The Use of “Resochin” as an Anti-arrhythmic Agent in Anaesthesia Moemen ME, Shahwan L, Hussein S Tanta Med J 1972; 1: 18-29
Intravenous slow administration of Resochin in a dose of 5 mg base/kg body weight, in 7 dogs and 39 patients, proved effective in both prophylaxis and management of different types of arrhythmias. Resochin appears to be effective against arrhythmias determined by increased vagotonia as it readily abolished sinus arrhythmias and prevented arrhythmias during endotracheal intubation. Again, Resochin seems to be effective against arrhythmias determined by increased sympathecotonia as it readily suppressed ectopic beats and ectopic rhythm and prevented arrhythmias that may be triggered by adrenaline injection during flouthane-oxygen anaesthesia.
Methoxyflurane Analgesia in Childbirth: A Clinical Trial Youinis M.N. and Moemen M.E J Egypt. Society of Obstetrics & Gynecology, 1975; 2: 18-25 A clinical trial has been undertaken to discover the potentialities of methoxy-flurane as compared to trichloroethylene in pain relief in obstetrics. Subjectively, methoxyflurane gave more “excellent” pain relief although the difference was not significant. Although mothers receiving methoxyflurane had less nausea and vomiting, they were less co-operative. Apgar scorings were not statistically different with both drugs.
The Use of Ketamine in Gynecology and Obstetrics M.E. Moemen, A.F. Abdel Salam, and M.N. Younis, Eg J Obst Gynec 1975; 2: 23-27
The role of ketamine has been investigated in the field of gynaecological and obstetrical anaesthesia in 100 patients. It offered no advantage as an induction agent in electrive C.S. In emergency C.S. with initial hypotension or shock, it gave the advantage of cardiovascular stimulation and stability. The low Apgar Scoring of infants recorded makes ketamine not the ideal induction agent in obstetrics. The high incidence of emergence reactions makes it not the ideal sole anaesthetic agent in gynaecological operations as patients are middle aged females prone to psychological upsets.
Effect of Ketamine on Spinal Analgesia Mohamed Ezzat Moemen, and Samy Hussein
Tanta Med J 1975; 3: 1-11
The effect of ketamine on spinal analgesia was studied in 200 patients. 100 patients received the drug as a cover to spinal analgesia and others acted as control receiving spinal block alone. Those supplemented with ketamine lied comfortably on the operating table disconnected from their surroundings. Their systolic, diastolic and mean arterial blood pressures were maintained. The pulse rates were increased and the rhythm was not affected. Mild emergence reactions as dreams and visual disturbances occurred in 9% of cases. Patients of the control group were alert and anxious. They got different degrees of hypotension needing close observation for prophylactic and active treatment of any signs of cerebral hypoxia.
The Second Conference on Nuclear Sciences and Applications Addition to the Session on Radiobiology & Medicine
Effect of Anaesthesia and Surgery on Plasma Cortisol, Insulin and Total Thyroxin
Moemen, M.E; Zaki, L.A.; Ibrahim, I.I. and El-Haig, M.O. J Eg Nucl Sciences & Applications 1977; 8: 15-23 The effect of anaesthesia and surgery on plasma levels of cortisol, insulin and total thyroxin measured by radio-immunoassay was varied out on 12 patients undergoing elective surgery. During premedication, plasma cortisol and total thyroxin levels showed no change while plasma insulin showed a slight decline, blood sugar showed a slight tise. During anaesthesia minimal changes were noticed in all parameters. During surgery significant rises in cortisol and thyroxin levels occurred and persisted post-operatively. Plasma insulin and blood sugar showed minimal fluctuations during surgery with a tendency to rise post-operatively. It is concluded that: 1- Effective premedication can suppress adreno-cortical response during anaesthesia. 2- The rise in insulin level at the end of surgery may be gradual and parallel with the rise in blood sugar level. 3- An increased total thyroxin level during general anaesthesia may be a stress response. 4- Pain relief in the post-operative period may diminish the plasma cortisol level.
