bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential effect of agomelatine versus dexmedetomidine during awake fiberoptic intubation; role of catacholamine
Authors: Attia Josef Z. , Hassanine Ahmed
Published: September 2024

Background

Awake fiber-optic intubation is one of the recommended strategies for surgical patients with suspected difficult airway, especially when simultaneous difficult ventilation is anticipated.

Patients and methods

In all, 90 patients of both sexes aged between 20 and 55 years, American Society of Anesthesiologist I and II stages were scheduled for elective abdominal surgeries. Patients were randomized into three equal groups. Group A: oral agomelatine at a dose of 10 mg administered with a sip of water 120 min before surgery. Group B: agomelatine+dexmedetomidine. Group C: dexmedetomidine infused at a dose of 1 μg/kg loading infusion per 10 min followed by a continuous infusion of 0.2 μg/kg/h. The following variables (mean arterial pressure, heart rate, oxygen saturation, cough score, postintubation score) and Richmond agitation sedation scale score were recorded in addition to the serum level of norepinephrine.

Conclusion

Agomelatine is more effective than dexmedetomidine in making better intubation state with sedation, less desaturation, and hemodynamic stability during awake fiber-optic intubation. Synergestic effect between agomelatine and dexmedetomidine was detected.
Effect of lignocaine versus sodium bicarbonate on reducing pain due to intravenous injection of propofol: a prospective randomised double-blinded, controlled study
Authors: Mourad Karim Hussein , Marzouk Sahar Ali , Mohammed Aliaa Helmy , Abougabal Ayman
Published: September 2024

Context

Propofol is the most commonly used intravenous (IV) anesthetic drug for induction of anaesthesia and for sedation, but pain which occur during its injection still remains a problem. Approximately 70 to 90% of patients who receive propofol for anaesthesia induction experience pain during injection and this pain can be quite severe. The most frequently used drug to alleviate pain in propofol injection is IV Lignocaine which acts through the local anesthetic effect on the veins. Administration of sodium bicarbonate with lidocaine was proved to reduce pain in propofol injection through increasing sodium ions concentration as well as increasing serum pH through its buffering effect.

Aims

To compare the effect of adding lignocaine vs sodium bicarbonate to propofol in reducing pain on propofol injection.

Settings and design

A randomized, controlled, double-blinded trial.

Methods and material

One hundred and eighty patients underwent conscious sedation during surgical procedures were randomly divided into three equal groups as follows: Group (L) 3 ml (60 mg) of lignocaine 2% premixed with propofol, group (B) 3 ml of sodium bicarbonate 8.5% premixed with propofol and group (S) 3 ml of normal saline premixed with propofol. The 3 groups were compared regarding pain intensity immediately after IV injection of propofol using the four-point verbal rating and BP.

Results

The incidence of pain and the pain score were significantly lower in the lignocaine group (43%) in comparison to both group (Saline 81% and bicarbonate 71%) P value < 0.001. However, no difference in pain score or the incidence of pain were found between Group S and Group B.

Conclusions

Our study demonstrated that mixing lignocaine with propofol appears to be effective in reducing both the incidence and severity of the pain during propofol injection when compared to mixing propofol with sodium bicarbonate or normal saline.
Sacrococcygeal local anesthesia versus spinal anesthesia for pilonidal sinus surgery: a prospective randomized controlled study
Authors: Ali Hani G. , Elatief Elnegeery Naglaa A.
Published: September 2024

Background

Spinal anesthesia is the most common anesthetic technique applied for patients undergoing surgery for pilonidal disease. However, it has multiple disadvantages like hypotension and headache. This prospective study was designed to compare the outcomes of sacrococcygeal local anesthesia technique versus spinal anesthesia for surgical treatment of patients with pilonidal disease.

Patients and methods

The included 220 patients diagnosed with the pilonidal disease were assigned into two groups according to the method of anesthesia, the spinal and local groups. The primary outcome was pain score, whereas other outcomes included duration of stay in the operative theater, recovery room, postoperative opioid consumption, time to first analgesic request, complications, and patient satisfaction.

Results

Age and sex distribution showed no significant difference between the two groups. Time spent inside the operative room and total hospital stay showed a significant decrease in the local group. Postoperative pain was statistically comparable between our groups, apart from the six-hour reading, which was higher in the local group. The spinal group showed superior analgesic outcomes regarding the first analgesic request and total opioid consumption. Likewise, patient satisfaction was significantly higher in the same group. Postoperative nausea was more encountered in the local group.

