Pub Date : 2016-07-01DOI: 10.4103/1687-7934.189093
Vivek Chowdhry, B. B. Mohanty
Delirium or psychosis is a common entity in the postoperative period, affecting elderly ands well as middle-aged and young patients. Multiple factors predispose a patient to different forms of delirium. Postoperative delirium is associated with acute alteration in attention and cognitive impairment, which is responsible for significant increase in both morbidity and mortality. A wide range of drugs, including fluoroquinolones, can cause mental status changes in the postoperative period. Thus, a thorough knowledge of various drug actions and interactions as well as various risk factors can help an anesthesiologist counter the possible deleterious effects of delirium during the perioperative period. The side effects of fluoroquinolones on the central nervous system are well documented, although they are rarely suspected as the offending agents for delirium. We report the case of a middle-aged lady who after mitral valve replacement became delirious following levofloxacin administration in the postoperative period.
{"title":"Levofloxacin: a rarely suspected cause of delirium","authors":"Vivek Chowdhry, B. B. Mohanty","doi":"10.4103/1687-7934.189093","DOIUrl":"https://doi.org/10.4103/1687-7934.189093","url":null,"abstract":"Delirium or psychosis is a common entity in the postoperative period, affecting elderly ands well as middle-aged and young patients. Multiple factors predispose a patient to different forms of delirium. Postoperative delirium is associated with acute alteration in attention and cognitive impairment, which is responsible for significant increase in both morbidity and mortality. A wide range of drugs, including fluoroquinolones, can cause mental status changes in the postoperative period. Thus, a thorough knowledge of various drug actions and interactions as well as various risk factors can help an anesthesiologist counter the possible deleterious effects of delirium during the perioperative period. The side effects of fluoroquinolones on the central nervous system are well documented, although they are rarely suspected as the offending agents for delirium. We report the case of a middle-aged lady who after mitral valve replacement became delirious following levofloxacin administration in the postoperative period.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83397137","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 : 2016-07-01DOI: 10.4103/1687-7934.189099
A. A. Abd El-Hamid, Mohamed A. Alrabiey
Objectives This study aimed to evaluate the effect of the addition of dexamethasone to levobupivacaine on the duration of analgesia in forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients and methods This prospective randomized controlled, double-blind clinical trial was conducted on 60 patients who underwent elective forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients in the levobupivacaine group (group L) received 25 ml of 0.5% levobupivacaine plus 2 ml of normal saline 0.9%. Patients in the levobupivacaine dexamethasone group (group LD) received 25 ml of 0.5% levobupivacaine plus 2 ml of dexamethasone (8 mg). The onset of sensory and motor block, duration of the sensory block, time to first analgesic request, the number of failed block, total morphine consumption, side effects, and complications were recorded and compared. Results Onset of sensory block and motor block was significantly earlier in group LD compared with group L. Duration of sensory block and time to first analgesic request were significantly longer in group LD compared with group L. Total morphine consumption was significantly lower in group LD in comparison with group L. The number of failed blocks was nonsignificantly lower in group LD. The incidence of side effects and complications was low and comparable in both groups. Conclusion Addition of dexamethasone to levobupivacaine significantly shortens the onset of sensory and motor block, prolongs the duration of analgesia, decreases the 24 h morphine consumption, and prolongs the time to first analgesic request with minimal side effects.
