bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lactate Clearance Versus Base Deficit Correction in Monotoring of Septic Shock
Authors: Fahmy Adel Mikhail , Kamal Ahmed , Mohamed Abdelwahab Wael Abd Elmonem , Ahmed Ameer Shokry 
Published: October 2021

Abstract

Background
Tissue perfusion and oxygenation monitoring is the fundamental of management to immediately identify and properly manage (impending) organ dysfunction in septic shock. This is a study of a prospective randomized trial that aims to comparing the prognostic value of lactate clearance versus base deficit correction as an indicator of tissue perfusion in septic shock, trying to prove the superiority of one over the other.

Objective
To assess the clinical utility of lactate clearance and arterial base deficit correction in predicting mortality in septic shock.

Patients and Methods
This is a Prospective randomized observational study that was conducted to assess the clinical utility of lactate clearance and arterial base deficit in predicting mortality in septic shock. This study included forty patients who were divided into two equal groups; each of twenty patients, group I (non-survivors), and group II (survivors).

Results
In this study, the base deficit values revealed statistically notable difference between the two groups at admission, 18 hours, 24 hours and 2 days of admission. The values revealed no notable difference at the 3rd. 4th, and 5th day of admission. At the 6th and 7th day of admission, the base deficit started to increase again in the non-survivor group with statistically notable increase in the values as compared to the survivor group. The cutoff point of base deficit to differentiate between nonsurvivors from survivors was &gt; 11.43 with 62% sensitivity and 100% specificity. In this study, initial serum lactate levels at admission revealed higher accuracy in prediction of mortality as compared with initial base deficit.

Conclusion
Lactate clearance is a better predictor of mortality and morbidity than base deficit correction.
The Effect of Low Dose Ketamine Infusion versus Low Dose Dexmedetomidine Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery
Authors: Ibrahim Ibrahim A , Taher Walid A. AL , Abd Elhamid Hadil M , Ibrahim Dina E 
Published: October 2021

Abstract

Background
In cardiac surgery, the extent of systemic inflammatory response is closely

Mobile
associated with patient’s outcome. A systemic inflammatory response syndrome (SIRS) may develop after operations using cardiopulmonary bypass (CPB).

Aim of the Work
to evaluate the 01006705713 potential effects of intravenous infusion of ketamine versus dexmedetomidine on attenuation f stress responses during coronary artery bypass grafting (CABG) operation.

Patients and Email
elsayed@hotmail.com

Methods
This randomized controlled interventional study was conducted on 90 patients who dinaunderwent elective CABG procedure at Ain Shams University Hospital over 24 months from Jan 2018 to Jan 2020. The patients were divided into 3 groups, 30 patients for each group. Group D: received dexmedetomidine infusion, Group K: received ketamine infusion and Group N (control group): received normal saline. Then following measurements recorded at following time interval before induction of anesthesia (T1), after weaning from CPB (T2), 24 h(T3) and 48 h(T4) after completion of the anastomoses. Mean arterial blood pressure records, heart rate & Inflammatory and stress markers including CRP, cortisol, WBC count, glucose and lactate levels.

Results
Mean arterial pressure among three groups was not statistically significant. Also serum glucose level was not statistically significant between groups. Serum lactate level didn’t show statistically significant difference between groups. From aspects of inflammatory markers, we got good results which were superior for dexmedetomidine followed by ketamine infusion group suggested by statistically significant, suggesting that dexmedetomidine and ketamine may have a role in attenuation inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.

Conclusion
Our study that compared Intravenous infusion of ketamine and dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation suggests that dexmedetomidine was superior to ketamine infusion in attenuation of inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.
Stress ulcer prophylaxis in the critically ill patients
Authors: Ibrahim Ahmed Saeed Mohamed , Taha Sameh Salem Hefni , Daniel Samuel Habachi , Salh Emil Noshy Aziz 
Published: October 2021

Abstract

Background
Sfress Ulceration was an important cause of morbidity and mortality in critically ill patients. Early active treatment reduces the risk of clinically significant bleeding, ulcer prophylaxis therefore became a standard of care in all critically ill patients.

