bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiography for left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index as a predictor to fluid responsiveness in severe sepsis
Authors: Nasr D A M , Moharam A A , Abdallah M M K , Karam A A S M 
Published: May 2020

Abstract

Background
Severe sepsis is the most common cause of death for patients admitted to the critical care units. Sepsis is a multifaceted host response to an infecting pathogen that may be significantly amplified by endogenous factors. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This emphasizes the primacy of the non-homeostatic host-response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition.

Aims
The aim of this work is to compare Left ventricular Outflow Tract (LVOT) velocity time Integral (VTI) and inferior Vena Cava (IVC) collapsibility index as a predictor to fluid responsiveness in patients with severe sepsis and septic shock.

Methodology
This study was conducted on 40 patients of both sex who were admitted to the intensive care unit were diagnosed as severe sepsis and /or septic shock. Patients were divided in two groups: Responders (R): 22 patients with LVOT ΔVTI 500 ≥ 15%. Non-responders (NR): 18 patients with LVOT ΔVTI 500 &lt; 15%.

Results
Our results showed that IVCCI 100 and 500 were a less reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock than ΔVTI 500. However when using IVCCI after 100 or 500 cc of fluid resuscitation, patients with IVCCI 100 above 38% or IVCCI 500 above 30% are more likely to respond to fluid challenge. More precisely, an IVCCI 100 below 38% and IVCCI 500 value below 30% cannot exclude fluid responsiveness.

Conclusions
IVC collapsibility Index is less reliable predictor than VTI (LVOT) in predicting fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and/ or septic shock

Recommendations
IVCCI should be used more cautiously as a predictor to fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and /or septic shock.
The Effect of Anesthesia and Analgesia on Control of Breathing after Bariatric Surgery: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Ibrahim A I , Farag H M , Labib M M 
Published: May 2020

Abstract

Background
general anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and results in decreased oxygenation in the post anesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the pre anesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults.
Aim of the Work: Study of the effect of anesthesia and analgesia on control of breathing after bariatric surgery.

Patients and Methods
study design: Systemic Review and Meta-analysis study. Published studies and abstracts concerning prevention and management of complications associated with patient positioning during surgeries were identified through a comprehensive search of electronic databases that will include PubMed (www.ncbi.nlm.nih.gov./entrez/query.fcgi), ScienceDirect (www.sciencedirect.com), Scirus (www.scirus.com/srsapp), ISI Web of Knowledge (http://www.isiwebofknowledge.com), Google Scholar (http://scholar.google. com) and CENTRAL (Cochrane Central Register of Controlled Trials (http://www. mrw.interscience.wiley.com/cochrane/cochrane_clcentral_articles_fs.htm), using a combination of the following key words: “Anesthesia”, “analgesia”, “respiratory outcome” and “morbid obese”.

Results
our initial search yielded 98 citations. Based on the screening criteria for titles and abstracts, 47 citations were excluded. After reviewing the full text of the remaining 52 reports, only 17 eligible RCTs fit our inclusion criteria and were selected for the study. All studies were published in English during 2000 to 2017, and the sample sizes ranged from 28 to 90 patients. Among these studies 50 obese patients were elevated and reported distinct outcome measurements. In all trials, the recruited patients were American Society of Anesthesiologists (ASA) status I–III who underwent general anesthesia with endotracheal intubation. In addition, in all trials the patients underwent elective bariatric operations. The mean BMI of the patients ranged from 37.7 to 54.0 kg/m2.

Conclusion
our meta-analysis indicated that recovery was significantly faster in the desflurane groups than in the sevoflurane, isoflurane, and propofol groups in obese adult patients who underwent bariatric surgery. Although no clinically relevant difference was observed in the PACU discharge time, or postoperative pain scores, patients who were given desflurane exhibited higher oxygen saturation on entry to or during stays in the PACU. Thus, in morbidly obese patients, we suggest that desflurane should be considered as the inhaled anesthetic because of its more rapid and consistent recovery profile.
Hemodynamic Effects of Intrathecal Magnesium Sulphate as an Adjuvant for Spinal Anesthesia in Pre-Eclamptic Patients
Authors: Elkabarity R H , Ali R M M , Naseef J N , Hanna M M F 
Published: May 2020

Abstract

Background
pre-eclampsia is defined as a disorder that occurs in pregnancy after twenty weeks of gestation which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement with an incidence of 5-10% of all pregnancies.