目的探讨左旋布比卡因加地塞米松对超声引导下斜角间臂丛阻滞前臂手术镇痛时间的影响。患者与方法本前瞻性、随机对照、双盲临床试验对60例在超声引导下斜角肌间臂丛阻滞下接受选择性前臂手术的患者进行了研究。左布比卡因组(L组)给予0.5%左布比卡因25 ml加0.9%生理盐水2 ml。左布比卡因地塞米松组(LD组)患者给予0.5%左布比卡因25 ml加地塞米松2 ml (8 mg)。记录并比较感觉和运动阻滞的发生、感觉阻滞的持续时间、到第一次止痛要求的时间、阻滞失败次数、吗啡总消耗量、副作用和并发症。结果LD组感觉阻滞和运动阻滞发生时间明显早于l组，感觉阻滞持续时间和第一次请求镇痛时间明显长于l组。LD组吗啡总消耗量明显低于l组，阻滞失败次数显著低于l组，两组不良反应和并发症发生率均较低，具有可比性。结论左布比卡因加用地塞米松可显著缩短感觉和运动阻滞的发生时间，延长镇痛持续时间，减少24 h吗啡消耗，延长首次镇痛时间，且副作用最小。
{"title":"Dexamethasone added to levobupivacaine prolongs ultrasound-guided interscalene brachial plexus blockade: a prospective, randomized, controlled study","authors":"A. A. Abd El-Hamid, Mohamed A. Alrabiey","doi":"10.4103/1687-7934.189099","DOIUrl":"https://doi.org/10.4103/1687-7934.189099","url":null,"abstract":"Objectives This study aimed to evaluate the effect of the addition of dexamethasone to levobupivacaine on the duration of analgesia in forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients and methods This prospective randomized controlled, double-blind clinical trial was conducted on 60 patients who underwent elective forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients in the levobupivacaine group (group L) received 25 ml of 0.5% levobupivacaine plus 2 ml of normal saline 0.9%. Patients in the levobupivacaine dexamethasone group (group LD) received 25 ml of 0.5% levobupivacaine plus 2 ml of dexamethasone (8 mg). The onset of sensory and motor block, duration of the sensory block, time to first analgesic request, the number of failed block, total morphine consumption, side effects, and complications were recorded and compared. Results Onset of sensory block and motor block was significantly earlier in group LD compared with group L. Duration of sensory block and time to first analgesic request were significantly longer in group LD compared with group L. Total morphine consumption was significantly lower in group LD in comparison with group L. The number of failed blocks was nonsignificantly lower in group LD. The incidence of side effects and complications was low and comparable in both groups. Conclusion Addition of dexamethasone to levobupivacaine significantly shortens the onset of sensory and motor block, prolongs the duration of analgesia, decreases the 24 h morphine consumption, and prolongs the time to first analgesic request with minimal side effects.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74863078","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 : 2016-07-01DOI: 10.4103/1687-7934.189100
D. Chandramohan, S. D'souza
Introduction Caudal epidural block is a commonly performed procedure in pediatric anesthesia worldwide. Ketamine is used as an adjuvant in single-shot caudal blocks to prolong postoperative analgesia. Aims of the study This randomized double-blind study was carried out to evaluate the effect of the addition of preservative-free racemic ketamine 0.5 mg/kg to 0.25% bupivacaine (1 ml/kg) in caudal block on the duration of postoperative analgesia in pediatric patients and to observe adverse effects, if any. Materials and methods Sixty children, aged 2–9 years, undergoing infraumbilical surgical procedures were assigned randomly to one of two groups, B or BK, to receive 1 ml/kg of 0.25% bupivacaine or a mixture of 0.5 mg/kg of preservative-free racemic ketamine with 1 ml/kg of 0.25% bupivacaine, respectively, for single-shot caudal anesthesia. The postoperative pain score was assessed. Sedation, motor weakness, and other adverse effects were also observed. Observations and results The mean duration of analgesia was significantly longer (P < 0.01) in group BK (12.933 h) than in group B (3.467 h). The incidences of adverse effects such as urinary retention, vomiting, and motor weakness were comparable in the two groups (P > 0.05). Conclusion Preservative-free racemic ketamine at a dose of 0.5 mg/kg may be used as a safe and reliable adjunct to caudal bupivacaine for prolongation of postoperative analgesia in children. As racemic ketamine is less expensive and more easily available than S(+)-ketamine, further studies comparing their cost-effectiveness may help to establish the racemic preparation as an appropriate adjuvant for single-shot caudal analgesia, especially in nations where cost constraints exist.
