RESEARCH PROJECTS
Airway humidification during general anesthesia The aim of this work is to study the relative humidity and
temperature of the anesthesia circuit during general anesthesia, which
will determine the absolute humidity of the patient’s airway. Below a threshold
of humidity (20 mgH2O/L), positive pressure ventilation with dry gases
is well known to produce adverse respiratory side effects, such as plugging
of secretions and lung atelectasis. Different fresh gas flows and heat
and moisture exchangers are compared to determine the best setup concerning
humidification of inhaled gases during general anesthesia. M. Aouad
Maroun. (Supported by AUB URB.)
Preoperative administration of IV Dexamethasone for the prevention of postoperative pain and vomiting following tonsillectomy in children This study is designed to evaluate the efficacy of preoperative
administration of 0.5 mg/kg dexamethasone for the prevention of vomiting
and pain following tonsillectomy in children. Tonsillectomy carries a very
high incidence of postoperative vomiting and pain in children, to dehydration
and increased morbidity. Recent studies have demonstrated a beneficial
effect from the administration of dexamethasone preoperatively, while ether
studies failed to prove its efficacy. Our aim is to try to clear this controversy
by comparing a group of children undergoing tonsillectomy and pretreated
with dexamethasone versus a placebo treated group. M. Aouad Maroun.
(Supported by AUB URB.)
A modified Guedel Airway for continuous oxygenation and suctioning during fiberoptic bronchoscopy The purpose of this modification is to allow continuous oxygen
administration and continuous suctioning during fiberoptic bornchoscopy.
C.M.
Ayoub, A. Lteif, M. Itani, A. Baraka. (Supported by AUB URB.)
Evaluation of the Thyro-Mental (TM) distance as a predictor of difficult intubation The purpose of this study is to evaluate the TM distance as
a predictor of difficult airway. C.M. Ayoub, M. Khatib, M. Muallem,
A. Baraka. (Supported by AUB URB.)
Fast-track pre-oxygenation technique versus the traditional technique The arterial PaO2 following pre-oxygenation using eight deep
breaths within 60 seconds at an oxygen flow of 10 L/min is compared to
that achieved by the traditional tidal volume breathing for 3 minutes at
an oxygen flow of 5 L/min. Also, the time of hemoglobin desaturation during
subsequent apnea is compared between the two techniques. A. Baraka,
S. Taha, M. Aouad, M. El-Khatib, N. Kawkabani. (Supported by AUB URB.)
Apnea-induced hemoglobin desaturation during One-lung versus Two-lung ventilation The investigation compares the rate of apnea-induced hemoglobin
desaturation during one-lung ventilation (OLV) versus two-lung ventilation
(TLV) in-patients undergoing thoracic surgery. Patients undergoing thoracotomy
or thoracoscopy are included. Each patient serves as his/her own control.
Patients are ventilated with 100% oxygen using TLV, to be followed after
20-30 minutes by OLV. Apnea is induced following the two techniques of
ventilation, and the times for every 1% decrease in hemoglobin saturation
from 100% to 95%, as monitored by pulse oximetry, are recorded. The PaO2
at 100% saturation and 95% saturation are compared in the two groups, as
well as the times for every 1% drop in the saturation. A. Baraka, M.
Aouad, S. Taha, M. El-Khatib, N. Kawkabani, A. Soueidi. (Supported
AUB URB.)
Lidocaine for prevention of reperfusion ventricular fibrillation during Cardiopulmonary Bypass Reperfusion ventricular fibrillation can frequently follow
release of the aortic cross clamp in patients undergoing cardiopulmonary
bypass. The report investigates the influence of administration of a bolus
of lidocaine 1.5 mg/kg prior to the release of the aortic cross clamp.
The incidence of reperfusion ventricular fibrillation is compared to that
achieved in a control group when no lidocaine is administered. A. Baraka,
N. Kawkabani, A. Dabbous, M. Nawfal, C. Ayyoub, S. Haroun. (Supported
by AUB URB.)
Cisatracurium in Myasthenic patient undergoing thymectomy The report investigates the neuromuscular block of cisatracurium,
a new non-depolarizing muscle relaxant, in myasthenic patients undergoing
thymectomy. The neuromuscular block of 0.05 mg/kg cisatracurium is monitored
by Datex electromyography. The electromyographic response is compared to
that achieved in a control group of non-myasthenic patient. A. Baraka,
N. Kawkabani, A. Dabbous, M. Nawfal, C. Ayyoub, S. Haroun. (Supported
by AUB URB.)
