Pub Date : 2023-07-05DOI: 10.1080/11101849.2023.2230047
Ahmed Yahya Ibrahim Ahmed, Mounir Kamal Mohamed Ahmed Afifi, Emad Abdelmoenam Elmonem Arida, M. Abdelhady
ABSTRACT Background Bariatric surgeries can be complicated by decreased perfusion of tissues, which can be caused by obesity itself or different factors during surgery. This study’s primary aim was to test how magnesium affects the mean tissue perfusion and whether it can increase the perfusion or decrease the effects of hypoperfusion, while the secondary aim was to investigate its effect on decreasing postoperative pain and total analgesic consumption, sedation, and incidence of side effects Settings and Design This study was a prospective double blinded randomized controlled study. Methods Sixty patients (ASA II-III) with morbid or complicated obesity scheduled for sleeve gastrectomy (LSG) participated in this trial. Patients were divided into two groups by randomization, the M group received an IV bolus infusion of 30 mg/kg magnesium (in a volume of 50 ml) after induction and 20 mg/kg IV infusion (in a volume of 50 ml) for 8 h postoperative and C group which received a bolus of 50 ml normal saline infusion after induction and 50 ml in saline infusion for 8 h postoperative. Serum magnesium was withdrawn after induction and before starting the bolus infusion. The perfusion index together with the level of rise in liver enzymes was compared throughout the study. Also, total analgesic use and pain severity (measured by the VAS score) were compared between the two groups. Results In comparison to the C group, the perfusion index was significantly higher in the M group (p-value <0.001). Also, the C group consumed much more analgesics and the VAS score was significantly higher (p < 0.01). Conclusion Magnesium may have a role in increasing perfusion and consequently decreasing morbidity during bariatric surgeries with no more added complications
{"title":"Effect of magnesium levels on mean tissue perfusion during and after bariatric surgeries: A randomised control trial","authors":"Ahmed Yahya Ibrahim Ahmed, Mounir Kamal Mohamed Ahmed Afifi, Emad Abdelmoenam Elmonem Arida, M. Abdelhady","doi":"10.1080/11101849.2023.2230047","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230047","url":null,"abstract":"ABSTRACT Background Bariatric surgeries can be complicated by decreased perfusion of tissues, which can be caused by obesity itself or different factors during surgery. This study’s primary aim was to test how magnesium affects the mean tissue perfusion and whether it can increase the perfusion or decrease the effects of hypoperfusion, while the secondary aim was to investigate its effect on decreasing postoperative pain and total analgesic consumption, sedation, and incidence of side effects Settings and Design This study was a prospective double blinded randomized controlled study. Methods Sixty patients (ASA II-III) with morbid or complicated obesity scheduled for sleeve gastrectomy (LSG) participated in this trial. Patients were divided into two groups by randomization, the M group received an IV bolus infusion of 30 mg/kg magnesium (in a volume of 50 ml) after induction and 20 mg/kg IV infusion (in a volume of 50 ml) for 8 h postoperative and C group which received a bolus of 50 ml normal saline infusion after induction and 50 ml in saline infusion for 8 h postoperative. Serum magnesium was withdrawn after induction and before starting the bolus infusion. The perfusion index together with the level of rise in liver enzymes was compared throughout the study. Also, total analgesic use and pain severity (measured by the VAS score) were compared between the two groups. Results In comparison to the C group, the perfusion index was significantly higher in the M group (p-value <0.001). Also, the C group consumed much more analgesics and the VAS score was significantly higher (p < 0.01). Conclusion Magnesium may have a role in increasing perfusion and consequently decreasing morbidity during bariatric surgeries with no more added complications","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47952769","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 : 2023-07-04DOI: 10.1080/11101849.2023.2230049
Magdy Mohammed Mahdy, E. E. Abdelhakeem, A. Fawzy, M. S. Abbas
