bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Perineural versus Systemic Dexamethasone to Prolong Analgesia after Ultrasound Guided TAP Block for Patients Undergoing Lower Abdominal Surgeries
Authors: Fltaoos Abanoub M , Elkadi Galal A , Kamal Karim Y , Elawady Diaa Eldin S
Published: August 2023

Background

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain.

Aim of the Work

to study the effect of adding dexamethasone perineurally & systemicly as an adjuvant to bupivacaine in TAP block. The comparison included the effect on postoperative pain & postoperative analgesic requirement and haemodynamics.

Patients and Methods

In our study, 52 patients were randomly divided into two equal groups: Group A: Patients who received 2 ml volume of dexamethasone (8 mg) perineurally combined with the 20 ml of bupivacaine of (0.25%) concentration in the block (total 22 ml), followed by injecting 5 ml saline intravenous. Group B: Patients who received 2 ml of dexamethasone (8 mg) intravenously diluted over 3 cm saline in a 5 ml syringe intravenously following injection of the perineural 20 ml bupivacaine (0.25%) combined with 2 ml saline to have the same syringe volume for the block (22 ml)

Results

Our study showed that addition of dexamethasone to bupivacaine in TAP block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects & better outcome to the perineural route.

Conclusion

Addition of perineural dexamethasone to bupivacaine in TAP block provided adequate post operative analgesia & patient satisfaction along with reduced numbers of rescue analgesia doses. Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects & better outcome to the perineural route.
US Guided vs Landmark Guided in Paramedian Spinal in Elderly
Authors: Bayoumi Ahmed Ashraf Abdelaziz , Gomaa Salama Hala , Farag Hanan Mahmoud , Mohamed Wael Abdelmoneim
Published: August 2023

Background

The ultrasound-assisted paramedian technique reduces the technical difficulty of spinal anaesthesia in the elderly. Compared with the landmark-guided paramedian technique, the use of ultrasound reduced the number of needle manipulations required for success, increased the firstattempt success rate and reduced block-associated pain and discomfort.

Aim of the Work

The study aims to evaluate whether ultrasound assisted paramedian spinal anaesthesia in the elderly can achieve successful dural puncture with fewer needle passes compared with the conventional landmark guided paramedian technique.

Patients and Methods

After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain shams University; this study conducted in the operating theatres of Ain Shams University Hospitals with sample size of 10 patients / group will be needed. The patients randomly divided pre-operatively into two groups using their computer-generated random numbers such that „even numbers‟ will be enrolled in “group-L” for patients receive spinal anaesthesia by the paramedian approach by landmark guided palpation and „odd numbers‟ will be enrolled in “group-s” for patients ultrasound assisted approach.

Results

Ultrasonography might improve the efficacy of spinal anaesthesia by improving the accuracy of identification of intervertebral level, depth measurement of the intrathecal space and location of the interlaminar window that permits needle passage compared with the landmark guided technique, ultrasound assisted spinal anaesthesia decreases the number of puncture attempts and improves the success rate at the first attempt in patients with potential technical difficulties we believe that individualisation is a key element of minimising technical difficulties. Because of the large intersubject variability in anatomy, the blind technique have a theoretical upper limit of success rate. Through which we obtained success rates of 90 and 100% at the first attempt and within two attempts, respectively, in the ultrasound group.

Conclusion

Ultrasound-assisted paramedian spinal anaesthesia significantly reduces the number of needle manipulations required for success, increases the success rate at first pass and decreases periprocedural pain and patient discomfort compared with the landmark-guided paramedian technique in the elderly. Our results suggest that the neuraxial ultrasonography enhances the efficacy and comfort of spinal anaesthesia in the elderly.
A Comparative Study between Rectus Sheath Block and Quadratus Lumborum Block for Post-Operative Analgesia Following Para-Umbilical Hernia Repair Surgery
Authors: Al-Majeed Alaa Adel Abd , Al-Kadi Galal Adel , Shoukry Randa Ali , Ibrahim Dalia Ahmed
Published: August 2023

Background

Umbilical hernia repair, is a common day-surgery procedure and associated with considerable postoperative discomfort. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization.

Aim of the Work

To assess the analgesic efficacy of ultrasound-guided trans-muscular quadratus lumborum block compared with rectus sheath block during para-umbilical hernia repair surgery and in the early postoperative period by measuring and comparing postoperative VAS score and first time to rescue analgesia and the total amount of opioid (pethidine) given in the first 24 hours.

Patients and Methods

Patients undergoing paraumbilical hernia repair will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group 1 (QL group) will receive bilateral ultrasound guided QLB. Group 2 (RSB group) will receive bilateral ultrasound guided RSB.

Results

The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia. Demographic data, post-operative hemodynamics, and sedation score were also assessed.