Effects of ketamine versus thiopentone On some blood parameters
Moemen, M.E.; Laila A. Zaki; Moneim, A.A. and Masoud, S.M Zagazig Univ Med J 1978; 1: 125-31
The effects of ketamine anaesthesia on some blood parameters were compared to the previously widely studied thiopentone effects in 24 patients divided into two equal groups. Ketamine was found to increase the red cell parameters while thiopentone decreased them. Ketamine caused leucocytosis while thiopentone caused leucopenia. Both anaesthetics reduced neutrophilic and increased lymphocytic counts. Ketamine and thiopentone indued no change in coagulation time, non significant changes in bleeding time and significant increase in prothrombin time.
Effects of Ether and Flouthane Anaesthesia on Some Blood Parameters
Moemen, M.E.; Laila A. Zaki; Moneim, A.A. and El-Aziz, E.M.A Zagazig Univ Med J 1978; 1: 139-45
In this study effects of ether and fluothane anaesthesia without surgical interference, on some blood parameters were compared in 24 patients. The study showed that ether causes leucocyosis and fluothane causes leucopenia. Non significant changes took place after ether or fluothane in regard to red blood count, haemoglobin concentration, platelet count, coagulation time, bleeding time or prothrombin time.
Changes in intellectual functions After anaesthesia and surgery
Laila A. Zaki; Moemen, M.E.; Gawish, H.H.; Fawzi M.H.M. and El-Sayed, A.A.
Zagazig Univ Med J 1978; 1: 165-70
This paper describes the results of a preliminary investigation into the post-operative intellectual changes. Using the “Wechsler-Bellevue Scales”, ten patients were tested, 2 days before and 8 days after operation (laminectomy). All patients received thiopentone –fluothane – flaxedil – oxygen sequence with assisted respiration. Blood loss did not exceed 250 ml. in any of these patients. pH, oxygen and carbon dioxide tensions were measured 2 days before operation, every 30 minutes during operation and, on the third and seventh days after operation. On no occasion, these parameters were deviated from the physiological ranges. On psychological testing, however, a selective impairment of intellectual functions was detected on the eighth day after surgery. An attempt to explain this finding is made by a hierarchy of damaged caused by halothane and, further research is urged.
Comparative Study of Methods of Prevention of Post-operative Muscle Pain Following Suxamethonium
M.E., Moemen and K.A. El-Hawary Zagazig Univ Med J 1978; 1: 221-8
Different methods of clinical importance for prevention of post-operative muscle pain following suxamethonium were compared in a series of 450 patients. The effects of these methods on the clinical conditions for endotracheal intubation was considered. Pretreatment with non-depolarizing muscle relaxants was found to be the method of choice. Slow administration of suxamethonium, tetrahydroaminacrine – suxamethonium mixture and using ketamine-suxamethonium sequence were found to occupy next positions in descending order. Pretreatment with lignocaine in a dose of 1mg/kg body weight neither affected the clinical conditions for endotracheal intubation nor the incidence of post-operative muscle pain.
Correlation Between Pancuronium Requirements and Plasma Protein Pattern in Patients with Bilharzial Hepatic Fibrosis
El-Hawary, K.A.; Moemen, M.E.; Serag Eldin, M.M. and Salem, S.M. Zagazig Univ Med J 1978; 1: 507-13
Twenty male patients, comprising 10 non-bilharzial and 10 with bilharzial hepatic fibrosis were submitted to surgery. After atropine premedication anaesthesia was induced by thiopentone and maintained by gas and oxygen using pancuronium as muscle relaxant. There was no significant correlation between the dose of pancuronium, total serum protein and plasma protein fractions in bilharzial patients. A significant negative correlation was found between pancuronium dose and gamma globulin fraction in non-bilharzial patients. It may be concluded that pancuronium can be considered the relaxant of choice for patients suffering from bilharzial hepatic fibrosis.
The Effect of halothane Anaesthesia on Blood and Plasma Volumes in Bilharzial Hepatosplenomegaly Attalla M, El-Hawary K, Moemen ME, Kanishy MH
Mansoura Med J 1978; 6: 15-23
Ten male patients with bilharzial hepatosplenomegaly were the subject of this study. Another ten male patients of nearly the same age and body weight were taken as control. The plasma and blood volumes were estimated before and 30 minutes after 2% halothane anaesthesia without any surgical interference. The plasma volume was determined by Evans blue dye method and the total blood volume was calculated from the haematocrit value. There was no significant difference between the mean blood volumes of the two groups before the administration of halothane. The 2% halothane administration for 30 minutes, significantly increased the mean total blood volumes in both groups, although the difference between the mean percent increases was not significant. The mean haematocrit values of both groups did not display any significant change before or following the exposure to halothane. Patients with bilharzial heptosplenomegaly developed more hypervolaemia during halothane anaesthesia, possibly mainly due to an increase in the plasma volume.
