bluuebunny/crossref_metadata_2025 huggingface dataset:
Powers of Entry, Search, and Seizure: Part II
Authors: Ozin Paul , Norton Heather
Published: August 2023

This chapter discusses Part II of the Police and Criminal Evidence Act (PACE) 1984, which gives power to issue search warrants both by magistrates and judges. It points out how PACE created special categories of material that are used to describe the type of items which can only be obtained by an application to a judge. It also considers an alternative to a search warrant, which provides a procedure for compelling a person, by notice, to provide access to material. The chapter highlights Section 15 of Part II that provides safeguards, common to both s 8 applications and Sch 1, para 12 applications, to the form of the application and the form of the warrant. It covers Section 16 that sets out the requirements and procedure that are common to both s 8 applications and Sch 1, para 12 applications for the execution of warrants.
Arrest: Part III
Authors: Ozin Paul , Norton Heather
Published: August 2023

This chapter highlights Part III of the Police and Criminal Evidence Act (PACE) 1984, which outlines powers and duties in relation to arrest. It discusses arrest without warrant by constables and other persons, information to be given on arrest, and powers and procedures with respect to persons arrested elsewhere than at a police station. It also reviews provisions on the bail of persons arrested elsewhere than at a police station and the arrest of persons at police stations, attending voluntarily or by arrest for further offence. The chapter explores the power and duty of the search of persons and search and entry of premises upon arrest at a place other than a police station. It mentions the Serious Organised Crime and Police Act 2005 (SOCPA), which splits the general power of arrest into two sections: arrests effected by constables and arrests effected by other persons.
Detention: Part IV
Authors: Ozin Paul , Norton Heather
Published: August 2023

This chapter describes Sections 34 to 51, which make up Part IV of the Police and Criminal Evidence Act (PACE) 1984. Part IV sets out the conditions under which a person can be held in police detention and when they must be released, the role and responsibilities of the custody officer, and a timetable within which decisions relating to detention and charge must be made. It also talks about a person in police detention for the purposes of PACE if taken to a police station following arrest or is arrested at the police station. The chapter examines how a person is to be treated as under arrest for an offence where they return to a police station to answer bail. It cites Section 34(1), which specifies that a person arrested for an offence will not be kept in police detention except in accordance with the provisions of PACE.
The Investigative Focus and Mindset in Childhood Death
Authors: Marshall David
Published: August 2023

This chapter discusses the investigative focus and mindset in sudden and unexpected childhood deaths. Sudden and unexpected deaths in childhood can be usefully considered as falling into three broad groups that overlay a diagnostic and investigative continuum extending from a natural death at one end of the continuum to an un-natural death, featuring criminal intent and homicide, at the opposite end. The chapter looks at Sudden and Unexpected Death of an Infant (SUDI) or Child (SUDC). Ultimately, any childhood death investigation should be a search for the truth. Keeping the deceased child as the central and primary focus of the investigation together with any siblings, but with an empathetic secondary, but still essential focus, on the parents and family will help in the investigative decision-making process. There is a legal and moral basis that supports this investigative position which is contained within the United Nations Convention on the Rights of the Child (1989) and also the Human Rights Act 1998. It is essential to remember and emphasize that any investigation into a childhood death involves professionals from many different agencies, who all have distinct roles but who complement each other by working together to establish how and why the child died, most crucially by sharing information and professional knowledge.
Case Management and Reviews
Authors: Marshall David
Published: August 2023

This chapter explains that another facet of child death investigations that is different to other deaths is the number of additional related processes and proceedings that can be involved. Child homicides, like any other major crime, will invariably culminate in judicial proceedings at Crown Court. Professional preparation, planning, and presentation with regards to a trial or sentencing is expected from Senior Investigating Officers (SIOs) and their teams tasked with this responsibility. Child homicide trials can present additional challenges in the case management and trial process. A case may be simultaneously subject to criminal investigation/prosecution, family proceedings such as care or wardship, and/or a Serious Case Review (SCR). Where there are parallel proceedings, the timing and extent of disclosure of information between the different proceedings is often extremely important. The chapter then looks at SCRs and major crime reviews. It also reflects on future considerations and research.
Blackstone’s Custody Officers’ Manual
Authors: Smart Huw
Published: August 2023

This book is a reference and training resource which presents all relevant legislation, together with analysis and explanation of the areas of the Codes of Practice that are most commonly misunderstood, to offer a treatment of all elements of the custody officer's role. Professionals involved in the criminal justice system will be acutely aware of the ever-changing legislation that governs the reception, treatment, and welfare of people detained at police stations. This book interprets the Police and Criminal Evidence Act (PACE) 1984 and accompanying Codes of Practice, and also covers detainees' entitlements, reviews and relevant times, identification and samples, as well as the extension of detention in terrorist cases. The fifth edition contains revised material on safer detention, clinical treatment and attention, and identification and samples, and is fully updated to cover all recent legislation, including the Terrorism Act 2000, the Criminal Justice Act 2003, and the 2012 updates to the PACE Codes of Practice.
The Role of the Custody Officer
Authors: Smart Huw
Published: August 2023