Conclusion

Quadratus lumborum block was more effective technique in providing analgesia after para-umbilical hernia repair surgery in comparison to rectus sheath block and even more time covering to rescue opioid.
Ultrasound Guided Modefied Pectoral Nerve Block (PECII) versus Serratus Anterior Plane Block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy
Authors: Abd El Salam Alaa Ashraf Hassan , Shokri Hoda , Moris Kerolos Emad , Mahmoud Mohamed Sidky
Published: August 2023

Background

Breast cancer is the most common cancer in women in both the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases.

Objective

to evaluate the effectiveness of ultrasound guided Modefied pectoral nerve block (PEC II) versus Serratus Anterior plane block (SAPB) as a postoperative Analgesia in MRM. Regarding the time of the first analgesic dose and the total amount of analgesia consumed during the first 24 hrs inaddition to the pain score and incidence of complications.

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in Ain Shams University Hospitals. It included 70 female patients undergoing MRM were divided randomly into two groups, each group consisted of 35 patients; Group I patients received Modified PECS, Group II patients received Serratus Anterior Plane Block (SAPB). The two groups were compared regarding analgesic outcome by using the numeric rating score system, time for first for analgesic need and total consumption of opioid in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.

Results

The results of our study showed that there was no statistically significant difference between groups regarding demographic data. Also, there was a statistically significant decrease in Mean blood pressure (mmHg) in Group II compared with Group I from 1 hr. to 6 hrs postoperative. However, a statistically significant decrease in group II compared to group I regarding postoperative heart rate (beat/min) from 1 hr. to 6 hrs.

Conclusion

SAPB block was more effective in reducing postoperative pain scores for 1-6 hours and lower total 24-h postoperative opioid and analgesic consumption after MRM under general anesthesia, compared to Modefied PECS block.
Effect of Preoperative Intravenous Iron for Anemic Patients on Outcomes after Cardiac Surgery: A Systematic Review
Authors: Fahmy Sameh Michel Hakim , Hakim Mahmoud Abdel , Daniel Samuel Habachi , El-Gendy Alaa Esmat Ali
Published: August 2023

Background

Iron-deficiency anemia is a global health problem and a common medical condition seen in everyday clinical practice and especially with patients going through cardiac surgery. The most rapid and effective method of correcting anemia is by transfusion of red blood cells. However, blood transfusion itself is not without risk. Treatment of perioperative anemia using iron replacement therapy is, in contrast to blood transfusion, a safe, cheap, and relatively convenient therapy

Aim of the Work

This study aims to perform a systematic review regarding the effect of preoperative intravenous iron therapy on the need for perioperative blood transfusion and the incidence of major morbidity in anemic patients undergoing cardiac surgery.

Search Methodology

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and articles were identified by searching PubMed, Web of Science, EMBASE, COCHRANE Database of systematic reviews (CDSR), Scopus, and Web of Science. Quality of the studies was assessed using the Cochrane Risk of Bias Tool 2 (ROB-2) and Risk of Bias in Non-randomized Studies tool (ROBANS). The primary outcomes are change in hemoglobin and hematocrit after cardiac surgery and perioperative need for blood transfusion, while secondary outcomes are postoperative length of hospital stay and incidence of major adverse outcomes.

Results

Of the articles reviewed a total of six randomized controlled trials (RCT) and seven non-randomized observational studies (NRSI) were included in the review. Across studies, 1,732 patients were enrolled. The quality of the RCTs was mostly high, while the quality of the NRSTs was low, primarily due to issues related to blinding of assessors. Two studies showed higher hemoglobin with iron therapy, and only one study showed significant differences in multiple outcomes such as transfusion and morbidity. Hospital stay was reported in 4 studies and averaged 9 days.

Conclusion

Our results showed benefits of preoperative intravenous iron administration in reducing the likelihood of allogeneic blood transfusion and providing a modest increase a modest increase in hemoglobin concentration in anemic patients undergoing caridac surgery.
Evaluation of Ultrasound- Guided Quadratus Lumborum Block for Postoperative Analgesia after Hip Surgery
Authors: Hawas Amira Y , Kamaly Ayman M , Maarouf Mohammed M , Anis Sherif G
Published: August 2023

Background

With improvement of surgical technique, hip surgery became more frequent with increased need for adequate postoperative analgesia The main advantage of quadratus lumborum block (QLB) compared to spinal anaesthesia is the extension of local anesthetic agent beyond the transverses abdominis plane to the thoracic paravertebral space producing extensive analgesia and prolonged action.

Aim of the Work

to assess the analgesic efficacy of ultrasound-guided (US) trans-muscular QLB compared to spinal anaesthesia during Hip surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.

Patients and Methods

64 patients were randomly allocated to one of 2 groups (n = 32; each); group QLB received US-guided QLB before induction of spinal anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group Spinal Anaesthesia alone: received Spinal anaesthesia alone, 3.5 ml of 0.5% bupivacaine plus 25 µg fentanyl.

QLB results in decreased incidence and severity of postoperative pain resulting in a decrease in incidence and degree of sedation and total opioid requirement. The quadratus lumborum block was more efficient than the spinal anaesthesia alone. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) in QLB group were superior to that for the spinal anaesthesia group.