ABSTRACT Background One of the foremost common medical reasons for delayed discharge following ambulatory surgery is pain. Erector spinae plane block (ESPB) is a comparatively new technique utilized for intra‑ and post‑operative analgesia. We aimed to compare the analgesic efficacy of ESPB with port site infiltration in laparoscopic cholecystectomy (LC) patients. Methods Forty-four patients 18–60 years old with body mass index (BMI) of 18–35 kg/m2 who were scheduled for laparoscopic cholecystectomy were randomized into two groups (22 patients each) either to obtain an ultrasound‑guided Bilateral ESPB (group A) or port‑site infiltration of local anesthetic (group B) after anesthesia induction. The primary outcome was the total postoperative nalbuphine consumption in the first 24 h. Results The overall amount of rescue analgesia was significantly lower in group A (8.27 ± 1.12 mg for nalbuphine as first-line rescue analgesic and 10 patients needed ketorolac as second line rescue analgesic) than in group B (15.92 ± 2.11 mg for nalbuphine as first-line rescue analgesic and 22 patients needed ketorolac as second-line rescue analgesic) during the first 24 h postoperatively. The time to first analgesic request showed statistically significant difference between the two groups with longer time in group A (p value < 0.001). The numerical rate score at rest and when coughing was significantly lower in group A than group B. Conclusion Erector spinae plane block was superior to port site infiltration regarding decrease in analgesic consumption and prolongation in time of postoperative rescue analgesia in patients undergoing laparoscopic cholecystectomy.
{"title":"Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy","authors":"Magdy Mohammed Mahdy, E. E. Abdelhakeem, A. Fawzy, M. S. Abbas","doi":"10.1080/11101849.2023.2230049","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230049","url":null,"abstract":"ABSTRACT Background One of the foremost common medical reasons for delayed discharge following ambulatory surgery is pain. Erector spinae plane block (ESPB) is a comparatively new technique utilized for intra‑ and post‑operative analgesia. We aimed to compare the analgesic efficacy of ESPB with port site infiltration in laparoscopic cholecystectomy (LC) patients. Methods Forty-four patients 18–60 years old with body mass index (BMI) of 18–35 kg/m2 who were scheduled for laparoscopic cholecystectomy were randomized into two groups (22 patients each) either to obtain an ultrasound‑guided Bilateral ESPB (group A) or port‑site infiltration of local anesthetic (group B) after anesthesia induction. The primary outcome was the total postoperative nalbuphine consumption in the first 24 h. Results The overall amount of rescue analgesia was significantly lower in group A (8.27 ± 1.12 mg for nalbuphine as first-line rescue analgesic and 10 patients needed ketorolac as second line rescue analgesic) than in group B (15.92 ± 2.11 mg for nalbuphine as first-line rescue analgesic and 22 patients needed ketorolac as second-line rescue analgesic) during the first 24 h postoperatively. The time to first analgesic request showed statistically significant difference between the two groups with longer time in group A (p value < 0.001). The numerical rate score at rest and when coughing was significantly lower in group A than group B. Conclusion Erector spinae plane block was superior to port site infiltration regarding decrease in analgesic consumption and prolongation in time of postoperative rescue analgesia in patients undergoing laparoscopic cholecystectomy.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43375619","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 : 2023-07-03DOI: 10.1080/11101849.2023.2230048
Mohammed Nassef Elsayed, Ahmed Mohammed Al-Attar, Emad Eldin Abd Elmonem Arida, Aliaa Rabia Abd Elaziz
ABSTRACT Background Cuffed tracheal tubes (CTT) emerge to prevent air leakage despite that most anaesthesiologists prefer the uncuffed tracheal tubes (UTT) in the paediatrics. Using recent tools for evaluation of endotracheal intubation sequelae may help to prevent airway injury and determine the appropriate type and size of endotracheal tube (ETT). Purpose The study aimed to detect the early airway changes after using CTT or UTT in paediatrics. Also, to find out the correlation between the endoscopic and ultrasonographic findings in detection of post intubation sequelae in paediatrics. Methods A prospective, randomized study was performed over 80 children aged from two to five years, scheduled for abdominal surgeries under the effect of general anaesthesia. Patients were assigned into two equal groups: Group C: CTT and Group U: UTT. Results There was less statistically significant ETT exchange in the group C (p = 0.020). No significant difference could be found as regard to the change in the subglottic diameter, the incidence of stridor, laryngospasm and croup, and the occurrence of airway injuries. There was a positive correlation between the change in the subglottic diameter and the prevalence of airway injuries (P = 0.014). The duration of the endotracheal intubation could not influence the incidence of neither the stridor nor the airway injuries in both groups. Conclusion There were no difference between the use of CTT or UTT in the paediatrics in terms of early airway changes. However, the rate of tube exchange is significantly lower when using CTT. A positive correlation is found between the endoscopic and ultrasound findings in the detection of post intubation sequelae in paediatrics. Short-term endotracheal intubation neither affects the incidence nor the severity of airway injuries. Using the external diameter of the endotracheal tube instead of the inner diameter is crucial for proper sizing in paediatrics.
