bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Intraoperative Dexmedetomidine Infusion in Enhanced Recovery after Surgery Protocols for Reducing Postoperative Analgesic Requirements in Laparoscopic Bariatric Surgeries
Authors: Zaki Hany V , Akl Diaa Abd Elkhalek , Gendiy Amr Saleh Yousef , Haggag Adham Magdy 
Published: August 2023

Abstract

Background
The prevalence of obesity in modern societies leads to continuous growing of bariatric surgery throughout the world as it is an effective treatment for obesity. Dexmedetomidine (DEX), a selective α2-adrenergic agonist, is an opioid-sparing adjuvant sedative that avoids respiratory depression and has been shown to be beneficial in bariatric surgery patients

Aim of the Work
The aim of this study is to evaluate the analgesic profile of intraoperative Dexmedetomidine on postoperative analgesic requirements.

Patients and Methods
This study was carried out at bariatric surgery unit - Ain shams University Hospitals and included 06 patients of both sexes undergoing elective laparoscopic bariatric surgery.

Results
The main finding in this study was that nalbuphine consumption was less in group D compared to group C with p value &lt; 0.001 with high significant difference between the two groups also it revealed a high significant difference between the two groups according to time for first use of rescue analgesia. There was a highly significant difference between the two groups according to hemodynamics including (MAP & HR) but with no clinically significant differences. While there was no significant difference as regard SO2 or respiratory rate

Conclusion
In patients undergoing bariatric surgeries using of intraoperative dexmedetomidine infusion with its opioid-sparing effect enhanced the recovery of this study population of morbidly obese patients with minimal side-effects.
Role of Local Anesthetic Infiltration of Port Sites in Laparoscopic Cholecystectomy in Reducing Postoperative Pain and Opioid Consumption
Authors: Zaki Gamal Fouad Saleh , Mohamed Asmaa Abobakr AbdAllah , Ammar Mona Ahmed 
Published: August 2023

Abstract

Background
Laparoscopic cholecystectomy is the gold standard for treating patients with cholelithiasis. It is a minimally invasive technique that reduces surgical trauma with small and more cosmetic incision, reduces blood loss and is associated usually with fewer postoperative complications and decreased length of hospital stay.

Aim of the Work
The aim of this study was to evaluate the efficacy of the long acting local anesthetic (bupivacaine) infiltrated at the port sites in laparoscopic cholecystectomy, in reducing postoperative pain and opioid consumption.

Patients and Methods
In the period from March 2021 to September 2021 fifty patients who underwent laparoscopic cholecystectomy were randomly allocated to one of two groups and comparative study was done. In the bupivacaine group (A), after skin preparation and before port insertion, 20 ml of 0.25% bupivacaine solution was infiltrated through the abdominal wall 4 ml around each port site. Postoperatively, pain score using VAS score, time of rescue analgesic and total rescue analgesic dose was calculated.

Results
The results showed that there a decrease in pain intensity in the bupivacaine group compared to control group with a significant difference, and there was delay in the time of rescue analgesia and total doses of rescue analgesia the bupivacaine group compared to control group with a statistically significant difference.

Conclusion
Port- site infiltration of bupivacaine in laparoscopic cholecystectomy successfully decrease post-operative pain during first 6 hour and delayed the time of rescue analgesia.
A Comparative Study of Using Ondansetron with Dexamethasone or Ondansetron with Haloperidol in Prophylaxis against Post-Operative Nausea and Vomiting after Elective Laparoscopic Abdominal Surgeries
Authors: Elsaidi Mohamed Ismail , ElSerwi Heba Bahaa Eldin , Kamal Mohamed Mohamed , Elshaer Ayat Mohamed Hisham 
Published: August 2023

Abstract

Background
Laparoscopic surgery is associated with a remarkably high risk of postoperative nausea and vomiting. the reasons for this high rate of PONV include mechanical factors (such as pressure on the stomach and gut caused by the pneumoperitoneum), neural factors (such as vagal reflexes elicited by irritation of parasympathetic nerve endings in the abdomen), and chemical factors (which include speculative considerations regarding a possible influence of CO2 on PONV). Postoperative nausea and vomiting are usually selflimiting but if persistent or severe, can cause medical complications such as dehydration, electrolyte imbalance and delay in patient’s discharge.