Conclusion

patients having preoperative single shot QLB, as an adjuvant to spinal anesthesia, have significant less time for discharge from the postoperative care unit and better postoperative pain control compared to spinal anesthesia alone for hip surgery, in terms of VAS score and total opioid consumption as well as frequency of need.
Ultrasound Guided Preoperative Assessment of Inferior Vena Cava Collapsibility Index in Prediction of Intraoperative Hypotension in Patients Undergoing Laparoscopic Cholecystectomy Surgery under General Anesthesia
Authors: Boles Ghobrial Bassem , Labib Heba Abdel Azim , Mohamed Mahmoud Saad , Sayed Yassen Amr Abd El-Razek
Published: August 2023

Background

Laparoscopic surgery aims to minimize trauma of the interventional process but still achieve a satisfactory therapeutic results. It is commonly performed because of various advantages such as reduced postoperative pain, faster recovery and more rapid return to normal activities, shorter hospital stay, and reduced postoperative pulmonary complications.

Aim of the Work

In this study we aim to evaluate effectiveness of preoperative IVC ultrasonography (IVC CI) in prediction of hypotension (mean arterial pressure >60 mmHg) which develops following intraabdomenal gas insufflation, and in determining hypovolemia occurring in patients undergoing laparoscopic cholecystectomy surgery under general anesthesia.

Patients and Methods

This study was a prospective observational study conducted on 50 patients inside the operative theatre of El demerdash hospital after ethical committee approval.

Results

There was a statistically significant negative correlation between IVC CI and Change of MBP (mmHg) After induction from baseline with; while Change of MBP (mmHg) After insufflation of abdomen from baseline was of negative correlation but insignificant as there was no dehydrated patients among this study group preoperatively according to our measurements and for ethical purposes we considered that if there was any patient needed hydration preoperative according to preoperative assessment of IVC-CI should be managed before surgery in order not to have intraoperative hypotension which can affect his wellness intra and postoperative, also all the patients were ASA I/II with no critical illness affect volemic status and usage of deprevan, fentanyl and atracurium during induction which can cause hypotension post induction.

Conclusion

In this study there was a statistically significant negative correlation between IVC CI and Change of MBP (mmHg) After induction from baseline; while Change of MBP (mmHg) After insufflation of abdomen from baseline is of negative correlation but insignificant. We believe that IVC ultrasonography may be helpful in prediction of preoperative hypovolemia in patients who underwent laparoscopic cholecystectomy.
Change in Serum Chloride and Its Relation to Acute Kidney Injury in Septic Shock Patients
Authors: Abdel-Hameed Amr Essam , Hussein Noha Sayed , El Sayed Abo Shawaly Ayman El Shishtawy
Published: August 2023

Background

Septic shock is a dysregulated host response to infection resulting in potentially lifethreatening organ dysfunction. Acute kidney injury (AKI) id one of the most common and serious complications associated with septic shock patients especially in intensive care units.

Aim of the Work

To evaluate the predictive value of change in serum chloride and its relation to acute kidney injury in septic shock patients.

Patients and Methods

The study was included 65 septic patients who admitted to intensive care units of Ain Shams University Hospitals, Cairo, Egypt. All the included cases were subjected to full history taking and full general and local examination. Full laboratory investigations were taken from all the cases. The following were done; GCS, SOFA and APACHE II score. The initial serum chloride level and the highest level of chloride during stay was recorded with calculation the difference as the change of serum chloride level.

Results

In our study, diabetes was the most common comorbidity in the included cases (49 cases – 75.4%), followed by hypertension (40 cases – 61.5%), chest infection was the commonest source of sepsis in our study (33 cases – 50.8%), followed by UTI (23 cases – 35.4%). Other causes included intra-abdominal infections, skin and soft tissue infections and blood stream sepsis.

Conclusion

Acute kidney injury is a frequent complication in septic patients and optimization of fluid management is fundamental in order to limit the detrimental role of fluids on renal metabolism.
Prospective Randomized Study of the Post-Operative Analgesic Efficacy of Transversus Abdominis Plane Block versus Lumbar Epidural Analgesia after Total Abdominal Hystrectomy and Bilateral Salpingo-Oophorectomy
Authors: El Ghany Bassiouny Mohsen Abd , Khattab Salwa Omar El , Ismaeil Mohammad Abdulmohsen Abdulnaeim , Ali Doaa Ragab Ali Abu
Published: August 2023

Background

Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.

Aim of the Work

To study the analgesic efficacy of bilateral ultrasound guided single shot Transversus Abdominis Plane (TAP) Block with bupivacaine compared to single shot lumbar epidural block with magnesium adjuvant to bupivacaine after total abdominal hysterectomy and bilateral salpingo-oophorectomy surgeries.

