Pub Date : 2023-06-10DOI: 10.1080/11101849.2023.2222471
Sherif Abdullah Mohamed, Marco Makram Saad, H. Gomaa, H. Omar
ABSTRACT Background Pain control after surgery is of highest priority. Erector spinae plane block [ESPB] was reported to be a successful method to reduce pain scores and consumption of postoperative opioids. However, hardly any investigation has looked at the ideal volume of bupivacaine for ESPB. So, this work tried to fill this gap of literature in patients undergoing simple nephrectomy. Methods In this randomized double blinded control study, 100 cases undergoing simple nephrectomy were randomized into 4 groups with 25 patients per group. Group E1, 2, and 3 received ESPB with 2.5, 3.4, and 6.6 ml/segment of 0.25% bupivacaine, respectively, whereas there was no block given to the control group. Intraoperative fentanyl consumption, heart rate [HR] and the blood pressure [BP], Postoperative morphine consumption, time passed to first analgesic request, numerical rating score [NRS] of pain, the complications, HR and BP were documented for 24 hours after the operation. Results The reduction in intraoperative fentanyl consumption, postoperative morphine consumption and NRS were a significantly different between the block groups and control. Group E3 had significant difference from other groups with the longest time to first analgesia request. A lower HR was shown in block groups but within normal range. BP showed insignificant difference between groups. There were no reported complications in all study groups. Conclusions The volume of 6.6 ml/level was associated with the best pain control, without significant hemodynamic changes or adverse events as compared to other groups. This suggests that this volume may be the optimal for ESPB in patients undergoing simple nephrectomy.
{"title":"Efficacy of different local anaesthetic volumes during erector spinae block for postoperative pain management in patients undergoing open nephrectomy operations. A randomized controlled study","authors":"Sherif Abdullah Mohamed, Marco Makram Saad, H. Gomaa, H. Omar","doi":"10.1080/11101849.2023.2222471","DOIUrl":"https://doi.org/10.1080/11101849.2023.2222471","url":null,"abstract":"ABSTRACT Background Pain control after surgery is of highest priority. Erector spinae plane block [ESPB] was reported to be a successful method to reduce pain scores and consumption of postoperative opioids. However, hardly any investigation has looked at the ideal volume of bupivacaine for ESPB. So, this work tried to fill this gap of literature in patients undergoing simple nephrectomy. Methods In this randomized double blinded control study, 100 cases undergoing simple nephrectomy were randomized into 4 groups with 25 patients per group. Group E1, 2, and 3 received ESPB with 2.5, 3.4, and 6.6 ml/segment of 0.25% bupivacaine, respectively, whereas there was no block given to the control group. Intraoperative fentanyl consumption, heart rate [HR] and the blood pressure [BP], Postoperative morphine consumption, time passed to first analgesic request, numerical rating score [NRS] of pain, the complications, HR and BP were documented for 24 hours after the operation. Results The reduction in intraoperative fentanyl consumption, postoperative morphine consumption and NRS were a significantly different between the block groups and control. Group E3 had significant difference from other groups with the longest time to first analgesia request. A lower HR was shown in block groups but within normal range. BP showed insignificant difference between groups. There were no reported complications in all study groups. Conclusions The volume of 6.6 ml/level was associated with the best pain control, without significant hemodynamic changes or adverse events as compared to other groups. This suggests that this volume may be the optimal for ESPB in patients undergoing simple nephrectomy.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46564720","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 : 2023-06-01DOI: 10.1080/11101849.2023.2287794
D. Ibrahim, Z. Mostafa, Yasser Alaa Ismail, T. Ashoor
ABSTRACT Background Children’s agitation increases following sevoflurane anaesthesia. With indefinite results, nalbuphine and midazolam have been used as preventative treatments. Patients and Methods This study involved 90 children with American Society of Anesthesiologists score I-II and aged 4–10 who had sevoflurane-based adenotonsillectomy. Each child was randomly assigned to one of three groups; group N, group K, and group S. Nalbuphine was given to Group N at 0.1 mg/kg, ketamine was given to Group K at 0.25 mg/kg, and saline was given to Group S at equivalent volume. Sevoflurane was discontinued after the procedure, and the study drugs were given. The emergence agitation (EA) scale was used in the post-anesthesia care unit (PACU) to measure agitation upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), and 30 min (T30). Clinical trials. gov ID: NCT05176119. Results In the PACU, the incidence of EA was significantly lowered in N (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S in comparison to K and N groups (p-value = 0.011), more patients experienced postoperative pain in S group compared to N group and K group (p-value < 0.001). Conclusion Children who had sevoflurane-induced adenotonsillectomy can avoid emergence agitation with ketamine 0.25 mg/kg or nalbuphine 0.1 mg/kg.