A Clinical Study of Post-Operative Muscle Pain Following Suxamethonium
Moemen, M.E.; Laila, A. Zaki and Magid, H.M Zagazig Univ Med J 1978; 1: 59-65
A clinical study of post-operative muscle pain following suxamethonium was carried out on 250 patients. While increasing the dose for endotracheal intubation increased muscle pains, adding another dose during anaesthetic maintenance decreased them. Slowing the rate of injection of the drug reduced pain incidence. The relationship between fasciculations and muscle pains was found to be a dose-rate response effect. Being hazardous to the surgical patients, reduction of suxamethonium pains by prophylactic measures was recommended.
Pathological Changes After Enflurane (Ethrane) Anaesthesia in Experimental Animals
Moemen, M.E.; Zaki, L A. Zagazig Univ Med J 1978; 1: 119-24
Macro and microscopic aspects of different organs of 12 ginae pigs exposed to anaesthetic and subanaesthetic concentrations of enflurane (ethrane) were studied. No pathological changes were noted after the first exposure to anaesthetic concentrations. Repeated exposures induced changes in lungs, livers, spleens and kidneys. If these results can be applied to man, it may be advisable to restrict the repeated use of enflurane (ethrane) within a short period of time, to the same patient.
Variation in Insulin and Proinsulin Levels in Plasma After Intravenous Anaesthesia Moemen ME, Megahed Y.M.; El-Aasar S.T. and. Abdin M.A J. Kwt. Med. Assoc. 1978; 12: 207-14 Nowadays we are confronted with a large group of intravenous anaesthetic agents, which act with different clinical pictures and mechanisms in the human body. The interpretation of changes in serum hormones and enzymatic activities is the most expanding field in clinical biochemistry. In this work we aimed to study the effect of some commonly used intravenous anaesthetic agents (thiopental, epontol, althesin, ketamine) on proinsulin, insulin and total insulin levels in human plasma without surgical interference. Althesin proved to be the agent with the least effect on insulin, and may be the drug of choice in patients with disordered carbohydrate metabolism. A Study of Some Haemodynamic Effects During Anaesthesia For Cardiac Surgery
Mohamed Ezzat Moemen Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 9-23 The techniques of neuroleptanaesthesia and combined halothane anaesthesia were compared in a total of 23 patients undergoing valve replacement or coronary artery bypass graft operations. Both techniques provided protection from the circulatory reactiosn of laryngoscopy and tracheal intubation. Haemodynamic variables were similar during surgery before and during the cardio-pulmonary bypass period. Blood gas tensions, pH, serum potassium and urine output did not show significant differences. Although both techniques are acceptable, halothane may be preferred on clinical basis as it ensures unconsciousness, induces a deeper and more even level of anaesthesia and provides earlier post-operative communication with the patient. The study was carried out in Sheffield university and Northern cardiothoracic Hospital in Sheffield area, during July – August 1979, as the author was licenced to practice anaesthesia.
The Cardio-Vascular Effects of Enflurane: Pharmacological and Clinical Studies
Moemen. M.E (M.D.); Haggag, I.A. (F.F.A.R.C.S.); Zaki, L.A. (M.D.) and ElWakil, S.A. (D.A.; D.M.)
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 25-43
A study was carried out to verify the cardio-vascular effects of enflurane pharmacologically in intact animals and isolated preparations and clinically in 73 surgical patients during enfluraneanaesthesia. The study also aimed to identify the possible underlying mechanisms of these cardio-vascular effects. The drug produced significant drop in arterial blood pressure which proved to be due to direct myocardial inhibition. The degree of blood pressure drop was proportional to enflurane concentration. Parasympatholytic, adrenolytic, ganglion-blocking and histaminic effects were excluded. Although the cardiac rhythm was stable, tachycardia was always present which might be compensatory to the accompanying hypotension. Enflurane produced vaso-dilatation of systemic blood vessels including the coronaries. It was concluded that enflurane is a useful inhalational anaesthetic agent but safe cardio-vascular responses require calculated concentrations and efficient ventilation during its administration.