Aim of the Work
our study will examine the hemodynamic effects of adding two different doses of magnesium sulphate to bupivacaine in patients with severe preeclampsia undergoing caesarean section using spinal anesthesia.

Patients and Methods: type of Study
Prospective comparative study; it was done after approval of the Research Ethics Committee of Anesthesia, Intensive Care and Pain Management Department, Ain Shams University.

Study Setting
Ain Shams University Hospitals, Cairo, Egypt.

Study Period
3 months.

Study Population
Pregnant females with severe preeclampsia undergoing caesarian section.

Results
results of this study indicated that the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section. But the addition of 100 mg magnesium sulfate lead to a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade compared to the addition of 50mg magnesium sulphate. Also there is no significant difference between the addition of 50 &100mg on shivering, nausea and vomiting, sedation, postoperative pain score (at 2,4 and 8 hours) and APGAR score (at 1 and 5 min).

Conclusion
the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine in our study, showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section.
Comparative study between paracetamol versus paracetamol and pregabalin combination for postoperative analgesia in hip surgeries
Authors: Hassab A R M , Fawzy H M , Elfawal S M , Kamaleldin D M 
Published: May 2020

Abstract

Introduction
Pregabalin has been used for treatment of chronic pain, but recently it has been introduced in treatment of acute postoperative pain.

Aim of Study
This study is conducted to evaluate the postoperative analgesic effect of paracetamol and pregabalin combination versus paracetamol after hip surgeries.

Methods
The study was done on 20 randomly chosen patients after approval of the medical ethical committee of Ain Shams University. Patients were divided randomly into two groups, each group consisted of 10 patients.After preoperative assessment and obtaining baseline vital data all patients received spinal anaesthesia. Group I received paracetamol 1gm intravenous immediately postoperatively and every 6 hours for 24 hours. Group II received the same as group I plus two doses of oral pregabalin 300mg in the recovery room and 12 hours later. The two groups were assessed postoperatively and they were compared regarding demographic data, postoperative pain control, sedation, total pethidine consumption, hemodynamics and side effects.

Results
In pregabalin group (group II), pain scores and total pethidine consumption were significantly lower and sedation scores were higher than group II. Heart rate and arterial blood pressure were lower in group II but without clinical significance.

Conclusions
This study revealed that combination of paracetamol and pregabalin as multimodal analgesia is better than paracetamol alone in postoperative analgesia, and decreasing use of opioids without significant effect on hemodynamics but with increased incidence of side effects such as somnolence, dizziness and blurred vision.
Comparative Study between Magnesium Sulfate and Pethidine for Controlling Shivering after Spinal Anesthesia
Authors: Ali N M , Mahrose R A , Elsayed S M 
Published: May 2020

Abstract

Background
Shivering is an involuntary muscular activity. Increased muscle tone during shivering is due to temperature-induced changes in neuronal activity in the reticular formation. Synchronization of motor neurons during shivering may be mediated by recurrent inhibition through renshaw cells.

Aim of the Work
To verify the efficacy of magnesium sulfate for controlling post spinal shivering, to compare the efficacy of magnesium sulfate and pethidine for controlling post spinal shivering and to detect the side effects of both magnesium sulfate and pethidine after their use for controlling post spinal shivering.

Patients and Methods
This prospective study was conducted at El-Matarya Teaching Hospital from 2018 till 2019. After obtaining approval from the Research Ethical Committee of Ain Shams University, informed patient consent was obtained before the procedure. After giving the spinal anesthesia, only patients who developed post-spinal shivering were followed for the study. 60 patients with post-spinal shivering were included with the following criteria:

Results
Regarding age, weight, height and duration of surgery; there were no statistically significant differences between the two studied groups. Comparison of the two studied groups revealed no statistically significant changes at all times of measurement.