This chapter tackles the role of the custody officer. It highlights the importance of leadership and decision making for custody officers, especially when custody officers have a responsibility to ensure all detainees are treated in accordance with their individual needs without discrimination. The Police Reform Act 2002 allowed the appointment of non-police officers to act as detention officers and their powers. Additionally, Article 5 of the Human Rights Act of 1998 indicates people's right to liberty and security of the person. The chapter then looks into the appointment of officers in correlation with the Police and Criminal Evidence Act 1984 (PACE).
Safer Detention
Authors: Smart Huw
Published: August 2023

This chapter discusses the application of the Guidance on the Safer Detention and Handling of Persons in Police Custody 2012. It details the effect of Code C of the PACE Codes of Practice as it applies to custody staff. Most custody staff are primarily concerned with the risk of a person dying, or committing suicide during their detention. The chapter notes what the custody officer can do to minimize the risk of detainees attempting to self-harm or suicide by observing the detainee's behaviour. It also explains how Article 2 of the Human Rights Act 1998 is enacted to ensure that everyone's right to life is protected by law.
Reviews and Relevant Time
Authors: Smart Huw
Published: August 2023

This chapter explores the importance of a custody officer's review time and relevant time. The Police and Criminal Evidence Act (PACE) 1984 presents the requirements of how long a person may be kept in police detention and how their period of detention is monitored. The review procedure adds integrity to the process by ensuring that a person's detention is monitored at regular intervals by an inspector as a continual process by a custody officer. Moreover, PACE and the Codes of Practice provide guidance to the timing and conduct of reviews. The chapter also explains that Article 5 of the Human Rights Act 1998 indicates the importance of reviewing officers who are monitoring the detainee's lawful arrest and detention.
Dealing with Legal Representatives
Authors: Smart Huw
Published: August 2023

This chapter focuses on the role of the solicitor throughout the custody procedure. According to Code C of the Codes of Practice, a solicitor can either be someone who holds a current practising certificate or an accredited or probationary representative within the register of representatives maintained by the Legal Services Commission. The chapter also mentions that solicitors may also be any person representing a detainee at a police station. Accredited representatives may act on behalf of defence solicitors when defending suspects at police stations. The chapter then explains how solicitors can either play an active role in the interview or not by referencing some guidance into their possible involvement.
Interviewing
Authors: Smart Huw
Published: August 2023

This chapter focuses on the custody officers' duties regarding interviews that are part of the custody process. It also elaborates on the relationship between custody officers and medical healthcare professionals. The custody officer has the responsibility of assessing whether a detainee is fit enough to be interviewed. Thus, the custody officer must strike the right balance between the welfare considerations of the detainee and the needs of the investigating officer. The chapter then cites how Article 3 of the Human Rights Act 1998 ensures that a detainee's human rights may still be affected if the correct procedure is not followed.
Exploring the concept of leadership
Authors: Boon Bryan
Published: August 2023

This chapter examines the concept of leadership. Leaders are visionary, forward-looking, change agents, who plan to inspire a strong sense of purpose in followers. Police leaders have to network not only with colleagues but also with external agencies to maximise their efficiency and effectiveness. Moreover, poor leadership often results in negative outcomes including disenchanted followers, wasted resources, and public disapproval, while good leadership offers a sense of purpose, direction, and achievement. The chapter discusses the difference between leadership and management before detailing what successful leaders must do to be successful. It then looks into how leaders exercise their authority to carry out tasks, give directions, and maintain discipline where necessary.
Leadership and team work
Authors: Boon Bryan
Published: August 2023

This chapter highlights the importance of team work. It explains that the leader should ensure that team members have clear roles and that obstructions to progress are removed. Thus, teams can offer an efficient way of utilising and maximising individual skills and talents to offer the best possible service to the public. Meanwhile, teams can be dysfunctional for a variety of reasons, which can ultimately lead to inter-team conflict or a loss of public support. The chapter explains how teams develop over time while the leader ensures positive outcomes which references forming, storming, norming, performing, and adjourning as stages of team development.
Treating people equally and valuing diversity
Authors: Boon Bryan
Published: August 2023

This chapter looks into leaders treating people equally and valuing diversity. A leader's role must be fully aware of the nature of interactions between team members and their colleagues in the police service and police officer relationships with members of the public. Police sergeants and inspector leaders, who are in very close contact with the public, must set high standards of personal behaviour as an example to others. The chapter tackles several equality law provisions in correlation with institutional racism and public sector equality duty. The chapter then goes into the importance of valuing diversity, as this may help individuals, team members, police, and the public.
Planning
Authors: Boon Bryan
Published: August 2023