Objective
The overall aims of the Stress ulcer prophylaxis in the critically ill patients is to determine the benefits and risks of stress ulcer prophylaxis stress ulcer prophylaxis (SUP) in intensive care unit

Materials and Methods
We performed this systematic review and meta-analysis according to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In the our systematic review and meta-analysis, we searched Medline via PubMed, CENTRAL, Web of Science, SCOPUS, and Google Scholar from March 1977 till August 2019. The search retrieved 2289 unique records. We then obtained 237 final results for full-text screening. At last, 28 recorded studies were involved in our in the present study.

Results
23 included studies reported the rates of clinically important GI bleeding. The overall effect estimates favored SUP over control for decreasing the hazards of clinically significant GI hemorrhage (P value &lt;0.001, OR— 0.55, CI of 95%[0.35 0.86]). The overall effect estimates did not favor SUP over control for reducing the rate of death (P value =0.24, OR 1.21, 95% CI [0.87 — 1.69]). 23 studies reported the rates of pneumonia. The overall effect estimates showed that the SUP was not related to elevated hazards of nosocomial pneumonia over control (P value —0.15, OR —1.5, CI of 95% [0.83 3.02]). The analysis showed that only Cimetidine 900 mg was effective in reducing the incidence of clinically important GI bleeding (OR 0.45 [0.24, 0.82], p *0.009). In contrary, none of the included PPIs (pantoprazole, lansoprazole, omeprazole), ranitidine, or sucralfate were effective in reducing the incidence of clinically important GI bleeding.

Conclusion
SUP is associated with lower risk of GI bleeding in critically ill patients; however, the current published literature shows significant inconsistency. Our analysis showed that, no significant difference between H2RA and PPI in term of incidence of clinically important GI bleeding, H2RAs (mainly cimetidine) more effective than other classes of SUP which significantly reduced the risk of overt GI hemorrhage, and none of the drug classes was effective in reducing the mortality rates.
The Effect of Dexmedetomidine Infusion Versus Magnesium Sulphate Infusion on Emergence Delirium in Pediatric Patients Undergoing Lower Abdominal Surgery
Authors: Mahmoud Esraa Alaa El-Dien , El Zahaby Hany Mohamed Mohamed , Moharram Assem Adel Moharram Ahmed , Asaad Anis Fikry Anis 
Published: October 2021

Abstract

Background
Emergence delirium (ED) is a clinical state during emergence from general anesthesia in which patients are awake but have an altered mental state. Its underlying cause remains unknown. Age, preoperative anxiety, anesthetic technique or agents, surgical procedure and pain are all suggested to play a role in its development. Several drugs were used to lower it's incidence in children.

Objective
Evaluating the incidence and intensity of emergence delirium in pediatric patients undergoing lower abdominal surgery after using either intravenous dexmedetomidine infusion or magnesium sulphate infusion intraoperatively.

Patients and Methods
100 patients were randomized to receive intraoperatively either dexmedetomidine loading dose (0.5 µg/kg) over 10 min. followed by infusion rate of (0.2 µg / kg / hr.) or magnesium sulphate loading dose (30 mg/kg) followed by infusion rate of (10 mg/kg/hr) after induction with sevoflurane, LMA application and administration of caudal block. PEAD score was used for assessing emergence delirium.

Results
Incidence of emergence delirium according to PAED scale ≥10 was significantly lower in dexmedetomidine group than magnesium sulphate group with Pvalue &lt;0.001, &lt;0.001, 0.031, 0.012, 0.012 at 0,5,10,15,20 min. respectively during PACU stay. This statistically significant vanishes after 20 min. stay in PACU. There were no significant differences as regard fentanyl top up doses, postoperative FLACC pain score, postoperative fentanyl requirements.