Conclusion
Magnesium sulfate in a dose of 30 mg/kg IV infusion in 100 ml normal saline over 10 min is effective for control of post spinal shivering. Pethidine in a dose of 0.5 mg/kg IV bolus is effective for control of post spinal shivering.
Furoemside versus mannitol as a renal protection after adult cardiac surgery
Authors: Saleh G A , Hussein W R , Shorbagy M S , Abdelkader A M 
Published: May 2020

Abstract

Background
Occurrence of acute oliguric renal failure in the immediate postoperative period carries important morbidity and mortality after a successful cardiac surgical procedure. Adult cardiac and aortic surgical procedures are especially prone to this complication with the incidence varying between 2% to 15% and the mortality rate as high as 40% to 60%.

Aim of the Work
to compare between furosemide versus mannitol as a renal protection after adult cardiac surgery.

Patients and Methods
This prospective comparative trial was conducted at Academy of Cardiothoracic Surgery Ain Shams University on patients undergoing CABG operation consisting of a total of 50 patients with normal renal function, EF of greater than 40%, normal protein and electrolyte levels.

Results
the study revealed no statistically significant difference between groups according to cystatin-C

Conclusion
The difference between patients given mannitol and patients given furosemide regarding urinary microalbumin, urinary creatinine and serum cystatin-c was insignificant. Addition of mannitol to the priming solution of the cardiopulmonary bypass acts as a renal protector against AKI postoperative. Finally, giving furosemide infusion to patients undergoing cardiac surgery at the beginning of the CPB improves renal perfusion.
Prophylactic use of intravenous tramadol vs intravenous nalbuphine for control of postspinal shivering after knee arthroscopy: a randomized double-blind placebo controlled trial
Authors: Fahmy A M , Esmat I M , Shabana T , Etman M S M 
Published: May 2020

Abstract

Background
Post-anesthetic shivering refers to spontaneous, involuntary, rhythmic, oscillating and tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia. Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions.

Objective
The aim of this work is to compare the efficacy of intravenous tramadol VS nalbuphine for prevention of post spinal shivering during knee arthroscopy.

Methods
This prospective randomized double blinded study was carried in Ain Shams University hospitals on 90 patients scheduled for knee arthroscopy. Patients were randomized into three groups 30 patients each: Group C: patients received normal saline 0.9%) intravenously. Group T: Patients received Tramadol 0.5 mg/kg intravenously. Group N: Patients received nalbuphine 0.1mg/kg intravenously. All drugs were given immediately after intra thecal injection of the anaesthetic drugs and returning to the supine position.

Results
The study revealed that the incidence of shivering was less in the tramadol (23.3%) and nalbuphine (26.7%) groups compared to the saline group (56.7%) (P &lt; 0.05) with no significant difference between Nalbuphine and Tramadol groups (p &gt; 0.05). The mean grade of shivering was comparable between the three groups (P &gt; 0.05). Shivering onset was significantly earlier in the saline group (24.1±2.9 min) compared to Nalbuphine (32.3±4.9min) and Tramadol (36.4±4.3min) groups (P &lt; 0.05) with no significant difference between Nalbuphine and Tramadol groups (p &gt; 0.05). There were no significant differences among the three groups as regards hemodynamics (Heart rate and mean blood pressure), respiratory rate, oxygen saturations, body temperature, the incidence of nausea or vomiting (P &gt; 0.05). While sedation grade was significantly highest in Nalbuphine group followed by Tramadol group and least in Saline group (P &lt; 0.001).

Conclusion
The current study revealed that both tramadol 0.5mg/kg and balbuphine 0.1mg/kg was effective in prevention of post spinal shivering in patients undergoing knee arthroscopy.
Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl dilatation and curettage
Authors: Kamel G F , Ali R M , Ismail A E A , Hanna B E A 
Published: May 2020

Abstract

Background
Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis.

Objective
It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done.

Patients and Methods
In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus.

Results
Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol.

Conclusion
This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.
Hypertriglyceridemia with total parenteral nutrition versus enteral nutrition in patients with acute pancreatitis
Authors: Ghobreal B B , Mahmoud S F , Elsamie H S A , Metwally A M 
Published: May 2020

Abstract

Background
Acute pancreatitis (AP) is an inflammatory condition of the pancreas that can cause local injury, systemic inflammatory response syndrome, and organ failure. Worldwide, AP is a common gastrointestinal condition and there is evidence that the incidence has been rising in recent years. AP is associated with substantial suffering, morbidity, and cost to the health care system.