This chapter considers the primary responsibility of leaders to plan. It highlights how inefficiency and ineffectiveness caused by a waste of effort and resources can result in a poor public reaction. Thus, good planning is important because it offers a sense of direction and purpose with clear outcomes. Moreover, good planning takes account of the risks involved, resources required, obstacles to be overcome, and timescale. The chapter discusses several planning considerations that involve strategic and tactical plans, which involve risks and SMART objectives. Since plans rarely go without a hitch, leaders must manage and mitigate risks at the outset.
Problem solving
Authors: Boon Bryan
Published: August 2023

This chapter explains that problem solving is a vital part of working life as it is an integral part of people's everyday existence. A distinct focus on problem solving in the police service amounts to a critically important leadership skill and activity. Since some problems may be more difficult to resolve, the chapter offers a six-stage approach to solving problems which highlights the importance of established standards. Leaders may prevent problems from arising by training people to do their jobs, checking procedures, being approachable, and running regular team meetings. The chapter notes how problems in the workplace take many forms and can relate, for example, to administrative difficulties.
Misconduct and discipline
Authors: Boon Bryan
Published: August 2023

This chapter explains how discipline is an extrinsic motivator although not a particularly good one because it is imposed. Regardless of the difficulty, misconduct matters must be dealt with promptly and professionally. A leader will know whether a misconduct or disciplinary matter has been resolved satisfactorily when the conditions that caused misconduct in the first place no longer exist. The chapter mentions how weak leaderships often invite challenges of team members behaving badly. It cites the inevitability of disciplinary action due to the offender's behaviour and the effect it has on their work, the performance of others or members of the public.
Communications—interpersonal skills
Authors: Boon Bryan
Published: August 2023

This chapter focuses on interpersonal skills to explore these basic communications building blocks. It defines interpersonal skills as how people use their oral skills to communicate in a positive and effective way with other people. Several things stand in the way of good communication, which includes a poor grasp and use of important interpersonal skills and a failure to prepare for important conversations. First-class communication often involves empathy, words, body language, voice tone, listening, note-taking, questioning, silence, clarifying, and summarising. The chapter looks into how a leader can improve their interpersonal skills, such as by understanding the complexity of language and the importance of communication.
Positive communications—assertiveness
Authors: Boon Bryan
Published: August 2023

This chapter tackles the nature of assertive behaviour in communication. It cites that assertiveness skills are possibly the most important communication skills that can be acquired for success in both work and social situations. Mental agility is an essential component. However, it is difficult to exercise with confidence to achieve a high standard of competence. Generally, assertiveness recognises that all individuals are important human beings to be treated with respect and courtesy. Behaving assertively will help a sergeant and inspector leader to communicate successfully and without aggravation at all levels of contact. The chapter explains that assertive behaviour depends on the notion of rights and responsibilities.
Influencing skills—report writing
Authors: Boon Bryan
Published: August 2023

This chapter covers a written report as an influencing agent. It explains report writing as very useful for gathering ideas and suggestions and facts and evidence to present a particular point of view for consideration by others interested in outcomes and in perhaps approving the way forward. Since poorly written reports are likely to reflect badly upon the writer, sergeant and inspector leaders should not regard report writing as burdensome but as a means to gain and exercise influence. The chapter then details the important features and structure of a report, which correlates to the significance of planning. It notes that a leader will know if they were a good report writer when the report's aim is achieved.
Leader’s leadership skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 2, ‘Exploring the concept of leadership’)

Summary

A leader is required to take the lead in current circumstances but must also be able to look ahead and establish what is required in the medium and long-term future. A leader should create a...
Leader’s team skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 3, ‘Leadership and team work’)

Summary

A leader is unlikely to be successful without well-motivated and efficient team members acting harmoniously together.

Team members require clear roles and objectives and they must know what is needed of them and also their team...
Leader’s planning: SMART objectives
Authors: Boon Bryan
Published: August 2023

(See Chapter 5, ‘Planning’)

Summary

Planning is a key leadership skill. Central to the planning process is the creation of SMART objectives (Doran 1981) for they offer structure and direction and the means for action and measuring results.

