Pub Date : 2023-07-24DOI: 10.1080/11101849.2023.2236863
Mohamed said mostafa elmeligy, Neveen A. Kohaf, Reda K. Abdelrahman
ABSTRACT Background Fentanyl administration is associated with fentanyl-induced cough (FIC), which can be distressing for both the patient and the medical team. Midazolam has a bronchodilator action on the smooth muscle of the airway. Aim This study aims to study the efficacy of different oral midazolam doses in controlling FIC in children. Methods A total of 120 children who underwent elective surgeries with orotracheal intubation (OTI) were involved in this randomized, double-blind, controlled study. Cases were randomized equally into three groups. Group C (control group) – received plain oral solution prepared by a pharmacist who did not participate in the study. Group MID 0.5 mg/kg – received 0.5 mg/kg of oral midazolam solution. Group MID 0.7 mg/kg – received 0.7 mg/kg of oral midazolam solution. Results Incidence of cough was 39 (97.5%) in control group, 36 (90%) in MID 0.5 mg/kg group, and 15 (6%) in MID 0.7 mg/kg group with statistically significant differences among the three groups (p < 0.001). The onset of cough was insignificantly different between the three groups (p > 0.05). Severity of cough was significantly different among the groups, with severe cases more predominant in control group followed by Group MID 0.5 while no cases suffered severe cough in Group MID 0.7 (p < 0.001). Conclusions Premedication with 0.7 mg/kg oral midazolam was superior to 0.5 mg/kg oral midazolam and placebo in suppressing FIC as evidenced by lower incidence and severity of FIC in children who underwent elective surgeries with OTI.
{"title":"Premedication with Oral Midazolam Suppress Fentanyl- Induced Cough in Children: A Randomized Double-Blind Trial","authors":"Mohamed said mostafa elmeligy, Neveen A. Kohaf, Reda K. Abdelrahman","doi":"10.1080/11101849.2023.2236863","DOIUrl":"https://doi.org/10.1080/11101849.2023.2236863","url":null,"abstract":"ABSTRACT Background Fentanyl administration is associated with fentanyl-induced cough (FIC), which can be distressing for both the patient and the medical team. Midazolam has a bronchodilator action on the smooth muscle of the airway. Aim This study aims to study the efficacy of different oral midazolam doses in controlling FIC in children. Methods A total of 120 children who underwent elective surgeries with orotracheal intubation (OTI) were involved in this randomized, double-blind, controlled study. Cases were randomized equally into three groups. Group C (control group) – received plain oral solution prepared by a pharmacist who did not participate in the study. Group MID 0.5 mg/kg – received 0.5 mg/kg of oral midazolam solution. Group MID 0.7 mg/kg – received 0.7 mg/kg of oral midazolam solution. Results Incidence of cough was 39 (97.5%) in control group, 36 (90%) in MID 0.5 mg/kg group, and 15 (6%) in MID 0.7 mg/kg group with statistically significant differences among the three groups (p < 0.001). The onset of cough was insignificantly different between the three groups (p > 0.05). Severity of cough was significantly different among the groups, with severe cases more predominant in control group followed by Group MID 0.5 while no cases suffered severe cough in Group MID 0.7 (p < 0.001). Conclusions Premedication with 0.7 mg/kg oral midazolam was superior to 0.5 mg/kg oral midazolam and placebo in suppressing FIC as evidenced by lower incidence and severity of FIC in children who underwent elective surgeries with OTI.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44790643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.1080/11101849.2023.2238518
H. Mohammed, K. Sarhan, Tamer Mohammed Atteya Mahmoud
ABSTRACT Chemical meningitis is a feared complication to the skin antiseptic solutions used in skin preparation during neuraxial blocks. We report a case of a yellow CSF tap with a suggested management protocol. MAIN POINTS Yellow CSF tap could indicate a possible CSF contamination with Povidone-iodine. A contaminated spinal needle can be a source of chemical meningitis. Use of disposable spinal trays for skin preparation should be encouraged to avoid the possibility of CSF contamination. A stepwise management protocol for contaminated spinal needle may help to decrease the incidence of chemical meningitis.