{"title":"The effect of low dose nalbuphine or ketamine in the prevention of emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy with or without adenoidectomy","authors":"D. Ibrahim, Z. Mostafa, Yasser Alaa Ismail, T. Ashoor","doi":"10.1080/11101849.2023.2287794","DOIUrl":"https://doi.org/10.1080/11101849.2023.2287794","url":null,"abstract":"ABSTRACT Background Children’s agitation increases following sevoflurane anaesthesia. With indefinite results, nalbuphine and midazolam have been used as preventative treatments. Patients and Methods This study involved 90 children with American Society of Anesthesiologists score I-II and aged 4–10 who had sevoflurane-based adenotonsillectomy. Each child was randomly assigned to one of three groups; group N, group K, and group S. Nalbuphine was given to Group N at 0.1 mg/kg, ketamine was given to Group K at 0.25 mg/kg, and saline was given to Group S at equivalent volume. Sevoflurane was discontinued after the procedure, and the study drugs were given. The emergence agitation (EA) scale was used in the post-anesthesia care unit (PACU) to measure agitation upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), and 30 min (T30). Clinical trials. gov ID: NCT05176119. Results In the PACU, the incidence of EA was significantly lowered in N (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S in comparison to K and N groups (p-value = 0.011), more patients experienced postoperative pain in S group compared to N group and K group (p-value < 0.001). Conclusion Children who had sevoflurane-induced adenotonsillectomy can avoid emergence agitation with ketamine 0.25 mg/kg or nalbuphine 0.1 mg/kg.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"15 1","pages":"894 - 899"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139371363","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 : 2023-05-25DOI: 10.1080/11101849.2023.2217593
Mona Gad Mostafa Elebieby, Mohammed Nashaat Mohammd, K. Abdelwahab, Emadeldeen Hamed, Zenat Eldadamony Mohamed Eldadamony
ABSTRACT Background Surgery for breast malignancy is linked to severe perioperative discomfort. Pain management reduces the need for opioids and general anesthesia. The “erector spinae plane block” (ESPB) recently became an effective choice in this concern. Our trial assessed the effectiveness of calcitonin as an LA adjuvant in ESPB for pain control in patients underwent cancer breast surgery. Patients and Methods One hundred and thirty patients were randomly allocated into two groups, BC and B. BC group received ESPB with 20 mL of bupivacaine 0.25% in addition to 50 IU of calcitonin in 2 mL of saline, while the other group received the same bupivacaine dose in addition to saline (2 ml). Main outcome was time for first rescue analgesia. Secondary outcomes included 24-h total morphine consumption postoperatively, postoperative VAS scores, levels of inflammatory cytokines, total intraoperative fentanyl consumption, and side effects. Results The period before the first-time analgesia was required was extended (12.18 ± 4.969 h vs 6.60 ± 3.116 h, P < 0.001), with less postoperative opioid consumption in the BC group (6.40 ± 1.876 mg vs 7.74 ± 2.117 mg, P < 0.001). Pain scores and the number of patients who asked for painkillers after surgery were less in the BC group. Patients in the BC group had a significant decline in serum inflammatory cytokines (TNF-α, IL-6), while IL-10 showed a significant increase in the BC group (P < 0.001). Intraoperative fentanyl and postoperative adverse effects recorded were statistically comparable in the two studied groups. Conclusion The addition of calcitonin to bupivacaine in the ESPB block can give an extended analgesic effect with lower inflammatory cytokine indicators.