Toolkit

SMART is a mnemonic that...
Leader’s motivation skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 9, ‘Motivation’)

Summary

Maintaining a well-motivated team of followers is an essential leadership task. A leader is likely to fail if team members feel demotivated and demoralised. Dissatisfaction among team members means that tasks and objectives are unlikely to be successfully completed,...
Leader’s misconduct and discipline
Authors: Boon Bryan
Published: August 2023

(See Chapter 10, ‘Misconduct and discipline’)

Summary

Dealing with misconduct issues is one of the hardest things that a leader has to do, especially when coming up against very strong and dominant personalities. But a failure to act may discredit the leader and result...
Leader’s communication skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 11, ‘Communications—general discussion’)

Summary

It cannot be overstated how important both personal and police communications are to creating a motivated and energetic workforce able to satisfy business plans. To make things even harder, the acquiring of sophisticated communication skills requires training, practice...
Leader’s assertiveness skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 13, ‘Positive communications—assertiveness’)

Summary

Learning how to behave assertively is one of the most important things that a leader can do and assertiveness skills are absolutely essential to establishing good relationships with others. Being assertive should never be interpreted as being either...
Leader’s communications feedback
Authors: Boon Bryan
Published: August 2023

(See Chapter 15, ‘Communications—feedback’)

Summary

A good leader should regard feedback as an essential communication tool. Feedback helps greatly with learning, self-development, problem solving, motivation, spreading good practice and efficiency and effectiveness.

Leaders should endeavour to ensure that feedback is regarded as a natural...
Leader’s debriefing skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 17, ‘Communications—debriefing skills’)

Summary

Running effective debriefing sessions following individual, small or major operations allows a leader to evaluate the worth of the original briefing and ascertain whether objectives have been satisfactorily completed; identify good practice and things that did not go...
Leader’s influencing skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 18, ‘Communications—influencing skills’)

Summary

Influencing skills are particularly relevant to the role of a police leader as a significant part of a leader’s role concerns persuading people (e.g. team members, peers, seniors, agencies and members of the public) to adopt certain courses...
Leader’s report-writing skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 19, ‘Influencing skills—report writing’)

Summary

It is essential that a leader should have good oral and writing skills. This is in order to express him or herself clearly so as to be able to gain influence and desired results. Poorly written, confusing...
Leader’s meeting skills
Authors: Boon Bryan
Published: August 2023

(See Chapter 20, ‘Meeting skills’)

Summary

Meetings can be very frustrating, expensive time-wasters and should only be called when absolutely necessary to assist with the promotion of efficiency and effectiveness and public service. The chair of a meeting amounts to a leader directing and...
Cyber Threats
Authors: Staniforth Andrew
Published: August 2023

The development of the internet and digital technologies represent a major opportunity for the UK, transforming businesses and providing new tools for everyday communication. More than 80 per cent of households in the UK now have an internet connection and internet users are spending increasing amounts of time online, undertaking a greater range of online and social networking activities. In terms of business, online retail spending accounts for approximately 15 per cent of all retail spend each month, an approximate average weekly online spend of £600 million and growing. The internet and online activities have now become central to the very way in which people live their lives in modern society.
Cyber Strategy
Authors: Staniforth Andrew
Published: August 2023

To effectively tackle all manner of cyber threats requires a coherent strategic approach. An important part of this chapter is the explanation of the development, structure, strategic aim and objectives of the UK’s cyber strategies which provide a framework for all cyber crime investigative activity. Contemporary cyber crime machinery now cuts across government departments, law enforcement agencies and intelligence agencies, all of which have an important role to play. The national cyber crime architecture has quickly developed over recent years in response to cyber threats and remains in its infancy. For police officers of all ranks and responsibilities, a better understanding of the role of the police in cyber security, cyber-terrorism and cyber crime will serve to contextualise their contribution to national strategies and reinforce the collaborative approach required to tackle cyber crime today. The primary UK strategies which provide the national frameworks to tackle cyber threats include;
Cyber Crime Investigation Skills
Authors: Staniforth Andrew
Published: August 2023

The complexity of cyber crime continues to challenge the capacity and capability of UK policing. Over recent years, in direct response to the threats from cyber crime, the need for a professionally trained, highly skilled cyber investigative workforce has been recognised. This workforce must prepare and equip itself for the cyber challenges that lie ahead and at its heart is the cybercriminal investigator whose skills and abilities are absolutely essential for the effective fight against cyber crime.
Cyber-Dependent Crime
Authors: Staniforth Andrew
Published: August 2023

There have been several attempts to define cyber crime but they are most commonly viewed as falling into one of two categories. Those offences which are used against new technologies—cyber-dependent and are catered for within the Computer Misuse Act 1990, and the older type of offence where the new technology is being used to facilitate it. This chapter will explore those offences created to address those cyber-dependent crimes which in essence ‘attack the machine and networks’.
Cyber-Enabled Fraud
Authors: Staniforth Andrew
Published: August 2023

Cyber-enabled crimes are those traditional crimes (identified under the Home Office Counting Rules) which can be carried out and increased in their scale by the use of computers, networks or other forms of ICT. Over the past years, cyber-enabled fraud and theft have increased.
Forensic Evidence Recovery from Persons
Authors: Beaufort-Moore Deborah
Published: August 2023