Patients and Methods

The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: Group TAP: 25 Patients of this group will receive bilateral ultrasound guided lateral approach TAP block at the end of surgery using 20 ml of 0.25% bupivacaine for each side with a maximum dose of (3 mg/kg). Group EA: 25 Patients of this group will receive epidural analgesia through catheter injection using a single dose of 15 ml of 0.25% bupivacaine and 100 mg MgSo4 (1 ml of 10% MgSo4) at the end of surgery for postperative pain relief.

Results

Revealed that Lumber epidural showed the best response as regard pain control post operatively in 1st 4 hour. Then TAB block shows more superior in analgesia starting from 6 hours postoperative than single shoot epidural with less overall rescue analgesia consumption and complications as hypotension and tachycardia.

Conclusion

Lumber epidural showed the best response as regard pain control post operatively in 1st 4 hour. Then TAB block shows more superior in analgesia starting from 6 hours postoperative than single shoot epidural with less overall rescue analgesia consumption and complications as hypotension and tachycardia.
Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Congenital Inguinal Hernia Repair
Authors: Ewais Bahaa Eldeen , Taeimah Mohamed , Kamal Mohamed Mohamed , Mohamed Elsayed Mohamed Ali
Published: August 2023

Background

Inguinal hernia is the most common lower abdominal surgery of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. Analgesic techniques in pediatric patients having surgery are often delayed by the inherent difficulties of conducting a large randomized clinical trial in those patients. TAP block and caudal epidural block are two anesthetic techniques that are commonly used in pediatric age group for lower abdominal surgeries.

Aim of the Work

Compares the efficacy of Dexmedetomidine as an adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for postoperative analgesia in children undergoing congenital inguinal hernia repair especially to provide prolonged post-operative analgesia and decrease opioid consumption.

Patients and Methods

We conducted a prospective, randomized, controlled and comparative study in Ain shams university hospitals in a period of 6 months including 50 patients divided on 2 groups; group A 25 of them received ultrasound guided transversus abdominis plane block with 0.3 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 2.5-8 years and they were 6 females (24%) and 19 were males (76.0%) and group B 25 patients received caudal epidural block with 0.6 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 3 – 9 years and they were also 4 females (16%) and 21 were males (84.0%).

Results

In the present study there was statistically significant increase in pain at 1 hr, 2 hrs and 4 hrs in caudal block group and increase in pain score at 12 hrs in tap block group but there was no statistically significant difference found between them at 6 hrs, 18 hrs and 24 hrs. There was statistically significant increase in rescue analgesia in caudal block group at 4 hr with p-value <0.001; also there was statistically significant increase in rescue analgesia in tap block than caudal block at 12 hr with p-value = 0.009 while no statistically significant difference found between both groups at the other times of follow up.

Conclusion

TAP block was superior to caudal epidural anesthesia in terms of early postoperative pain, less need for rescue analgesia and need for less potent analgesia e.g. Paracetamol and NSAID. Addition of dexmedetomidine to conventional regional anesthetic protocol showed significant reduction of postoperative pain and the need for rescue analgesia.
Evaluation of Left Ventricular Diastolic Function Using a Tissue-Doppler Imaging Based Algorithm According to 2016 Ase/Eacvi Guidelines in Patients with Decompensated Liver Cirrhosis: A Prospective Observational Study
Authors: Shokeir Mohamed Hossam , Barakat Ashraf Abdelkhalek , Metwaly Amna Ahmed , Gendy Hanaa Abdallah El , Elsaid Mohamed Moien Mohamed , EL Moaz Basha Attallah Eslam Mohammed Maher Abd
Published: August 2023

Background

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The prevalence of cirrhosis has nearly doubled over the last decade, and the number of hospitalizations has similarly increased.

Aim of the Work

We aimed to correlate between the severity of liver cirrhosis using new MELD score and left ventricle diastolic dysfunction using tissue doppler imaging.

Patients and Methods

A prospective observational study in ICU of Theodor Bilharz Research Institute Hospital and Ain Shams University Hospitals for 6 months from June 2021 till end of November 2021 on hepatic patients who were admitted to ICU of Theodor Bilharz Research Institute Hospital and Ain Shams University Hospitals.

Results

In the studied group, the mean age was 53.13±9.44 years with males constituting more than half of them (57.8%). The mean MELD score was 24.08±6.01, and the mean left ventricular ejection fraction (LVEF %) was 60.43±5.49%. There were 5 patients (5.6%) with normal LV diastolic function and 85 patients (94.4%) with abnormal LV diastolic dysfunction. Out of the 90 patients, 5 patients were normal, 44 patients (48.9%) had a grade I LVDD, 28 patients (31.1%) had a grade II LVDD and 13 patients (14.4%) had a grade III LVDD. There was a highly statistically significant positive association between the grades of left ventricular diastolic dysfunction according to ALT, AST, T.Bilirubin, D.Bilirubin, INR and Creatinine. Additionally, there was a highly statistically significant negative association between grading of left ventricular diastolic dysfunction according to platelet count and sodium levels.