{"title":"A stepwise management approach to an unexpected cause of a yellow CSF tap; A case report","authors":"H. Mohammed, K. Sarhan, Tamer Mohammed Atteya Mahmoud","doi":"10.1080/11101849.2023.2238518","DOIUrl":"https://doi.org/10.1080/11101849.2023.2238518","url":null,"abstract":"ABSTRACT Chemical meningitis is a feared complication to the skin antiseptic solutions used in skin preparation during neuraxial blocks. We report a case of a yellow CSF tap with a suggested management protocol. MAIN POINTS Yellow CSF tap could indicate a possible CSF contamination with Povidone-iodine. A contaminated spinal needle can be a source of chemical meningitis. Use of disposable spinal trays for skin preparation should be encouraged to avoid the possibility of CSF contamination. A stepwise management protocol for contaminated spinal needle may help to decrease the incidence of chemical meningitis.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48773172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.1080/11101849.2023.2238529
Maha Misk, A. Alshawadfy, Medhat Lamei, F. Khames, Mohamed Abd Elgawad, H. Hendawy
ABSTRACT Background Although ultrasound-guided nerve blocks have lately been used to control pain, there is not much evidence assessing the outcome of trigeminal nerve block (TNB) in maxillofacial surgery. This study sought to evaluate the safety and efficacy of analgesia with an ultrasound-guided trigeminal nerve block (USGTNB) in patients undergoing unilateral maxillofacial surgery under general anesthesia. Methods This single-blinded, parallel-group, randomized clinical trial included 50 adult patients who had American Society of Anesthesiologists physical status I or II and were prepared for elective unilateral maxillofacial procedure under general anesthesia. The patients were randomized into two groups. In the intervention (TNB) group, 25 patients received USGTNB using 5 ml of bupivacaine 0.25%, while in the control group, 25 patients received only general anesthesia. Total intraoperative fentanyl consumption was the primary outcome. The secondary outcomes were the intraoperative hemodynamic parameters besides the postoperative pain, total opioid consumption, complications, and patient satisfaction. Results Compared to general anesthesia, USGTNB significantly reduced the intraoperative fentanyl consumption (2.38 ± 0.62 vs 0.36 ± 0.55, p < 0.001), and the intraoperative heart rate and mean arterial blood pressure at 1, 2, and 3 h (p < 0.001), the numerical rating score during the 24 postoperative hours (p < 0.001), and the postoperative nalbuphine consumption (11.60 ± 4.72 vs 1.92 ± 3.28, p < 0.001). USGTNB had a better safety profile and showed better patient satisfaction compared to general anesthesia alone (8.04 ± 0.89 vs 5.84 ± 0.90, p < 0.001). Conclusion USGTNB can provide an effective, safe approach for controlling pain in adult patients undergoing maxillofacial surgery.
{"title":"Evaluating the perioperative analgesic effect of ultrasound-guided trigeminal nerve block in adult patients undergoing maxillofacial surgery under general anesthesia: A randomized controlled study","authors":"Maha Misk, A. Alshawadfy, Medhat Lamei, F. Khames, Mohamed Abd Elgawad, H. Hendawy","doi":"10.1080/11101849.2023.2238529","DOIUrl":"https://doi.org/10.1080/11101849.2023.2238529","url":null,"abstract":"ABSTRACT Background Although ultrasound-guided nerve blocks have lately been used to control pain, there is not much evidence assessing the outcome of trigeminal nerve block (TNB) in maxillofacial surgery. This study sought to evaluate the safety and efficacy of analgesia with an ultrasound-guided trigeminal nerve block (USGTNB) in patients undergoing unilateral maxillofacial surgery under general anesthesia. Methods This single-blinded, parallel-group, randomized clinical trial included 50 adult patients who had American Society of Anesthesiologists physical status I or II and were prepared for elective unilateral maxillofacial procedure under general anesthesia. The patients were randomized into two groups. In the intervention (TNB) group, 25 patients received USGTNB using 5 ml of bupivacaine 0.25%, while in the control group, 25 patients received only general anesthesia. Total intraoperative fentanyl consumption was the primary outcome. The secondary outcomes were the intraoperative hemodynamic parameters besides the postoperative pain, total opioid consumption, complications, and patient satisfaction. Results Compared to general anesthesia, USGTNB significantly reduced the intraoperative fentanyl consumption (2.38 ± 0.62 vs 0.36 ± 0.55, p < 0.001), and the intraoperative heart rate and mean arterial blood pressure at 1, 2, and 3 h (p < 0.001), the numerical rating score during the 24 postoperative hours (p < 0.001), and the postoperative nalbuphine consumption (11.60 ± 4.72 vs 1.92 ± 3.28, p < 0.001). USGTNB had a better safety profile and showed better patient satisfaction compared to general anesthesia alone (8.04 ± 0.89 vs 5.84 ± 0.90, p < 0.001). Conclusion USGTNB can provide an effective, safe approach for controlling pain in adult patients undergoing maxillofacial surgery.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49238591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.1080/11101849.2023.2236865