This chapter details practical techniques for the recovery of non-intimate samples for potential particulate evidence. It highlights the importance of recovering potential forensic evidence from suspects, victims, and witnesses in order to confirm or refute accounts of the incident. The types of evidence transferred will depend on the particular offence. The chapter considers the issues of the consent of recovering samples by force or without consent, citing that trained specialists should only recover non-intimate samples while doctors or nurses must recover intimate samples. For initial responders, the use of an early evidence kit enables the timely recovery of potential evidence.
Blood Pattern Analysis
Authors: Beaufort-Moore Deborah
Published: August 2023

This chapter examines the principles of blood pattern analysis (BPA). It explains that BPA is based on the physical properties of blood and how it reacts under certain circumstances. The shapes, size, location and distribution of bloodstains at a crime scene can provide investigators with information that can serve to corroborate or refute the accounts given and provide an interpretation or recreation of the crime. Thus, bloodstaining should be accurately recorded by a crime scene investigator (CSI) or appropriate forensic specialist by photography or digital video recording. The chapter then considers the health and safety considerations when dealing with bloodstains and conducting BPA.
Death Investigation
Authors: Beaufort-Moore Deborah
Published: August 2023

This chapter discusses the process of a death investigation. It explains the main strands of death investigations, which are establishing the cause and manner of death and investigating the circumstances where the death was unexpected. Where it is felt the circumstances surrounding the death are suspicious, access to the scene must be restricted immediately and scene preservation actions put in place. Moreover, establishing the time of death can be beneficial to investigators to narrow down time frames for investigative trace, identify, eliminate (TIE) parameters. The chapter then highlights the role of initial responders and the importance of identifying post-mortem changes.
The Crucible of Recovery: 1989–90
Authors: Brain Timothy
Published: August 2023

There could be no
doubt about it; by 1989 the Police Service in England and Wales was in trouble.
It had endured several successive years of criticism from the hard and soft left
of British politics, and Labour had adopted a broad agenda that would assert a
high degree of political control over it. For much of 1984 and some of 1985
police had stood in various long thin lines around the country, standing against
working people, the class from which most of the officers of all ranks came
from, who were in fear of losing their jobs as the country journeyed through a
period of profound social, economic, and political change. Crime had risen
throughout the preceding decade, questioning the service’s competence. Rioting
and disorder had marked the beginning, middle, and final years of the decade,
with officialdom in the form of Scarman and Taylor attributing much of the blame
to the police. All the while the police seemed to enjoy immunity from
Thatcherite Conservatism, seeing increases in general spending, numbers of
officers, and above-inflation pay increases. Whether they liked it or not, to
many the police were simply ‘Maggie’s army’.
Police Reform 1—the Conservatives: 1991–3
Authors: Brain Timothy
Published: August 2023

The extreme
unpopularity of the Poll Tax hastened the end of Mrs Thatcher. Despite winning a
third term in 1987 her popularity had waned and by the autumn of 1990 elements
within her party had begun to differ with her over policy, particularly European
policy and economic policy, or had begun to consider she might have become an
electoral liability. The Poll Tax riots would have been simply a ‘blip’ if the
tax itself had not proved massively unpopular. However, it was internal party
dissent that finally dealt the fatal blow. She had already lost Lawson the year
before; on 1 November she lost her long-term ally Geoffrey Howe, ostensibly over
differences on European policy, but as much in reality because he had become
increasingly sidelined since his move sideways from the Foreign Office in the
1989 reshuffle. His resignation as Leader of the House and Deputy Prime Minister
triggered a leadership challenge by Michael Heseltine. In the ballot that
followed she failed to win an outright victory in the first round and the
majority of the Cabinet told her it was time to go. Even Waddington, who owed
his position entirely to her, lined up with the majority, although it seems he
was able to convey his message with some sensitivity. In the manoeuvring that
followed the 47-year-old and relatively inexperienced Chancellor of the
Exchequer John Major emerged as a compromise candidate between Hurd and
Heseltine, becoming Prime Minister on 28 November.
Police Reform 2—the Conservatives: 1993–7
Authors: Brain Timothy
Published: August 2023

Howard inherited
an extensive programme of action, and he soon received the first instalment. The
White Paper, unambiguously titled Police Reform, was published on Monday
28 June. There was just enough time to absorb its contents when two days later
Sheehy published his report, Inquiry into Police Responsibility &
Rewards. Presumably the coincidence of timing was intended, emphasizing
the common ground between the two and wrong-footing any potential opposition.
What was not so clear was Howard’s commitment to what was essentially his
predecessor’s agenda.
Potential Benefit of Combined Topical and Intravenous Administration of Tranexamic Acid in Congenital Heart Surgery
Authors: El Dein Abdelaziz Farouk Kamal , Sharaf Samia Ibrahim Ibrahim , Seif Eman Mohamed Kamal Abo , Ismail Abdelrahman Mohamed Tharwat Abdelaziz
Published: August 2023