{"title":"Preservative-free racemic ketamine with bupivacaine: a desirable option for extended caudal analgesia in pediatric surgery","authors":"D. Chandramohan, S. D'souza","doi":"10.4103/1687-7934.189100","DOIUrl":"https://doi.org/10.4103/1687-7934.189100","url":null,"abstract":"Introduction Caudal epidural block is a commonly performed procedure in pediatric anesthesia worldwide. Ketamine is used as an adjuvant in single-shot caudal blocks to prolong postoperative analgesia. Aims of the study This randomized double-blind study was carried out to evaluate the effect of the addition of preservative-free racemic ketamine 0.5 mg/kg to 0.25% bupivacaine (1 ml/kg) in caudal block on the duration of postoperative analgesia in pediatric patients and to observe adverse effects, if any. Materials and methods Sixty children, aged 2–9 years, undergoing infraumbilical surgical procedures were assigned randomly to one of two groups, B or BK, to receive 1 ml/kg of 0.25% bupivacaine or a mixture of 0.5 mg/kg of preservative-free racemic ketamine with 1 ml/kg of 0.25% bupivacaine, respectively, for single-shot caudal anesthesia. The postoperative pain score was assessed. Sedation, motor weakness, and other adverse effects were also observed. Observations and results The mean duration of analgesia was significantly longer (P < 0.01) in group BK (12.933 h) than in group B (3.467 h). The incidences of adverse effects such as urinary retention, vomiting, and motor weakness were comparable in the two groups (P > 0.05). Conclusion Preservative-free racemic ketamine at a dose of 0.5 mg/kg may be used as a safe and reliable adjunct to caudal bupivacaine for prolongation of postoperative analgesia in children. As racemic ketamine is less expensive and more easily available than S(+)-ketamine, further studies comparing their cost-effectiveness may help to establish the racemic preparation as an appropriate adjuvant for single-shot caudal analgesia, especially in nations where cost constraints exist.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77401021","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 : 2016-07-01DOI: 10.4103/1687-7934.189097
H. Toulan, E. Kamal
Background Early fluid resuscitation is vital to patients with sepsis. However, the choice of fluid has been a hot topic of discussion. The objective of this study was to compare hydroxyethyl starch (HES) 6% (130/0.4) with albumin 4% as a resuscitation fluid in septic patients. Patients and methods In this prospective randomized study, 80 patients aged 20–60 years of both sexes with sepsis were assigned to receive either HES (130/0.4) in 0.9% saline or human albumin 4% as a resuscitation fluid. Mortality rate after 28 days, need for renal replacement therapy, and duration of ICU stay were compared between the two groups. Results The mortality rate in the albumin group (22.5%) was lower than in the HES 6% group (40%) with significant P value (0.033). Also, the need for renal replacement therapy (RRT) and length of ICU stay were significantly higher in the HES 6% group compared with the albumin group. Conclusion Use of human albumin 4% has a significant effect in reducing mortality rates in the ICU in patients with severe sepsis compared with HES 6%.
{"title":"Human albumin 4% versus hydroxyethyl starch 6% for fluid resuscitation in sepsis","authors":"H. Toulan, E. Kamal","doi":"10.4103/1687-7934.189097","DOIUrl":"https://doi.org/10.4103/1687-7934.189097","url":null,"abstract":"Background Early fluid resuscitation is vital to patients with sepsis. However, the choice of fluid has been a hot topic of discussion. The objective of this study was to compare hydroxyethyl starch (HES) 6% (130/0.4) with albumin 4% as a resuscitation fluid in septic patients. Patients and methods In this prospective randomized study, 80 patients aged 20–60 years of both sexes with sepsis were assigned to receive either HES (130/0.4) in 0.9% saline or human albumin 4% as a resuscitation fluid. Mortality rate after 28 days, need for renal replacement therapy, and duration of ICU stay were compared between the two groups. Results The mortality rate in the albumin group (22.5%) was lower than in the HES 6% group (40%) with significant P value (0.033). Also, the need for renal replacement therapy (RRT) and length of ICU stay were significantly higher in the HES 6% group compared with the albumin group. Conclusion Use of human albumin 4% has a significant effect in reducing mortality rates in the ICU in patients with severe sepsis compared with HES 6%.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91319131","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 : 2016-04-01DOI: 10.4103/1687-7934.179910
M. Allam
