bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Spinal Anesthesia versus Combined Spinal Epidural Anesthesia for Major Orthopedic Hip Surgeries
Authors: Abdelaziz M S , Elshaar A N , Elagamy A E , Ibrahim M A , Saleh M A 
Published: May 2020

Abstract

Background
hip replacement surgery is common among elderly patients. These patients have increased risk for perioperative mortality and morbidity due to additional comorbidities, such as cardiac, endocrine, renal, cerebral and respiratory diseases.

Aim of the Work
to compare between continuous spinal anesthesia and combined spinal epidural anesthesia in patients scheduled for elective major hip surgeries as regards their effectiveness and possible complications during operation.

Patients and Methods
after obtaining the approval of the ethical committee of faculty of medicine, Ain-Shams University, and patients’ written informed consents, this prospective randomized clinical trial study was conducted at Ain Shams University Hospitals at the orthopedics operating theatre. Seventy two patients aged older than 30 years, of both sexes and American Society of Anesthesiologists (ASA) class I, II, scheduled for elective major hip surgeries like total hip replacement or hemi arthroplasty were included in the study. All Patients were assigned randomly by using a computer generated program with closed envelops to one of the two equal groups:CSAgroup(36)patient and CSEgroup(36)patient.

Results
there was no statistically significant differences between the CSA and CSE groups as regards demographic data; Age, Sex or BMI. Baseline HR was similar in both groups. The heart rate was significantly higher in the CSE group at 5 min and 15 min when compared to CSA group. The mean blood pressure was significantly lower in group CSE at 5min anf 15 min when compared to CSA group.The total dose of bupivacaine 0.5% mg collectively given was much lower in the CSA group than the CSE group. The onset of sensory block (time between the end of injection and the time to reach T10sesnsory level) and degree of motor block between two groups showed no statistically significant difference but the level of sensory block was significantly higher in CSE group than CSA group.there was no significant difference as regard PDPH, Post operative nausea and vomiting, Bradycardia but there was significant difference as regard incidence of hypotension being higher in CSE group than CSA group. The time of first analgesic request showed no significant difference between the two groups

Conclusion
both continuous spinal anesthesia and compined spinal epidural anesthesia are safe anesthetic techniques for lower limb surgeries. CSA offers possibilities of more hemodynamic stability with smaller doses of local anesthetics than CSE with rapid onset of sensory block and good extendede post operative analgesia.
Perioperative Pain Control in Bariatric Surgeries, a Systematic Review
Authors: Abdelsabour Y G , Mohamed G S , Kamal E M , Abdelkawy A S 
Published: May 2020

Abstract

Introduction
Research on adequate postoperative pain management is a current trend in post-anesthetic and surgical areas. Patient satisfaction is a parameter of medical quality. High pain scores increase the incidence of post-operative morbidity and lead to delayed recovery, prolonged hospital stay and increased healthcare costs.1 Bariatric Surgeries are surgeries performed for morbid obese patient to reduce patient’s weight through several methods and because morbid obese patients are at higher risk of complications after surgery2, Pain control during bariatric surgery is a major challenge3. Opioids play an important role in anesthesia practice; however, related complications like; sedation, airway obstruction, and respiratory depression are of concern in morbid obese patients .Therefore, opioids should be used sparingly. And newly safe methods better to be used for better perioperative pain control in bariatric surgeries.

Objective
To cover the gab of knowledge regarding the evidence of the safest and most efficient method to control perioperative pain in bariatric surgeries by reviewing the literature about this evidence through comparative systematic review study.

Methodology
Systematic review study discussed the results of 30 studies found in the literature related to perioperative pain control in bariatric surgeries according to the inclusion and exclusion criteria .

Results and Discussion
30 different studies were discussed about the different methods of anesthesia in bariatric surgeries 6 of them about Transverses abdominis plane. ‘TAP’ block, 5 about Local anesthesia, 4 about Dexmedetomidine, 3 about spinal morphine, 3 about multi modal analgesia, 2 about preoperative medication, 2 about patient controlled analgesia ‘PCA', 1 about continuous infusion catheter, 1 about ibuprofen, 1 about Pulmonary recruitment maneuver, 1 about Sugammadex and 1 about non opioid anesthesia). Results are recorded about the efficacy of each method through the outcome measures.