Objective

Pediatric patients who undergo repair of congenital heart diseases on cardiopulmonary bypass are at great risk of postoperative bleeding. The major causes of bleeding are thrombocytopenia, platelets dysfunction, hemodilution and increased fibrinolysis during cardiopulmonary bypass (CPB). Non-surgical postoperative bleeding occurs due to micro-vascular bleeding from pericardial and mediastinal tissues when blood comes in contact with non-endothelial surfaces of the Cardio-Pulmonary Bypass (CPB) machine, compounded by liberal use of heparin and a complex interaction of humoral and cellular pathways.

Aim of the Work

The aim of the study is to asses if there is potential benefit of intrapericardial topical application of tranexamic acid when it is combined with the intravenous administration in reduction of postoperative bleeding after pediatric cardiac surgery on cardiopulmonary bypass (CPB).

Patients and Methods

Type of the study: Interventional, randomized and double blinded clinical trial. Study Setting: The operating theaters of Ain Shams University Hospitals. Study period: Over one year (from March 2020 to March 2021). Standard management: Intravenous Tranexamic acid (TxA) injection.

Results

The estimated blood loss postoperatively in first 24 hrs. Were less in the combined group than the IV group. Requirements of blood transfusion also were statically significant in combined group than IV group from aspects of volume of PRBCs transfusion, Total number of patients exposed to transfusion and transfusion rate. There is no difference regarding ICU stay and need of surgical re exploration.

Conclusion

The combined use of low dose IV and topical intrapericardial tranexamic acid in children with congenital heart disease undergoing on pump cardiac surgery reduced the risk of post-operative bleeding and need for blood products transfusion when compared to the administration of IV tranexamic acid only suggesting a potential benefit of topical tranexamic acid in hemostasis.
Albumin as Early Fluid Bolus Therapy after Cardiac Surgery in the Critical Care Units
Authors: Noureldin Bassel , Hakim Karim , Ali Heba , Abdelsalam Ahmed
Published: August 2023

Introduction

After cardiac surgery, the use of intravenous fluids to reach specific goals is associated with improved clinical outcomes and shortened intensive care units (ICU) stay. Although type of fluid doesn’t seem to be of a great importance. Clinicians will have been involved in many local debates about the best fluid. Absence of evidence about what is the ideal fluid in this situation push researchers to conduct clinical trials in this context.

Aim of the Work

The aim of this study is to investigate the cardiovascular effect of using 20% albumin in patients after cardiac surgery.

Methods

This was a double blinded RCT that was conducted at Department of Critical Care Medicine, Ain Shams University Hospital over 6 months on post-cardiac surgery mechanically ventilated patients with a clinical decision to administer fluid bolus therapy, that was assessed for enrollment.

Results

There was no statistically significant difference between two groups regarding delta serum chloride at 24 h post-op (mmol/L) and renal replacement therapy post-operatively in ICU, and there was statistically significant difference found between two groups regarding ICU, and Hospital stay, duration of mechanical ventilation, total dose nor epinephrine/kg in the first 24 h post-op (microg/kg), time to cessation of nor epinephrine infusion (h) and Delta serum creatinine at 24 h post-op (mg/dl).

Conclusion

In patients admitted to ICU following cardiac surgery, FBT with 20% albumin, when compared to crystalloid FBT, achieved equivalent cardiovascular optimization with smaller volumes of resuscitation fluid, less positive cumulative balance, and without evidence of any negative sequelae. Moreover, the use of 20% albumin for FBT was associated with lower amounts of vasopressor being delivered and shorter duration.
Role of Minimal Dose of Norepinephrine in Prevention of Hypotension Induced by Subarachnoid Anesthesia in Elective Cesarean Section
Authors: Latif Fahmy Saad , Anis Sherif George , Abdel-Dayem Ahmed , Tawfik Ahmed Mohamed Kamal Mahmoud
Published: August 2023

Background

Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Spinal anesthesia techniques produce hypotension through blockade of sympathetic nerve fibers which control vascular smooth muscle tone. For elective cesarean section, regional anesthesia is preferred as a technique to general anesthesia because of maternal and fetal show a risk to morbidity and mortality. Spinal anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration, and avoids neonatal drug depression from general anesthetics.

Aim of the Work

The aim of this study to assess the effectiveness of minimal dose of norepinephrine in preventing the episodes of hypotension that follow subarachnoid anesthesia in elective cesarean section.

Patients and Methods

The study was conducted on 60 randomly chosen patients full filling the inclusion criteria at Ain-Shams university hospitals after approval of medical committee. They were allocated in two groups of 30 patients each: Group (A) received the minimal dose of norepinephrine (25 nanogram/kg/h). Group (B) didn’t receive an infusion with vasopressor.