Conclusion

When compared with spinal anesthesia, sacrococcygeal local anesthesia seems to have a weaker analgesic profile manifested in increased opioid requirements and earlier rescue analgesia. However, it is associated with comparable pain scores, less operative time, and shorter hospitalization.
Role of enteral metoprolol tartrate on hemodynamics and clinical outcomes of septic shock patients of various pretargeted heart rate groups
Authors: Habib Tamer N. , Fayed Akram M. , Marouf Mohamed M. , Ahmed Islam E.
Published: September 2024

Introduction

Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected.

Objective

The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups.

Methods

Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score.

Results

After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P = 0.001).

Conclusion

Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.
Autologous platelet-rich plasma in the treatment of third-degree pressure ulcers; pilot randomized-controlled trial
Authors: Habib Tamer N. , Fayed Akram M. , Deghady Akram A. , Maklad Osama M. , Ahmed Islam E.
Published: September 2024

Background

Platelet-rich plasma (PRP) is a mixture of cytokines, thrombocytes as well as multiple growth factors which are produced mainly by α-granules of platelets which enhance the process of natural healing process with less time. The role of autologous PRP in managing nonhealing pressure ulcers has been questioned as it enhances tissue healing by providing the necessary growth factors.

Objectives

Determining the relative efficacy of autologous PRP in treating grade III skin ulcers compared with standard care.

Methods

In this pilot randomized-controlled trial, 28 patients with grade III pressure ulcers in the critical care units of Alexandria Main University Hospital were enrolled and randomized into two groups. Patients of group A were subjected to PRP injections in the periphery of their pressure ulcers along with the standard care, while group B were subjected only to the standard care of pressure ulcers.

Results

PRP group showed significantly reduced mean ulcer volume at week 1 (18.88 vs. 21.42, P=0.047), week 2 (17.14 vs. 21.15, P=0.017), week 3 (14.92 vs. 19.99, P=0.020) and week 4 (10.68 vs. 17.35, P=0.019) than control group. PRP group showed significantly reduced mean ulcer surface area at week 1 (13.76 vs. 14.81, P=0.047), week 2 (10.64 vs. 14.11, P=0.032), week 3 (8.00 vs. 14.17, P=0.013) and week 4 (6.30 vs. 12.94, P=0.023) than control group.

Conclusion

Adding weekly autologous PRP injections to the standard care of noninfected grade III pressure ulcers may be a potentially effective approach. In critically ill patients, it was associated with reduced ulcer volumes, reduced ulcer surface areas, and better healing starting from the first week of injections.
Peribulbar block for retinal surgery comparison among dexmedetomidine, fentanyl, and local anesthesia
Authors: Abu-Elwafa Wesam A. , Ahmed Islam M. , Abdul-Aziz Salah-Eldin A. , Hassan Ahmed H.
Published: September 2024

Introduction

Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications.

Aim

To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery.

Patients and methods

The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded.

Results

The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D.

Conclusion

Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.
Assessment of volume responsiveness by ultrasound parameters of carotid blood flow in patients with cardiogenic shock
Authors: Helmy Nehal Y. , Megahed Mohamed A. , Elmenshawy Ahmed M
Published: September 2024

Introduction

There is no noninvasive method that can reliably and accurately identify fluid responsiveness. As such, in patients with undifferentiated shock, treatment often involves empiric fluid administration, in the hope that volume expansion will increase preload, which will then serve to increase cardiac output. However, for patients on the flat portion of the Starling curve, aggressive fluid administration results in no appreciable increase in cardiac output and may be detrimental to hemodynamically unstable patients.

Objective

The aim of this study was to compare the sensitivity and specificity of cardiac output measurement using bedside ultrasound on carotid artery and Transthoracic Echocardiogram(TTE) while assessing volume responsiveness in cardiogenic shock patients.

Patients and methods

In this prospective observational study, 40 cardiogenic shock patients were enrolled. Carotid artery Doppler ultrasound was performed where carotid blood flow (CBF) was calculated and TTE where cardiac output was calculated before and after passive leg-raising test to assess volume responsiveness.

