithotomy were enrolled. They were randomized into two groups by a computerized digital random allocation method. Before anesthesia induction, group D (Diphenhydramine group) (n = 48) received 5 ml normal saline containing 0.5 mg/kg of diphenhydramine intravenously. In group C (Control group) (n = 48), 5 ml of normal saline was injected in the same manner. Induction and maintenance of anesthesia were identical in both groups. The incidence and severity of CRBD and postoperative pain were assessed at recovery room.

Results: The incidence of CRBD was significantly lower in group D than in group C (14% vs. 63%, P=0.001). The severity of CRBD was milder in group D in comparison to group C (P<0.05). Postoperative pain score was significantly lower in group D (P<0.05).

Conclusion: Intraoperative administration of diphenhydramine is an effective practice for the prevention of CRBD after percutaneous nephrolithotomy in male patients and can reduce postoperative pain as well.

Quality of Life Comparison between Front-Line Residents and Medical Students during COVID-19 Pandemic

2024-06-29T16:00:49+00:00

Background: The Covid-19 disease was the most significant pandemic of the century. Health care providers showed great sacrifices in managing this disease and saving humanity, and they suffered many injuries. So, this study aimed to investigate the effect of Covid-19 on the resident’s quality of life and comparison with medical students.

Methods: This cross-sectional study was performed on 223 Residents and 225 medical students. Using a random sampling method, WHOQOL-BREF 26 questionnaire was distributed among the participants. The collected data were analyzed with SPSS 21 software using T-test and ANCOVA.

Results: The results showed that covid-19 had caused a decrease in the quality of life of residents compared to medical students (P value<0.001). In addition, more advanced statistical analyzes showed that high work and study hours, irregular sleep, work history in COVID-19 wards, and the experience of CPR and intubation conditions of covid-19 patients have independent effects on the quality of life.

Conclusion: Covid-19 hurt all aspects of the quality of life of residents. Considering the essential role of residents in educational and treatment hospitals, it is necessary to make plans to improve the quality of life and psychological support of these people to prevent the decline in the quality of healthcare services.

Hip to Neck Circumference Ratio as an Independent Predictor of Difficult Intubation in Obese Patients

2024-06-29T16:01:33+00:00

Background: Anaesthesiologists face difficult intubation (DI) more frequently in obese patients. Thus, we aimed to test if central obesity indices including hip circumference (HC), neck circumference (NC) or waist circumference (WC) can effectively predict DI and difficult mask ventilation (DMV) in them.

Methods: HC, NC, WC, mask ventilation grade, intubation difficulty scale (IDS), history of snoring and obstructive sleep apnoea (OSA) were measured in 300 patients with BMI ≥ 30 kg/m2. Receiver operating characteristic curve (ROC) and multivariate, logistic regression were employed to identify predictors of DI (IDS ≥5) and DMV define as mask ventilation grade of 3 or 4.

Results: DI and DMV were, respectively, detected in 14.7% and 12.7% of subjects. According to Multiple logistic regression analysis BMI (Odds ratio (OR):1.17, 95% confidence interval (CI): 1.08-1.28, p<0.001), NC (OR: 1.26, 95% CI: 1.04-1.52, p=0.01), HC (OR:1.06, 95% CI: 1.03-1.10) and HC/NC ratio (OR: 4.9, 95% CI: 1.64-14.92, p= 0.004) considered as independent predictors of DI. The same analysis recognized BMI (OR:1.13, 95% CI: 1.03-1.24, p=0.006), WC (OR: 1.06, 95% CI:1.01-1.11, p=0.01), and HC/BMI ratio (OR=0.18, 95% CI:0.06-0.53, p=0.002) as DMV predictors. Sensitivity of BMI >35.8 kg/m2, NC >39.9 centimetres (cm), HC>118cm and HC/NC ratio >2.9 were determined as 70.5%, 68.2%, and 69.3% respectively for prediction of DI. Sensitivity of BMI >36.6 kg/m2 and WC >118 cm for predicting DMV were identified as 71.0% and 73.6%.

Conclusion: This study proposes to simultaneously consider the HC/NC ratio and WC as a predictor of difficult airway in the obese.

Assessment of the Impact of Prolonged Cesarean Section on Neonatal PH

2024-06-29T16:02:11+00:00

Background: Prolonged predelivery time in cesarean-section (C-section) may be associated with worse neonatal outcomes such as lower umbilical cord acid-base profile. This study investigated the association between surgical and anesthetic predelivery time intervals and neonatal acidosis in pregnant women delivering via C-section under spinal anesthesia.

Methods: This cross-sectional study was conducted on 70 pregnant women candidates for elective cesarean C-section, referred to Yas Hospital.

Results: Umbilical artery pH<7.3 was observed in 27 (38.6%) out of 70 included participants. The study variables including maternal age, hypertension, and gestational diabetes were not associated with umbilical pH level. 1-minute Apgar scores were linearly associated with pH (β: 0.170, 0.100 to 0.239, p-value<0.001). Among all evaluated surgical and anesthetic intervals, induction of spinal anesthesia to delivery (β: -0.008, -0.012 to -0.004, p-value<0.001), and skin incision to uterine incision interval (β: -0.006, -0.009 to -0.002, p-value=0.002) interval time had a significant linear association with PH.

