Vasilios Dimitriou | King Saud Bin Abdulaziz University for Health Sciences (original) (raw)
Books by Vasilios Dimitriou
Papers by Vasilios Dimitriou
s laryngoscope (AL) is a new single use indir- ect laryngoscope designed to facilitate tracheal i... more s laryngoscope (AL) is a new single use indir- ect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intuba- tion under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a sus- pected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available.
Regional Anesthesia and Pain Medicine, 2006
Regional Anesthesia and Pain Medicine, 2005
We study with lattice Monte Carlo simulations the interactions and macroscopic behaviour of a lar... more We study with lattice Monte Carlo simulations the interactions and macroscopic behaviour of a large number of vortices in the 3-dimensional U(1) gauge+Higgs field theory, in an external magnetic field. We determine non-perturbatively the (attractive or repelling) interaction energy between two or more vortices, as well as the critical field strength H c , the thermodynamical discontinuities, and the surface tension related to the boundary between the Meissner phase and the Coulomb phase in the type I region. We also investigate the emergence of vortex lattice and vortex liquid phases in the type II region. For the type I region the results obtained are in qualitative agreement with mean field theory, except for small values of H c , while in the type II region there are significant discrepancies. These findings are relevant for superconductors and some models of cosmic strings, as well as for the electroweak phase transition in a magnetic field.
European Journal of Anaesthesiology, 2008
European Journal of Anaesthesiology, 2004
Neither bleeding nor thrombo-embolic complication occurred during his hospitalisation. No acquire... more Neither bleeding nor thrombo-embolic complication occurred during his hospitalisation. No acquired FVII inhibitor was found after substitution therapy. Conclusions: The regimen of intra-and post-operative substitution therapy applied to our patient was thus effective in preventing bleeding. No adverse effect was documented.
European Journal of Anaesthesiology, 2004
Background and Goals: Difficult airway management is often responsible for respiratory-related ad... more Background and Goals: Difficult airway management is often responsible for respiratory-related adverse outcomes in anesthesia. There has been a heightened awareness and an increase in the amount of literature being published on the recognition and prediction of the difficult airway (1). During the preoperative evaluation of the airway, a thorough history and physical, specifically related to the airway, as well as various measurements of anatomic features and noninvasive clinical tests can be performed to enhance this assessment. The aim of this study was to correlate primarily the Mallampati modified score and other indexes with laryngoscopic view in order to show a relationship to the difficult airway. Material and Methods: 1956 patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. The study was permitted by the Institutional Human Investigation Committee. Prior to surgery, each patient received a clinical physical evaluation with an emphasis on anatomical features of the mouth, face and neck that are known to affect both bag mask ventilation (BMV) and endotracheal intubation. Intraoperative assessment consisted of the Cormack Lehane (C-L) and a subjective operator endotracheal intubation difficulty scale (OIDS) scoring. Both of these scores were compared to airway characteristics noted in the preoperative evaluation. A linear correlation index (LCI) was calculated for Mallampati versus C-L as well as OIDS score. Results: Mallampati vs. C-L LCI was 0.91. A Mallampati 3 correlated to C-L Grade 2 (0.94), whereas a Mallampati 4 mostly correlated to C-L Grade 3 (0.85) and a C-L Grade 4 (0.80). OIDS compared to C-L showed a LCI of 0.96. Conclusions: There was no correlation between difficult mask ventilation and difficult intubation or difficult laryngoscopy and anatomical risk factors in this study. Although there is a correlation between oropharyngeal volume and difficult intubation, the Mallampati score, by itself, is not sufficient to predict difficult endotracheal intubation.
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2011
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
SAE Technical Paper Series, 1996
European Journal of Drug Metabolism and Pharmacokinetics, 2004
The aim of this study was to investigate the response of cortisol, insulin and lipid parameters [... more The aim of this study was to investigate the response of cortisol, insulin and lipid parameters [serum Lipoprotein Lipase activity, choleseryl-ester transfer protein, triglycerides, total Cholesterol, High Density Lipoprotein, Free Fatty Acids] during the perioperative period in obese patients undergoing laparoscopic cholecystectomy. Twenty obese patients were included and divided in two groups. In group A (n=lO) patients were anaesthetized with propofol and group B (n=lO) with etomidate. Blood samples were collected before induction in anaesthesia, just after the end of the operation and at one, two and three hours postoperatively. According to our results, in both groups serum LPL activity showed a significant decrease whereas serum Free Fatty Acids a potent increase over time. Likewise, both groups did not demonstrate significant changes over time in choleseryl-ester transfer protein activity, total cholesterol, triglycerldes, High Density Lipoprotein or insulin concentrations in serum. Furthermore, cortisol release was significantly inhibited in the etomidate group while substantially enhanced in propofol group. Additionally, apart of triglycerides, no difference was found between the two groups in all the lipid parameters and insulin concentrations. In conclusion, serum Free Fatty Acids levels and Lipoprotein Lipase activity demonstrated significant alterations in obese patients underwent laparoscopic cholecystectomy and this result did not seem to be related with the anaesthetic agent used for induction in anaesthesia.