{"title":"Assessment of early paediatric airway sequelae after using cuffed or uncuffed endotracheal tubes with ultrasound and flexible endoscopy","authors":"Mohammed Nassef Elsayed, Ahmed Mohammed Al-Attar, Emad Eldin Abd Elmonem Arida, Aliaa Rabia Abd Elaziz","doi":"10.1080/11101849.2023.2230048","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230048","url":null,"abstract":"ABSTRACT Background Cuffed tracheal tubes (CTT) emerge to prevent air leakage despite that most anaesthesiologists prefer the uncuffed tracheal tubes (UTT) in the paediatrics. Using recent tools for evaluation of endotracheal intubation sequelae may help to prevent airway injury and determine the appropriate type and size of endotracheal tube (ETT). Purpose The study aimed to detect the early airway changes after using CTT or UTT in paediatrics. Also, to find out the correlation between the endoscopic and ultrasonographic findings in detection of post intubation sequelae in paediatrics. Methods A prospective, randomized study was performed over 80 children aged from two to five years, scheduled for abdominal surgeries under the effect of general anaesthesia. Patients were assigned into two equal groups: Group C: CTT and Group U: UTT. Results There was less statistically significant ETT exchange in the group C (p = 0.020). No significant difference could be found as regard to the change in the subglottic diameter, the incidence of stridor, laryngospasm and croup, and the occurrence of airway injuries. There was a positive correlation between the change in the subglottic diameter and the prevalence of airway injuries (P = 0.014). The duration of the endotracheal intubation could not influence the incidence of neither the stridor nor the airway injuries in both groups. Conclusion There were no difference between the use of CTT or UTT in the paediatrics in terms of early airway changes. However, the rate of tube exchange is significantly lower when using CTT. A positive correlation is found between the endoscopic and ultrasound findings in the detection of post intubation sequelae in paediatrics. Short-term endotracheal intubation neither affects the incidence nor the severity of airway injuries. Using the external diameter of the endotracheal tube instead of the inner diameter is crucial for proper sizing in paediatrics.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42204414","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 : 2023-07-03DOI: 10.1080/11101849.2023.2230404
Nahla N Shehab, Walaa Y. Elsabeeny, Sayed M Abed
ABSTRACT Background A wide range of drugs are used for sedation in gastrointestinal (GI) endoscopy procedures, including midazolam, dexmedetomidine, and ketamine. Therefore, this study aimed to compare the effects of these drugs in combination with propofol among cancer patients undergoing GI endoscopy. Methods This randomized, double-blinded study was carried out on 75 cancer patients who underwent GI endoscopy. Patients were categorized into three equal groups. Group D: received dexmedetomidine 0.5 µg/kg bolus infusion over 10 min. Group K: received ketamine 0.5 mg/kg. Group M: received midazolam 0.05 mg/kg. With these drugs, 0.5 mg/kg propofol was administered intravenously with incremental 20 mg till achievement of Ramsey sedation score (RSS) 3–4. After that, 0.5 mg/kg propofol boluses were offered for rescue sedation. Results The endoscopy duration was comparable in the three groups. Time of RSS 3–4 achievement and total propofol dose (P < 0.05) were significantly lower in group D and group K compared to group M. Time to eye-opening were significantly lower in groups D, and K compared to group M, with insignificant difference between group K and group D. Moreover, the heart rate (HR) and mean arterial pressure (MAP) of group K at 10 min, 15 min, 20 min, 25 min, and 30 min, and PACU were significantly greater than D and M groups (P < 0.05). Incidence of hypotension and bradycardia were comparable in the three groups. Conclusions In cancer patients who underwent GI endoscopy, dexmedetomidine-propofol and ketamine-propofol had better sedation efficacy [lower achievement time of RSS 3–4, total propofol dose, and eye-opening time] compared to midazolam-propofol group with superior sedative effect of ketamine-propofol than dexmedetomidine-propofol. While ketamine-propofol had more stable HR and MAP.