Comparative Study on the Antidysrhythmic Activity of Lidocaine, Etidocaine and Mepivacaine Moemen ME, Nayel H, El-Safoury A.
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 45-53
While monitoring one hundred and twenty patients during spontaneous halothane anaesthesia, different types of dysrhythmias were recorded. Local analgesic drugs especially those with an amide group are used as anti-dysrhythmic agents. In the present work lidocaine and two other related drugs mepivacaine and etidocaine are investigated for their anti-dysrhythmic properties. Lidocaine was taken as the standard agent to convert dysrhthmia. The comparative study revealed that etidocaine was as effective as lidocaine. Its effect was more rapid, while its dose was only one quarter that of lidocaine. Myepivacaine had a limited value and was effective only in cases of unifocal ventricular premature beats. The pharmacological properties of each drug are discussed.
The Cardio-Vascular Effects Of Etomidate: An Experimental Study Moemen ME, Gaafar TY, Zaki L, Haggag LA
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 63-72
A study has been carried out, on intact animals and isolated animal preparations, to investigate the effects of the intravenous anaesthetic etomidate on the cardio-vascular system. The therapeutic dose of etomidate of 0.2 mg/kg body weight produced no hypotensive effect, while higher doses produced progressively increasing hypotension. By investigating the possible underlying mechanisms of hypotension due to etomidate, it was shown that the drug has no histamine-like action, no ganglion blocking effect, a direct depressant effect on the properties of the myocardial muscles and a direct inhibitory effect on the smooth muscles of the walls of peripheral vessels. An experimental Study of the Cardiovascular Effects of Fazadinium Moemen ME, Habib ASM, Zaki L, Haggag LA
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 73-81
Fazadinium, has been praised among non-depolarizing muscle relaxants for its unique rapidity of onset of action. The present study has been designed to verify the cardiovascular effects of this drug in the intact anaesthetized animal and isolated animal preparations. Fazadinium has induced a dose-dependant hypotensive effect in the chloralosed dog. It could be concluded that such a hypotensive effect is due to ganglionic blockade, central cholinergic effect on the myocardium and a depressant action on the walls of peripheral blood vessels.
The Cardiovascular Effects of Etidocaine Moemen ME, Maguid HMA, Haggag LA
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 83-9
A study was carried out to investigate the cardiovascular effects of etidocaine in the experimental anaesthetized animals and isolated animal preparations. Etidocaine in small dose of 0-125 mg/kg bod weight induced a hypotensive effect. The mechanism of this hypotension has proved to include a ganglion blocking effect and a direct myocardial depressant action.
Electroconvulsive Therapy Under Etomidate Anaesthesia Moemen ME, Fawzi MH, Gaafar TY
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 99-100
In electroconvulsive therapy (E.C.T.), a preliminary barbiturate anaesthetization has become the standard procedure in most of the centres of the world. However, this paper describes a within-patient comparison of the new non-barbiturate anaesthetic drug etomidate (0.2 mg/kg) with thiopentone (4.0 mg/kg). Each of these two drugs was used for 112 E.C.T. sessions given to 28 psychiatric patients and careful observations were made. The results suggest that this new drug can be used in E.C.T. whenever barbiturate anaesthesia is contraindicated.
The Use of Pyridostigmine Bromide For prophylaxis of Post-spinal Headache Mohamed Ezzat Moemen
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 23-9
The present study has been carried out on 136 patients, divided into 4 equal groups, undergoing minor surgical operations under low spinal analgesia. The distribution of typical and atypical spinal headaches was compared in patients with and without atropine premedicaton. Atropine was found to increase atypical and total headaches to significant levels. The study recommends against the routine use of atropine for premedication of spinal analgesia, a habit adopted by some anaesthetists. It gives the advice to keep atropine for treatment of bardycardia should it occur during the course of anaesthesia. Pyridostigmine bromide circulated under the tradename “Mestinon” is indicated by Roche manufactures in prophylaxis of headache following lumber puncture in a dose of 1 mg s.c. or 15 I.M., minutes before the puncture. The present study shows that pyridostigmine bromide decreases the incidence of typical, atypical and total headaches significantly. Further investigations are recommended to elucidate the mechanism of this effect.
Heat Loss During Anaesthesia: A Study at Zagazig University Hospital
Moemen, M.E. (M.D); Zaki, L.A. (M.A.); Haggag, I.A. (FFARCS) and Abd-el Aziz, E.M. M.Sc.)