Objective
To compare between the effect of combination of ondansetron with haloperidol and ondansetron with dexamethasone on prophylaxis against postoperative nausea and vomiting in laparoscopic abdominal surgeries.

Methods
After approval of anaesthesiology department, scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 25; each); group A (the ondansetron plus dexamethasone group) and Group B (the ondansetron plus haloperidol group).

Results
The two groups were adequately monitored and assessed post-operatively and they were compared regarding post-operative nausea and vomiting outcome by recording the incidence of nausea and vomiting and recording the call for rescue antiemetic. Demographic data, intra-operative hemodynamics and post-operative pain score, occurrence of side effects, sedation score and patient satisfaction scores were also assessed.

Conclusion
The combination of ondansetron with haloperidol is as effective as the combination of ondansetron with dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic abdominal surgeries.
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache after Cesarean Section: A Randomized Controlled Study
Authors: Wahba Sherif Samir , AbdelGhaffar Wael Sayed Ahmed , Helmy Amr Fouad Hafez , Dawoud Beshoy Atef Gamil 
Published: August 2023

Abstract

Background
Post dural puncture headache (PDPH) is a known side effect following spinal anesthesia occurring in 2.5-40% of patients, it typically starts after 2 days but may be delayed up to 2 weeks and almost resolves spontaneously within a few days. Classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia and dizziness.

Objective
The aim of the study is to know if the neostigmine and atropine can improve PDPH treatment when added to conventional management after cesarean sections.

Patients and Methods
After obtaining approval from research ethics committee of Faculty of Medicine, Ain Shams University and after obtaining informed written consents from the patients. The study was conducted in the operating theaters of Ain Shams University Hospitals. The study period was 6 months after approval of the protocol, computer generated simple randomization. Patients with PDPH and a VAS &lt; 5 were randomly allocated to receive either: Group 1: Slow intravenous injection with 20 µg/Kg neostigmine and 10 µg/Kg atropine in 20 ml 0.9% Saline given over 5 minutes every 8 hours up to 72 hours, Group 2: 20 ml of 0.9% saline intravenous every 8 hours.

Results
In this study, we compared the efficacy of neostigmine versus placebo (Both groups received the conventional management) in treating the PDPH, All of the 2 groups (neostigmine and Placebo) were effective in lowering VAS scores at 24, 48 and 72 h after headache's onset but neostigmine alleviated the pain more effectively and with rapid onset. The mean VAS score was significantly lower in neostigmine group compared with other group 6, 12, 24, 36, 48 and 72 h after start of medications (p &lt; 0.001 for all of them) Placebo group 6, 12, 24, 36, 48, and 72 h (p &lt; 0.001 for all of them). This may cause the drug to be one of the potential new drug therapies for such distressing condition, especially with its different mechanism of action that differs from other drugs.

Conclusion
Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood–brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.
Single Lung Ventilation versus Two Lung Ventilation in Video Assisted Thoracoscopic Lung Surgeries
Authors: El-Safty Omar Mohamed Taha Abdallah , Mohamed Salwa Omar El-Khattab Amin , Taeimah Mohamed Osman Awad , Arafa Esraa Abd El-Latif Mohamed Shawky Abd El-Hameed 
Published: August 2023

Abstract

Background
VATS is being widely used nowadays in thoracic surgeries. One lung ventilation (OLV) is a technique routinely used in thoracic anesthesia to facilitate thoracic surgery. Double-lumen tubes (DLT) remain the most popular and reliable choice for one lung ventilation especially in adult patients.