{"title":"Analgesic effect of adding calcitonin to bupivacaine in erector spine plane block for breast surgery, a double blind randomised study","authors":"Mona Gad Mostafa Elebieby, Mohammed Nashaat Mohammd, K. Abdelwahab, Emadeldeen Hamed, Zenat Eldadamony Mohamed Eldadamony","doi":"10.1080/11101849.2023.2217593","DOIUrl":"https://doi.org/10.1080/11101849.2023.2217593","url":null,"abstract":"ABSTRACT Background Surgery for breast malignancy is linked to severe perioperative discomfort. Pain management reduces the need for opioids and general anesthesia. The “erector spinae plane block” (ESPB) recently became an effective choice in this concern. Our trial assessed the effectiveness of calcitonin as an LA adjuvant in ESPB for pain control in patients underwent cancer breast surgery. Patients and Methods One hundred and thirty patients were randomly allocated into two groups, BC and B. BC group received ESPB with 20 mL of bupivacaine 0.25% in addition to 50 IU of calcitonin in 2 mL of saline, while the other group received the same bupivacaine dose in addition to saline (2 ml). Main outcome was time for first rescue analgesia. Secondary outcomes included 24-h total morphine consumption postoperatively, postoperative VAS scores, levels of inflammatory cytokines, total intraoperative fentanyl consumption, and side effects. Results The period before the first-time analgesia was required was extended (12.18 ± 4.969 h vs 6.60 ± 3.116 h, P < 0.001), with less postoperative opioid consumption in the BC group (6.40 ± 1.876 mg vs 7.74 ± 2.117 mg, P < 0.001). Pain scores and the number of patients who asked for painkillers after surgery were less in the BC group. Patients in the BC group had a significant decline in serum inflammatory cytokines (TNF-α, IL-6), while IL-10 showed a significant increase in the BC group (P < 0.001). Intraoperative fentanyl and postoperative adverse effects recorded were statistically comparable in the two studied groups. Conclusion The addition of calcitonin to bupivacaine in the ESPB block can give an extended analgesic effect with lower inflammatory cytokine indicators.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42075728","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 : 2023-05-24DOI: 10.1080/11101849.2023.2216534
Sameh Salem Hafny Taha, Beshoy Eshak Aziz Hanna, Gamal M. Elewa, Hadil Magdy Abd Elhamid Mohamed, Dalia Fahmy Emam Ali, Mohamed MoienMohamed Elsaid
ABSTRACT Background Video-assisted thoracoscopic surgery is a minimally invasive technique resulting in decrease levels of pain. However, to provide more effective pain control after VATS, this necessitates analgesia that inhibits somatic and visceral nerve fibers. Aim of the study Aim of the study is to compare SAPB or ESPB for postoperative analgesia following VATS, as determined by the time until the first analgesic requirement. Comparisons of adverse effects and total analgesic requirement in the first 24-hour post-operative were the secondary endpoints. Patients and Methods Forty patients participated in this prospective randomized clinical study. At the conclusion of surgery, 20 patients underwent a single-injection US-guided ESPB, and 20 patients underwent a SAPB after VATS. Inclusion Criteria: (ASA) 1–3. Exclusion criteria: Patients <20 or >80 years old, patients who refuse to take part in the research, patients have a history of medication allergies, contraindication to regional anesthesia, severe hepatic and renal dysfunction Results As regarding to demographic information, there were no significant changes between the two groups. Timing of the first analgesic requirement was statistically faster among SAPB Group (12.54 ± 6.46 h) compared to ESPB Group (18.29 ± 6.05 h). Postoperative pethidine required was significantly higher in SAPB group than in ESBP group [ESPB (35.71 ± 19.67 mg) < SAPB (63.08 ± 25.29 mg), with p-value <0.05. No remarkable side effects were found in the two groups. Conclusion Both ESPB and SAPB can be used for pain control after VATS. Our study showed that US-directed ESPB offers more effective pain management than SAPB.
{"title":"Comparison between serratus anterior plane block versus erector spinae plane block for postoperative analgesia after video-assisted thoracoscopic surgery (VATS)","authors":"Sameh Salem Hafny Taha, Beshoy Eshak Aziz Hanna, Gamal M. Elewa, Hadil Magdy Abd Elhamid Mohamed, Dalia Fahmy Emam Ali, Mohamed MoienMohamed Elsaid","doi":"10.1080/11101849.2023.2216534","DOIUrl":"https://doi.org/10.1080/11101849.2023.2216534","url":null,"abstract":"ABSTRACT Background Video-assisted thoracoscopic surgery is a minimally invasive technique resulting in decrease levels of pain. However, to provide more effective pain control after VATS, this necessitates analgesia that inhibits somatic and visceral nerve fibers. Aim of the study Aim of the study is to compare SAPB or ESPB for postoperative analgesia following VATS, as determined by the time until the first analgesic requirement. Comparisons of adverse effects and total analgesic requirement in the first 24-hour post-operative were the secondary endpoints. Patients and Methods Forty patients participated in this prospective randomized clinical study. At the conclusion of surgery, 20 patients underwent a single-injection US-guided ESPB, and 20 patients underwent a SAPB after VATS. Inclusion Criteria: (ASA) 1–3. Exclusion criteria: Patients <20 or >80 years old, patients who refuse to take part in the research, patients have a history of medication allergies, contraindication to regional anesthesia, severe hepatic and renal dysfunction Results As regarding to demographic information, there were no significant changes between the two groups. Timing of the first analgesic requirement was statistically faster among SAPB Group (12.54 ± 6.46 h) compared to ESPB Group (18.29 ± 6.05 h). Postoperative pethidine required was significantly higher in SAPB group than in ESBP group [ESPB (35.71 ± 19.67 mg) < SAPB (63.08 ± 25.29 mg), with p-value <0.05. No remarkable side effects were found in the two groups. Conclusion Both ESPB and SAPB can be used for pain control after VATS. Our study showed that US-directed ESPB offers more effective pain management than SAPB.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44265655","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 : 2023-05-22DOI: 10.1080/11101849.2023.2215089