Results

The patients in the study group (A) had less events of hypotension 10% compared to 76% in group (B) and less Tachycardia in group (A) with only 3.3% compared to group (B) which were 70%. Although no statistical difference in all other parameters measured in this study.

Conclusion

Our study suggests that the use of norepinephrine as a vasopressor in the treatment of subarachnoid induced hypotension is safe and effective.
Role of Intraoperative Dexmedetomidine Infusion in Enhanced Recovery after Surgery Protocols for Reducing Postoperative Analgesic Requirements in Laparoscopic Bariatric Surgeries
Authors: Zaki Hany V , Akl Diaa Abd Elkhalek , Gendiy Amr Saleh Yousef , Haggag Adham Magdy
Published: August 2023

Background

The prevalence of obesity in modern societies leads to continuous growing of bariatric surgery throughout the world as it is an effective treatment for obesity. Dexmedetomidine (DEX), a selective α2-adrenergic agonist, is an opioid-sparing adjuvant sedative that avoids respiratory depression and has been shown to be beneficial in bariatric surgery patients

Aim of the Work

The aim of this study is to evaluate the analgesic profile of intraoperative Dexmedetomidine on postoperative analgesic requirements.

Patients and Methods

This study was carried out at bariatric surgery unit - Ain shams University Hospitals and included 06 patients of both sexes undergoing elective laparoscopic bariatric surgery.

Results

The main finding in this study was that nalbuphine consumption was less in group D compared to group C with p value < 0.001 with high significant difference between the two groups also it revealed a high significant difference between the two groups according to time for first use of rescue analgesia. There was a highly significant difference between the two groups according to hemodynamics including (MAP & HR) but with no clinically significant differences. While there was no significant difference as regard SO2 or respiratory rate

Conclusion

In patients undergoing bariatric surgeries using of intraoperative dexmedetomidine infusion with its opioid-sparing effect enhanced the recovery of this study population of morbidly obese patients with minimal side-effects.
Role of Local Anesthetic Infiltration of Port Sites in Laparoscopic Cholecystectomy in Reducing Postoperative Pain and Opioid Consumption
Authors: Zaki Gamal Fouad Saleh , Mohamed Asmaa Abobakr AbdAllah , Ammar Mona Ahmed
Published: August 2023

Background

Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incision, reduces blood loss and is associated usually with fewer postoperative complications and decreased length of hospital stay.

Aim of the Work

The aim of this study was to evaluate the efficacy of the long acting local anesthetic (bupivacaine) infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain and opioid consumption.

Patients and Methods

In the period from March 2021 to September 2021 fifty patients who underwent laparoscopic cholecystectomy were randomly allocated to one of two groups and comparative study was done. In the bupivacaine group (A), after skin preparation and before port insertion, 20 ml of 0.25% bupivacaine solution was infiltrated through the abdominal wall 4 ml around each port site. Postoperatively, pain score using VAS score, time of rescue analgesic and total rescue analgesic dose was calculated.

Results

The results showed that there a decrease in pain intensity in the bupivacaine group compared to control group with a significant difference, and there was delay in the time of rescue analgesia and total doses of rescue analgesia the bupivacaine group compared to control group with a statistically significant difference.

Conclusion

Port- site infiltration of bupivacaine in laparoscopic cholecystectomy successfully decrease post-operative pain during first 6 hour and delayed the time of rescue analgesia.
A Comparative Study of Using Ondansetron with Dexamethasone or Ondansetron with Haloperidol in Prophylaxis against Post-Operative Nausea and Vomiting after Elective Laparoscopic Abdominal Surgeries
Authors: Elsaidi Mohamed Ismail , ElSerwi Heba Bahaa Eldin , Kamal Mohamed Mohamed , Elshaer Ayat Mohamed Hisham
Published: August 2023

Background

Laparoscopic surgery is associated with a remarkably high risk of postoperative nausea and vomiting. the reasons for this high rate of PONV include mechanical factors (such as pressure on the stomach and gut caused by the pneumoperitoneum), neural factors (such as vagal reflexes elicited by irritation of parasympathetic nerve endings in the abdomen), and chemical factors (which include speculative considerations regarding a possible influence of CO2 on PONV). Postoperative nausea and vomiting are usually selflimiting but if persistent or severe, can cause medical complications such as dehydration, electrolyte imbalance and delay in patient’s discharge.

Objective

To compare between the effect of combination of ondansetron with haloperidol and ondansetron with dexamethasone on prophylaxis against postoperative nausea and vomiting in laparoscopic abdominal surgeries.

Methods

After approval of anaesthesiology department, scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 25; each); group A (the ondansetron plus dexamethasone group) and Group B (the ondansetron plus haloperidol group).