Results

CBF measurements in comparison with cardiac output for assessment of fluid responsiveness had a sensitivity of 83.33% and specificity of 100%.

Conclusion

Carotid Doppler ultrasound and calculation of CBF is a reliable predictor to fluid responsiveness in patients with cardiogenic shock where transthoracic echocardiography is the gold standard in dynamic monitoring of the change in stroke volume after a maneuver that increases venous return (preload).
Effect of adding dexamethasone to intrathecal bupivacaine on blood sugar of controlled diabetic patients undergoing diabetic foot surgeries
Authors: Ismail Eman A. , Askar Fatma , Toni Asmaa , Elyounsi Mohamed , Askar Omnia
Published: September 2024

Background

Spinal anesthesia is acceptable in patients undergoing diabetic foot surgery. The duration of the spinal anesthesia has been improved by the addition of other drugs such as opioids, dexmedetomidine, clonidine, and dexamethasone. Dexamethasone may affect blood glucose levels. The primary outcome of the study was the effect of a single dose of intrathecal dexamethasone on blood glucose levels during the first 24 h postoperatively.

Patients and methods

After approval, 60 diabetic patients, American Society of Anesthesiologists grades 2 and 3 with ages ranging from 20 to 70 years were enrolled in this randomized, double-blinded, placebo-controlled trial. All patients who underwent diabetic foot surgery under spinal anesthesia have controlled type II diabetes. Patients were randomly allocated into two equal groups: the control group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 1 ml of 0.9% sodium chloride. The dexamethasone group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 4 mg of dexamethasone.

Results

The control group had significantly lower levels of blood sugar at different times compared with the dexamethasone group. However, at the end of 24 h, nonsignificant changes were present between the two groups. Also, using 200 mg/dl as a cutoff for high blood sugar, there were nonsignificant changes all through the 24 h in both groups. Moreover, dexamethasone prolongs the duration of analgesia and decreases paracetamol requirements during the first 24 h postoperatively.

Conclusions

Addition of intrathecal dexamethasone did not change postoperative glycemic evolution in controlled diabetic patients undergoing diabetic foot surgery. However, it significantly prolongs the duration of analgesia and decreases analgesic consumption during the first 24 h postoperatively.
Prediction of protective lung tidal volume using the ulna length in Egyptian adults
Authors: Marie Hosam E.M. , Soliman Fouad I. , Refaie Bahaa M.
Published: September 2024

Background

Ventilation with low tidal volume (VT) is advised for critically ill patients to protect against ventilator-induced lung injury and provide better clinical outcomes. Previous studies showed poor compliance with using height to predict VT. Ulna length has been used successfully to predict protective low VT. Our study aims to evaluate the ability of ulna length measurement to predict accurate protective lung VT in Egyptian people in reference to their standing height.

Methods

This study included healthy adult volunteers aged greater than or equal to 18 years. The height of each patient was measured while standing upright against a wall. Then, the left ulna was measured with a measuring tape from the olecranon to the mid-point of the styloid process. From ulna length, height was estimated, and protective lung VT was calculated using predicted body weight (PBW).

Results

Total 102 participants were enrolled in this study. The agreement between the calculated VT from standing height and ulna length was analyzed with Bland Altman analysis and showed a bias of (-5.7) ml, and limits of agreements (±1.96 SD) −91 ml to 76 ml in females; when the calculated VT of ulna length was compared with predicted body weight from height, the predicted mean VT was 6.2 ml/kg (95% confidence interval CI 4.5-7.8 ml/kg). In males, using ulna length, the predicted mean VT was 6.1 ml/kg (95% CI 4.8-7.4 ml/kg).

Conclusion

Ulna length can be used to predict protective lung VT in Egyptian people compared with their standing height.
Ultrasound-guided infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for hand and forearm surgeries
Authors: Morsi Yahya H. , Ammar Ramadan A.E. , Elshafie Ahmed M.A.
Published: September 2024

Background

Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia.

Objective

To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements.

Patients and methods

This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm.

Results

The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C.