R. M. Hashim, Nada Mohamed Radwan, Omar Mohamed Taha Elsafty, Waleed Abdalla Ibrahim, T. Shabana
ABSTRACT Background and Aims Liver transplantation is associated with hemodynamic instability. Systemic and Splanchnic circulations interact closely. Portal hypertension is linked to vasodilatory molecules resulting in arterial vasodilatation. Terlipressin, is a synthetic vasopressin analogue causes selective vasoconstriction of splanchnic arteriols, thus decreasing splanchnic blood flow and shifting blood from the splanchnic to the systemic circulation resulting in enhanced systemic hemodynamics. This study aimed to assess the impact of intraoperative terlipressin on systemic and hepatic hemodynamics in recipients of living donor liver transplantation (LDLT). Methods The present longitudinal observational study was carried out at Ain Shams Center for Organ Transplant on 30 cases suffering from portal hypertension and chronic liver disease undergoing LDLT. Subjects were equally categorized into two groups: Group 1(control): patients did not receive intraoperative terlipressin, Group 2 (terlipressin): patients received terlipressin (1 mg intravenously over 10 min) just after exposure of the portal vein to maintain mean arterial blood pressure over 65 mmHg. Results Systolic and diastolic blood pressure were better preserved in the terlipressin group, with reduced norepinephrine requirements as well as a substantial decline in the heart rate during the anhepatic and reperfusion phases (P < 0.05). Terlipressin significantly decreases portal venous pressure with (P = 0.03) and portal vein flow (P < 0.001) without altering the hepatic artery resistivity index (HARI) (P = 0.219). Conclusion Intraoperative terlipressin during liver transplantation surgery was associated with improved systemic hemodynamics despite decreased portal venous pressure and blood flow, without affecting HARI.
{"title":"Effect of terlipressin on systemic and hepatic hemodynamics in patients undergoing liver transplantation","authors":"R. M. Hashim, Nada Mohamed Radwan, Omar Mohamed Taha Elsafty, Waleed Abdalla Ibrahim, T. Shabana","doi":"10.1080/11101849.2023.2215089","DOIUrl":"https://doi.org/10.1080/11101849.2023.2215089","url":null,"abstract":"ABSTRACT Background and Aims Liver transplantation is associated with hemodynamic instability. Systemic and Splanchnic circulations interact closely. Portal hypertension is linked to vasodilatory molecules resulting in arterial vasodilatation. Terlipressin, is a synthetic vasopressin analogue causes selective vasoconstriction of splanchnic arteriols, thus decreasing splanchnic blood flow and shifting blood from the splanchnic to the systemic circulation resulting in enhanced systemic hemodynamics. This study aimed to assess the impact of intraoperative terlipressin on systemic and hepatic hemodynamics in recipients of living donor liver transplantation (LDLT). Methods The present longitudinal observational study was carried out at Ain Shams Center for Organ Transplant on 30 cases suffering from portal hypertension and chronic liver disease undergoing LDLT. Subjects were equally categorized into two groups: Group 1(control): patients did not receive intraoperative terlipressin, Group 2 (terlipressin): patients received terlipressin (1 mg intravenously over 10 min) just after exposure of the portal vein to maintain mean arterial blood pressure over 65 mmHg. Results Systolic and diastolic blood pressure were better preserved in the terlipressin group, with reduced norepinephrine requirements as well as a substantial decline in the heart rate during the anhepatic and reperfusion phases (P < 0.05). Terlipressin significantly decreases portal venous pressure with (P = 0.03) and portal vein flow (P < 0.001) without altering the hepatic artery resistivity index (HARI) (P = 0.219). Conclusion Intraoperative terlipressin during liver transplantation surgery was associated with improved systemic hemodynamics despite decreased portal venous pressure and blood flow, without affecting HARI.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45566858","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 : 2023-05-18DOI: 10.1080/11101849.2023.2213936
Nirvana Ahmed Elshalakany
ABSTRACT Objective The goal of this trial was to determine if fentanyl PCIA and background infusion are effective for post-total hip replacement analgesia. Methods This trial examined two groups of patients receiving PCIA who had total hip replacements: group A (n = 35) with no background infusion, lockout time of 6 min; group B (n = 35) with background infusion 2 mL/h infusion, lockout time of 10 min. The fentanyl dose in each group was diluted with 100 mL normal saline. Primary outcome was VAS scores at rest after 24 hr. The secondary outcomes included VAS scores at rest at 6, 12, and 18 hr, fentanyl consumption, injection to attempt ratio, blood pressure, and heart rate. Results Neither background infusion nor no background infusion showed significant differences in VAS scores at 24 hr. Background infusion groups exhibited lower VAS pain levels at 6, 12, and 18 hr. At 24 hr after surgery, attempts, injections, and fentanyl consumption were significantly different between the two groups (P < 0.001). While BP and HR did not differ significantly between groups, pain control effectiveness showed statistically significant differences between groups. Conclusion Background infusion increased the overall quantity of fentanyl consumed within 24 hr after total hip replacement. The background infusion considerably decreased the pain at 6, 12, and 18 hr, but it had little effect on hip replacement pain at 24 hr. Importantly, it did not increase the incidence of BP, and HR. However, there were no significant differences in BP or HR between both groups, Fentanyl Background infusion was effective for post-total hip replacement analgesia.