Mohamed said mostafa elmeligy, A. Abdelhamid, E. Mahdy
ABSTRACT Background Intranasal dexmedetomidine premedication has been employed in children for controlling stress before induction of general anesthesia. Until now, the effect of intranasal dexmedetomidine in relation to other premeditations remains incompletely studied. Objectives This study was conducted to study the effectiveness and safety of intranasal dexmedetomidine premedication in pediatrics. Sittings Meta-analysis-based study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methods Systematic searches of the databases MEDLINE, EMBASE, PubMed, and Cochrane were conducted to collect all published randomized, controlled, clinical trials in the last seven years which compare the intranasal dexmedetomidine premedication with other methods of premedication in different procedures. Results Twenty-five studies were collected for inclusion in this research including 2601 patients. The bias risk was low. Meta-analysis showed that the use of dexmedetomidine intranasally as a premedication when compared with other premedication regimes results in significant evidence of decreasing emergence agitation (RR = 0.64 [0.54, 0.77] 95% CI; I2 = 84%; P = 0.0001) fewer sedation scores (Mean difference = 51 [0.38, 0.65]; 95% CI; I2 = 99%; P = 0.00001), significantly less incidence of postoperative nausea and vomiting ((RR = 0.30 [0.20, 0.45] 95% CI; I2 = 12%; P = 0.00001), significantly decreased BP ((Mean difference = -2.28 [−3.42, −1.14]; 95% CI; I2 = 88%; P = 0.0001), and significantly decreased heart rate and (mean difference = -6.67 [−8.37, −4.97]; 95% CI; I2 = 94%; P = 0.00001). Conclusion Intranasal dexmedetomidine provided a satisfactory level of emergence agitation, more satisfactory sedation, more hemodynamic stability, and reduced the incidence of postoperative complications in relation to other premeditations.
{"title":"Challenge of using Intranasal dexmedetomidine as a premedication modality in pediatric patients: A meta-analysis of randomized controlled trials","authors":"Mohamed said mostafa elmeligy, A. Abdelhamid, E. Mahdy","doi":"10.1080/11101849.2023.2236865","DOIUrl":"https://doi.org/10.1080/11101849.2023.2236865","url":null,"abstract":"ABSTRACT Background Intranasal dexmedetomidine premedication has been employed in children for controlling stress before induction of general anesthesia. Until now, the effect of intranasal dexmedetomidine in relation to other premeditations remains incompletely studied. Objectives This study was conducted to study the effectiveness and safety of intranasal dexmedetomidine premedication in pediatrics. Sittings Meta-analysis-based study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methods Systematic searches of the databases MEDLINE, EMBASE, PubMed, and Cochrane were conducted to collect all published randomized, controlled, clinical trials in the last seven years which compare the intranasal dexmedetomidine premedication with other methods of premedication in different procedures. Results Twenty-five studies were collected for inclusion in this research including 2601 patients. The bias risk was low. Meta-analysis showed that the use of dexmedetomidine intranasally as a premedication when compared with other premedication regimes results in significant evidence of decreasing emergence agitation (RR = 0.64 [0.54, 0.77] 95% CI; I2 = 84%; P = 0.0001) fewer sedation scores (Mean difference = 51 [0.38, 0.65]; 95% CI; I2 = 99%; P = 0.00001), significantly less incidence of postoperative nausea and vomiting ((RR = 0.30 [0.20, 0.45] 95% CI; I2 = 12%; P = 0.00001), significantly decreased BP ((Mean difference = -2.28 [−3.42, −1.14]; 95% CI; I2 = 88%; P = 0.0001), and significantly decreased heart rate and (mean difference = -6.67 [−8.37, −4.97]; 95% CI; I2 = 94%; P = 0.00001). Conclusion Intranasal dexmedetomidine provided a satisfactory level of emergence agitation, more satisfactory sedation, more hemodynamic stability, and reduced the incidence of postoperative complications in relation to other premeditations.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43974671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.1080/11101849.2023.2238530
R. Hussien, Mohamed Sabry Abdel-Badea Ismail, Amir Ibrahim Mohamed Salah, Ahmed Nagah Elshaer, Ayman Ahmad Elsayed Abdellatif, T. Abdelrahman