Objective
To evaluate single lung ventilation as an alternative to conventional ventilation in video assisted thoracoscopic lung surgeries despite the claimed intra operative and post-operative hypoxemia which could be avoided or even minimized by changing ventilatory setting.

Patients and Methods
After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, Patients were included in the study in form of two equal groups (each of 30 patients). Group A: (no.=30) Patients did lung surgeries with single lung ventilation using double lumen endotracheal tube. Group B: (no.=30) Patients did lung surgeries with two lung ventilation using conventional single lumen endotracheal tube (two lung ventilation).

Results
In our study it was found that intraoperative hypoxemia (SaO2 &lt; 90%) occurred during some cases of single lung ventilation in 4 out of 30 cases. However, it was irrelevant to any other intraoperative or post-operative complication. Moreover, it was irrelevant to post-operative arterial oxygen saturation or any end organ complication. In our study also all comorbidities which can affect arterial oxygen saturation were excluded from the study from the start. However, better studies are urgently needed to investigate an individual “best oxygen content” concept for each patient undergoing one-lung ventilation.

Conclusion
The result of this study comparing single lung ventilation versus to lung ventilation in video assisted thoracoscopic surgeries concerning mainly intraoperative and post-operative hypoxia demonstrated that intra operative hypoxia occurred in some cases of single lung ventilation. However, this intraoperative hypoxia was irrelevant to post-operative hypoxia or any intraoperative or post-operative complications. So, our study recommends that using DLT for one lung ventilation is ideal for video assisted thoracoscopic lung surgeries, providing better surgical field, lesser surgery duration and better surgeon satisfaction.
Efficacy of Neutrophil Lymphocyte Stress Factor in Diagnosis of Sepsis and Prediction of Mortality in Septic Patients Admitted to the ICU
Authors: El-said Kamel Amr M , Abd El-malek Fady A , Shorbagy Mohamed S , El-sayed Mahmoud A 
Published: August 2023

Abstract

Background
Sepsis is a major public health concern. It is among the most common reasons for admission to intensive care units (ICUs) throughout the world. Severe sepsis and septic shock are associated with 30-60% mortality rate which is very high compared to other common diseases, such as myocardial infarction or breast cancer. Sepsis is now defined as a “life-threatening organ dysfunction due to a dysregulated host response to infection”.

Aim of the Work
to evaluate the efficacy of neutrophil lymphocyte stress factor (NLSF) in the diagnosis of sepsis and prediction of mortality in septic patients admitted to the ICU.

Patients and Methods
We conducted this prospective observational study on 60 patients after informed consents were taken from patients or their next of kin. We enrolled adult patients admitted to the ICU with the diagnosis of septic shock. We excluded patients younger than 18 years, pregnant females, patients with terminal malignancy, patients with liver cirrhosis child-pugh C, patients with shock of mixed origin and patients with aplasia, immunosuppressive disease or receiving immunosuppressive therapy. Then we classified patients into 2 main groups according to presence of sepsis into; Septic group (30 patients), and Non-Septic group (30 patients).

Results
from our study concluded that NLSF can be used in diagnosis of sepsis, although it’s the least accurate diagnostic marker among PCT, CRP and NLSF, it provides the cheapest tool for diagnosis of sepsis. It was also found that NLSF can be used in prediction of mortality in septic patient during the period of our study and that it’s the most accurate prognostic marker of mortality among PCT, CRP and NLSF.

Conclusion
NLSF in combination with other parameters can be used as a cheap easy tool for the early detection of sepsis in intensive care units. NLSF can be used as a prognostic marker in sepsis for prediction of mortality in ICU. Further studies are required to clarify these results on a larger group of patients and for longer periods of time.
Assessment of Brain Midline Shift Using Sonography in Traumatic Brain Injury (TBI) in Critically Ill Patients: A Comparative Study with CT
Authors: Elkabarity Reem H , Hakim Kareem Y , Hafez Mahmoud M 
Published: August 2023

Abstract

Introduction
Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment.