Conclusion

There was a statistically significant correlation found between the severity of liver cirrhosis represented by the new MELD score and the grade of left ventricular diastolic dysfunction. Therefore, in order to prepare the best post-procedural management of cirrhotic patients, echocardiography is required for all patients before any interventional procedure or liver transplantation regardless of the stage of cirrhosis. The mechanism of cardiac involvement in patients with cirrhosis seems to be complex and multifactorial.
Comparison of Three Different Doses of Dexamethasone Added to Midazolam for Prophylaxis against Nausea and Vomiting after Laparoscopic Cholecystectomy during Early Postoperative Period
Authors: Ebrahim Ahmed Saeed Mohamed , Elkhattab Salwa Omar , Mohamed Marwa Mamdoh , Abdelrahman Haytham Ahmed Maher
Published: August 2023

Background

General anesthesia using volatile anesthetics is associated with high incidence of postoperative nausea and vomiting ranging between 20% - 30% within 24 hours after surgery. Postoperative nausea and vomiting is thought to be of multifactorial etiology involving anesthetics, surgical and individual factors.

Objective

To compare between three different doses of Dexamethasone in conjunction with predetermined fixed dose of Midazolam which can provide effective prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy.

Patients and Methods

1ry outcome was to decrease nausea and vomiting after laparoscopic cholecystectomy and 2ry outcome was itching and dizziness. The present study was conducted in Ain shams University hospitals on 120 adult female patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled to an elective laparoscopic cholecystectomy. After obtaining approval from the research ethical committee of faculty of medicine of Ain Shams University, a written informed consent was obtained from every patient after explaining the procedure.

Results

Over 24 h, the incidence of nausea, vomiting and rescue antiemtic use reduced significantly in Group ІІ and Group ІІІ when compared to group І. As with incidence, the severity of nausea was even significantly reduced in the group ІІ and group ІІІ group (P 0.043 and 0.009) respectively compared to group І in 24 hours postoperative. Postoperative pain was assessed for initial 6 h. Group ІІ and group ІІІ had significant reduction in severity of pain (P < 0.016 and 0.006) respectively when compared to group І while there was no significant difference between group ІІ and group ІІІ. Moreover, the incidence of use of rescue analgesia significantly reduced from 82.5% in group І to 52.5% and 45% in group ІІ and group ІІІ, respectively. However, dose of rescue analgesia used in 6 h was significantly reduced in Group ІІІ only (P = 0.013).

Conclusion

The minimum effective dose for prevention of postoperative nausea is 4 mg of Dexamethasone in combination with Midazolam in female patients undergoing Laparoscopic cholecystectomy with additional advantage of analgesia in the early postoperative period. Further reduction in incidence and severity of PONV can be achieved with a dose of 8 mg dexamethasone.
The Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to the Addition of Fentanyl to Epidural Bupivacaine in Patients Undergoing Lower Limb and Pelvic Orthopedic Surgery under Combined Spinal Epidural Anesthesia
Authors: El Ghafar Hazem M Abd , Aziz Mohamed S Abdel , Yossif Osama R , Mohamed Wael A
Published: August 2023

Background

Epidural anesthesia is safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. Research continues concerning different techniques and drugs that could provide better surgical anesthesia and postoperative pain relief.

Aim of the Work

to investigate how the addition of magnesium sulphate to 0.5% bupivacaine affects duration, quality, complications and dermatome spread of anesthesia in comparison to fentanyl.

Patients and Methods

The current study included 50 patients who had been scheduled to undergo lower limb or pelvic orthopedic surgery under combined spinal - epidural anesthesia. The study had been done after approval of the local ethics committee and after obtaining written informed consent from all patients enrolled in the study; which had been held at Ain Shams Hospital, Faculty of Medicine.

Results

Pain assessment using VAS showed no statistically significant difference between the two studied groups in the first and second hours postoperative. Starting from the third hour statistical significant differences were observed between the two groups, VAS was higher in groups (M) than in group (F); (1.82 ±0.6 vs. 1.42 ±0.4 in both groups respectively. At the fourth hour; VAS was higher in groups (M) than in group (F); (2.80±0.8 vs. 1.76 ± 0.6 in both groups respectively. The incidence of complications was significantly lower among group (M) where 52% of patients had no complications at all.

Conclusion

the use of both magnesium and fentanyl as adjuvants to local anesthetics in epidural anesthesia is safe and effective. No significant differences regarding quality of motor block and hemodynamics. But the study shows that fentanyl is significantly a better adjuvant regarding postoperative analgesia and time for first analgesic dose. While magnesium is a significantly better adjuvant regarding complications such as nausea, vomiting and pruritis.
Mean Platelet Volume as a Prognostic Marker in Sepsis in ICU
Authors: Awad Hossam Magdy , El Shantory Sherif Farouk Ibrahim , El Fawal Sanaa Mohamed Mohamed , Ezzat Ahmed Wagih
Published: August 2023

Background

Sepsis is defined as a systemic inflammatory response to confirmed or suspected infection. It is a major cause of morbidity and mortality, and the incidence is rising, probably due to the growing elderly population, antibiotic resistance, immunosuppressive medication and, invasive surgery. Pneumonia is the most common infection leading to sepsis, followed by urinary tract infections and abdominal infections. These infections are usually localized and controlled by the immune system, but they can sometimes spread and cause sepsis.