ABSTRACT Background For successful rehabilitation and optimal functional outcomes after total knee arthroplasty surgery, patients must have effective pain control. Peripheral nerve blocks offer an excellent solution for perioperative multimodal analgesia and are advocated to reduce postoperative opioid consumption. Objectives The objective of this study is to compare the efficacy of combined Femoral-Sciatic nerve block and Adductor- interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block in terms of total rescue analgesia dosage and ambulation on the first postoperative day. Method This is a prospective, randomized, double-blinded trial was conducted at Ain Shams University Hospital. Sixty patients scheduled for total knee arthroplasty (TKA) were randomly divided into two equal groups: one group received a Femoral-Sciatic nerve block, and the other received an Adductor-IPACK block. Both ultrasound-guided blocks were performed by injecting 20 mL of 0.25% bupivacaine immediately after anaesthesia induction. The postoperative opioid requirement in the first 24 hours was assessed using the visual analogue scale (VAS). Motor power, intraoperative fentanyl consumption, intraoperative hemodynamic changes, procedure time, surgery duration, tourniquet time, and technique complications were also recorded. Results Femoral-Sciatic group had lower opioid consumption. The Adductor-IPACK group showed a statistically significant higher Modified Bromage score. However, there was no statistically significant difference between the groups in the postoperative pain score assessed using the VAS. Conclusion Based on our study, we conclude that Femoral-Sciatic blocks required a lower dose of rescue analgesia compared to the Adductor-IPACK group. The Adductor-IPACK group also experienced lesser postoperative muscle power impairment.
{"title":"Postoperative analgesic effectiveness of ultrasound guided combined femoral - sciatic nerve block versus combined adductor canal block – I PACK block in patients undergoing total knee arthroplasty: A double- blind randomized study","authors":"R. Hussien, Mohamed Sabry Abdel-Badea Ismail, Amir Ibrahim Mohamed Salah, Ahmed Nagah Elshaer, Ayman Ahmad Elsayed Abdellatif, T. Abdelrahman","doi":"10.1080/11101849.2023.2238530","DOIUrl":"https://doi.org/10.1080/11101849.2023.2238530","url":null,"abstract":"ABSTRACT Background For successful rehabilitation and optimal functional outcomes after total knee arthroplasty surgery, patients must have effective pain control. Peripheral nerve blocks offer an excellent solution for perioperative multimodal analgesia and are advocated to reduce postoperative opioid consumption. Objectives The objective of this study is to compare the efficacy of combined Femoral-Sciatic nerve block and Adductor- interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block in terms of total rescue analgesia dosage and ambulation on the first postoperative day. Method This is a prospective, randomized, double-blinded trial was conducted at Ain Shams University Hospital. Sixty patients scheduled for total knee arthroplasty (TKA) were randomly divided into two equal groups: one group received a Femoral-Sciatic nerve block, and the other received an Adductor-IPACK block. Both ultrasound-guided blocks were performed by injecting 20 mL of 0.25% bupivacaine immediately after anaesthesia induction. The postoperative opioid requirement in the first 24 hours was assessed using the visual analogue scale (VAS). Motor power, intraoperative fentanyl consumption, intraoperative hemodynamic changes, procedure time, surgery duration, tourniquet time, and technique complications were also recorded. Results Femoral-Sciatic group had lower opioid consumption. The Adductor-IPACK group showed a statistically significant higher Modified Bromage score. However, there was no statistically significant difference between the groups in the postoperative pain score assessed using the VAS. Conclusion Based on our study, we conclude that Femoral-Sciatic blocks required a lower dose of rescue analgesia compared to the Adductor-IPACK group. The Adductor-IPACK group also experienced lesser postoperative muscle power impairment.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49451677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.1080/11101849.2023.2236866
A. M. Alansary, M. M. Ali, M. Elshafie
ABSTRACT Background Spinal anesthesia is a widely used technique for cesarean delivery, but it often results in hypotension, bradycardia, and reduced cardiac output (CO). Atropine has a potent muscarinic receptor antagonist activity in the heart. It may be a good choice to prevent post-spinal bradycardia and minimize the marked CO reduction. Methods Sixty pregnant women between the ages of 18 and 40 who were ASA-PS II and planned for elective cesarean delivery were divided into two equal groups at random. Both groups received spinal anesthesia. Atropine group (I) (n = 30): patients received 0.01 mg/kg atropine, while control group (II) (n = 30): patients received the same volume of saline. CO measured by electrical cardiometry (EC) was the primary outcome where, heart rate (HR), mean blood pressure (MBP), stroke volume (SV), systemic vascular resistance (SVR), and neonatal outcomes were the secondary outcomes. Results CO after the intervention was higher in the atropine (group I) than in the control (group II). Also, CO reduction at 5 and 10 min following spinal anesthesia was less in the group I than in the group II. Except for baseline reading, HR was significantly higher in the atropine group versus the control group. MBP was higher in the atropine group than in the control group in all readings. SV and SVR were similar in both groups. Neonatal outcomes were equivalent in both groups. Conclusion Pre-spinal atropine was effective in preventing post-spinal bradycardia and minimized CO reduction in patients undergoing elective cesarean delivery under spinal anesthesia.