Aim of the Work
The aim of this study was to assess brain midline shift using transcranial sonography in comparison to plain CT.

Methods
The study was carried out on 45 neurocritical patients of both sex admitted to the critical care department in Ain shams University Hospital. The ultrasound MLS was assessed through the temporal bone window by measuring the distance from skull to the third ventricle on both sides prior to plain CT. CT MLS was determined either by the distance from the external bone table to the center of the third ventricle bilaterally (method 1) or the distance between the ideal midline and the septum pellucidum (method 2).

Results
60% of patients were males, the mean GCS on admission was 7.12±1.66.All the patients were mechanically ventilated.
Measurement of MLS by transcranial sonography was possible in all 45 patients. MLS of 4.29 ± 2.17 mm. A MLS &gt;6 mm was observed in 24% (11/45) of the patients. CT MLS was 5.18 ± 2.49 mm (using method 1) and 5.35 ± 2.64 mm (using method 2). A MLS &gt;8 mm with CT was observed in 29% (13/45) of the patients. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS &gt;5 mm) was 100, 91.3% respectively when using CT method (2) to measure MLS. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS &gt;5 mm) was 95.2, 95.8% respectively when using CT method (1) to measure MLS. The correlation coefficient between (the difference between US MLS and CTMLS) and CTMLS was 0.619 (p &lt; 0.001).The smaller the MLS the narrower the difference between the measurement of USMLS and CTMLS. The narrowest difference between US MLS and CT MLS 0.5 (0.5 -0.7) was at MLS &lt;2 mm. At this reading was the most accurate point of comparison between US MLS and CTMLS. The relation between US MLS and GCS was statistically significant, the greater the US MLS the lower the GCS. The relation between US MLS and length of ICU stay and ventilation days was tested and it was statistically significant. The greater the US MLS the longer the length of ICU stay and ventilation days. There was significant relation between US MLS and mortality, 100 % of the cases survived with US MLS less than 4 mm. 100 % of the cases with US MLS greater than 6 mm died. The greater the US MLS the higher the mortality.

Conclusion
This study suggests that TCS can be used as an easy bedside tool to detect MLS in neurocritical patients.
Ultrasound-Guided Rectus Sheath Block versus Transversus Abdominus Plane Block for Post-Operative Analgesia in Elective Cesarean Section
Authors: Maghawry Khaled Mohamed , Ahmed Eman Aboubaker ElSiddik , Almeligy Hany Attia , Abdou Marina Adel George 
Published: August 2023

Abstract

Background
Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cesarean section, cholecystectomy, prostatectomy, hysterectomy and transplant surgery.

Aim of the Work
The aim of this study is to test the efficacy of ultrasound guided TAP block versus ultrasound guided rectus sheath block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used.

Patients and Methods
In the current study eighty patients who received spinal anesthesia were included. Patients were divided randomly into two groups, each group consisted of 40 patients. Group A: Patients in this group received bilateral US guided TAP block at the end of surgery. Group B: Patients in this group received bilateral US guided rectus sheath block at the end of surgery.

Results
These result met with another study, Ayman Saleh et al which shows the time for first analgesic request (minutes) was significantly increased in TAP when compared to RS block groups (332.50±42.93 vs 220.10±21.51 minutes, respectively). Also, the total analgesic consumption (mg) was significantly reduced in TAP when compared to RS block groups respectively (90.40±27.02 vs 157.00±37.80 mg, respectively).

Conclusion
Ultrasound-guided TAP block was more effective than ultrasound-guided RS block in patients undergoing cesarean delivery with prolonged postoperative analgesia, less analgesics consumption and less postoperative nausea and vomiting.
Post-Operative Analgesic Effect of Intra-Articular Local Anesthetic Infiltration versus Adductor Canal Block after Knee Arthroscopic Surgeries
Authors: Hefni Amira F , Rahman Waleed A Abd El , Moris Kerolos E , Nabieh Mena M 
Published: August 2023

Abstract

Background
Knee arthroscopic surgery is one of the most common orthopaedic procedures. Postoperative pain after Knee arthroscopy is caused by irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection.