High frequency ventilation This work is completed and submitted for publication. It is
a review article looking at high frequency ventilation as a novel and safe
strategy of ventilation newborn (full term and premature) with severe respiratory
distress. It outlines the different strategies for different disease entities.
The review also looked at technical aspects of different available ventilators
that provide high frequency ventilation. N. El-Hassan, K. Younis, M.
El-Khatib. (Supported by AUB-URB.)
High frequency ventilation: the experience at the American University of Beirut Medical Center This is an on-going research project in which the experience
in the neonatal intensive care unit at the AUB-MC is reported. It includes
patients with different disease entities, their management with high frequency
ventilation, mortality and morbidity. N. El-Hassan, K. Younis, M. El-Khatib.
(Supported
by AUB-URB.)
Hand-washing and use of gloves while managing patients receiving mechanical ventilation in the intensive care unit The results of this work is already accepted for publication
in CHEST and is currently in Press. This work described practices
by health care workers when interacting with ventilatory supported patients
in ICU. It assessed the effect of some measures such as permanent labels
and in service education on the current practice of hand-washing and use
of gloves in an attempt to control the infection rates. M. El-Khatib,
G. Jamaleddine, A. Abdallah, Y. Ibrahim. (Supported by AUB URB.)
Nitric oxide therapy for severe status asthmaticus This is a completed work already accepted for publication
in Pediatric Pulmonology. This work evaluated the effect of inhaled nitric
oxide as a bronchodilator during severe attacks in pediatric patients with
severe asthma. R. Rishani, M. El-Khatib, S. Mroueh. (Supported by
AUB URB.)
Characterization of the spontaneous breathing during mechanical ventilation for patients who fail or do not fail extubation trials This study is aimed at differentiating between patients who
will pass or fail an extubation trial. This is done by utilizing non-linear
mathematical analysis to qualitatively and quantitatively assess the spontaneous
breathing pattern of a patient between intermittent mechanical breaths.
This research has already resulted in an abstract presented at the 11th
Annual Congress of the European Society of Intensive Care Medicine. Final
report is in preparation. M.
El-Khatib, M. Muallem, G. Jamaleddine. (Supported
byAUB-URB.)
Evaluation of hemostasis by the clot signature analyzer The purpose of this study is to evaluate this new device as
a rapid assessment of a patient’s coagulation status especially in the
obstetrical population. A.S. Haddadin*, C.M. Ayoub, F.B. Sevarino*,
C. Rinder*. (Supported by AUB URB.)
Long term results of laparoscopic treatment of hydatid cyst of the liver G. Khoury, T. Geagea, F. Abiad, S. Jabbour-Khoury.
Angioneurotic edema in a patient undergoing laparascopic splenectomy Angioneurotic edema results from reduction of G esterase inhibits
which regulates the complement cascade. It has 2 forms: the hereditary
form and the acquired form. Without G esterase inhibitor, Cl
cleans the lst component of complement into active form, which then activates
C4, C2 and the rest of the complement cascade resulting
in C3a and C5a, which has also vasoactive qualities.
The end result is uncontrolled vasodilation and capillary leak syndrome
the most dreaded complication is laryngeal edema. In this report, a 77
year old lady with an acquired angioneurotic edema scheduled for laparoscopic
splenectomy given C1 esterase inhibitor as prophylaxis. One
hour following the start of surgery, she developed hypotension, bradycardia,
relatively controlled by epinephrine and post-operative bleeding. Aprotinin
250,000 was given, the blood pressure rose and the bleeding was controlled.
In conclusion, patients with acquired angioneurotic edema aprotinin should
be used as prophylaxis along with C1 esterase inhibitor. G.
Khoury, S. Jabbour-Khoury, A. Soueidi, A. Baraka. (Supported by AUB
URB.)
Laparoscopic marsupialization vs. spleenectomy in the management of the cysts of the spleen G. Khoury, D. Litwin, N. Shabb, S. Jabbour-Khoury, M. Mneimneh.
Laparoscopic spleenectomy three trocar technique G. Khoury, G. Nabbout, Z. Salem, F. Abiad, S. Jabbour-Khoury.
Comparison between pall 25 and hygroster filter Pall & hygroster filters are used with anesthesia breathing
systems in the operating room. The purpose of this study is to evaluate
the efficiency of these filters in relation to humidity, expiratory and
inspiratory resistance and the patient’s end tidal carbon dioxide (ETCO2)
and arterial partial pressure of carbon dioxide(PaCO2). A.N. Sibai and
E. Loutfi. (Supported by AUB URB.)
Double T-Piece, an injector and Bird ventilator-use in MRI Suite The Double T-Piece breathing system is valveless, has low
expiratory valve, non-magnetic and easy to handle. The Bird Mark 2 ventilator
is small inexpensive and was used as an oxygen jet controller of the injector
placed at the distal end of the double T-piece. The Bird ventilator functioned
properly in the MRI suite at 1.8m distance from the 1.5 tesla electromagnet
without degrading its imaging. An active antipollution assembly is utilized.