{"title":"Safety and efficacy of dexmedetomidine vs ketamine vs midazolam combined with propofol in gastrointestinal endoscopy for cancer patients: A randomized double-blinded trial","authors":"Nahla N Shehab, Walaa Y. Elsabeeny, Sayed M Abed","doi":"10.1080/11101849.2023.2230404","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230404","url":null,"abstract":"ABSTRACT Background A wide range of drugs are used for sedation in gastrointestinal (GI) endoscopy procedures, including midazolam, dexmedetomidine, and ketamine. Therefore, this study aimed to compare the effects of these drugs in combination with propofol among cancer patients undergoing GI endoscopy. Methods This randomized, double-blinded study was carried out on 75 cancer patients who underwent GI endoscopy. Patients were categorized into three equal groups. Group D: received dexmedetomidine 0.5 µg/kg bolus infusion over 10 min. Group K: received ketamine 0.5 mg/kg. Group M: received midazolam 0.05 mg/kg. With these drugs, 0.5 mg/kg propofol was administered intravenously with incremental 20 mg till achievement of Ramsey sedation score (RSS) 3–4. After that, 0.5 mg/kg propofol boluses were offered for rescue sedation. Results The endoscopy duration was comparable in the three groups. Time of RSS 3–4 achievement and total propofol dose (P < 0.05) were significantly lower in group D and group K compared to group M. Time to eye-opening were significantly lower in groups D, and K compared to group M, with insignificant difference between group K and group D. Moreover, the heart rate (HR) and mean arterial pressure (MAP) of group K at 10 min, 15 min, 20 min, 25 min, and 30 min, and PACU were significantly greater than D and M groups (P < 0.05). Incidence of hypotension and bradycardia were comparable in the three groups. Conclusions In cancer patients who underwent GI endoscopy, dexmedetomidine-propofol and ketamine-propofol had better sedation efficacy [lower achievement time of RSS 3–4, total propofol dose, and eye-opening time] compared to midazolam-propofol group with superior sedative effect of ketamine-propofol than dexmedetomidine-propofol. While ketamine-propofol had more stable HR and MAP.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47151435","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 : 2023-06-29DOI: 10.1080/11101849.2023.2230050
Mohammad Elhossieny Mohammad Salama, Ezzat El-Taher, Ahmad Hamed Abdel-Rahman Al-Touny, Reda A Ismail, M. Abdel-Ghaffar
ABSTRACT Background The concept of lung protective ventilation (LPV) during general anesthesia (GA) aims at minimizing lung injury and postoperative pulmonary complications (POPCs). Recruitment maneuver (RM) as a part of LPV may improve lung mechanics and oxygenation, but despite extensive research, definitive guidelines for the applications of intraoperative RMs have not been established yet. Methods This study was a prospective, single-blinded, randomized clinical trial. Sixty-six subjects undergoing non-laparoscopic upper abdominal surgeries under GA were randomly assigned into two equal groups. Control group (C) received tidal volume of 8 ml/kg predicted body weight (PBW) and positive end expiratory pressure (PEEP) of 5 cmH2O without RM. Recruitment group (R) received tidal volume of 8 ml/kg PBW with stepwise RMs and individualized PEEP titration after each RM. Compliance, plateau pressure, driving pressure, SpO2 and hemodynamics were monitored at each step of RM. POPCs, length of hospital stay and mortality were recorded postoperatively. Results There was a significant reduction in POPCs in (R) group than in (C) group (P = 0.03). Also, there was a significant increase in compliance before extubation in (R) group (P = 0.001). However, no significant difference was noted between both groups as regards mortality rate and length of hospital stay. Conclusion Individualized stepwise lung RM significantly decreases the incidence of POPCs when added to LPV in patients undergoing non-laparoscopic upper abdominal surgeries under GA.