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 131-8
A lot of enquiries arose at Zagazig university hospital concerning the suitability of the currently used ambient temperature for the anaesthetized patient. The authors decided to carry out this study to determine the relationship between room and body temperature during a mean duration of three hours of anaesthesia. At ambient temperature 24-27° C, oesophageal temperature decreases significantly during the first hour and non-significant decrease continued during the second and third hours and the recovery period, but it did not reach the lower limit of normothermia. Skin temperature decreased also during anaesthesia and recovery. Rate pressure product denoted reduced oxygen consumption during the decrease in oesophageal and skin temperatures, and increased oxygen consumption during recovery. It was concluded that the ambient temperature used during the period of this study was suitable for the anaesthetized patients.
Anaesthesia Activity and Acute Toxicity Studies of Enflurane Moemen ME, El-Wakil SA, Zaki L, Haggag I
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 141-9
Anaesthesia activity and acute toxicity studies have been performed on enflurane in toads. The study of the anaesthetic activity entailed the determination of the minimal anaesthetic dose (MAD), the maximal anaesthtics dose (AD 100) as well as the anaesthetic featuers throught the anaesthetic range. Calculations were also made, according to the Spearman-Karber method, of the median anaesthetic dose (AD 50), with its 95% fiducial limits. Acute toxicity studies were conducted in a smilar way for the determination of the minimal lethal dose (MLD), the certainly lethal dose (LD100) and the features of their toxicity. Calculations were also made for the median lethal dose (LD50) with its 95% fiducial limits. Post-mortem examination was done to verify the cause of death. The therapeutic index was calculated from the ration LD50 to AD50, which proved a wide safety margin for enflurane in toads.
Biochemical Studies of the Effects of Mepivacaine (Carbocaine) in Rats Moemen ME, El-Aasar ST, Abdin MA
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 151-5
A study was carried out on 75 rats divided into 5 equal groups. Rats of 4 groups were I.M. injected with mepivacaine (3mg/100gm body wt.). Rats of one group were periodically sacrificed at 30 minutes intervals. Rats of the fifth group, acting as control, were injected with saline. The results showed that significant enzymatic changes in serum and muscles followed mepivacaine injection. It was recommended that mepivacaine should be used cautiously in patients with impaired liver function.
Haematological, Biochemical and Histopathological Studies of Thiophentone in the Experimental Dog. Moemen ME, Masoud SM, Shawki MM
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 161-73
Haematological, biochemical and histopathological studies are carried out on 30 dogs anaesthetized by thiopentone administered intraperitoneally. They were divided into a control group and a study group, each including 15 dogs. In the blood, thiopentone induced leucocytosis with neutrophilia and lymphopenia. It decreased potassium, protein and increased glucose levels. In the CSF, thiopentone decreased mature neuthrophils, and increased small lymphocytes. It decreased sodium and chloride levels and increased glucose level. Histopathologically, one single injection caused congestion of the liver and lung, while repeated injections led to their infiltration with round cells. Possible explanation concerning the different changes are suggested and discussed.
Effect of Hypoxia, Hypercarbia, Hyperventilation and Juglar Compression on Increased Intracranical Pressure Moemen ME, Gawish H, Sawan ZH
Proceedings of the First Egyptian Congress of Anaesthesia, 12-13 Dec 1979, Zagazig, Egypt: pp 175-82
A study has been carried out on 12 dogs to find out the effects of hypoxia, hypercarbia, hyperventilation and juglar venous compression on intracranial pressure when it is already high. I.C.P. was increased artificially by inflating a small balloon inside the parietal temporal region. Gradually increasing the size of the balloon mass, was followed by gradual increase in the ICP, till vital centres were affected. The study was carried out in this stage. Hyperventilation reduced I.C.P. rapidly then I.C.P. rose gradually. Juglar vein compression was shown to be more hazardous in raising I.C.P. than hypoxia or hypercarbia.