Conclusion

Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.
Intrathecal atropine versus preoperative intravenous ondasetron for prevention of postoperative nausea and vomiting due to intrathecal morphine in perineal surgery
Authors: Soliman Fouad I. , Mousa Elhadad A. , Ahmed Shehab M. , Hassan Ahmed H.
Published: September 2024

Background

Opioids are frequently added to neuroaxial local anesthetics (LAs). Intrathecal (IT) opioid is not devoid of adverse effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritis. IT atropine also carries a significant antiemetic effect, and this can be a valuable modality for the prevention of IT opioid-related PONV. The antagonist of 5-HT3 receptors such as ondasetron which is usually used to decrease the incidence of nausea and vomiting was considered for the prevention and treatment of neuroaxial opioid-induced (PONV).

Method

100 cases of ASA I-II aged 18 and 45 who planned to do elective perineal surgery, and receiving bupivacaine spinal anesthesia were randomly divided into two equal groups. Group (A) cases received IT hyperbaric bupivacaine (10 mg 0.5%) in combination with morphine 250 μg and atropine sulphate 100 μg. Before anesthesia, group (B) participants received IT hyperbaric bupivacaine (10 mg 0.5%) and 250 μg of morphine and 4 mg IV ondansetron. Follow-up for PONV attacks, vital signs, and side effects in the two groups.

Results

The occurrence of postoperative nausea were 4 and 18% in group A and B, respectively (P value=0.049) while postoperative vomiting was 0 and 12% in group A and B, respectively (P value=0.027). The occurrence of sedation, mouth dryness, headache, and drowsiness were more in group A compared with group B.

Conclusion

IT atropine is more effective than IV ondasetron preoperative in relieving PONV related to IT morphine, sedation is the frequent side effect occurred in IT atropine, headache is the frequent side effect occurred in the ondasetron group
A propensity score matching analysis for CPAP versus conventional oxygen therapy as a ceiling of care in COVID-19-associated type 1 respiratory failure
Authors: Yasser Noeman-Ahmed , Ashraf Roshdy , Abdulla Bedir , Iman El Sayed , Maryam Noeman , Gouri Koduri , Vinod Warrier , Sriya Gokaraju , Patrice Ayuen , Nour Abualela , Shashank Sharma , Duncan J. Powrie
Published: September 2024

Background

Continuous positive airway pressure (CPAP) is increasingly used as a ward ceiling of care. Nevertheless, little is known about its effectiveness.

Objective

A retrospective study to explore whether CPAP therapy as a ceiling of care improves outcome in coronavirus disease 2019 (COVID-19)-infected patients with acute respiratory failure.

Methods

A retrospective cohort study was conducted on adult COVID-19-infected patients admitted to two UK hospitals from the March 1 to June 30, 2020. All patients experienced type 1 respiratory failure and were not suitable for intubation. They were divided into two groups: patients for CPAP versus conventional oxygen therapy (COT).

Results

A total of 39 patients received CPAP, whereas 247 received COT. CPAP group patients were more hypoxic (mean SpO2 86.5% vs. 91%, P=0.003), younger (mean±SD: 71.8±8.8 vs. 80.7±9.8 years, P<0.001), and less frail than the COT group [median (interquartile range) clinical frailty score 4 (3–5) vs. 6 (4–7), P<0.001]. Overall, 35 patients died in the CPAP group (89.7%) compared with 185 patients in the COT group (74.9%) (P=0.041). Propensity score matching of the two groups showed that CPAP was still associated with higher mortality (90.3 vs. 67.7%, P=0.029). Length of hospital stay was similar in both groups (mean±SD 9.2±7.3 vs. 9.7±8.6 days, P=0.719).

Conclusion

In COVID-19-infected patients presenting with type 1 respiratory failure and deemed not suitable for escalation to intubation, the use of CPAP therapy does not carry extra benefit than COT. In such patients, COT appears to be the appropriate measure. Further studies are required to corroborate these findings.
Management of cerebral vascular spasm in posttraumatic subarachnoid hemorrhage using a combination therapy of oral nimodipine and intravenous milrinone
Authors: Fathi Heba M. , Medhat Marwa M.
Published: September 2024

Background

Intravenous milrinone has been investigated for management of vasospasm after aneurysmal subarachnoid hemorrhage (SAH); however, its role in vasospasm after traumatic SAH is still under evaluation.