{"title":"Influence of fentanyl-based Patient-Controlled Intravenous Analgesia (PCIA) with and without background infusion on postoperative pain intensity in patients following total hip replacement","authors":"Nirvana Ahmed Elshalakany","doi":"10.1080/11101849.2023.2213936","DOIUrl":"https://doi.org/10.1080/11101849.2023.2213936","url":null,"abstract":"ABSTRACT Objective The goal of this trial was to determine if fentanyl PCIA and background infusion are effective for post-total hip replacement analgesia. Methods This trial examined two groups of patients receiving PCIA who had total hip replacements: group A (n = 35) with no background infusion, lockout time of 6 min; group B (n = 35) with background infusion 2 mL/h infusion, lockout time of 10 min. The fentanyl dose in each group was diluted with 100 mL normal saline. Primary outcome was VAS scores at rest after 24 hr. The secondary outcomes included VAS scores at rest at 6, 12, and 18 hr, fentanyl consumption, injection to attempt ratio, blood pressure, and heart rate. Results Neither background infusion nor no background infusion showed significant differences in VAS scores at 24 hr. Background infusion groups exhibited lower VAS pain levels at 6, 12, and 18 hr. At 24 hr after surgery, attempts, injections, and fentanyl consumption were significantly different between the two groups (P < 0.001). While BP and HR did not differ significantly between groups, pain control effectiveness showed statistically significant differences between groups. Conclusion Background infusion increased the overall quantity of fentanyl consumed within 24 hr after total hip replacement. The background infusion considerably decreased the pain at 6, 12, and 18 hr, but it had little effect on hip replacement pain at 24 hr. Importantly, it did not increase the incidence of BP, and HR. However, there were no significant differences in BP or HR between both groups, Fentanyl Background infusion was effective for post-total hip replacement analgesia.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47561057","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 : 2023-05-11DOI: 10.1080/11101849.2023.2209415
Shady Rady Abdalla, Ahmed Salah Abdelazeem, Tarek Abdelhalium Kaddah, Abla Salah Elhadedy, Hanan Farouk Khafagy, Ahmed Abdalla Mohamed, Ahmed Mohamed Essam
Background Transesophageal Doppler (TED) is a minimally invasive monitor that allows continuous hemodynamic variables monitoring. Non-invasive electrical cardiometry (EC) and TED methods added an additional facility to monitor cardiac output (CO) continuously and guide fluid management. The aim of this study was to correlate hemodynamic monitoring between non-invasive EC and Esophageal Doppler (ED) in cases undergoing major abdominal surgery.Methods This prospective observational study was carried out on 35 adult cases, American Society of Anesthesiologists (ASA) physical status II or III, undergoing major abdominal surgery. Esophageal Doppler and EC were attached to the same patient. Parameters measured were hemodynamic parameters.Results Comparison of CO with ICON and ED showed that the ICON mean value ranged from 5.6 to 6.2 l/min, and the ED mean value always ranged from 5.7 to 7.6 l/min with the non-significant difference between the two methods. The precision for the ICON ranged from 15.19 to 17.99% and the precision for ED ranged from 13.39 to 17.08%. At a 15% change in ICON, the ED values’ sensitivity was 72.6% and specificity was 30.9% with AUC 0.505.Conclusion The agreement between CO measured by EC and ED is acceptable. Both monitored trend changes and guided fluid administration in the operation theater. The EC is as accurate as ED in measuring hemodynamics during major abdominal surgery.