{"title":"Impact of pre-spinal atropine on post spinal hemodynamic and cardiac output measured by electrical cardiometry in cesarean delivery, a randomized controlled trial","authors":"A. M. Alansary, M. M. Ali, M. Elshafie","doi":"10.1080/11101849.2023.2236866","DOIUrl":"https://doi.org/10.1080/11101849.2023.2236866","url":null,"abstract":"ABSTRACT Background Spinal anesthesia is a widely used technique for cesarean delivery, but it often results in hypotension, bradycardia, and reduced cardiac output (CO). Atropine has a potent muscarinic receptor antagonist activity in the heart. It may be a good choice to prevent post-spinal bradycardia and minimize the marked CO reduction. Methods Sixty pregnant women between the ages of 18 and 40 who were ASA-PS II and planned for elective cesarean delivery were divided into two equal groups at random. Both groups received spinal anesthesia. Atropine group (I) (n = 30): patients received 0.01 mg/kg atropine, while control group (II) (n = 30): patients received the same volume of saline. CO measured by electrical cardiometry (EC) was the primary outcome where, heart rate (HR), mean blood pressure (MBP), stroke volume (SV), systemic vascular resistance (SVR), and neonatal outcomes were the secondary outcomes. Results CO after the intervention was higher in the atropine (group I) than in the control (group II). Also, CO reduction at 5 and 10 min following spinal anesthesia was less in the group I than in the group II. Except for baseline reading, HR was significantly higher in the atropine group versus the control group. MBP was higher in the atropine group than in the control group in all readings. SV and SVR were similar in both groups. Neonatal outcomes were equivalent in both groups. Conclusion Pre-spinal atropine was effective in preventing post-spinal bradycardia and minimized CO reduction in patients undergoing elective cesarean delivery under spinal anesthesia.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48573061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-12DOI: 10.1080/11101849.2023.2235148
Islam Morsy, Amr A Abdelwahab, Heba Salem, M. Elsharkawy, Hussein Gamal Almawardy
ABSTRACT Background The use of scores in thoracic surgery has been done recently. European Society Objective Score (ESOS) and Thoracoscore are the most popular scores used in thoracic operations. This work aimed to compare ESOS and Thoracoscore’s ability in predicting the mortality after thoracic surgery. Methods This retrospective study involved 282 cases who were admitted to thoracic surgery unit, Tanta University Hospitals and other hospitals whose Thoracoscore and ESOS were calculated from January 2017 to December 2022. Results Mortality rate at 30 days postoperative was 7.44% in our study. Pneumonectomy and MV (mechanical ventilation) were significantly associated with mortality (P value < 0.001). Thoracoscore can predict mortality (P value = 0.004 and AUC = 0.629) with 61.9% sensitivity, 56.70% specificity, 10.3% positive predictive value (PPV), and 94.9% negative predictive value(NPV). ESOS can predict mortality (P value = 0.006 and AUC = 0.662) with 85.71% sensitivity, 37.55% specificity, 9.9% PPV and 97% NPV. ESOS was an independent significant predictor for mortality while Thoracoscore was not. Conclusions ESOS and Thoracoscore are applicable tools in predicting the mortality after thoracic surgeries. However, ESOS is more sensitive and more specific.