Patients and methods

A total of 30 patients with cerebral vascular spasm after traumatic SAH were randomly divided into two equal groups. Group H was given nimodipine (60 mg/4 h) orally or via nasogastric tube and then combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy). Group M was given nimodipine (60 mg/4 h) orally or in the nasogastric tube and then intravenous milrinone bolus of 0.1–0.2 mg/kg followed by intravenous infusion of 0.75–1.25 μg/k/min. The infusion was continued for 72 h before gradual discontinuation at a rate of 0.25 μg/kg/min every 24 h until complete weaning. For refractory cases in both groups, emergency angioplasty was done. Primary outcome was the transcutaneous cerebral regional oxygen saturation 14 days after starting treatment. Secondary outcomes were the Glasgow coma score 14 days after starting treatment, infarction rate, ICU and hospital stays, and modified Rankin scale and Glasgow outcome scale at 3 and 6 months after starting treatment.

Results

Group M showed significant increase in regional oxygen saturation and Glasgow coma score; decrease in infarction rate, ICU stay, and hospital stay; and improvement in modified Rankin scale and Glasgow outcome scale. Significance was set at P value less than 0.05.

Conclusion

The combination of oral nimodipine and intravenous milrinone improves the outcome of vasospasm in posttraumatic SAH.
Continuous positive airway pressure as a useful tool in coronavirus disease 2019-related acute hypoxemic respiratory failure
Authors: Noeman Ahmed Yasser , Setty Niranjan , Roshdy Ashraf , Powrie Duncan J. , Amran Dora A. , Elsheikh Alguili , Gokaraju Sriya , Tear Anne , Noeman Maryam , Darda Maria , El Sayed Iman , Karunanithi Vijayalakshmi , Mahalingam Aarani , Shafiq Muhammad , Abdul-Khaliq Iman , Samuel Johnson
Published: September 2024

Background

Many coronavirus disease 2019 (COVID-19) patients suffering acute hypoxemic respiratory failure (AHRF), fail to respond to conventional oxygen therapy (COT). Subsequently, some centers escalate to continuous positive airway pressure (CPAP), while others resort directly to invasive mechanical ventilation (IMV). We conducted a study to compare the use of CPAP versus COT alone in COVID-19-related AHRF.

Patients and methods

It is a retrospective cohort study of laboratory-confirmed COVID-19 patients suffering AHRF and deemed eligible for IMV escalation at three university hospitals (United Kingdom) during a 3-month period. The primary endpoint was the need for intubation and the secondary endpoint was 60-day mortality.

Results

In total, 174 patients were included. In total, 84 patients received CPAP (group 1) and 90 received only COT (group 2). Both groups had comparable demographic criteria and disease severity. There was nonsignificant reduction in the need for IMV when using CPAP compared with COT alone (50 vs. 76.6%, P=0.866). Sixty-day mortality was significantly higher in group 2 (25 vs. 37.8%, P=0.02). COT as stand-alone therapy for COVID-19 patients (group 2) was associated with a significant increased relative risk of death (relative risk 2.14, 95% confidence interval 1.39–3.29) corresponding to a number needed to treat of 3.74 (95% confidence interval 2.47–7.73). Among patients who progressed to IMV, there was no difference in the risk of mortality between the two groups.

Conclusion

Introducing CPAP rather than escalating FiO2 or endotracheal intubation in COVID-19 cases refractory to COT is safe and associated with improved mortality. Clinical trials are needed to guide the optimum timing and selection of patients most likely to benefit.
Ultrasound-guided paravertebral block for inguinal herniorrhaphy
Authors: Ali Hani G. , Elnegeery Naglaa A.E.
Published: September 2024

Background

There has been an increasing trend toward performing inguinal repair surgeries under regional anesthetic techniques like paravertebral block (PVB). Neostigmine has been used as an adjuvant to local anesthetics, but the existing research studies are few. This study was conducted to evaluate the efficacy of neostigmine as an adjuvant to local anesthesia used for PVB in inguinal hernia repair procedures.

Patients and methods

This prospective randomized study included 72 patients prepared for elective inguinal hernia repair under PVB. They were allocated into two groups: the neostigmine group received a mixture of bupivacaine and neostigmine (5 μg/kg), whereas the control group received bupivacaine alone. During the postoperative period, pain score, hemodynamic parameters, first analgesic request, total analgesic consumption, and the incidence of adverse effects were noted and recorded.