Results

The two groups were adequately monitored and assessed post-operatively and they were compared regarding post-operative nausea and vomiting outcome by recording the incidence of nausea and vomiting and recording the call for rescue antiemetic. Demographic data, intra-operative hemodynamics and post-operative pain score, occurrence of side effects, sedation score and patient satisfaction scores were also assessed.

Conclusion

The combination of ondansetron with haloperidol is as effective as the combination of ondansetron with dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic abdominal surgeries.
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache after Cesarean Section: A Randomized Controlled Study
Authors: Wahba Sherif Samir , AbdelGhaffar Wael Sayed Ahmed , Helmy Amr Fouad Hafez , Dawoud Beshoy Atef Gamil
Published: August 2023

Background

Post dural puncture headache (PDPH) is a known side effect following spinal anesthesia occurring in 2.5-40% of patients, it typically starts after 2 days but may be delayed up to 2 weeks and almost resolves spontaneously within a few days. Classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia and dizziness.

Objective

The aim of the study is to know if the neostigmine and atropine can improve PDPH treatment when added to conventional management after cesarean sections.

Patients and Methods

After obtaining approval from research ethics committee of Faculty of Medicine, Ain Shams University and after obtaining informed written consents from the patients. The study was conducted in the operating theaters of Ain Shams University Hospitals. The study period was 6 months after approval of the protocol, computer generated simple randomization. Patients with PDPH and a VAS < 5 were randomly allocated to receive either: Group 1: Slow intravenous injection with 20 µg/Kg neostigmine and 10 µg/Kg atropine in 20 ml 0.9% Saline given over 5 minutes every 8 hours up to 72 hours, Group 2: 20 ml of 0.9% saline intravenous every 8 hours.

Results

In this study, we compared the efficacy of neostigmine versus placebo (Both groups received the conventional management) in treating the PDPH, All of the 2 groups (neostigmine and Placebo) were effective in lowering VAS scores at 24, 48 and 72 h after headache's onset but neostigmine alleviated the pain more effectively and with rapid onset. The mean VAS score was significantly lower in neostigmine group compared with other group 6, 12, 24, 36, 48 and 72 h after start of medications (p < 0.001 for all of them) Placebo group 6, 12, 24, 36, 48, and 72 h (p < 0.001 for all of them). This may cause the drug to be one of the potential new drug therapies for such distressing condition, especially with its different mechanism of action that differs from other drugs.

Conclusion

Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood–brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.
Single Lung Ventilation versus Two Lung Ventilation in Video Assisted Thoracoscopic Lung Surgeries
Authors: El-Safty Omar Mohamed Taha Abdallah , Mohamed Salwa Omar El-Khattab Amin , Taeimah Mohamed Osman Awad , Arafa Esraa Abd El-Latif Mohamed Shawky Abd El-Hameed
Published: August 2023

Background

VATS is being widely used nowadays in thoracic surgeries. One lung ventilation (OLV) is a technique routinely used in thoracic anesthesia to facilitate thoracic surgery. Double-lumen tubes (DLT) remain the most popular and reliable choice for one lung ventilation especially in adult patients.

Objective

To evaluate single lung ventilation as an alternative to conventional ventilation in video assisted thoracoscopic lung surgeries despite the claimed intra operative and post-operative hypoxemia which could be avoided or even minimized by changing ventilatory setting.

Patients and Methods

After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, Patients were included in the study in form of two equal groups (each of 30 patients). Group A: (no.=30) Patients did lung surgeries with single lung ventilation using double lumen endotracheal tube. Group B: (no.=30) Patients did lung surgeries with two lung ventilation using conventional single lumen endotracheal tube (two lung ventilation).

Results

In our study it was found that intraoperative hypoxemia (SaO2 < 90%) occurred during some cases of single lung ventilation in 4 out of 30 cases. However, it was irrelevant to any other intraoperative or post-operative complication. Moreover, it was irrelevant to post-operative arterial oxygen saturation or any end organ complication. In our study also all comorbidities which can affect arterial oxygen saturation were excluded from the study from the start. However, better studies are urgently needed to investigate an individual “best oxygen content” concept for each patient undergoing one-lung ventilation.

Conclusion

The result of this study comparing single lung ventilation versus to lung ventilation in video assisted thoracoscopic surgeries concerning mainly intraoperative and post-operative hypoxia demonstrated that intra operative hypoxia occurred in some cases of single lung ventilation. However, this intraoperative hypoxia was irrelevant to post-operative hypoxia or any intraoperative or post-operative complications. So, our study recommends that using DLT for one lung ventilation is ideal for video assisted thoracoscopic lung surgeries, providing better surgical field, lesser surgery duration and better surgeon satisfaction.