Conclusion
It's found that the most effective method is multi modal analgesia represented in preoperative ultra sound guided TAP block, intraoperative port- sites and intraperitoneal infiltration with local anesthesia then recovery by sugammadex followed by postoperative IVI acetaminophen and PCA. Using preoperative clonidine, ketamine, pregabalin, epidural analgesia and pulmonary recruitment maneuver at the end of the surgery are also with low complication. Continuous infusion catheter, IV Ibuprofen, combined Dexmedetomidine and Acetaminophene, preoperative port-site infiltration and post operative intraperitoneal local anesthetic have no evidence based efficacy right now and it needs further studies.
Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block
Authors: Ibrahim A Y , Labib H A , Toulan H F A , Deabes E A 
Published: May 2020

Abstract

Background
In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia.

Aim of the Work
is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries.

Patients and Methods
After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study.

Results
Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P &lt; 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups.

Conclusion
Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.
Hyperglycemia as a Prognostic Factor In Acute Ischemic Stroke Patients
Authors: Abdelhamid A E E , El-Gendy H A , Nosseir M A E , Mohamed M A 
Published: May 2020

Abstract

Background
Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and non-diabetics.

Aim of the Work
to study the glycemic status after acute ischemic stroke and assess its role in influencing stroke out-come as regards the duration of hospital stay, motor deficit outcome and mortality.

Patients and Methods
This retrospective study was conducted in Elzaiton specialized hospital and Ain Shams University from June 2016 to June 2017 on 80 patients after approval of local medical ethical committee. Patients with acute ischemic stroke without other major comorbidities within 24 hours of onset of symptoms were evaluated.

Results
The study revealed that hospital stay mean was 12.04 ± 9.61 (in control group) and 21.36 ± 12.49 (in uncontrolled group), with p-value &lt; 0.022 S. A highly statistically significant difference between controlled and uncontrolled according to increase motor power at ICU admission in controlled a highly statistically significant difference between controlled and uncontrolled according to increase motor power discharge in controlled group. A highly statistically significant difference was found between both groups as regards outcome (mortality).

Conclusion
Hyperglycemia is common among acute stroke patients and is associate with less favorable outcome as regards mortality, hospital stay and functional outcome and euglycemic control is recommended in these patients.
Magnesium sulfate with Local Anesthetics versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors: Bassiony M A , Ghaly S I , Selima W Z , Mostafa F A 
Published: May 2020

Abstract

Background
Brachial plexus is a network of nerves that arises from the neck passing through the axilla to supply the whole upper limb with motor and sensory supply. Our target in upper limb surgeries is to block this plexus using local anesthetics. Different adjuvants have been mixed with local anesthetics (LAs) for peripheral nerve blocks (PNBs). These drugs usually affect may delay the onset of action and prolong the duration of analgesia.

Objective
The aim of the present study was to compare the effect of Magnesium with bupivacine vesus bupivacine alone in supraclavicular nerve block ultrasound guided in upper limb surgeries

Patients and Methods
In our study 82 patients are randomly divide into two equal groups, control group received only bupivacine 0.5 % and magnesium group received 250 mg in addition to bupivacine 0.5%

Results
Our study showed that addition of 150 mg of magnesium to bupivacine in ultra sound guided supraclavicular block prolong the onset time of both sensory and motor block (p value &gt;0.05) non significant. But it significantly prolonged their duration, p value &lt;0.05 for sensory block and &lt;0.001 for motor block which was highly significant

Conclusion
Addition of magnesium also did not affect the hemodynamics as regard systolic, diastolic blood pressure and o2 saturation. The previous findings proved that adding magnesium to bupivacine is more superior than the use of bupivacine alone.
Role of Insulin Glargine in Early Phase of Treatment of Diabetic Ketoacidosis
Authors: Wahba S S , Elsersi M , Alansary A M , Elzahaby M H 
Published: May 2020

Abstract

Background
Diabetic ketoacidosis (DKA) is a common cause of intensive care unit (ICU) admission, with high morbidity and mortality rates. A growing body of evidence has suggested that adding insulin Glargine to the standard regimen may facilitate the transition from an intravenous infusion of insulin to subcutaneous injection in the recovery of patients with DKA.