{"title":"Hemodynamic monitoring and correlation between electrical cardiometry and esophageal Doppler in patients undergoing major abdominal surgery","authors":"Shady Rady Abdalla, Ahmed Salah Abdelazeem, Tarek Abdelhalium Kaddah, Abla Salah Elhadedy, Hanan Farouk Khafagy, Ahmed Abdalla Mohamed, Ahmed Mohamed Essam","doi":"10.1080/11101849.2023.2209415","DOIUrl":"https://doi.org/10.1080/11101849.2023.2209415","url":null,"abstract":"Background Transesophageal Doppler (TED) is a minimally invasive monitor that allows continuous hemodynamic variables monitoring. Non-invasive electrical cardiometry (EC) and TED methods added an additional facility to monitor cardiac output (CO) continuously and guide fluid management. The aim of this study was to correlate hemodynamic monitoring between non-invasive EC and Esophageal Doppler (ED) in cases undergoing major abdominal surgery.Methods This prospective observational study was carried out on 35 adult cases, American Society of Anesthesiologists (ASA) physical status II or III, undergoing major abdominal surgery. Esophageal Doppler and EC were attached to the same patient. Parameters measured were hemodynamic parameters.Results Comparison of CO with ICON and ED showed that the ICON mean value ranged from 5.6 to 6.2 l/min, and the ED mean value always ranged from 5.7 to 7.6 l/min with the non-significant difference between the two methods. The precision for the ICON ranged from 15.19 to 17.99% and the precision for ED ranged from 13.39 to 17.08%. At a 15% change in ICON, the ED values’ sensitivity was 72.6% and specificity was 30.9% with AUC 0.505.Conclusion The agreement between CO measured by EC and ED is acceptable. Both monitored trend changes and guided fluid administration in the operation theater. The EC is as accurate as ED in measuring hemodynamics during major abdominal surgery.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135526898","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 : 2023-05-08DOI: 10.1080/11101849.2023.2208905
Yasser Essam Elfeil, E. Deghidy
ABSTRACT Background The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = −.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (−2.089, −4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = −1.9, P = .05) and (z = −4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5–15) vs. median of PI after 7.5 (6–15.5) (z = −6.6, P < .0001)]. Discussion After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure.
{"title":"Role of perfusion index in early detection of hypotension following spinal anesthesia for cesarean section","authors":"Yasser Essam Elfeil, E. Deghidy","doi":"10.1080/11101849.2023.2208905","DOIUrl":"https://doi.org/10.1080/11101849.2023.2208905","url":null,"abstract":"ABSTRACT Background The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = −.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (−2.089, −4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = −1.9, P = .05) and (z = −4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5–15) vs. median of PI after 7.5 (6–15.5) (z = −6.6, P < .0001)]. Discussion After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47981299","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 : 2023-05-04DOI: 10.1080/11101849.2023.2209411
Hamed Elgendy, A. Ganaw, Vipin Kumari, Vijay Settu, P. Chandra, Hanaa Nafady-Hego, Mohamad Hilani, H. Ismail, Mohamed Elkateeb
Background There were increased claims of thrombotic events in ICU-bound patients with COVID-19. We designed this observational study to examine implementation of systemic anti-coagulation on arterial catheter patency and its failure and to identify risk factors for arterial catheter failure. Methods A total of 245 COVID-19 subjects were included in this observational study, 48 patients in the non-systemic, (Non-SA), (Prophylactic) anticoagulation cohort, and 197 patients in the systemic (SA), (Therapeutic) anticoagulation group. The first arterial line inserted on ICU admission for every patient was monitored regarding its duration of the patency, number and location of consecutive arterial lines inserted during stay in ICU. Demographics of patients, ICU parameters and risk factors for arterial line failure were followed and analyzed. Results The percentage of arterial line failure was significantly higher in Non-SA group, 45.8% when compared to SA group, 25.9%, P = 0.007. The patients with arterial line failure exhibited higher D-dimer, co-morbidities, diabetic patients, received aspirin and mortality than the patent group, respectively, p = 0.002, p = 0.002, p < 0.0001, p < 0.0001, and p < 0.0001. This group also received higher sedation and prone position on mechanical ventilation and higher vasopressors, respectively, p = 0.034, p < 0.0001, p < 0.0001, and p < 0.0001 when compared to patent group. They had prolonged length of stay in ICU and hospital, respectively, p = 0.001 and p = 0.042. The cumulative incidence of index arterial line failure (Log-rank test 6.95, P = 0.008) with overall percentage was significantly lower in SA group (25.9%) compared to non-SA group (45.8%), respectively, P = 0.007. On Cox-proportional hazard multivariate regression analysis, independent predictors of arterial line failure increased platelets level (HR 1.00, 95% CI 1.00-1.01, P = 0.001), use of ultrasound use in arterial line insertion (HR 4.68, 95% CI 1.75-12.56, P = 0.002), and prone position in ICU (HR 1.94, 95% CI 1.09-3.42, P = 0.023). Conclusion We observed three independent predictors of arterial line failure including platelets level and ultrasound use during arterial catheter insertion and prone position in ICU. Systemic anticoagulation was associated with more patency of arterial catheter than prophylactic therapy group.