{"title":"Role of Thoracoscore and ESOS in Prediction of Outcomes after Thoracic Surgeries","authors":"Islam Morsy, Amr A Abdelwahab, Heba Salem, M. Elsharkawy, Hussein Gamal Almawardy","doi":"10.1080/11101849.2023.2235148","DOIUrl":"https://doi.org/10.1080/11101849.2023.2235148","url":null,"abstract":"ABSTRACT Background The use of scores in thoracic surgery has been done recently. European Society Objective Score (ESOS) and Thoracoscore are the most popular scores used in thoracic operations. This work aimed to compare ESOS and Thoracoscore’s ability in predicting the mortality after thoracic surgery. Methods This retrospective study involved 282 cases who were admitted to thoracic surgery unit, Tanta University Hospitals and other hospitals whose Thoracoscore and ESOS were calculated from January 2017 to December 2022. Results Mortality rate at 30 days postoperative was 7.44% in our study. Pneumonectomy and MV (mechanical ventilation) were significantly associated with mortality (P value < 0.001). Thoracoscore can predict mortality (P value = 0.004 and AUC = 0.629) with 61.9% sensitivity, 56.70% specificity, 10.3% positive predictive value (PPV), and 94.9% negative predictive value(NPV). ESOS can predict mortality (P value = 0.006 and AUC = 0.662) with 85.71% sensitivity, 37.55% specificity, 9.9% PPV and 97% NPV. ESOS was an independent significant predictor for mortality while Thoracoscore was not. Conclusions ESOS and Thoracoscore are applicable tools in predicting the mortality after thoracic surgeries. However, ESOS is more sensitive and more specific.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46145409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.1080/11101849.2023.2231709
Heba Abdelhamid Mohammed, A. M. Belal, R. S. Elkalla, S. Soliman
ABSTRACT Background For anesthesiologists, managing pain during and after thoracic surgery remains a significant challenge. This research aims to assess the safety and efficacy of ultrasound (US)-guided pre-emptive mid-point transverse process to pleura (MTP) block for posterolateral thoracotomy. Methods This prospective randomized, double-blind clinical trial was conducted on 70 patients scheduled for a posterolateral thoracotomy operation under general anesthesia (GA). Patients were classified randomly and equally into Group I (MTP group) received MTP blocks, and Group II (sham block) received 2 ml of saline solution. The blocks were done after induction of GA but before the skin incision. Results Numerical rating scale (NRS) at rest and cough, total morphine consumption, the incidence of chronic pain at 3 months, and undesirable side effects (nausea, vomiting, respiratory depression) were significantly lower in MTP block than in sham block. Oxygen saturation and SpO2/FiO2 raised significantly in the MTP block than in the sham block (P < 0.001). Conclusions The US-guided MTP block provided effective analgesia with a lower pain score, lesser rescue analgesics consumption, and reduced risk of developing chronic pain posterolateral thoracotomy.
{"title":"Analgesic efficacy of pre-emptive ultrasound-guided mid-point transverse process to pleura block for patients undergoing posterolateral thoracotomy incisions: Randomized controlled trial","authors":"Heba Abdelhamid Mohammed, A. M. Belal, R. S. Elkalla, S. Soliman","doi":"10.1080/11101849.2023.2231709","DOIUrl":"https://doi.org/10.1080/11101849.2023.2231709","url":null,"abstract":"ABSTRACT Background For anesthesiologists, managing pain during and after thoracic surgery remains a significant challenge. This research aims to assess the safety and efficacy of ultrasound (US)-guided pre-emptive mid-point transverse process to pleura (MTP) block for posterolateral thoracotomy. Methods This prospective randomized, double-blind clinical trial was conducted on 70 patients scheduled for a posterolateral thoracotomy operation under general anesthesia (GA). Patients were classified randomly and equally into Group I (MTP group) received MTP blocks, and Group II (sham block) received 2 ml of saline solution. The blocks were done after induction of GA but before the skin incision. Results Numerical rating scale (NRS) at rest and cough, total morphine consumption, the incidence of chronic pain at 3 months, and undesirable side effects (nausea, vomiting, respiratory depression) were significantly lower in MTP block than in sham block. Oxygen saturation and SpO2/FiO2 raised significantly in the MTP block than in the sham block (P < 0.001). Conclusions The US-guided MTP block provided effective analgesia with a lower pain score, lesser rescue analgesics consumption, and reduced risk of developing chronic pain posterolateral thoracotomy.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47412012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.1080/11101849.2023.2235149
A. Elbadry, S. Elrahwan, T. Mostafa, Laila Elahwal
ABSTRACT Background Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. Patients and methods This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Results Time to 1st rescue analgesia was significantly delayed in groups C and E than group P (P < 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P (P = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h (p < 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Conclusion Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.