{"title":"Effect of individualized intraoperative lung recruitment maneuver on postoperative pulmonary complications in patients undergoing upper abdominal surgeries under general anesthesia","authors":"Mohammad Elhossieny Mohammad Salama, Ezzat El-Taher, Ahmad Hamed Abdel-Rahman Al-Touny, Reda A Ismail, M. Abdel-Ghaffar","doi":"10.1080/11101849.2023.2230050","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230050","url":null,"abstract":"ABSTRACT Background The concept of lung protective ventilation (LPV) during general anesthesia (GA) aims at minimizing lung injury and postoperative pulmonary complications (POPCs). Recruitment maneuver (RM) as a part of LPV may improve lung mechanics and oxygenation, but despite extensive research, definitive guidelines for the applications of intraoperative RMs have not been established yet. Methods This study was a prospective, single-blinded, randomized clinical trial. Sixty-six subjects undergoing non-laparoscopic upper abdominal surgeries under GA were randomly assigned into two equal groups. Control group (C) received tidal volume of 8 ml/kg predicted body weight (PBW) and positive end expiratory pressure (PEEP) of 5 cmH2O without RM. Recruitment group (R) received tidal volume of 8 ml/kg PBW with stepwise RMs and individualized PEEP titration after each RM. Compliance, plateau pressure, driving pressure, SpO2 and hemodynamics were monitored at each step of RM. POPCs, length of hospital stay and mortality were recorded postoperatively. Results There was a significant reduction in POPCs in (R) group than in (C) group (P = 0.03). Also, there was a significant increase in compliance before extubation in (R) group (P = 0.001). However, no significant difference was noted between both groups as regards mortality rate and length of hospital stay. Conclusion Individualized stepwise lung RM significantly decreases the incidence of POPCs when added to LPV in patients undergoing non-laparoscopic upper abdominal surgeries under GA.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59762318","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 : 2023-06-29DOI: 10.1080/11101849.2023.2230405
H. Mostafa, A. Hasanin, M. Mostafa, H. Nagy
ABSTRACT Perioperative acute myocardial infarction is a life-threatening event. The aim of preoperative evaluation is identifying at-risk patient of developing postoperative complications and to undertake risk reduction measures to prevent such complications. We report a case of male patient with good functional capacity and unknown history cardiovascular disease undergoing radical cystectomy who suffered intra-operative cardiac arrest and ST-segment elevation myocardial ischemia. Postoperative urgent coronary revascularization was done and dual antiplatelets therapy was prescribed. Postoperative course was uneventful with no bleeding complication. Major perioperative cardiac events in noncardiac surgery are still probable despite the current guidelines of preoperative evaluation. Early revascularization and antiplatelet administration were feasible and did not produce critical surgical bleeding.