(Submitted for publication to Anesthesia & Analgesia, 1999.) A.N.
Sibai, M. Muallem, J. Zein. (Supported by AUB URB.)
Modification of an anesthesia machine for MRI Suite A wall mounted anesthesia machine was modified, rendering
it nonmagnetic for use in the magnetic resonance imaging suite. The modified
machine functioned properly at 1.8m distance from 1.5 tesla electromagnet
without degrading its imaging. (Accepted for publication in the Middle
East Journal of Anesthesiology, July 1999.) A.N. Sibai, M. Muallem,
J. Zein. (Supported by AUB URB.)
Hydroxyethylstarch vs lactated Ringer’s solution for prevention of hypotension after spinal anesthesia for Cesarean section Maternal hypotension is the most common serious problem following
spinal anesthesia for Cesarean section; volume preloading have been the
corner stones for prevention of spinal induced hypotension. Recent studies
have questioned the role of preloading with crystalloids in the prevention
of spinal induced hypotension in patients undergoing Cesarean sections.
Hydroxyethylstarch 105 solutions (HES200/05) a hyperoncotic colloidal solution
has a volume retaining effect in excess of 100%. Thus it may be effective
alone, for the prevention of spinal induced hypotension. The aim of this
study is to compare the efficacy of prehydration with 500ml hydroxyethyl
starch 10% versus l litre Lactated Ringer’s solution on the incidence and
degree of hypotension in women undergoing elective Cesarean section under
spinal anesthesia. Also, the Apgar scores as well as the umbilical venous
and arterial blood gases are compared between the two groups. S.Siddik-Sayyid.
(Supported
by AUB URB.)
Epidural tramadol for postoeprative pain after Cesarean section Use of intrathecal or epidural opioids has been recommended
for relief of post-operative pain including postoperative pain after Cesarean
section. Tramadol, a relatively new, centrally acting analgesic drug has
a low but preferential activity at opioid receptors, and also inhibits
both noradrenaline and 5-Hydroxy tryptamine neuronal reuptake, and facilitates
5-HT release. Thus, it has been advocated as an analgesic, without respiratory
depression. Previous studies have shown that epidural tramadol can produce
effective postoperative analgesia in-patients undergoing major abdominal
surgery without any serious side effects. The present report investigates
the effect of 100mg epidural tramadol vs 200mg for postoperative analgesia
in-patients undergoing elective Cesarean section. Results are compared
with those achieved in a control group receiving epidural saline. S.
Siddik Sayyid. (Supported by AUB URB.)
Epidural tramadol for post-operative pain after Cesarean section The purpose of this study is to investigate the post-operative