European Journal of Anaesthesiology, 2006
Anaesthesia and intensive care, 2008
Annals of Plastic Surgery, 2011
Our study aims to illustrate the advantages and disadvantages of Foucher&... more Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.
Local and regional anesthesia, 2017
We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery ... more We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery under epidural anesthesia. MHA is an inherited thrombocytopenia easily misdiagnosed as idiopathic (immune) thrombocytopenic purpura (ITP). Early and appropriate diagnosis of MHA during pregnancy is essential for optimal maternal and neonatal delivery outcome. Additionally, it can avoid unnecessary diagnostic studies, such as bone marrow aspiration and biopsy, and even harmful therapies with corticosteroids, immunosuppressive agents, and splenectomy. Consequently, the most serious impacts of this disease are iatrogenic managements due to misdiagnosis. It seems that in patients with MHA, adequate clinical coagulation is far more dependent on adequate platelet function than any particular platelet count. The diagnosis of MHA may pose a challenge for clinicians managing pregnant women with thrombocytopenia.
Anaesthesia and intensive care
ABSTRACT
s laryngoscope (AL) is a new single use indir- ect laryngoscope designed to facilitate tracheal i... more s laryngoscope (AL) is a new single use indir- ect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intuba- tion under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a sus- pected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available.
Regional Anesthesia and Pain Medicine, 2006
Regional Anesthesia and Pain Medicine, 2005
We study with lattice Monte Carlo simulations the interactions and macroscopic behaviour of a lar... more We study with lattice Monte Carlo simulations the interactions and macroscopic behaviour of a large number of vortices in the 3-dimensional U(1) gauge+Higgs field theory, in an external magnetic field. We determine non-perturbatively the (attractive or repelling) interaction energy between two or more vortices, as well as the critical field strength H c , the thermodynamical discontinuities, and the surface tension related to the boundary between the Meissner phase and the Coulomb phase in the type I region. We also investigate the emergence of vortex lattice and vortex liquid phases in the type II region. For the type I region the results obtained are in qualitative agreement with mean field theory, except for small values of H c , while in the type II region there are significant discrepancies. These findings are relevant for superconductors and some models of cosmic strings, as well as for the electroweak phase transition in a magnetic field.
European Journal of Anaesthesiology, 2008
European Journal of Anaesthesiology, 2004
Neither bleeding nor thrombo-embolic complication occurred during his hospitalisation. No acquire... more Neither bleeding nor thrombo-embolic complication occurred during his hospitalisation. No acquired FVII inhibitor was found after substitution therapy. Conclusions: The regimen of intra-and post-operative substitution therapy applied to our patient was thus effective in preventing bleeding. No adverse effect was documented.
European Journal of Anaesthesiology, 2004
Background and Goals: Difficult airway management is often responsible for respiratory-related ad... more Background and Goals: Difficult airway management is often responsible for respiratory-related adverse outcomes in anesthesia. There has been a heightened awareness and an increase in the amount of literature being published on the recognition and prediction of the difficult airway (1). During the preoperative evaluation of the airway, a thorough history and physical, specifically related to the airway, as well as various measurements of anatomic features and noninvasive clinical tests can be performed to enhance this assessment. The aim of this study was to correlate primarily the Mallampati modified score and other indexes with laryngoscopic view in order to show a relationship to the difficult airway. Material and Methods: 1956 patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. The study was permitted by the Institutional Human Investigation Committee. Prior to surgery, each patient received a clinical physical evaluation with an emphasis on anatomical features of the mouth, face and neck that are known to affect both bag mask ventilation (BMV) and endotracheal intubation. Intraoperative assessment consisted of the Cormack Lehane (C-L) and a subjective operator endotracheal intubation difficulty scale (OIDS) scoring. Both of these scores were compared to airway characteristics noted in the preoperative evaluation. A linear correlation index (LCI) was calculated for Mallampati versus C-L as well as OIDS score. Results: Mallampati vs. C-L LCI was 0.91. A Mallampati 3 correlated to C-L Grade 2 (0.94), whereas a Mallampati 4 mostly correlated to C-L Grade 3 (0.85) and a C-L Grade 4 (0.80). OIDS compared to C-L showed a LCI of 0.96. Conclusions: There was no correlation between difficult mask ventilation and difficult intubation or difficult laryngoscopy and anatomical risk factors in this study. Although there is a correlation between oropharyngeal volume and difficult intubation, the Mallampati score, by itself, is not sufficient to predict difficult endotracheal intubation.