Results

Both groups showed comparable findings regarding age and weight. However, the number of patients requiring rescue analgesia showed a significant increase in the control group. Moreover, controls reported significantly earlier first analgesic requests. Both diclofenac and fentanyl consumptions were increased without neostigmine administration. Pain score was significantly better with neostigmine at 4 and 6 h after surgery. Hemodynamic parameters were almost comparable between the two groups.

Conclusion

Neostigmine appears to be an efficient adjuvant to local anesthetics when administered during PVB as it significantly improves its analgesic profile. Its administration should be encouraged in clinical practice.
Efficacy of peritonsillar infiltration of levobupivacaine-dexamethasone versus levobupivacaine-dexmedetomidine in children undergoing tonsillectomy surgery
Authors: Hayes Salwa M.S. , Atef Ebada Hisham , El Bendary Hanaa M.
Published: September 2024

Purpose

We evaluated the quality of analgesia produced by peritonsillar infiltration of levobupivacaine with either dexamethasone or dexmedetomidine in children undergoing tonsillectomy surgery.

Patients and methods

Patients scheduled for tonsillectomy were randomly allocated into three groups with 27 patients in each group. Group L received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine, while group D received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexamethasone 0.5 mg/kg and group X received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexmedetomidine 1 μg/kg (with infiltration of 2.5 ml in each tonsil in all groups) with the first postoperative analgesic request as the primary outcome.

Results

Postoperative time to first analgesic paracetamol request was prolonged in group D (19.51±2.34 h) compared with group L (4.15±0.53 h) and group X (15.74±2.29 h). Face, leg, activity, cry, consolability (FLACC) Behavioral Pain Assessment score at rest and during swallowing decreased in group D compared with group L and group X. Total postoperative analgesic consumption decreased in group D (581.48±165.7 mg) compared with group L (1303.51±90.10 mg) and group X (680.50±160.67 mg).

Conclusions

We concluded that peritonsillar infiltration of levobupivacaine when mixed with either dexamethasone or dexmedetomidine for patients undergoing tonsillectomy produced prolonged analgesia; however, dexamethasone was superior to dexmedetomidine with more prolonged time to first paracetamol request and prolonged late postoperative pain relief.
Comparison between quadratus lumborum and transversus abdominus plane blocks for analgesia in abdominal surgeries
Authors: Abdelhady Mohamed M. , Omar Sherif Y. , Afifi Monir K. , Salah Eldin Kariman M.I.
Published: September 2024

Background

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Aim

The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score.

Patients and methods

A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level.

Results

There was no significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements.

Conclusion

US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.
High-flow nasal cannula versus noninvasive positive pressure ventilation in patients with acute respiratory failure
Authors: Ali Mohammed Ahmed S. , El Maraghi Sameh K. , Saber Hamdy M. , Mohammed Ahmed Y.
Published: September 2024

Introduction

Acute hypoxic respiratory failure (AHRF) is a serious complication of various diseases, which leads to 30% of ICU admissions; ∼42% of patients often requires endotracheal intubation and mechanical ventilation, and it has a mortality rate reaching to 50%. Noninvasive ventilation (NIV) as a respiratory supportive therapy is commonly used in patients with acute respiratory failure, which decreased the need for endotracheal intubation and improved the clinical outcomes but still has many disadvantages and failure reaching 30.6%. Recently, high-flow nasal cannula (HFNC) as an alternative is being used increasingly with critically ill patients, where it has been successfully applied to a variety of patients.

Aim

To evaluate the effect of HFNC on the rate of endotracheal intubation as a primary outcome and also oxygenation, tolerance, ICU stay, and mortality as secondary outcomes in adult patients with AHRF in comparison with NIV.

Patients and methods

A total of 40 patients with AHRF were randomly included in the study: patients were treated in a randomized order with either NIV, comprising 20 patients, or with HFNC, comprising 20 patients. Intubation rate, mortality rate, oxygenation, and patient’s tolerance were evaluated in both groups.

Results

There was no statistically significant difference between the two groups regarding the need of intubation (P=0.677) and mortality rate (P=0.677). Although there was a significant difference between the two groups regarding patient tolerance in favor of HFNC (P=0.002), there was no statistically significant difference between the two groups regarding the ICU days (7.4±3.4 days in group A vs. 7.3±3.1 days in group B; P>0.05). There was a statistically significant difference between both groups after 12 h of therapy regarding the PaO2/FiO2 ratio (233.2±22.1 in group B vs. 184.3±15 in group A; P<0.001).