{"title":"Analgesic effect of sacral erector spinae, penile and caudal block after hypospadias surgery: A randomized single blind controlled trial","authors":"A. Elbadry, S. Elrahwan, T. Mostafa, Laila Elahwal","doi":"10.1080/11101849.2023.2235149","DOIUrl":"https://doi.org/10.1080/11101849.2023.2235149","url":null,"abstract":"ABSTRACT Background Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. Patients and methods This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Results Time to 1st rescue analgesia was significantly delayed in groups C and E than group P (P < 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P (P = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h (p < 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Conclusion Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44956381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.1080/11101849.2023.2234712
A. A. Sabry, Wael Nabil Abdel Salam, Mohammed Mostafa Abdel Salam, K. Moustafa, E. M. Gaber, B. Beshey
ABSTRACT Objective To investigate impact of five-level triage system on Emergency Department (ED) patients’ outcome and resources’ utilization. Design A comparative observational study (pre-/post-intervention). Setting ED of Alexandria Main University Hospital. Patients All trauma patients and adult emergencies presented to ED from 1st of September 2021 to 31st of May 2022. Patients who were discharged or left against medical advice were excluded. Methods Five-level triage was implemented in 1st of December 2021 using Australasian Triage Scale. Primary outcome was ED mortality, while secondary outcomes were resources’ utilization and ED length of stay (LOS). Multivariate logistic regression model for predictors of ED mortality was used. Results Totally, 9766 and 22,936 patients were subjected to three- and five-level triaging, respectively. ED mortality dropped from 5.26% to 1.46%. All resources including human factors were less utilized. ED LOS has declined from 170.1 ± 88.7 to 72.00 ± 109.8 min. All changes were statistically significant, p < 0.05. Significant predictors of ED mortality were three-level triaging, medical emergencies, initial code-1, time-to-clinical decision > 60 min, >5 differential diagnoses, more interventions, and longer ED LOS with different Odds ratios. Conclusion Five-level triaging reduced rates of mis-triaging, ED mortality, resources’ utilization, and ED LOS. KEY FINDINGS Physician-led five-level triage system significantly improved ED mortality. Five-level triage significantly reduced resources’ utilization including human factors and ED Length of stay. Rates of mis-triaging and crowding dropped with reassessment and allocation of more treatment areas.
{"title":"Impact of implementing five-level triage system on patients outcomes and resource utilization in the emergency department of Alexandria main university hospital","authors":"A. A. Sabry, Wael Nabil Abdel Salam, Mohammed Mostafa Abdel Salam, K. Moustafa, E. M. Gaber, B. Beshey","doi":"10.1080/11101849.2023.2234712","DOIUrl":"https://doi.org/10.1080/11101849.2023.2234712","url":null,"abstract":"ABSTRACT Objective To investigate impact of five-level triage system on Emergency Department (ED) patients’ outcome and resources’ utilization. Design A comparative observational study (pre-/post-intervention). Setting ED of Alexandria Main University Hospital. Patients All trauma patients and adult emergencies presented to ED from 1st of September 2021 to 31st of May 2022. Patients who were discharged or left against medical advice were excluded. Methods Five-level triage was implemented in 1st of December 2021 using Australasian Triage Scale. Primary outcome was ED mortality, while secondary outcomes were resources’ utilization and ED length of stay (LOS). Multivariate logistic regression model for predictors of ED mortality was used. Results Totally, 9766 and 22,936 patients were subjected to three- and five-level triaging, respectively. ED mortality dropped from 5.26% to 1.46%. All resources including human factors were less utilized. ED LOS has declined from 170.1 ± 88.7 to 72.00 ± 109.8 min. All changes were statistically significant, p < 0.05. Significant predictors of ED mortality were three-level triaging, medical emergencies, initial code-1, time-to-clinical decision > 60 min, >5 differential diagnoses, more interventions, and longer ED LOS with different Odds ratios. Conclusion Five-level triaging reduced rates of mis-triaging, ED mortality, resources’ utilization, and ED LOS. KEY FINDINGS Physician-led five-level triage system significantly improved ED mortality. Five-level triage significantly reduced resources’ utilization including human factors and ED Length of stay. Rates of mis-triaging and crowding dropped with reassessment and allocation of more treatment areas.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41315479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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