Catecholamine Release and Some Metabolic Changes During Ether Anaesthesia
Salah El Din Zaki Eid, Salah El Halaby, Mohamed Ezzat Moemen, Ali Khalia, and Sherif Moustafa Nagi The scientific meeting of anaesthesia department, Sheffield Univ. UK, 18 August 1979 The effect of 30 minutes, plane one third stage of ether anaesthesia without surgical interference on blood levels of glucose, lactate, catecholamines, triglycerides, total cholesterol and total lipids was studied in 20 fasting patients. They were divided into two equal groups, and to one group administration of 10 grams glucose as 200 ml of 5% solution was carried out during anaesthesia. Significant glucose intolerance and increased blood glucose and lactate, more marked in the group taking I.V. glucose, was obtained with insignificant changes of triglycerides, cholesterol and total lipids in both groups. Blood catecholamines estimations showed a minor sympathetic blockade in the group taking I.V. glucose. This finding may be of importance in anaesthetizing patients suffering from hypertension and cardiac diseases.
The Clinical Use of Ketamine in Balanced Total Intravenous Anaesthesia: Evaluation of Two Techniques
Mohamed Ezzat Moemen Zagazig Univ Med J 1979; 1: 67-76
The present study aims to explore the feasibility of two total intravenous anaesthetic techniques in 100 patients: (1) consisting of ketamine, oxygen and muscle relaxant with I.P.P.V. in intra-abdominal surgery (2) consisting of ketamine-thiopentone combination with spontaneous ventilation for surface surgery. Both techniques proved to be safe and are evaluated as satisfactory by patients and all surgeons. They eliminate the dangers of pollution of theatres with anaesthetic gases and vapours. They are of advantage in circumstances where anaesthetic gases are not available. They provide a step in the process of “taming” of the interesting agent: ketamine.
Effect of Anaesthesia and Surgery on Cell Mediated Immune Response
Moemen, M.E., Abd El Monem, A.M.; Zewar, M.M.; Swan, Z.H.; Abdel Aziz, E; Zagazig Univ Med J 1979; 3: 19-26
Anaesthesia and operative surgery were shown by different workers to affect the human immune response, but given data are characterized by inconsistency and contradiction. The present paper aims to study the effect of anaesthesia and surgery on cell-mediated immune response. It also aims to assess the contribution of anaesthesia and the effect of anaesthetic technique in this domain. The present paper may lead to the following conclusion: 1- Anaesthesia and surgery are followed by depression of cell mediated immune response. 2- Anaesthesia plays a minor role probably through the adrenocortical axis. 3- This depression is not much affected by the anaesthestic technique. 4- The cell mediated immune response is mainly depressed by the surgical trauma.
Changes in Fibrinolytic Activity on Application of a Limb-Tourniquet During anaesthesia
Amal Mohamed Abdel Moneim and Mohamed Ezzat Moemen
Zagazig Univ Med. J 1980; 3: 25
This work was carried out to study the effect of tourniquet application during surgical operations, on the fibrinolytic activity of the blood as previous literature was characterized by inconsistency. The study included 182 samples from 14 patients; 7 were undergoing orthopedic operations on limbs necessitating tourniquet application while 7 underwent surgical operations without tourniquet and acted as control. Obtained results showed that, irrespective of tourniquet application, the systemic blood exhibited the fibrinolytic response to surgery described by other authors. In the operated limb under tourniquet, however, the release of tourniquet was associated with declines of fibrinolytic activity, platelet count and fibrinogen concentration over 20 minutes. Since some authors suggested that application of completely occlusive tourniquet could be a simple form of prophylaxis against deep vein thrombosis, obtained data in the present study, argue against this suggestion.
Maternal and Neonatal Effects of General Anaesthesia Versus Spinal Analgesia Moemen ME, Abd-Elsalam AF Zagazig Univ. Med J 1980; 2: 1-6
The present study is designed to compare the effect of spinal analgesia and general anaesthesia in 100 deliveries, as regards the laboratory parameters and the clinical conditions of the mother and foetus. Maternal systolic hypotension of less than 90 mmHg occurred in 45% of patients receiving spinal analgesia with no bad effects on the mother or the foetus and was treated by fractionated doses of ephedrine. General anaesthesia using 0.5% halothane in N2O and O2did not modify the amount of blood loss. Umbilical venous and arterial O2tensions and PH at birth were normal and did not show significant differences. Apgar scoring and time intervals to delivery were comparable in both groups of neonates. The provision of left lateral tilt of 15° to mothers help in the improved neonatal outcome in both techniques.