Conclusions

HFNC showed a trend to improve the clinical outcomes and was as effective as NIV in terms of decreasing the need of intubation, mortality, or length of ICU stay. HFNC demonstrated a better tolerance and a higher degree of patient comfort than NIV but NIV demonstrated better oxygenation improvement.
Changes in carotid corrected flow time in guiding fluid resuscitation in septic patients
Authors: Sabri Sherif , Abdelbasset Ahmed , Yassien Ahmed , Nashaat Ahmed
Published: September 2024

Introduction

Accurate estimation of intravascular volume status is important in the resuscitation of patients in ICUs. Although intensive fluid therapy in patients with life-threatening volume depletion can prevent death and end-organ damage, volume overload is known to result in increased mortality, morbidity, and duration of hospital stay. Ultrasonography has become a common diagnostic choice in assessment of fluid status in septic patients. This method is noninvasive, easy to learn, and provides real-time assessment at the patient’s bedside. Various ultrasound modalities have been developed to provide accurate and minimally invasive assessment of volume status. In this regard, one of the most promising methods is the evaluation of the blood flow velocity waveform in the descending thoracic aorta via a nonimaging Doppler probe. This modality is based on calculating the systolic flow time with cycle time correction [corrected flow time (FTc)]. FTc is known to be directly associated with volume status. FTc measurement in carotid artery is a completely noninvasive and much more feasible approach.

Aim

To compare the use of ultrasonography in the measurement of the changes in carotid FTc with echocardiography in the assessment of changes in heart dynamics to assess changes in volume status before and after passive leg raising (PLR) in septic patients.

Patients and methods

A total of 40 septic patients, including 18 (45.5%) patients as fluid responders and 22 (54.5%) patients as nonfluid responders, were included. Increased FTc by 7 ms, as well as 10% increase in stroke volume was considered to be fluid responsive.

Results

Our study results showed that 45.5% (n=18) of study population were fluid responders. The PLR test could assess fluid responsiveness with a specificity of 100% and sensitivity of 95% at a cutoff of 10.6% change in CO to predict fluid responsiveness. The study showed a statistically significant moderate positive correlation between CCA FTc and the percent of change in CO measured by echocardiography. An agreement analysis was formed. We concluded that there was a strong relation between change in carotid corrected blood flow and change in COP before and after PLR, with P value less than 0.001. Therefore, we can use this parameter to predict fluid responsiveness after PLR.

Conclusions

Carotid artery blood flow is a promising noninvasive and easy-to-perform tool for the evaluation of fluid responsiveness in critically ill septic patients. The PLR maneuver has demonstrated excellent performance for predicting fluid responsiveness. It is simple to perform but requires a reliable system of carotid corrected blood flow (COP) monitoring able to quantify the short-term changes.
Comparative study between the use of bupivacaine alone or with nalbuphine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries
Authors: El-Medany Said M. , Shaaban Hisham A. , Ateba Kareem M. , Abdel Razek Ahmed A.
Published: September 2024

Background

Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects.

Objective

To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique.

Patients and methods

This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block.

Results

The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block.

Conclusion

Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.
Erector spinae plane block versus thoracic epidural block as analgesic techniques for chest trauma
Authors: El-Sherbiny Sameh M. , Kamal Ragab A. , Elhadary Islam H. , Abdallah Maha Y.Y.
Published: September 2024

Background

Effective analgesia, early mobilization, and respiratory support are the main goals for managing patients with rib fractures. The purpose of this study was to compare the differences between either continuous thoracic epidural and erector spinae plane (ESP) block in patients with chest trauma.

Patients and methods

This prospective study included 50 patients with American Society of Anesthesiologists status I and II, aged between 18 and 65 years old, admitted with chest trauma. The patients were randomly allocated into two equal groups: ESP block group and thoracic epidural analgesia group. A bolus dose of 15 ml of 0.125% bupivacaine was received in both groups and then continuous infusion was done by using 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 48 h. The primary outcome was to evaluate analgesic efficacy all over the 48 h. Secondary outcomes were the total analgesic requirements during the 48 h, the time of first analgesic request, the effect on hemodynamic parameters, in addition to assessment of the amelioration in respiratory functions and inflammatory substance level between the two groups.