Objective

To correlate between the mean platelet volume in patients with sepsis with C-reactive protein as a prognostic markers.

Patients and Methods

This is a prospective study conducted on 80 adult critically ill patients of both sexes with sepsis and sever sepsis who admitted to the units of Critical Care Medicine Ain Shams University Hospitals. The samples were collected during the period from 1st October 2019 to 31st March 2020, MPV results were correlated to CRP, SOFA score and APACHE score.

Results

The results of the present study revealed: 55.8 % were male and 44.2 % were females. Sex did not affect mortality, no statistical significance found. In this study, MPV was a significant parameter in septic patients. The cut off value for MPV was 10.5 fl which was found to be significant and of a magnitude considered to be clinically useful, with sensitivity 57.1%, specificity 80.8%, p value (0.003) and accuracy 72.5% in predicting mortality. A correlation was found between high MPV, CRP, SOFA and APACHE scores. Therefore, MPV may be used as an auxiliary test in the prognosis of sepsis.

Conclusion

Initial values of MPV were significantly correlated with CRP, APACHE and SOFA scores and with the estimated rate of mortality.
Midodrine as Adjunction Support for Weaning off Norepinephrine in Septic Shock
Authors: Hafez Hussien Gamal Mohammed , Nashed Sherif Wadie , El Malek Morkos Fady Adib Abd , El Wahab Wael Abd El_Moneim Mohamed Abd
Published: August 2023

Background

Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality.

Objective

To evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV norepinephrine and allow earlier discharge from ICU compared to control patients.

Patients and Methods

This was a Prospective comparative study. The population of the study included 60 patients whom were admitted to adult ICU department with septic shock. This study was included 60 critically ill patients who was fulfilled the diagnostic criteria for septic shock were randomly assigned to one of two group each one was included 30 patients.

Results

Concerning the effect of midodrine on the outcome of septic patients, our study showed that there was highly significant effect on the ICU length of stay and ICU mortality. (The ICU length of stay (days) in midodrine group = 6.2 VS 8.3 in control group (p = less than 0.001) and the ICU survival in midodrine group = 96.7%VS 60% in control group (p = 0.001). A number of confounding factors may have influenced this endpoint, including the provider confidence in patient stability, bed availability on floor or step-down units or continued need for ICU monitoring for other reasons.

Conclusion

Use of midodrine significantly reduces duration of IV vasopressor infusion during the recovery phase of septic shock. Use of midodrine has great impact on overall survival, length of ICU stay and ICU survival. Administration of midodrine improved MAP & serum lactate in midodrine group.
Fascia Iliaca Block versus Intra-Venous Analgesia for Positioning of Neck Femur Fracture in Patient Undergoing Spinal Anathesia
Authors: Abdelaziz Mohamed Saeed , Hakim Karim Youssef Kamal , Ibraheem Peter Naiem Abdelmassiah , Mohamed Mahmoud Abdelaziz
Published: August 2023

Background

Fracture of the femur is a well-known reason for surgical repair in patients of all ages. Locations include the neck, intertrochanteric, shaft, and distal fractures. Spinal anesthesia is the commonly used, preferred method for surgery and is associated with lower odds of mortality compared to general anesthesia. Spinal anesthesia is administered in either a sitting or lateral decubitus position. Positioning patients with a fractured femur for spinal anesthesia is challenging since minimal movement of the overriding fracture ends can cause extreme pain.

Objective

To elaborate the efficacy and safety of FICB with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture.

Methods

After approval of anesthesiology 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 FICB and control group.

Results

The study results show that there was no statistically significant difference found between FICB group and FENT group regarding demographic data and characteristics of the studied patients. While there was statistically significant increase in the quality of patient positioning in FICB group than FENT group with p-value = 0.021; also there was statistically significant increase in the patient satisfaction in FICB group than FENT group with p-value =0.021. And a statistically significant increase was found in the time to first rescue analgesic postoperative in FICB group than FENT group with p-value < 0.001.

Conclusion

Fascia Iliaca Compartment Block is more efficacious than intravenous fentanyl for positioning during spinal anaesthesia in surgery for fracture femur. Fascia Iliaca Compartment Block provides superior analgesia, better quality of patient positioning, greater patient satisfaction thereby reducing the time taken to perform spinal anaesthesia in sitting position compared to i.v. fentanyl in fracture femur surgery.
Effect of Ultrasound Guided Quadratus Lumborum Block as Postoperative Analgesia after Laparoscopic Cholecystectomy
Authors: Mina Marian Emil Riad , Hameed Hatem Saeed Abdel , Hashim Reham Mustafa , Fattah Mohamed Mohamed Abdel
Published: August 2023

Background

Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain.