Conclusion
This study shows that intraoperative administration of dexmedetomidine infusion is more effective than magnesium sulphate infusion in lowering the incidence of emergence delirium during the first 20 minutes postoperatively. In preschool aged children undergoing lower abdominal surgeries.
Spinal Anesthesia Versus Popliteal and Adductor Canal Blocks for Ambulation After Pott's Fracture Surgery
Authors: Salama Madonna Mounir , El-Shafie Mohamed Anwar , Zaki Hany Victor , Hashim Reham Mustafa 
Published: October 2021

Abstract

Background
Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use.

Objective
To compare the effect of spinal anesthesia versus popliteal and adductor canal blocks for ambulation after pott's fracture surgery.

Patients and Methods
Type of Study: Randomized Clinical Trial. Study Setting: Ain Shams university hospitals. Study Period: 3 months from March to May 2019.

Results
On the other hand, the side effects of peripheral nerve block surgery limit the usefulness of the procedure. The common side effects are: incomplete block, direct nerve damage, localized hematoma and consequent ischemic damage, infection, and the risk of intravenous administration of local anesthetic. In our study we compared spinal anaesthia with nerve blocks for pott’s fracture and found that the time to perform spinal block was shorter than that needed to perform nerve blocks.

Conclusion
The adductor-popliteal canal provides longer duration of analgesic, better intraoperative hemodynamics, and decreased need for postoperative rescue analgesia in comparison with spinal anaesethia in patients with pot’s fracture ankle surgery.
The analgesic effects of combined pectoral nerve blocks versus combined serratus anterior plane block and pecto-intercostal fascial plane block in breast surgery
Authors: ElZahaby Hany Mohamed Mohamed , Talaat Sahar Mohamed , El FattahGhoneim Mohamed Mohamed Abd , Matared Manar Mohsen Ahmed 
Published: October 2021

Abstract

Background
Poorly controlled acute pain after breast surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, prolonged hospital stay and increased likelihood of chronic pain. The analgesic regimen used for postoperative pain control needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient.

Objective
The aim of this study is to compare the intra-operative and the post-operative analgesic effects of the thoracic interfascial plane blocks (serratus anterior plane block in combination with pecto-intercostal fascial plane block) and pectoral nerve blocks (PECS I and II)in patients undergoing non-reconstructive breast surgeries.

Patients and Methods
The study was conducted on 50 randomly chosen patients in Ain Shams University General Surgery Hospital after approval of the medical ethical committee. They were allocated in two groups of 25 patients each. The two groups were compared regarding analgesic outcome by using the visual analogue scaling system in the first 24 hours postoperative and the patients' satisfaction using verbal rating scale and this was the primary outcome of our study. The amount of fentanyl consumed intra-operative, time for first call for rescue analgesia and the frequency of using it were recorded and compared to achieve the secondary outcome of the study which included reducing opiods requirements and avoiding their side effects.

Results
The study found that the total amount of intra-operative fentanyl consumption was significantly higher in the SAPB and PIFB group than the Pecs group with the range of 100-150 versus 100-200 micg fentanyl respectively, and the VAS was significantly higher in the combination of serratus anterior plane block and pecto-intercostal fascial plane block compared to Pecs I and II at 8th, 12th and 24th hours post operatively with p value 0.018, 0.022 and 0.032 respectively, also the frequency of administration of rescue analgesia was higher in the SABP and PIFB group with the range of (2 to 3) times in PECS I and II group versus (2 to 5) in SABP/PIFB group. Besides, the first request of post-operative morphine was significantly delayed in the pectoral nerve blocks than the SABP and PIFB group with the p value (0.020).

Conclusion
The present study found that Pecs I and II group provided superior intra-operative and post-operative analgesic control compared to the serratus and PIFB group in patients undergoing non-reconstructive breast surgeries.
Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to Addition of Fentanyl in Patients undergoing Lower Limb Orthopedic Surgery under Combined Spinal Epidural Anathesia
Authors: Mohamed Mohamed Ibrahim El-Desoukey , Mahmoud Sahar Mohammed Kamal , Kamal Kareem Youssef 
Published: October 2021

Abstract

Background
The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.