Conclusion: The duration of induction of spinal anesthesia to delivery and skin incision to the uterine incision in non-emergent C-sections is linked to lower neonatal umbilical pH which shows the importance of optimizing the timing of elective C-section surgeries and reducing the risk of neonatal acidosis for obstetricians and anesthesiologists.

Current State of Ventilator Setting and Their Relationship with Mortality Rate in Patients under Mechanical Ventilation: A Cross-Sectional Study

2024-06-29T16:03:16+00:00

Background: Given the importance of implementing lung protective strategies to prevent lung injury caused by ventilators and death of patients, it is necessary to monitor the current condition of hospitals and examine the relationship between the parameters set on the ventilators and patient mortality. This study conducted to determine the current state of ventilator setting and their relationship with mortality rate in patients under mechanical ventilation: a cross-sectional study.

Methods: This is a cross-sectional study that was conducted between June to December 2020 in one of the hospitals affiliated to Tehran University of Medical Sciences. The initial tidal volume set on the ventilator was recorded for 304 patients under mechanical ventilation and then, their heights were measured and their tidal volumes were determined based on the standard formula. Other parameters set on the ventilator as well as systolic and diastolic blood pressures of patients were also recorded and their survival rate was investigated. The data was analyzed by SPSS software, using descriptive statistics and logistic regression model.

Results: Among patients, who were under mechanical ventilation, 77.6% were hospitalized in intensive care units and the rest were hospitalized in general wards. The mean adjusted tidal volume for patients was 472.91 ± 32.13 ml. The mean peak inspiratory pressure and plateau pressure were 28.00±6.98 and 13.88±4.93 CmH2O, respectively. Also, 37.2% of patients died during the hospitalization. The results of adjusted odds ratio based on multivariate logistic regression model for predictors of mortality rate showed that the variables of patients' age [OR=1.040 (1.019-1.062)], the hospital’s general ward in comparison with the ICU [OR=11.379 (5.130-25.240)] and the peak inspiratory pressure [OR=1.072 (1.007-1.141)] had a direct and significant relationship with mortality rate (in all cases P<0.05). Meanwhile, the plateau pressure [OR=0.886 (0.808 -0.972)] had an inverse and significant relationship with mortality rate (P<0.05).

Conclusion: Despite the recommendations regarding lung protective strategies, in some cases, some parameters set in the ventilator are outside the recommended levels, which can effect on patients mortality. So monitoring and controlling the implementation of lung protective strategies and paying attention to controlling pressures set on the ventilator are among measures that should be taken in medical centers in order to prevent lung injuries and maintain patient safety.

Dabigatran for Dental Procedures in Patients with High Risk Bleeding

2024-06-29T16:03:49+00:00

Background: Management of patients with high risk of bleeding during oral and dental procedures faces many challenges. The aim of this study was review strategies for facing high risk of bleeding patients taking dabigatran under dental procedure.

Methods: Articles and scientific texts will be searched in the six main databases, such as PubMed, Scopus, Web of Science, Science Direct, Google Scholar and Cochrane Library from 2007 to 2022, with keywords “dabigatran” AND “bleeding” AND “dental procedures” OR “dental care”. The inclusion criteria for articles included in the study were papers published about treatment patients with dabigatran and undergoing a dental procedure, English language and design of case reports, case series, quasi-experimental studies and clinical trials. This study was performed using PRISMA.

Results: At first, 43 references included and finally 8 articles that met the inclusion criteria were select. CASP and STORBE checklists used for quality evaluation. Two reviewers checked eligibility of the selected articles, separately. Challenging Controversial results were found in selected studies. 4 studies demonstrated that Dabigatran should be interrupted at least 12 hours before invasive dental procedures. Some studies highlight that discontinuing Dabigatran depends on the patient's renal function. Also, it showed that deciding whether to stop Dabigatran or not by cardiologists determine based on elective or emergency high-risk patients.

Conclusions: Based on the results of the included studies, it is better to decide to stop or continue dabigatran before any dental treatment based on the type of intervention, the risk of bleeding and the patient's clinical situation. However, is preferred to discontinue taking this drug in high risk of bleeding dental procedures.

Large Pulmonary Bullae, Resulting from Tuberculosis, in the Context of Extensive Pneumothorax Caused by a Penetrating Chest Wound

2024-06-29T16:04:30+00:00

Pulmonary bullae typically occur either idiopathically or in the context of chronic obstructive pulmonary disease and pulmonary infections. Clinical manifestations of pulmonary bullae include cough, shortness of breath, and chest pain. In some cases, they may be asymptomatic. Differentiating between pneumothorax and pulmonary bullae can be challenging when they coexist. Therefore, obtaining a detailed patient history, conducting a physical examination, performing laboratory tests, and utilizing radiology studies are essential diagnostic tools that should be employed simultaneously. In this case report, we present a patient who developed a wide pneumothorax due to a penetrating chest wound caused by a knife. Initially, the large lung cavity, which had already formed due to tuberculosis, was misdiagnosed as a loculated pneumothorax.