Aim of the Work
to investigate the effect of adding Insulin Glargine to the standard regimen of treatment of DKA on the recovery process of patients regarding the amount of intravenous insulin infusion and the duration of the patients’ stay in the ICU.

Patient and Methods
This randomized controlled study was conducted on 50 Egyptian individuals, in National Institute of Diabetes and Endocrinology & Ain Shams University Hospitals. 50 Patients with Diabetic Ketoacidosis diagnosed according to The American Diabetes Association criteria. All patients were divided into 2 groups according the protocol used for treatment: The first group including 25 patients treated only with the standard regimen of intravenous regular insulin infusion (0.1 unit/kg/hour). The second group including 25 patients treated with intravenous regular insulin (0.1 unit/kg/hour) + Iv infusion of normal saline.

Results
Added insulin Glargine resulted in a significantly shorter length of hospital stay, compared to SOC alone. The present study showed that insulin Glargine led to statistically significant less amount of insulin infused until resolution of DKA than the SOC alone.

Conclusion
subcutaneous insulin Glargine coadministration with regular insulin results in a shorter length of hospital stay and less amount of infused insulin in DKA patients admitted to ICU. Larger multi-centric trials are still needed to confirm our findings.
Predictors of Success of Immediate Tracheal Extubation in Living Donor Liver Transplantation Recipients
Authors: Ibrahim D G M , Zaki G F , Aboseif E M K , Elfawy D M A , Abdou A M H 
Published: May 2020

Abstract

Background
Early tracheal extubation of recipients following liver transplantation (LT) has been promoted and gradually replacing standard postoperative prolonged mechanical ventilation, possibly contributing to better graft and patient survival and reduced costs. There are no universally accepted predictors of success of immediate extubation in LT recipients. We hypothesized a number of factors as predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Aim
The aim of this study was to evaluate the validity of the following hypothesized factors: Model for end stage liver disease (MELD) score, duration of surgery, number of intraoperatively transfused packed red blood cells (RBCs) units and end of surgery (EOS) serum lactate, as predictors of success of immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Methods
In this prospective clinical trial, perioperative data of adult LDLT recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour postransplant in the operating room. Patients were divided into; extubated group who were successfully extubated with no need for reintubation, and non-extubated group who failed to meet criteria of extubation or were re-intubated within 4 hours of extubation.

Results
Of 64 patients, 50 (76.9%) were extubated early after LDLT while 14 (23.07%) were transported to the intensive care unit (ICU) intubated. After data analysis, it was found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively, were good predictors of success of immediate extubation, while MELD scores had no statistically significant impact on the results. In addition, other factors such as EOS urine output and pH were shown to have significantly affected the results.

Conclusions
EOS serum lactate, duration of surgery and number of packed RBCs units transfused were predictors of post-transplant early extubation.
Efficacy of Noninvasive Positive Pressure Ventilation in Limiting Re-Intubation of COPD Patients After Extubation
Authors: Elkady G A A , Rabie A H , Hamza A H , Mohamed M N 
Published: May 2020

Abstract

Background
Mechanical ventilation is the most widely used supportive therapy in intensive care units (ICU). Several forms of external support for respiration have been described to assist the failing ventilator pump and had constituted a major advance in the management of patients with respiratory distress. More recently, new noninvasive positive pressure ventilation (NIPPV) techniques, using patient/ ventilator interfaces in the form of facial masks, have been designed. Noninvasive ventilation (NIV) is one of the most important developments in respiratory medicine over the past 15 years and is increasingly used in many countries, but with a highly variable frequency of use.

Objective
The aim of this study is to clarify the role of non-invasive ventilation in preventing re-intubation if was used immediately following planned extubation in patients suffered respiratory failure in COPD patients and requiring invasive mechanical ventilation for 5 to 7 days.

Methodology
Forty consecutive patients, who are invasively mechanically ventilated and classified as difficult to wean from the ventilator in the intensive care units of Ain Shams main university hospital between the 1st April and 1st of September 2018, were included. The mean age in the present study for oxygen group was 56.20±5.56 years, while in NIV group was 57.75±5.17 years, 70% of patients in this present study were males.