Objectives
The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia.

Patients and Methods
After approval of ethical committee in our study and obtaining written informed consent from eligible patients the study was conducted on 60 patients classified to ASA I and II scheduled for lower limb orthopedic surgery. The study presents double armed randomized interventional prospective study including patients allocated into two equal groups each consists of 30 patients. Group (A): patients received magnesium sulphate added to bupivacaine in epidural, Group (B): patients received fentanyl added to bupivacaine in epidural

Results
The results of their study showed that the maximum level of sensory blockade was significantly higher in the combined fentanyl with magnesium group as compared with fentanyl group alone and magnesium sulphate group alone. The duration of sensory blockade of the combined fentanyl and magnesium group was significantly prolonged as compared to the other two groups as for the other two group the difference in the blockade duration was insignificant

Conclusion
We concluded that either magnesium sulfate (75 mg) combined with (10 ml) 0.25% Bupivacaine or fentanyl (1 µg/kg) combined with (10 ml) 0.25% Bupivacaine in combined spinal epidural improves intraoperative analgesia and prolongs early postoperative analgesia in lower limb orthopedic surgeries. The duration of analgesia was more prolonged in magnesium sulphate group than in the fentanyl group and this difference was statistically significant.
Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair
Authors: Mohamed Mohammed Hosny Hasan , Nasr Dalia Abd El Hameed Mohamad , Ansary Amin Mohamed El 
Published: October 2021

Abstract

Background
Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia.

Objectives
The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia.

Patients and Methods
The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight.

Results
The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia .

Conclusion
The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.
Comparative study between the effect of intrathecal bupivacaine versus bupivacaine dexmedetomidine combination in spinal anaeshtesia for lower abdominal surgeries
Authors: Marzouk Mervat M , Thabet Wael R , Ashoor Tarek M , Ahmed Ahmed Morsy 
Published: October 2021

Abstract

Study objectives
We compared effect of intrathecal bupivacaine versus bupivacaine

Design
This is a prospective, randomized, double-blinded study.

Setting
The setting is at an operating room in Ain Shams University Hospital. Patients: 50 patients scheduled for general anesthesia were randomly allocated to the following 2 groups in equal numbers.

Interventions
Spinal anaesthesia will be performed in the sitting position at L3-L4 or L4-L5 level using a 25-gauge Quincke spinal needle by the most competent experts. The sensory block level will be assessed along the mid-clavicular line bilaterally. The motor block will be assessed according to Bromage scale

Measurements
Post operative (VAS) score and Time to first requested analgesia.(primary outcome), Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate will be recorded every 5 minutes for 20 minutes then every 15 minutes till the end of surgery, Nausea and/ or vomiting as yes/no, Level of highest sensory block, Bromage score ≥3, Onset of sensory block and Two segment regression time (secondary outcomes) were recorded..

Main results
Results of this study showed that the addition of dexmedetomidine to bupivacaine in spinal anaesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia and lower NRS scores with minimal adverse effects and haemodynamic stability.

Conclusions
We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower abdominal surgeries.
COMPARISON BETWEEN PERINEURAL DEXAMETHASONE AND INTRAVENOUS MAGNESIUM SULPHATE AS ADJUVANT IN SUPRACLAVICULAR BLOCK
Authors: El-Shaer Ahmed Nagah , Ali Ahmed Kamal Mohamed , El-Aziz Farouk Kamal Eldeen Abd , El-Sayed Mostafa Samir 
Published: October 2021

Abstract

Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time.
Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects.
Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one).

Results
From aspect of increasing the duration of sensory &motor block magnesium sulphate group (group A) showed higher prolongation of sensory & motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr.
Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).