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2011
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
European Journal of Anaesthesiology, 2004
SAE Technical Paper Series, 1996
European Journal of Drug Metabolism and Pharmacokinetics, 2004
The aim of this study was to investigate the response of cortisol, insulin and lipid parameters [... more The aim of this study was to investigate the response of cortisol, insulin and lipid parameters [serum Lipoprotein Lipase activity, choleseryl-ester transfer protein, triglycerides, total Cholesterol, High Density Lipoprotein, Free Fatty Acids] during the perioperative period in obese patients undergoing laparoscopic cholecystectomy. Twenty obese patients were included and divided in two groups. In group A (n=lO) patients were anaesthetized with propofol and group B (n=lO) with etomidate. Blood samples were collected before induction in anaesthesia, just after the end of the operation and at one, two and three hours postoperatively. According to our results, in both groups serum LPL activity showed a significant decrease whereas serum Free Fatty Acids a potent increase over time. Likewise, both groups did not demonstrate significant changes over time in choleseryl-ester transfer protein activity, total cholesterol, triglycerldes, High Density Lipoprotein or insulin concentrations in serum. Furthermore, cortisol release was significantly inhibited in the etomidate group while substantially enhanced in propofol group. Additionally, apart of triglycerides, no difference was found between the two groups in all the lipid parameters and insulin concentrations. In conclusion, serum Free Fatty Acids levels and Lipoprotein Lipase activity demonstrated significant alterations in obese patients underwent laparoscopic cholecystectomy and this result did not seem to be related with the anaesthetic agent used for induction in anaesthesia.
European Journal of Anaesthesiology, 2006
Anaesthesia and intensive care, 2008
Annals of Plastic Surgery, 2011
Our study aims to illustrate the advantages and disadvantages of Foucher&... more Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.
Local and regional anesthesia, 2017
We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery ... more We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery under epidural anesthesia. MHA is an inherited thrombocytopenia easily misdiagnosed as idiopathic (immune) thrombocytopenic purpura (ITP). Early and appropriate diagnosis of MHA during pregnancy is essential for optimal maternal and neonatal delivery outcome. Additionally, it can avoid unnecessary diagnostic studies, such as bone marrow aspiration and biopsy, and even harmful therapies with corticosteroids, immunosuppressive agents, and splenectomy. Consequently, the most serious impacts of this disease are iatrogenic managements due to misdiagnosis. It seems that in patients with MHA, adequate clinical coagulation is far more dependent on adequate platelet function than any particular platelet count. The diagnosis of MHA may pose a challenge for clinicians managing pregnant women with thrombocytopenia.
Anaesthesia and intensive care
ABSTRACT
Middle East journal of anaesthesiology, 2014
Although opioid-induced muscle rigidity occurs more commonly with large doses and rapid administr... more Although opioid-induced muscle rigidity occurs more commonly with large doses and rapid administration of the drugs, there is a number of cases reported, where muscle rigidity was experienced with lower doses of opioids. We present and discuss a case of muscle rigidity induced by an unusually low dose of fentanyl as primary agent during induction of anesthesia. A 79 year old male patient, scheduled for hernia repair, and with a preoperative physical examination of slight hand tremor, received a bolus of 100 mcg (1.2 mcg/kg) fentanyl as primary agent for induction. About 40 sec later he stopped responding, lost consciousness and developed neck and masseter muscle spasm with jaw closure and thoracoabdominal rigidity. Blood pressure was increased significantly. Ventilation was impossible. Rapid oxygen desaturation led us to proceed with IV propofol 150 mg and suxamethonium 100 mg. Opioid-induced muscle rigidity may cause life-threatening respiratory compromise and should be readily rec...
Minerva anestesiologica, 2008
The aim of this study was to identify Greek anesthesiologists' difficult airway management pr... more The aim of this study was to identify Greek anesthesiologists' difficult airway management practices, as well as the availability of equipment and familiarity with different airway management techniques. A questionnaire containing 21 questions was posted to the vast majority of specialist anesthesiologists practicing in Greece (N.=849). Filled copies of the questionnaire were returned anonymously. Response rate was 42% (360/849). Preoperative evaluation was performed by 95% of the respondents, with senior anesthesiologists relying mostly on subjective estimation of the airway. Ninety percent of the respondents had direct access to a difficult airway cart. Laryngeal masks were available in most anesthesia Departments (86%), but expertise was still unsatisfactory, especially in hospitals with a lower workload. Spreading and familiarity with newer airway adjuncts was insufficient, especially in smaller anesthesia Departments. Only 39% of the respondents had a flexible fibrescope re...