analgesic effect of 100mg epidural tramadol versus 200mg in patients undergoing
elective Cesarean section, and to compare the results with those achieved
in a control group receiving epidural saline. S. Siddik, M. Maroun,
D. Sleiman, M. Sfeir, A. Baraka. (Supported by AUB URB).
Ayoub, C.M., Ghobashyma, M.A.*, Koch, M.E.*, McGrimley, L.*, Silverman, D.G.*, Widespread application of topical steroids to decrease sore throat, hoarsness and cough after tracheal intubation. Anesthesia & Analgesia, 87 (3), 714-16, September 1998. Baraka, A., Vecuronium neuromuscular block in a patient with Charcot-Marie-Tooth Syndrome. Anesthesia and Analgesia, 84 (4), 927-928, 1997. ———, A simple technique for contralateral left bronchial intubation in children undergoing right thoracotomy or thoracoscopy. Journal of Cardiothoracic & Vascular Anesthesia, 11 (5), 684-685, 1997. ———, Gum elastic bougie for difficult double-lumen intubation. Anesthesia, 52, 929, 1997. ———, Jet ventilation via the suction port during fiberoptic bronchoscopy in a child. Pediatric Anesthesia, 7, 87-88, 1997. ———, Succinylcholine “resistance” in a patient with juvenile hyaline fibromatosis. Anesthesiology, 87 (5), 1250-1252, 1997. ———, Hazards of carbon dioxide insufflation during thoracoscopy. British Journal of Anesthesia, 81 (1), 100, 1998. Baraka, A., Aouad, M., Is propofol anticonvulsant or proconvulsant? Canadian Journal of Anesthesia, 44 (9), 1027, 1997. Baraka, A., Nawfal, M., Haroun-Bizri, S., Yamout, I., Nitroglycerin for management of intraoperative bronchospasm. Anesthesia, 54 (4), 395-396, 1999. Baraka, A., Salem, M.R., Joseph, N.J.*, The origin of the Algorithm. Anesthesiology, 89 (1), 277, 1998. ———, Critical hemoglobin desaturation can be delayed by apneic diffusion oxygenation. Anesthesiology, 90 (1), 332-333, 1999. Baraka, A., Siddik, S., Assaf, B., Thiopental-rocuronium versus ketamine-rocuronium for rapid-sequence intubation in parturients undergoing Cesarean Section. Anesthesia and Analgesia (Obstetric Anesthesia), 84 (7), 1104-1107, 1997. ———, Supplementation of general anesthesia with tramadol or fentanyl in parturients undergoing elective Cesarean section. Canadian Journal of Anesthesia, 45 (7), 631-634, 1998. Baraka, A., Siddik, S., Sfeir, M., Salem, M.R., Joseph, N., The self-inflating bulb versus end-tidal capnography for confirming tracheal intubation in the parturient undergoing Cesarean section. Anesthesia and Analgesia, 85 (4), 944, 1997. Baraka, A., Soueidi, A., Berzina, C., Cisatracurium in a patient with atypical plasma cholinesterase. British Journal of Anesthesia, 82 (2), 301, 1999. Baumeister, B.L., El-Khatib, M.F., Smith, P.G., Blumer, J.L., Evaluation of predictors of weaning from mechanical ventilation in pediatric patients. Pediatric Pulmonology, 24 (5), 344-352, 1997. Chatburn, R.L., El-Khatib, M.F., Blumer, J.L., Outcome of mechanical ventilation in a paediatric intensive care unit. Respiratory Care, 42 (2), 221-225, 1997. Dabbous, A., Itani, M., Kawas, N., Karam, V., Aouad, M., Baraka, A., Khoury, G., Post laparoscopic vomiting in women versus men—comparison of prophylactic antiemetic action of ondansetron versus metoclopramide. Journal Society of Laporascopic Surgery, 2, 273-276, 1998. El-Khatib, M.F., Kabalan, K., Ashou, N., Kotob, M., Nassrallah, R., Rasheed, I., A software simulation of human lungs during mechanical ventilation as help tool in clinical settings. Journal of Clinical Engineering, 24 (3), 101-105, 1999. Khoury, G., Jabbour-Khoury, S., Soueidi, A., Nabbout, G., Baraka, ., Laparoscopic treatment of hydatid cyst of liver: is anaphylactic shock an increased hazard? Surgical Endoscopy, 12, 452-454, 1998. Koche, M.E.*, Kain, Z.N.*, Ayoub, C.M., Rosen Baum, S.H.*, The sedative and analgesic sparing effect of music. Anesthesiology, 89, 300-6, 1998. Sinatra, R.S.*, Ayoub, C.M., Postoperative analgesia: epdirual
and spinal techniques. In, CHESTNUT, Obstetric Anesthesia: Principles
and Practice, ed. Chestnut, D., 2nd edition. USA: Mosby,
1999.
ABSTRACTS,
PRESENTATIONS AND PROCEEDINGS
Abdelhalim, A.*, Fontes, M.L.*, Stout, R.G.*, Ayoub, C.M., Silverman, D.G.*, The effects of remifentanil on the response to endotracheal suctioning after CABG surgery. Anesthesia & Analgesia, 88 (2S) (Supp 1135), February 1999. Abdelhalim, A.*, Navedo, A.*, Abdallah, C.*, Ayoub, C.M., Silverman, D.G.*, Intravenous vs nebulized lidocaine as means to blunt the response to tracheal intubation during general anesthesia. Anesthesiology, 89/3AS (Suppl: 1206A), September 1998. Aouad Maroun, M., Hemostasis and neuroaxial blockade. Annual Meeting of the Lebanese Society of Anesthesiologists, Beirut, Lebanon, 1998. El-Khatib, M.F., Muallem, M., Soubra, R., Jamaleddine, G., Qualitative assessment of spontaneous breathing (SB) during mechanical ventilation (MV) helps in predicting extubation outcome in critically ill patients. Intensive Care Medicine, 24 (1), S32, 1998. Ferneini, E.M.*, Ayoub, C.M., Al Mouzayan, M.*, Silverman,
D.G.*, Effects of atropine pretreatment on the response to mental stress.
Anesthesia
& Analgesia, 74 (2S - Supplement 74S), February 1999.
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