Topical Nitroglycerine for Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation
Moemen, M.E., Aly, A.Y., Sawan, Z.H. and Ramadan, M.E. Zagazig Univ Med J 1985; 8: 119-32
The effect of topical transdermal nitroglycerine on the pressor responses to laryngoscopy and endotracheal intubation was studied in 50 adult non-treated hypertensive patients undergoing emergency surgical operations. Nitroglycerine, 30 mg. was applied to a group of 25 patients, 15 minutes before induction of anaesthesia and the haemodynamic variables were measured during and for four minutes after laryngoscopy and endotracheal intubation. Statistical analysis of the data within and between patient groups proved the ability of nitroglycerine topical application to prevent significant rises in heart rate, blood pressure and rate pressure product means during and after intubation. In conclusion, topical nitroglycerine was suggested to form integral component of anesthetic induction technique in non-treated hypertensive patients undergoing emergency surgery, as it proved to be simple, safe and convenient to both the patient and the anaesthetist.
Respiratory Effect of Continuous Arterio-Venous Hemofiltration in Adult Respiratory Distress Syndrome: A Report of Three Cases
M.N. Aboras, A.Y. Ali, M.E. Moemen Proceedings of the 3rd international symposium on acute renal failure satel, Halkidiki, Spain 1993: 583-93
Continuous arterio-venous hemofiltration has been used for the management of acute oliguric renal failure in three patients with adult respiratory distress syndrome on mechanical ventilation. During the hemofiltration period (3-7 days), casual progressive improvement in arterial oxygenation occurred with the same F102; PEEP could be gradually reduced and radiological chest infiltrates showed progressive resolution. Findings were discussed, concluding the benefit of continuous arterio-venous hemofiltration when patients on mechanical pulmonary support get renal impairment. The continuous arterio-venous hemofiltration technique is suggested to be considered as a conventional method of treatment in intensive care units, as it was found to improve the cardiopulmonary functions and to stabilize the renal functions. The Difficult Airway Problem Mohammed Ezzat Moemen The First Damietta Conference, 24-26 June 1998
Although medicine has changed much since the times of Hippocarates, the goals of medicine did not change at all, namely, to do no harm (no bad iatrogenesis) and to do always good (good iatrogenesis) to the patient. The most important responsibility of the anesthetist is to preserve the patency of the airway during induction, maintenance and recovery from anesthesia. Morbidity and mortality for anesthesia are mostly related to inability to manage the airway. Keeman and Boyan (1985) and caplan et al (1990) are examples of authors who reported 30-40% of anesthetic deaths related to the difficult airway problem. What is astonishing is that the vast majority of airway complications can be avoided or solved. This is accomplished if the anesthetist respects the airway, if he/ she gives attention to its adequate assessment and if he/ she succeeds to anticipate the problem. In so doing he/ she will be able to put a successful plan to safeguard the airway.
Methods Used To Smoothen Postextubation Emergence Phenomena After General Anesthesia Mohamad Ezzat Moemen; Sahar M.S. El-Deen El-Gammal and Amal A. Salah Zagazig Univ Med J 1999; Suppl: 131-9.
Postextubation coughing is a dangerous early complication of general anaesthesia specially in some groups of patients. To reduce postextubation cough reflex in these situations, different trials were performed. In our study, we tried the technique of intracuff inflation by two concentrations of lidocaine (4% and 2%) as lidocaine can diffuse across the cuff membrane, the cuff acts as a drug reservoir and induces a continuous local anesthesia of tracheal receptors. We studied 58 patients of ASA I and II physical status, divided into five groups according to the tube cuff inflation solution. In group (I) we used 0.9% saline solution to inflate the tube cuffs at room temperature, in group (2) we used lidocaine 4% at room temperature, in group (3) we used lidocaine 2% at room temperature, in group (4) we used warm lidocaine 2% (38°C), and in group (5) we used a mixture of warm lidocaine 2% plus 1 ml of 8.4% sodium bicarbonate solution as an alkalinizing agent. Lidocaine 4% at room temperature showed good results in reduction of cough reflex, warm lidocaine 2% produced results nearly similar to those of lidocaine 4% while warm alkalinized lidocaine 2% attained the best results in prevention of cough reflex. We concluded that we can replace the high concentration (4%) of lidocaine (to avoid drug toxicity) by lower concentration (2%) together with some conditions that can improve its diffusion across the tube cuff such as warming alone or together with alkalinization, all can produce better and smooth extubation phenomena. |