Introduction Dexmedetomidine is a highly selective a-2 adrenoceptor agonist and eight times more specific than clonidine. It exerts its major sedative and analgesic effect through stimulation of the a-2 adrenoceptor and the locus coeruleus. Its analgesic effect is also produced by direct stimulation of the a-2 adrenoceptor in the spinal cord. The unique sedative effect of dexmedetomidine that mimics natural sleep makes the postsedative delirium after stopping dexmedetomidine very rare. Moreover, even on the sedative score Richmond Agitation-Sedation Scale (RASS)-1-2, patients can respond easily to verbal command and go back to sleep. The most commonly reported adverse effects are bradycardia and hypotension. Aim of the work This was a comparative prospective double-blind study comparing dexmedetomidine versus midazolam as a sedative agent used in noninvasive ventilation (NIV) and short-term intubation and mechanical ventilation (5 days). Patients and methods In all, 200 patients admitted to King Abd el Aziz Specialist Hospital, Taif, in the ICU with acute hypoxemia with SpO 2 less than 80% were allocated randomly to two groups. All patients in both groups were subjected to NIV for 3 days and if this failed (persistent hypoxemia, became hemodynamically unstable, or showed marked tracheal secretion), intubation and mechanical ventilation was considered for 5 days. Group A included 100 patients who received midazolam as a sedative agent, whereas group B included 100 patients who received dexmedetomidine as a sedative agent. The number of patients who responded to NIV in both groups was recorded and the number of patients who were extubated and weaned from mechanical ventilation in 5 days in both groups was also recorded together with the complications from sedation. Results There was a significant increase in the number of patients who responded to NIV in group B compared with group A. Moreover, there was a significant increase in the number of patients extubated and weaned from mechanical ventilation in the 5-day period in group B compared with group A. Conclusion Dexmedetomidine is a safer agent for sedation of critically ill patients with fewer incidences of delirium, and less morbidity and mortality compared with midazolam with the same efficacy.
{"title":"Dexmedetomidine versus midazolam for sedation of critically ill patients on noninvasive mechanical ventilation","authors":"M. Allam","doi":"10.4103/1687-7934.179910","DOIUrl":"https://doi.org/10.4103/1687-7934.179910","url":null,"abstract":"Introduction Dexmedetomidine is a highly selective a-2 adrenoceptor agonist and eight times more specific than clonidine. It exerts its major sedative and analgesic effect through stimulation of the a-2 adrenoceptor and the locus coeruleus. Its analgesic effect is also produced by direct stimulation of the a-2 adrenoceptor in the spinal cord. The unique sedative effect of dexmedetomidine that mimics natural sleep makes the postsedative delirium after stopping dexmedetomidine very rare. Moreover, even on the sedative score Richmond Agitation-Sedation Scale (RASS)-1-2, patients can respond easily to verbal command and go back to sleep. The most commonly reported adverse effects are bradycardia and hypotension. Aim of the work This was a comparative prospective double-blind study comparing dexmedetomidine versus midazolam as a sedative agent used in noninvasive ventilation (NIV) and short-term intubation and mechanical ventilation (5 days). Patients and methods In all, 200 patients admitted to King Abd el Aziz Specialist Hospital, Taif, in the ICU with acute hypoxemia with SpO 2 less than 80% were allocated randomly to two groups. All patients in both groups were subjected to NIV for 3 days and if this failed (persistent hypoxemia, became hemodynamically unstable, or showed marked tracheal secretion), intubation and mechanical ventilation was considered for 5 days. Group A included 100 patients who received midazolam as a sedative agent, whereas group B included 100 patients who received dexmedetomidine as a sedative agent. The number of patients who responded to NIV in both groups was recorded and the number of patients who were extubated and weaned from mechanical ventilation in 5 days in both groups was also recorded together with the complications from sedation. Results There was a significant increase in the number of patients who responded to NIV in group B compared with group A. Moreover, there was a significant increase in the number of patients extubated and weaned from mechanical ventilation in the 5-day period in group B compared with group A. Conclusion Dexmedetomidine is a safer agent for sedation of critically ill patients with fewer incidences of delirium, and less morbidity and mortality compared with midazolam with the same efficacy.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74091062","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 : 2016-04-01DOI: 10.4103/1687-7934.182290
B. K. Naithani, U. Hariharan, S. Shah
Ever since the advent of organ transplantation, the survival rate and future encounter of recipients with anesthesiologists has increased. There have been several case reports and reviews on anesthesia for renal transplant recipients. We present a unique case of a patient who had previously undergone double renal transplantation, presenting to the anesthesiologist with four kidneys for laparoscopic radical nephrectomy for renal cell carcinoma. To the best of our knowledge, there has been no reported case of a postrenal transplant patient with four kidneys presenting for minimally invasive radical nephrectomy. Hemodynamic stability, preservation of renal function, careful choice of anesthetic agents, protection of fistula sites, complete asepsis, institution of extensive monitoring, cautious positioning, and use of ultrasound-guided regional block for pain management are some of the clinical pearls gained from this unique and rare case.