Aim of the Work

The aim of this study was to assess the postoperative analgesic efficacy of quadratus lumborum block (QLB) compared to general anesthesia with multimodal routes of analgesia as paracetamol, ketorolac and morphine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received.

Patients and Methods

The study was conducted on 60 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or Il scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Group A: (n = 30): patients received general anesthesia followed by QLB at the end of the operation and before emergence of GA, with rescue drug morphine 0.05 mg/kg IV, Group B: (n = 30): patients received general anesthesia only, with post-operative control of pain using multimodal routes of analgesia as paracetamol I gm IVI 16 hrs, ketorolac 30 mg in 100 ml normal saline solution every 12 hrs and rescue drug morphine 0.05 mg [kg IV.

Results

The results of the study revealed that the Patients receiving QLB had significantly lower pain scores at rest for the whole first 24 hrs while upon coughing there was no difference in the first 6 hrs between the two groups and lower pain in 12, 18, 24 hrs in QLB group postoperatively and decrease total need of analgesic in first 24 hrs postoperatively compared with patients who received multimodal routes of analgesia.

Conclusion

Bilateral QLB was effective in reducing postoperative pain scores at rest and upon coughing and lower total 24 hrs postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to multimodal routes of analgesia, This technique can be a promising mode of postoperative analgesia. Use of adjuncts of continuous catheters might be used in the next studies for prolonging the duration of block.
Serum Procalcitonin, CRP, Lactate and Albumin as Predictors of Mortality in Critically Ill Cirrhotic Patients
Authors: Awad Hala Gomaa Salama , El Damarawy Mervat Mohamed , Ahmed Waleed Abdallah Ibrahim , Saleh Ashraf Nabil , El Azim Ibrahim Mohammed Abd , Ghonim May Elraey Abdelaziz Aly
Published: August 2023

Background

Cirrhosis is the last complication of chronic hepatic disease. Cirrhotic patients may be asymptomatic or have symptoms such as ascites, encephalopathy, variceal haemorrhage, and jaundice, which are all signs of liver malfunction or portal hypertension. Other problems, such as infection, hepatocellular carcinoma, or kidney failure, may have an influence on these individuals' survival. Patients' survival rates are significantly reduced as a result of these problems.

Aim of the Work

The aim of this study is to evaluate serum procalcitonin, CRP, lactate and albumin as predictors of mortality in critically ill cirrhotic patients.

Patients and Methods

This Prospective study was conducted at ICU of Theodor Bilharz Research Institute Hospital. This study included 60 Patients who were admitted to ICU of Theodor Bilharz Research Institute Hospital. The duration of the study was 6 months.

Results

The main results of this study were as following: The present study showed that as regard risk factors; There were 3 patients (5.0%) of them had “HTN”; 27 patients (45.0%) of them had “DM” and 17 patients (28.3%) of them had “Renal Imp.”, while there are no cases of IHD and stroke among risk factors. There was no statistically significant difference between the nonsurvivors’ group and survivors’ group as regard risk factors. The current study showed that according to vital data in the study group, was mean of SBP mmHg (96.17±13.42); mean of DBP mmHg (61.17±10.59); mean of HR (102.07±14.15); mean of RR (19.30±4.80); mean of Temperature (37.32±0.43) and mean of SPO2% (95.10±3.05). There was highly statistically significant difference between the non-survivors’ group and survivors’ group as regard vital signs.

Conclusion

Non-survivors of critically sick cirrhotic patients had greater CRP, PCT, and lactate levels than survivors while, albumin was higher in survivors than non survivors. PCT and CRP are the most significant predictor of poor outcome and increased mortality, followed by Lactate and albumin.
Accuracy of Initial Chest Computed Tomography Scan for Diagnosis of COVID-19: A Systematic Review
Authors: Fahmy Sameh Michel Hakim , Nofal Waleed Hamed Abdelmenaem , Ibrahim Peter Naiem Abdelmassiah , Armanious Michael Nabil Botros
Published: August 2023

Background

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus (SARS- COVID-19) with recent outbreak occurred on 11 March 2020. A computerized tomography (CT) scan for chest was proved to be a helpful tool for diagnosis of COVID-19 pneumonia. But little is known about its diagnostic accuracy.

Aim of the Work

This systematic review aims at determining current evidence regarding accuracy of initial chest CT scan for detection of COVID-19 infection.

Patients and Methods

We conducted an electronic search through different databases; PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL). We included clinical trials whether randomized or nonrandomized prospective or retrospective cohorts, case control, cross sectional studies and case series larger than 10 cases). All studies that reported data about the diagnostic accuracy of initial chest CT for diagnosis of COVID-19 infection were enrolled. We evaluated the methodological quality for included studies using QUADAS-2 Risk of Bias tool.