Objective
Our study aims to compare between the effect of enteral (EN) and parenteral nutrition on serum triglycerides in patient with acute pancreatitis in intensive care unit of Ain Shams University (ICU). We found that enteral route is more safe than parenteral nutrition regarding serum triglycerides.

Patients and Methods
An informed written consent was obtained from patients and /or relatives who were included in this study. All patients were adults, more than 18 years old, admitted to ICU of Ain Shams University Hospital, either have acute pancreatitis on admission or acquired acute pancreatitis in ICU due to different causes in period of six months of approval of the protocol. Patients were divided into two groups: 30 patients started total parenteral nutrition TPN ) one day after admission consisting of 70% carbohydrate (in the form of dextrose 25%) and 30% fat (smoflipid 250 ml, 2 gm per ml). The other 30 patients started enteral nutrition rich in carbohydrates with low fat content one day after admission (peptamen) 6 scoops in 200 ml water every 2 hours, stopped from 12 am to 8 am. Serum triglyceride level was measured at first day of admission, then 3 days after admission, then one week after admission.

Results
Our study showed that TPN was associated with more increase of serum triglycerides level from first day of admission to 3 days after admission when compared with enteral nutrition, there is also increase in serum triglycerides from 3days to one week after admission, comparing the three periods together, there is increase in serum triglycerides with TPN group more than in enteral group.

Conclusion
The study showed that TPN was associated with higher mortality rate than EN, also there was an increase in serum triglycerides with TPN more than EN; suggesting that, enteral nutrition is a safer mode of nutrition in patients with acute pancreatitis.
Facilitatory Effects of Perineural Dexmedetomidine on Neuraxial and Peripheral Nerve Block
Authors: Seifelnasr G , Abdelhamid H M , Abdou A M H , Sobhy M M 
Published: May 2020

Abstract

Background
DXM is an anxiety reducing, sedative, and pain medication. It has been used as adjunct to local anesthetics to improve the quality of perioperative analgesia and prolong its duration. Alpha2-adrenergic agonists have expanded the horizons of regional anesthesia. DXM is a highly selective α-2 agonist similar to clonidine but with a greater affinity for the α-2 receptor. It is the pharmacologically active d-isomer of medetomidine, a full agonist of α-2 adrenergic receptors.

Objective
The aim of this study is to evaluate the efficacy of DXM as an adjuvant to local anesthetics for intrathecal and supraclavicular blocks compared to LA alone.

Methods
This is a meta-analysis study. Searches were conducted in PubMed, Ovid/MEDLINE and Embase using free text and controlled vocabulary terms relating to Dexmedetomidine (MeSH). Results will be combined using Boolean operator “AND” with search terms analgesia, anesthesia, adjuvant, local anesthetics, nerve block, perineural, and terms designating route of administration such as neuraxial, intrathecal, supraclavicular, arm, and brachial plexus. Additional non-indexed articles will be retrieved using Google Scholar; and reference sections of retrieved trials will be hand-searched for additional relevant studies. Search will be limited to randomized trials published in English language, conducted on humans over the last 15 years. All protocols were approved by the local ethics committee or institutional review board of their respective institution.

Results
Throughout the studies reviewed, the dose of DXM was either given through a lumbar puncture performed in lateral or sitting position (range 3ug – 10ug) or via the supraclavicular approach in supine position with arm adducted (range 30ug – 100ug). DXM has been shown to prolong sensory and motor block duration in spinal and supraclavicular blocks. However, sensory and motor block onset has varied greatly from one study to another. DXM has also proved to have no significant adverse effects in the short term.

Conclusion
The study results indicate that the use of dexmedetomidine as a local anesthetic adjuvant prolongs sensory and motor block duration when administered intrathecally as part of spinal anesthesia or peripherally as part of a supraclavicular block.
Comparative study between: Epidural bupivacaine versus Patient Controlled Analgesia for postoperative pain control in total knee arthroplasty
Authors: Elkhouly A T A , Bassiony M A , Elshafey M M N , Khalaf K M , Alansary A M 
Published: May 2020

Abstract

Introduction
Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization.

Aim
The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty.

Patients
Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study.

Methods
patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response.

Results
The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA.

Conclusion
The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.