Regional Anaesthesia with Non Invasive Ventilation and Conscious Sedation: An Alternative to General Anaesthesia in Morbidly Obese Patients with Obstructive Sleep Apnea in Retrograde Intrarenal Surgery

2024-06-29T16:05:06+00:00

Obstructive sleep apnea(OSA) is a syndrome characterized by obstruction in the upper airway during sleep. OSA patients undergoing procedures under GA are at increased risk for hypoxemia, pneumonia, difficult intubation, atelactasis, myocardial infarction making it a challenge for anesthesiologist. Retrograde intrarenal surgery(RIRS) is normally performed under GA to prevent respiratory embaracement. There are very few studies focusing on Regional anesthesia in RIRS procedure.

A Sixty-three-year-old male known case of morbid obesity (BMI- 35 kg/meter square), OSA (on CPAP support at night) presented with left renal pelvis calculus, STOP BANG score (=5) therefore making it a case of difficult airway. Respiratory discomfort improved at 30-35-degree head up due to existing OSA considering the severe OSA and anticipated difficult airway, the surgery was planned under Lumbar subarachnoid block with preparation for management of difficult airway if conversion to GA required. 3 ml of 0.5 percent Bupivacaine heavy and 25 mcg fentanyl injected into subarachnoid space. T6 level block acheived after 3 minutes. The patient was put on his home CPAP machine with 5cm H2O PEEP. The patient was maintained on sponatneous ventilation and monitored using Etco2 at aliquot of 1mg midazolam given to mimic natural sleep pattern.

The surgery was uneventful and the risk of induction of GA and difficult intubation was succesfully avoided.

Patient with regional anaesthesia who are prone to converted to GA due to multiple risk factors, i.e., OSA with anticipated difficult airway can create a chaotic situation. So as a preliminary step NIV can be used, and along with it, mild sedation can be supplemented to improve acceptance and to avoid asynchrony. In this case NIV was used as a preemptive ventilation strategy even before actual requirement of BiPAP by mimicing the natural sleep pattern and make patient comfortable while a smooth conductance of the procedure.

Anesthesiologist’s Perspective on a Child with Acute Lymphoblastic Leukemia undergoing Neurosurgery: Case Report

2024-06-29T16:05:45+00:00

Acute lymphoblastic leukemia (ALL) is the most common hematological malignancy in the pediatric age group. Anesthesia in such patients necessitates special considerations, in terms of disease progression and its respective treatment as well. We present a case of a 2-year-old child, a known case of ALL posted for drainage of multifocal brain abscess under general anesthesia. Anesthetic management of children with ALL presenting for neurosurgical procedures should focus on disease and its various systemic manifestations, treatment-related side effects, and anesthetic interactions which sometimes may be disastrous

Epidural Blood Patch in Subdural Hematoma Due to Spontaneous Intracranial Hypotention: A Case Report and Literature Review

2024-06-29T16:06:41+00:00

Spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome with variable symptoms and complications which is often misdiagnosed at initial manifestations. SIH results from spontaneous CSF leakage leading to brain sag. The typical findings on cranial MR imaging consist of subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain. Subdural hematoma may occur as a result of tearing of bridging veins and usually develop into chronic subdural hematoma. The majority of patients with SDH due to SIH have chronic DSH and, therefore, rarely present with neurological deficits. Evacuation of SDH may be performed for large SDH with ME (mass effects), or when dilated or asymmetric pupil is present. However in most cases, evacuation of the hematoma is not necessary and may result in worsened outcomes. The epidural blood patch (EBP) is a treatment of choice. Fortunately, most of these subdural hematomas can be handled with treatment directed at the underlying spinal CSF leak without the need for surgery.

We report the case of 42-year-old man with the chief complaint of orthostatic headache. He was admitted to neurology ward and after imaging studies, it was found that he has bilateral subdural hematoma. Due to the lack of history of trauma, underlying disease, and coagulation disorder, and considering the imaging findings, the patient was referred to the pain department to perform an epidural blood patch. After performing the epidural blood patch, the patient's pain was relieved immediately, and during a three-month follow-up period, the epidural hematoma was completely absorbed.

Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed and underdiagnosed disorder and requires a high index of suspicion for diagnosis. During the last decades, a much larger number of spontaneous cases are identified. Literature is a bit confusing, with some authors recommending evacuation of subdural fluid in cases of deteriorating consciousness and few others recommending EBP first even in patients with comatose state but epidural patch is often an important part of treatment.

One Way for Air, While Great Vessels in Despair!

2024-06-29T16:07:24+00:00

The Article Abstract is not available.

Short-Time Anesthesia Management for Duchenne Muscular Dystrophy

2024-06-29T16:08:14+00:00

The Article Abstract is not available.