{"title":"Intraoperative ST-segment elevation myocardial infarction and sudden cardiac arrest during radical cystectomy: A case report","authors":"H. Mostafa, A. Hasanin, M. Mostafa, H. Nagy","doi":"10.1080/11101849.2023.2230405","DOIUrl":"https://doi.org/10.1080/11101849.2023.2230405","url":null,"abstract":"ABSTRACT Perioperative acute myocardial infarction is a life-threatening event. The aim of preoperative evaluation is identifying at-risk patient of developing postoperative complications and to undertake risk reduction measures to prevent such complications. We report a case of male patient with good functional capacity and unknown history cardiovascular disease undergoing radical cystectomy who suffered intra-operative cardiac arrest and ST-segment elevation myocardial ischemia. Postoperative urgent coronary revascularization was done and dual antiplatelets therapy was prescribed. Postoperative course was uneventful with no bleeding complication. Major perioperative cardiac events in noncardiac surgery are still probable despite the current guidelines of preoperative evaluation. Early revascularization and antiplatelet administration were feasible and did not produce critical surgical bleeding.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48318007","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}
ABSTRACT Background Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy. Aim Of The Study The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation. Patients And Methods 50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision. Results There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation. Conclusion Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.
{"title":"The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy","authors":"Fady Medhat Mokhtar Nessim, Alaa Eid Mohamed Hassan, Fahmy Saad Latif Eskander, Riham Fathy Galal Nady","doi":"10.1080/11101849.2023.2227474","DOIUrl":"https://doi.org/10.1080/11101849.2023.2227474","url":null,"abstract":"ABSTRACT Background Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy. Aim Of The Study The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation. Patients And Methods 50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision. Results There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation. Conclusion Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49492548","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 : 2023-06-17DOI: 10.1080/11101849.2023.2223829
M. Gamal, A. Rady, M. Gamal, Haitham Hassan
ABSTRACT Background Virtual reality (VR) distraction has been considered an alternative to medication to treat acute pain related to different procedures. This study aimed to evaluate the safety and efficacy of VR in reducing anxiety and pain in patients having orthopedic forearm operations under supraclavicular brachial plexus block. Methods This was an open-label, parallel-group, randomized trial. Thirty adult patients with American Society of Anesthesiologists physical status I or II were enrolled for orthopedic forearm operations performed under supraclavicular brachial plexus block. The patients were randomized into two equal groups. In the VR group, 15 patients performed the procedure with the use of VR and administration of midazolam according to the patient’s request, while in the control group, 15 patients received 2 mg midazolam followed by a titration dose according to the patient’s request. The primary outcome was the total intravenous sedation needed for the patient. Secondary outcomes included total perioperative analgesic utilization, incidence of harmful effects, patient satisfaction rating, and hemodynamic parameters. Results Virtual distraction technique significantly reduced the intraoperative midazolam consumption (2.00 ± 0.00 vs 6.67 ± 2.09 mg, respectively, p < 0.001) compared to the control group. The total perioperative analgesic consumption, incidence of adverse effects, and hemodynamic parameters were not significantly different in both groups. Patients who performed the block with the VR distraction technique showed better satisfaction scores compared to the control group (9.60 ± 0.51 vs 8.53 ± 0.92, respectively, p = 0.001). Conclusion In orthopedic forearm surgeries under supraclavicular nerve block, the VR distraction technique can reduce intraoperative sedation requirements and improve patient satisfaction.