背景:在重症监护病房内的COVID-19患者中，血栓事件的发生率有所增加。我们设计了这项观察性研究，以检查全身抗凝对动脉导管通畅及其失败的实施情况，并确定动脉导管失败的危险因素。方法本观察性研究共纳入245例COVID-19患者，其中非全身性(Non-SA)(预防性)抗凝组48例，全身性(SA)(治疗性)抗凝组197例。监测每位患者在ICU入院时插入的第一条动脉线的通畅时间、住院期间插入的连续动脉线的数量和位置。对患者的人口学特征、ICU参数及动脉线衰竭的危险因素进行跟踪分析。结果非SA组动脉线衰竭发生率明显高于SA组，分别为45.8%和25.9%，P = 0.007。动脉线衰竭患者的d -二聚体、合并症、糖尿病患者、阿司匹林服用和死亡率分别高于专利组，p = 0.002、p = 0.002、p < 0.0001、p < 0.0001和p < 0.0001。与专利组相比，该组镇静、俯卧位机械通气、血管加压药物均高于专利组，p = 0.034、p < 0.0001、p < 0.0001、p < 0.0001。ICU和住院时间分别延长，p = 0.001和p = 0.042。SA组的累加动脉线衰竭发生率(Log-rank检验6.95,P = 0.008)与总百分比相比(25.9%)显著低于非SA组(45.8%)，P = 0.007。在Cox-proportional hazard multivariate regression analysis中，动脉线衰竭的独立预测因子增加血小板水平(HR 1.00, 95% CI 1.00-1.01, P = 0.001)，超声在动脉线插入中的使用(HR 4.68, 95% CI 1.75-12.56, P = 0.002)，以及ICU俯卧位(HR 1.94, 95% CI 1.09-3.42, P = 0.023)。结论观察到血小板水平、动脉导管置入时超声使用和ICU俯卧位三个独立的预测动脉线衰竭的因素。全身抗凝治疗组动脉导管通畅率高于预防治疗组。
{"title":"Risk factors influence the arterial line patency in ICU-bound patients during COVID-19 pandemic: An observational cohort study","authors":"Hamed Elgendy, A. Ganaw, Vipin Kumari, Vijay Settu, P. Chandra, Hanaa Nafady-Hego, Mohamad Hilani, H. Ismail, Mohamed Elkateeb","doi":"10.1080/11101849.2023.2209411","DOIUrl":"https://doi.org/10.1080/11101849.2023.2209411","url":null,"abstract":"Background There were increased claims of thrombotic events in ICU-bound patients with COVID-19. We designed this observational study to examine implementation of systemic anti-coagulation on arterial catheter patency and its failure and to identify risk factors for arterial catheter failure. Methods A total of 245 COVID-19 subjects were included in this observational study, 48 patients in the non-systemic, (Non-SA), (Prophylactic) anticoagulation cohort, and 197 patients in the systemic (SA), (Therapeutic) anticoagulation group. The first arterial line inserted on ICU admission for every patient was monitored regarding its duration of the patency, number and location of consecutive arterial lines inserted during stay in ICU. Demographics of patients, ICU parameters and risk factors for arterial line failure were followed and analyzed. Results The percentage of arterial line failure was significantly higher in Non-SA group, 45.8% when compared to SA group, 25.9%, P = 0.007. The patients with arterial line failure exhibited higher D-dimer, co-morbidities, diabetic patients, received aspirin and mortality than the patent group, respectively, p = 0.002, p = 0.002, p < 0.0001, p < 0.0001, and p < 0.0001. This group also received higher sedation and prone position on mechanical ventilation and higher vasopressors, respectively, p = 0.034, p < 0.0001, p < 0.0001, and p < 0.0001 when compared to patent group. They had prolonged length of stay in ICU and hospital, respectively, p = 0.001 and p = 0.042. The cumulative incidence of index arterial line failure (Log-rank test 6.95, P = 0.008) with overall percentage was significantly lower in SA group (25.9%) compared to non-SA group (45.8%), respectively, P = 0.007. On Cox-proportional hazard multivariate regression analysis, independent predictors of arterial line failure increased platelets level (HR 1.00, 95% CI 1.00-1.01, P = 0.001), use of ultrasound use in arterial line insertion (HR 4.68, 95% CI 1.75-12.56, P = 0.002), and prone position in ICU (HR 1.94, 95% CI 1.09-3.42, P = 0.023). Conclusion We observed three independent predictors of arterial line failure including platelets level and ultrasound use during arterial catheter insertion and prone position in ICU. Systemic anticoagulation was associated with more patency of arterial catheter than prophylactic therapy group.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47709939","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 : 2023-05-02DOI: 10.1080/11101849.2023.2205721
Salwa Omar Elkhattab, Z. A. Mustafa, M. Kamal, Gamal Saad Abdelhamid Hassab