Results

Both groups had statistically significant decrease in the visual analog scale score after intervention compared with their pre-interventional values (P<0.01), without statistically significant difference between them (P≥0.05). Moreover, hemodynamic parameter, pulmonary functions, and inflammatory substance levels showed statistical improvement (P<0.01), but it was not statistically different between both groups (P≥0.05), except only mean arterial pressure values showed statistical significance between the two groups(P<0.01).

Conclusions

ESP block is comparable to thoracic epidural in providing analgesia for patients with thoracic trauma.
A Down’s syndrome case with coronavirus disease 2019 pneumonia
Authors: Kumar Abhyuday , Kumar Amarjeet , Kumari Babli , Pattanayak Arunima , Pradhan M.N.
Published: September 2024

Management of Down’s syndrome (DS) cases with coronavirus disease 2019 in ICU has unique challenges, and strategic planning is needed for its management. Patients with DS are more likely to experience a severe course of disease with higher rates of medical complications and mortality than the general population, particularly adults older than 40 years of age. DS with co-occurring health conditions like obesity, diabetes, obstructive sleep apnea, and craniofacial dysmorphogenesis as in our case has special considerations. Apart from comorbid conditions, we faced challenges in prone positioning, mask ventilation, intubation, central vein cannulation, positioning during tracheostomy, and high peak pressure during ventilation. The clinician should be vigilant toward the challenges and plan management strategies accordingly.
Comparison between ultrasound-guided serratus anterior plane block and thoracic epidural for postoperative analgesia after modified radical mastectomy
Authors: Omar Sherif Y.A. , Afify Mounir K. , Abd El-Hameed Mohamed A.E.-H. , Abd El-Hady Mohamed M.
Published: September 2024

Background

Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high-quality analgesia with minimal side effects. The aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the first 24 h determined by the visual analog scale (VAS) score. The second aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the first 24 h, and patient satisfaction.

Patients and methods

Forty female patients aged 25–50 years, American Society of Anesthesiologists class II or III scheduled for elective unilateral modified radical mastectomy were studied. Patients were randomly allocated to two groups; group E (epidural group) (n=20) received 20 ml of 0.25% bupivacaine and group S (serratus anterior block group) (n=20) received 20 ml of 0.25% bupivacaine.

Results

There was no difference between both groups as regards demographic data, heart rate, systolic blood pressure, SpO2, and end-tidal CO2and associated complications. Moreover, group E had a significant lower VAS score than group S. Group E took longer time to perform the analgesic technique. Group E required significantly less rescue analgesia in the first 24 h. Group S analgesic duration was significantly shorter than in group E.

Conclusions

Serratus anterior plane block is a good, simple alternative and a safe technique than thoracic epidural analgesia both providing effective intraoperative analgesia and prolonged postoperative pain relief after breast surgery with comparable postoperative VAS score in the first 24 h.
Pre-emptive ultrasound-guided transversus abdominis plane block in open appendicectomy
Authors: Fawzy Asmaa , Aleem Omar A. , Rayan Ayman A. , Aiad Alaaeldin A.
Published: September 2024

Background

Transversus abdominis plane (TAP) block is a newly effective peripheral block which involving mainly the nerves of the anterior abdominal wall in lower abdominal surgery. The present study aimed to evaluate the postoperative analgesic efficacy of right-sided ultrasound guided TAP block by using 20 millimeters of bupivacaine 0.25% in patients undergoing open appendicectomy.

Patients and methods

After taking informed consent, fifty patients (ASA I and II) undergoing open appendicectomy were randomized into 2 groups (25 each). After induction of general anesthesia; Group B received right side ultrasound guided TAP block using 20 ml bupivacaine 0.25%. Group S (standard group) received general anesthesia without TAP block. Postoperative analgesia by ketorolac and paracetamol was given as required. Postoperative VAS at rest and movement, intra and post operative hemodynamics, analgesic requirements and their side effects were recorded for 24 hours.

Results

A significant reduction of VAS up to twelve hours postoperatively detected in the TAP block group with bupivacaine 0.25%. There was also significant elongation of time to the first analgesia, significant reduction in number of rescue analgesics, as will as there were significant decrease in nausea, vomiting and pruritus between two groups.

Conclusion

Right-sided ultrasound guided TAP block using 20 ml of bupivacaine 0.25% had effective postoperative analgesia for twelve hours after the open appendicectomy.