Aim of the Work
To compare between intra-articular local anaesthetic infiltration and ultrasound guided adductor canal block to achieve effective and safe postoperative analgesia after knee arthroscopic surgeries as regarding duration of postoperative analgesia, need for analgesic supplements postoperatively, patient satisfaction, time of ambulation, and presence of any associated complications or side effects.

Patients and Methods
A prospective randomized comparative study was conducted in Ain Shams University hospitals, on patients aged from 20 to 60 years, ASA class I-II-III assigned for knee arthroscopic surgeries. For six to eight months started after approval from ethical committee of Ain Shams University. A written informed consent had been obtained from all patients. Every patient received an explanation for the purpose of the study and research results only used for scientific purposes.

Results
The study showed that adductor canal group had lower Pain perception (VAS-10) at rest, but the differences were statistically significant beginning from hour-8. Also, adductor canal group had lower Pain perception (VAS-10) during movement, but the differences were statistically significant beginning from hour-8. Rescue analgesia was significantly less frequent in adductor canal group. High satisfaction (Good/excellent) grades were significantly more frequent in adductor canal group.

Conclusion
The findings of our study revealed that ACB Provides better postoperative analgesia after knee arthroscopic surgeries than intra-articular local anaesthetic infiltration at rest and movement. Furthermore it facilitated earlier mobility than local anaesthetic infiltration. However, in clinical practice intra-articular local anaesthetic infiltration is easier to perform than ACB which requires experienced anaesthesiologist.
Effect of Glycemic Control on Sepsis in Critically Ill Diabetic Patients: A Prospective Cohort Study
Authors: Hamid Hatem Said Abdel , Rabie Amal Hamed , Danial Samuel Habachi , Anwar Michael Mamdouh 
Published: August 2023

Abstract

Background
Hyperglycemia is common and often multifactorial in critically ill patients. Severe hyperglycemia can result in endothelial dysfunction, cytokine release, platelet activation, mitochondrial dysfunction and electrolyte and acid base disturbances and has been associated with an adverse outcome in a variety of settings in patients without a history of diabetes; this association has not been demonstrated in diabetes patients.

Aim of the Work
Aim is to evaluate the outcome of glycemic control in critically ill diabetic patients.

Patients and Methods
This Prospective Cohort study was performed at Ain Shams University Hospitals - El – Zaitoun Specialized Hospital. 60 patients that are known diabetic and admitted to ICU suffering from sepsis aging over 18 years. Patients have been divided equally into two groups: 1st group RBG measurements less than or equal 150 mg/dl while the 2nd group RBG measurements above 150 mg/dl. So there was highly statistically significant difference between the two studied groups and glucose level on admission.

Results
There was statistically insignificant difference between the two studied groups and Sex or Age. Also there is no significant difference in special habits (smoking) between the two groups. Considering ICU stay, in our study, there was statistically significant higher mean of ICU stay in 2nd group, in comparison to 1st group. The calculated Acute Physiology and Chronic Health Evaluation (APACHEII) in our study showed no significant difference between two groups Considering complications, our study reported insignificant increase in complicated cases the 2nd group in comparison to 1st group. This may be due to the small number of patients in our study. Further observational and randomized control studies are suggested to further evaluate the variability of complications.

Conclusion
Glycemic control in the ICU continues to be challenging at best. Glucose control in the intensive care unit adds yet another facet to the routine care of a highly complex patient profile. Although observational studies and certain interventional trials have suggested that intensive glucose control can reduce mortality in this setting, recent studies have failed to confirm these findings. Like that is our study, hyperglycemia was associated with increased duration of total days in the intensive care unit. There was insignificant increase in complicated cases in hyperglycemic group in comparison to the other group. This may be due to the small number of patients in our study. So further observational and randomized control studies are suggested to further evaluate the variability of complications.