Results

From a total 4617 screened citations, 40 studies met our inclusion criteria. We divided the identified studies into two groups: studies that reported both sensitivity and specificity (6 studies, n = 1431) and studies that included only positive COVID-19 cases from which we could estimate only sensitivity (34 studies, n = 3515). Among six studies that evaluated accuracy of CT chest, there was high sensitivity ranged from to 93% to 100% but CT chest specificity was low ranged from to 10% to 56%. Rest of 34 studies had a wide range of sensitivity between 61% and 100% with few studies reported sensitivity below 80%.

Conclusion

Our results suggest that CT chest is a great screening tool for COVID-19 with high sensitivity but it had low specificity. However, interpretation of CT chest along with other laboratory could enhance its diagnostic accuracy.
Comparitive Study between Dexamethasone versus Fentanyl as Adjuvant to Local Anesthesia in Supraclavicular Nerve Block in Upper Limb Surgery
Authors: Mostafa Zakaria Abdelaziz , Said Alfred Maurice , Abdelhaq Ahmed Abdeldayem , Abdelsatar Mohamed Abdelmaabod
Published: August 2023

Background

Peripheral nerve block as an anesthetic technique plays an important role in modern regional anesthesia. Upper limb surgeries are mostly performed under peripheral blocks such as the brachial plexus block. Peripheral nerve blocks not only provide intra-operative anesthesia, but also extend analgesia in the post-operative period without major systemic side-effects by minimizing stress response and using minimal anesthetic drugs.

Objective

To evaluate the effects of adding dexamethasone and fentanyl to bupivacaine in ultrasound guided supraclavicular brachial plexus block for upper limb surgery versus bupivacaine alone.

Patients and Methods

After obtaining approval from the medical ethical committee in Al-Matareya Teaching Hospital, this study was conducted in Al-Matareya Teaching Hospital in cooperation with Ain Shams University. It was include patients undergoing elective upper limb surgery. A written informed consent was obtained from every patient after explaining the procedure. A randomized double-blinded controlled study is thought to be the most suitable design to achieve the study objectives.

Results

The present study showed that addition of dexamethasone and fentanyl to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of both sensory and motor blocks and significantly prolonged their duration compared to bupivacaine olny.

Conclusion

In the current study, the addition of dexamethasone or fentanyl to bupivacaine for supraclavicular brachial plexus block make the onset of sensory & motor block faster and prolongation of motor and sensory block duration and prolongation of duration of analgesia more than using bupivacaine only. But onset of motor and sensory block was shorter in fentanyl group than dexamethasone group and duration of sensory and motor block more in dexamethasone rather than fentanyl.
Role of Therapeutic Bronchoscopy in Comparison to Standards of Care in Critically Ill Patients with Acute Respiratory Failure
Authors: Noureldin Bassel Essam , Abdellatif Ayman Ahmed , Mahmoud Noura Mohammed Youssri Ahmed , Hassan Mohamed Atef Elbasiony
Published: August 2023

Background

Acute respiratory failure (ARF) is a sudden failure of oxygenation, carbon dioxide clearance or both, Hypoxic ARF is most commonly caused by pneumonia, cardiogenic or noncardiogenic pulmonary edema, or pulmonary haemorrhage, while the underlying causes of hypercapnic ARF include drug overdose, neuromuscular disease, chest wall abnormalities and severe obstructive airway disorders. Treatment for respiratory failure includes clearing the airways by suction, use of bronchodilators, tracheostomy and endotracheal tube with ventilator support. Additionally, the treatment regimen includes antibiotics for infections, anticoagulants for pulmonary thromboembolism, and electrolyte replacement for fluid imbalance.

Objective

To evaluate difference between use of therapeutic bronchoscope to standards of care, including open and closed suctioning (no bronchoscopy) regarding patient outcome.

Patients and Methods

Study included 80 patients who were divided by alternation into two groups: Group A: 40 patients were subjected to traditional standards of care including chest percussion, closed and open suctioning. Group B: 40 patients were subjected to therapeutic bronchoscope (fibreoptic bronchoscopy) with endobronchial washing and suctioning in addition to traditional standards of care.

Results

Regarding ABG significant improvements were observed, (in terms of PaCO2, PaO2 and PaO2/FiO2 ratio) in group B (fibreoptic bronchoscopy) in comparison with group A (traditional standards of care) at all follow up periods (P < 0.05). Regarding the radiological improvement, in this study we observed significant improvement after 3 days, after 8 days and total improvement were observed in group B (fibreoptic bronchoscopy) compared to group A (traditional standards of care) (P < 0.05). Regarding the patient’s ICU length of stay, both groups demonstrated insignificant differences (8.24±3.06 in group A versus 6.78±4.09 in group B) (P > 0.05).

Conclusion

The current study revealed that fibreoptic bronchoscopy was associated with significant improvement compared to traditional standards of care, in ARF cases in terms of ABG parameters as well as radiological findings. However, ICU length of stay and duration of mechanical ventilation seemed to be comparable.