{"title":"Four kidneys and a tumor: Laparoscopic radical nephrectomy in a renal transplant recipient","authors":"B. K. Naithani, U. Hariharan, S. Shah","doi":"10.4103/1687-7934.182290","DOIUrl":"https://doi.org/10.4103/1687-7934.182290","url":null,"abstract":"Ever since the advent of organ transplantation, the survival rate and future encounter of recipients with anesthesiologists has increased. There have been several case reports and reviews on anesthesia for renal transplant recipients. We present a unique case of a patient who had previously undergone double renal transplantation, presenting to the anesthesiologist with four kidneys for laparoscopic radical nephrectomy for renal cell carcinoma. To the best of our knowledge, there has been no reported case of a postrenal transplant patient with four kidneys presenting for minimally invasive radical nephrectomy. Hemodynamic stability, preservation of renal function, careful choice of anesthetic agents, protection of fistula sites, complete asepsis, institution of extensive monitoring, cautious positioning, and use of ultrasound-guided regional block for pain management are some of the clinical pearls gained from this unique and rare case.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80025218","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 : 2016-04-01DOI: 10.4103/1687-7934.182225
Yasser A Salem, R. Hassan, D. Elfawy, Neveen Girgis
Background Management of severely burnt children is one of the most challenging situations in the ICU. Control of the hypercatabolic state is the most limiting step that determines patient survival. Immunocompromisation and delayed wound healing usually result in severe sepsis, which is the most common direct cause of death in these patients. There is debate about the efficacy and safety of recombinant human growth hormone (rGH), although it has been used to improve healing of burnt patients. Role of growth hormone in immunomodulation has been proposed theoretically and serologically, but it has not been tested clinically. We reported in this study how far the use of rGH in the management of burnt patients can improve their immune status and increase survival. Patients and methods Forty pediatric patients were enrolled in this study, randomly assigned into two groups. Group A received rGH and was compared with group B, which did not receive rGH. Those two groups were compared with respect to overall mortality rate, hospital and ICU stay, serum transferrin, C-reactive protein, and positivity of blood culture. Results The overall mortality rate was slightly lower in group A (20%) compared with B group (25%). No significant decrease in hospital stay was noticed between the two groups. There was significant improvement in serum transferrin especially by day 14 in addition to a significant drop in C-reactive protein in group A. Group A was found to be more protected from bacteremia. Conclusion The use of rGH in pediatric burnt patients improves overall mortality and optimizes immune status, in addition to improvement of wound healing and donor site healing. This eventually reduces the length of hospital stay.
