Back ground and Purpose: Bronchiectasis is associated with impairment of the mucociliary escalator and retention of secretions within the bronchial tree, making airway clearance a primary concern in the management of bronchiectasis. Patients and methodology: Objective: The objective of this study was to determine the effect of active cycle of breathing as an airway clearance technique on functional capacity in adults with productive bronchiectasis by using six minute walk test and dyspnea index. Design: The study was cohort design carried out on 45 patients (mean age 54. 93± 3.82 years) of both genders with stable productive bronchiectasis receiving multiple sessions (3 times/week for two months) of active cycle of breathing. Measurements: Pre and post treatment measures were recorded for functional capacity in form of six minute walk test and dyspnea index. Results: All 45 patients were stable during the study period. The functional capacity and level of dyspnea were significantly improved post treatment sessions with mean difference 48.06 for six minute walk test and 29.2 for dyspnea index. Conclusion: The active cycle of breathing technique is an effective method for airway clearance and improving functional capacity in patients with bronchiectasis.
Background and Aims:The analgesic effect of an interscalene block with bupivicaine and lidocaine in a mixture ratio:1:1 with dexamethasone intravenously
Methods:A 68 years old female was admitted and scheduled for an urgent operation because she was in visit in Lebanon and had to leave for her country. She had a double fracture in the right upper limb: clavicular and elbow fractures. An interscalene block was done using bupivicaine 0.5%-20ml and lidocaine 2%-20ml in 2 syringe of 20ml mixed together then 8mg of dexamethasone was given intravenously. After the settling of the block the patient was intubated given 2mg of midazolam 50mcg of fentanyl 100mg of propofol and 8mg of nimbex. Patient was in back rest position and the maintenance was by sevoflurane
ResultsThe operation took 6 hours. The blood pressure was between 95 and 85 mm hg for the systolic and 65 to 50mm hg for the diastolic the heart rate was between 62 and 65 beat by min. No fentanyl was added. After the extubation the patient was in the recovery room for 30 min then sending her to the wards. She didn't take any analgesia in the recovery room the EVA was <40. After 4 hours she didn't need any analgesia and after 3 hours she went home without no pain.
Conclusions:An ISB with bupivicaine and lidocaine in a mixture of 1:1 with 8 mg of dexamethasone iv gives a good analgesic effect more then 8 hours
The operation went well for 4 hours Median incision was done and an enteral anastomosis was successfully created. Hemodynamic was stable and the patient went to the wards with an EVA <40. There she was kept NPO, and took paracetamol 1g iv each 6 hours and tramadol 100 mg IM when EVA>40. The nasogastric tube was removed in the 4th day and she began to drink water and then liquid fluid and solid nutrition. On the 7th day she left home on her feet.
All patients were left on spontaneous respiration without adding any anesthetic agent. The operations were done within 20 to 40 minutes. Then all patients were in the recovery room for 15 min with an EVA <40 then transferred to the wards. After 2 hours they left home with no pain.
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