{"title":"Efficacy of virtual reality distraction technique for anxiety and pain control in orthopedic forearm surgeries performed under supraclavicular brachial plexus block: A randomized controlled study","authors":"M. Gamal, A. Rady, M. Gamal, Haitham Hassan","doi":"10.1080/11101849.2023.2223829","DOIUrl":"https://doi.org/10.1080/11101849.2023.2223829","url":null,"abstract":"ABSTRACT Background Virtual reality (VR) distraction has been considered an alternative to medication to treat acute pain related to different procedures. This study aimed to evaluate the safety and efficacy of VR in reducing anxiety and pain in patients having orthopedic forearm operations under supraclavicular brachial plexus block. Methods This was an open-label, parallel-group, randomized trial. Thirty adult patients with American Society of Anesthesiologists physical status I or II were enrolled for orthopedic forearm operations performed under supraclavicular brachial plexus block. The patients were randomized into two equal groups. In the VR group, 15 patients performed the procedure with the use of VR and administration of midazolam according to the patient’s request, while in the control group, 15 patients received 2 mg midazolam followed by a titration dose according to the patient’s request. The primary outcome was the total intravenous sedation needed for the patient. Secondary outcomes included total perioperative analgesic utilization, incidence of harmful effects, patient satisfaction rating, and hemodynamic parameters. Results Virtual distraction technique significantly reduced the intraoperative midazolam consumption (2.00 ± 0.00 vs 6.67 ± 2.09 mg, respectively, p < 0.001) compared to the control group. The total perioperative analgesic consumption, incidence of adverse effects, and hemodynamic parameters were not significantly different in both groups. Patients who performed the block with the VR distraction technique showed better satisfaction scores compared to the control group (9.60 ± 0.51 vs 8.53 ± 0.92, respectively, p = 0.001). Conclusion In orthopedic forearm surgeries under supraclavicular nerve block, the VR distraction technique can reduce intraoperative sedation requirements and improve patient satisfaction.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42500104","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 : 2023-06-17DOI: 10.1080/11101849.2023.2224651
Zeinab Hamed Sawan, Sanaa Ahmed El-Tohamy, Khadeja M. Elhossieny, Osama Hussein Abdel-Halim Basha, Amr Shaaban Hafez
ABSTRACT Background Steroid injection is a widespread treatment for plantar fasciitis but seems to be useful to a lesser extent, Platelet-rich Plasma (PRP) injections into the plantar fascia start the healing process required to stop the degeneration of the plantar fascia at its root. Aim of the study To compare analgesic efficacy, functional outcome, degree of satisfaction and improvement of fascial thickness and echogenicity after platelet-rich plasma injection versus corticosteroids injection in refractory cases of plantar fasciitis. Patients & method 60 patients with refractory plantar fasciitis who were resistant to conservative treatment were randomized to receive either PRP or steroid injection. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Score (VAS) for pain, the Roles-Maudsley (RM) Score and plantar fascia thickness and echogenicity. Data were collected prospectively, pre-treatment, at 3, 6, 12 week, and 6 months post-injection. Results There was significant improvement in both groups as regards the clinical outcome measures involving (VAS & AOFAS) and radiological outcome measures including (thickness and echogenicity) in all post-injection times. However, steroid group showed early improvement (at 3rd week post-injection) with short duration while PRP group showed improvement at 12 weeks post-injection till the end of the study. Conclusion The use of PRP injection is safer with better analgesia and functional outcome than steroid therapy for treating chronic plantar fasciitis.
{"title":"Analgesic efficacy and functional outcome in refractory cases of plantar fasciitis treated with platelet-rich plasma: randomized comparative study with corticosteroids injection","authors":"Zeinab Hamed Sawan, Sanaa Ahmed El-Tohamy, Khadeja M. Elhossieny, Osama Hussein Abdel-Halim Basha, Amr Shaaban Hafez","doi":"10.1080/11101849.2023.2224651","DOIUrl":"https://doi.org/10.1080/11101849.2023.2224651","url":null,"abstract":"ABSTRACT Background Steroid injection is a widespread treatment for plantar fasciitis but seems to be useful to a lesser extent, Platelet-rich Plasma (PRP) injections into the plantar fascia start the healing process required to stop the degeneration of the plantar fascia at its root. Aim of the study To compare analgesic efficacy, functional outcome, degree of satisfaction and improvement of fascial thickness and echogenicity after platelet-rich plasma injection versus corticosteroids injection in refractory cases of plantar fasciitis. Patients & method 60 patients with refractory plantar fasciitis who were resistant to conservative treatment were randomized to receive either PRP or steroid injection. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Score (VAS) for pain, the Roles-Maudsley (RM) Score and plantar fascia thickness and echogenicity. Data were collected prospectively, pre-treatment, at 3, 6, 12 week, and 6 months post-injection. Results There was significant improvement in both groups as regards the clinical outcome measures involving (VAS & AOFAS) and radiological outcome measures including (thickness and echogenicity) in all post-injection times. However, steroid group showed early improvement (at 3rd week post-injection) with short duration while PRP group showed improvement at 12 weeks post-injection till the end of the study. Conclusion The use of PRP injection is safer with better analgesia and functional outcome than steroid therapy for treating chronic plantar fasciitis.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41972204","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 : 2023-06-13DOI: 10.1080/11101849.2023.2223474
Amani H. Abdel-wahab, Radwan A. Torky
ABSTRACT Background The best ventilation mode that suits with LMAs is still unclear. In this study, we investigated the ventilatory performance of Baska masks in patients who underwent elective laparoscopic cholecystectomy under general anaesthesia and pneumoperitoneum with either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) mode. Methods Fifty-Six patients with ASA I – II, who underwent laparoscopic cholecystectomy, were randomly classified into VCV (n = 28) and PCV (n = 28) groups. The lung was ventilated with a tidal volume of 8 ml/kg in the VCV group. It was ventilated initially using an inflating pressure that delivered a tidal volume of 8 ml/kg with a maximum of 35 cmH2O in the PCV group. The primary outcome was the intraoperative oropharyngeal leak pressure (OLP) of the Baska mask. Secondary outcomes were intraoperative lung mechanics, arterial carbon dioxide levels, and perioperative adverse effects. Results After pneumoperitoneum inflation, the OLP, peak inflation pressure (PIP), mean pressure (Pmean), PaCO2, and end-tidal CO2 significantly increased, and the calculated dynamic compliance significantly decreased in both ventilation modes. All variables partially returned to baseline after pneumoperitoneum deflation. Patients ventilated with PCV mode demonstrated significantly lower PIP and PaCO2 levels but higher dynamic compliance with statistically comparable OLP-PIP difference and higher leak fraction. Conclusion In this study, Patients ventilated with PCV mode showed lower PIP and PaCO2 but higher dynamic compliance, and higher leak fraction. However, both modes investigated provided effective Baska mask ventilation and maintained the OLP throughout the procedure with a statistically comparable OLP-PIP difference.
{"title":"Pressure versus volume-controlled ventilation with BASKA mask airway in laparoscopic cholecystectomy: A randomized clinical study","authors":"Amani H. Abdel-wahab, Radwan A. Torky","doi":"10.1080/11101849.2023.2223474","DOIUrl":"https://doi.org/10.1080/11101849.2023.2223474","url":null,"abstract":"ABSTRACT Background The best ventilation mode that suits with LMAs is still unclear. In this study, we investigated the ventilatory performance of Baska masks in patients who underwent elective laparoscopic cholecystectomy under general anaesthesia and pneumoperitoneum with either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) mode. Methods Fifty-Six patients with ASA I – II, who underwent laparoscopic cholecystectomy, were randomly classified into VCV (n = 28) and PCV (n = 28) groups. The lung was ventilated with a tidal volume of 8 ml/kg in the VCV group. It was ventilated initially using an inflating pressure that delivered a tidal volume of 8 ml/kg with a maximum of 35 cmH2O in the PCV group. The primary outcome was the intraoperative oropharyngeal leak pressure (OLP) of the Baska mask. Secondary outcomes were intraoperative lung mechanics, arterial carbon dioxide levels, and perioperative adverse effects. Results After pneumoperitoneum inflation, the OLP, peak inflation pressure (PIP), mean pressure (Pmean), PaCO2, and end-tidal CO2 significantly increased, and the calculated dynamic compliance significantly decreased in both ventilation modes. All variables partially returned to baseline after pneumoperitoneum deflation. Patients ventilated with PCV mode demonstrated significantly lower PIP and PaCO2 levels but higher dynamic compliance with statistically comparable OLP-PIP difference and higher leak fraction. Conclusion In this study, Patients ventilated with PCV mode showed lower PIP and PaCO2 but higher dynamic compliance, and higher leak fraction. However, both modes investigated provided effective Baska mask ventilation and maintained the OLP throughout the procedure with a statistically comparable OLP-PIP difference.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46744380","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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