Results
APACHE II score, PaO2 and mean arterial blood pressure which might have a role in respiratory failure showed no statistically significant differences between both study groups. Meanwhile, respiratory rate, pulse rate and arterial blood gases showed high significance between both study groups

Conclusion
The use of NIV is associated with a marked reduction in the need for endotracheal intubation after planned extubation.
Effect of Granisetron Plus Dexamethasone versus Granisetron Alone on Postoperative Shivering in patients undergoing Gynecological surgery under general anesthesia
Authors: Abdelfatah I , Abdelmohsen S , Fathy A 
Published: May 2020

Abstract

Background and rational
Shivering, a very common complication of surgery owing to postoperative pain and post anesthesia hypothermia, is distressing for both patients and clinicians. It can be defined as involuntary and oscillatory muscular activities that increase the metabolic rate by two to three folds to maintain the core temperature. Both neuraxial (epidural and spinal anesthesia) and general anesthesia are associated with a significant incidence of shivering. The incidence is 40%-60% in regional anesthetic patients and up to 60% in general anesthetic ones.

Patients and Methods
This study was conducted at Ain Shams University Hospitals between September 2018 and February 2019, after obtaining approval of research ethical committee and patients’ informed consents, 150 patients were included in the study and underwent elective gynecological, and received general anesthesia.

Results
this study show incidence of post anesthetic shivering is significantly reduced after combination of granisetron and dexamethasone compared to control group

Conclusion
Combination of granisetron and dexamethasone significantly reduced Post anesthetic shivering (PAS) compared to granisetron alone. It is difficult to establish which drug can be considered the gold standard in prevention of PAS after general anesthesia. Because many research centers have reported that the effects of different anti-shivering drugs are similar, it is wise to administer the cheapest and safest drugs.
Comparison between subcutaneous ketamine with intramuscular pethidine versus intramuscular pethidine for post-operative analgesia after cesarean section
Authors: Noureldin B M E , Kamal M M , Bedewy A A A , Sultan H M M 
Published: May 2020

Abstract

Background
Cesarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system.

Objective
to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level.

Patients and Methods
The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia in Ain Shams University Hospitals and Helwan University Hospitals.

Group A
patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5.

Group B
patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5.

Results
There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study. There was highly significant increase in the time to first pethidine demand in group A than B. There was highly significant decrease in total dose of pethidine given (in group A than in B.

Conclusion
Subcutaneous ketamine with a dose of (0.9mg/kg) can be used in reducing pain in postoperative period after CS with minimal side effects. The addition of SC ketamine to the pethidine appear to cause more pain control and decrease the total dose of pethidine given in post-operative period.
Comparative Study between Fractional Excretion of Sodium and Fractional Excretion of Urea in Differentiating Prerenal From Renal Acute Kidney Injury in ICU Patients with Circulatory Shock
Authors: Sargious S W N , Hassan M H M , Mostafa S A R , Saad G S R 
Published: May 2020

Abstract

Background
The incidence of acute renal injury (AKI) in ICU is 5%. The mortality rate increases up to 50% if AKI is a part of multiple organ dysfunction syndrome.

Aim of the Work
Comparison between FENa and FEurea in differentiating renal from prerenal acute kidney injury in circulatory shock, and the effect of diuretics on their handling.

Patients and Methods
This retrospective study was conducted on 45 Egyptian patients with AKI complicating circulatory shock admitted to the ICUs of AIN SHAMS University Hospital, from August 2018 to February 2019. Consents were taken from all of them according to the local ethics committee approval.

Results
The cutoff points of both FENa and FEurea as a predictor of mortality were not statistically justified. This is explained as all our patients had circulatory shock, and so patients with mild renal impairment may die from their severe shock state, and patients with severe renal affection may survive if their shock could be rapidly corrected. This cutoff point calculation is recommended only in patients with AKI without other organ affections or shock that may affect the mortality.

Conclusion
Although both fractional excretion of urea (FEurea) and fractional excretion of sodium (FENa) are feasible, reproducible, and inexpensive markers used in differentiating renal from prerenal azotemia, in our study FEurea showed higher sensitivity and specificity than FENa, not only in differentiating renal from prerenal azotemia in critically ill patients complicating circulatory shock, but also its values were not affected by the use of diuretics like FENa in the same group of patients.