Acute kidney injury post cardiac surgery in patients who develop low cardiac output syndrome (LCOS) postoperatively is a serious complication. Many studies have been performed to assess the effect of inotropic agents on cardiac function when administered postoperatively, some studies performed to evaluate the nephroprotective effect of conventional inotropic agents as compared to levosimendan. To evaluate the possible nephroprotective effect of Levosimendan as compared to betaagonists in cardiac surgery patients with LCOS. It is a randomized prospective comparative study at Ain Shams university hospitals from December 2020 to May 2021. A total of 60 patients who have developed low cardiac output syndrome post cardiac surgery divided into two groups of 30 patients each. Group A received beta-agonists (dobutamine 2 - 20 µ/kg/min or adrenaline 0.01 to 0.5 mcg/kg/minute) and Group B received levosimendan for 24 h at a rate of 0.1 mcg/kg/min to a target dose of 12.5 mg. we assessed the incidence of renal failure in these patients. We assessed the progress of acute kidney injury in patients who developed acute renal impairment at diagnosis of LCOS in both treatment groups. Parameters assessed include hemodynamics and renal function parameters. The incidence of acute kidney injury at diagnosis of LCOS postoperative was 30% (n = 9) in each group, 44% of them in the control group (n = 4) developed renal failure at discharge from ICU and none of the study group patients developed renal failure at discharge. At time of discharge from ICU the incidence of renal failure in beta – agonist group was 13.3% while the incidence in the levosimendan group was 0%. Levosimendan has a nephroprotective effect that plays a role in preservation of renal functions and decreasing the incidence of kidney failure in patients with LCOS post cardiac surgery as compared to beta – agonists.
{"title":"Comparison between levosimendan versus beta agonists in preservation of renal function in cardiac surgery patients with low cardiac output syndrome","authors":"Salwa Omar Elkhattab, Z. A. Mustafa, M. Kamal, Gamal Saad Abdelhamid Hassab","doi":"10.1080/11101849.2023.2205721","DOIUrl":"https://doi.org/10.1080/11101849.2023.2205721","url":null,"abstract":"\u0000 \u0000 \u0000 Acute kidney injury post cardiac surgery in patients who develop low cardiac output syndrome (LCOS) postoperatively is a serious complication. Many studies have been performed to assess the effect of inotropic agents on cardiac function when administered postoperatively, some studies performed to evaluate the nephroprotective effect of conventional inotropic agents as compared to levosimendan.\u0000 \u0000 \u0000 \u0000 To evaluate the possible nephroprotective effect of Levosimendan as compared to betaagonists in cardiac surgery patients with LCOS.\u0000 \u0000 \u0000 \u0000 It is a randomized prospective comparative study at Ain Shams university hospitals from December 2020 to May 2021. A total of 60 patients who have developed low cardiac output syndrome post cardiac surgery divided into two groups of 30 patients each. Group A received beta-agonists (dobutamine 2 - 20 µ/kg/min or adrenaline 0.01 to 0.5 mcg/kg/minute) and Group B received levosimendan for 24 h at a rate of 0.1 mcg/kg/min to a target dose of 12.5 mg. we assessed the incidence of renal failure in these patients. We assessed the progress of acute kidney injury in patients who developed acute renal impairment at diagnosis of LCOS in both treatment groups. Parameters assessed include hemodynamics and renal function parameters.\u0000 \u0000 \u0000 \u0000 The incidence of acute kidney injury at diagnosis of LCOS postoperative was 30% (n = 9) in each group, 44% of them in the control group (n = 4) developed renal failure at discharge from ICU and none of the study group patients developed renal failure at discharge. At time of discharge from ICU the incidence of renal failure in beta – agonist group was 13.3% while the incidence in the levosimendan group was 0%.\u0000 \u0000 \u0000 \u0000 Levosimendan has a nephroprotective effect that plays a role in preservation of renal functions and decreasing the incidence of kidney failure in patients with LCOS post cardiac surgery as compared to beta – agonists.\u0000","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44041299","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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