{"title":"Effect of recombinant growth hormone on immune response in pediatric burn patients","authors":"Yasser A Salem, R. Hassan, D. Elfawy, Neveen Girgis","doi":"10.4103/1687-7934.182225","DOIUrl":"https://doi.org/10.4103/1687-7934.182225","url":null,"abstract":"Background Management of severely burnt children is one of the most challenging situations in the ICU. Control of the hypercatabolic state is the most limiting step that determines patient survival. Immunocompromisation and delayed wound healing usually result in severe sepsis, which is the most common direct cause of death in these patients. There is debate about the efficacy and safety of recombinant human growth hormone (rGH), although it has been used to improve healing of burnt patients. Role of growth hormone in immunomodulation has been proposed theoretically and serologically, but it has not been tested clinically. We reported in this study how far the use of rGH in the management of burnt patients can improve their immune status and increase survival. Patients and methods Forty pediatric patients were enrolled in this study, randomly assigned into two groups. Group A received rGH and was compared with group B, which did not receive rGH. Those two groups were compared with respect to overall mortality rate, hospital and ICU stay, serum transferrin, C-reactive protein, and positivity of blood culture. Results The overall mortality rate was slightly lower in group A (20%) compared with B group (25%). No significant decrease in hospital stay was noticed between the two groups. There was significant improvement in serum transferrin especially by day 14 in addition to a significant drop in C-reactive protein in group A. Group A was found to be more protected from bacteremia. Conclusion The use of rGH in pediatric burnt patients improves overall mortality and optimizes immune status, in addition to improvement of wound healing and donor site healing. This eventually reduces the length of hospital stay.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82071238","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 : 2016-04-01DOI: 10.4103/1687-7934.182226
Rehab S El-Kalla, M. E. El Mourad
Background The aim of the present study was to evaluate the anesthetic properties such as the onset of required hypotension, the quality of the surgical field, the percentage of inhaled anesthesia, intraoperative consumption of fentanyl, time to recovery, and adverse events of dexmedetomidine (DEX) as a hypotensive agent in comparison with sodium nitroprusside (SNP) in maxillofacial surgery. Patients and methods A total of 70 ASA I or II patients, aged 20-60 years, scheduled for maxillofacial surgery were randomly assigned to receive either DEX 1 mg/kg before induction of anesthesia for over 10 min followed by 0.2-0.5 mg/kg/h infusion during maintenance (DEX group; n = 35 patients) or SNP 0.25 mg/kg/min infusion after induction of anesthesia (SNP group; n = 35 patients) to maintain mean arterial blood pressure (MAP) between 50 and 65 mmHg. Hemodynamic variables and end-tidal isoflurane concentration were recorded, quality of surgical field was assessed by the same surgeon who was blinded of the selected hypotensive agent, and intraoperative fentanyl consumption and recovery time were recorded. Results Heart rate was significantly lower (P < 0.05) in DEX group. Both drugs were effective in achieving the desired level of hypotension (MAP: 50-65 mmHg). However, the time needed to reach the target MAP was significantly shorter in the SNP group than in the DEX group. End-tidal isoflurane concentration and intraoperative fentanyl consumption were significantly lower in the DEX group than in the SNP group, and the quality of the surgical field was better in the DEX group compared with the SNP group, but the time for recovery was significantly longer in the DEX group than in the SNP group. Conclusion We concluded that DEX is an effective and safe agent with anesthetic benefits for controlled hypotension, and that compared with SNP DEX offers the advantage of better quality of the surgical field and decreased anesthetic and fentanyl requirements intraoperatively. However, DEX was associated with significantly longer time to reach the target MAP and delayed recovery from anesthesia compared with SNP.
{"title":"Deliberate hypotensive anesthesia during maxillofacial surgery: A comparative study between dexmedetomidine and sodium nitroprusside","authors":"Rehab S El-Kalla, M. E. El Mourad","doi":"10.4103/1687-7934.182226","DOIUrl":"https://doi.org/10.4103/1687-7934.182226","url":null,"abstract":"Background The aim of the present study was to evaluate the anesthetic properties such as the onset of required hypotension, the quality of the surgical field, the percentage of inhaled anesthesia, intraoperative consumption of fentanyl, time to recovery, and adverse events of dexmedetomidine (DEX) as a hypotensive agent in comparison with sodium nitroprusside (SNP) in maxillofacial surgery. Patients and methods A total of 70 ASA I or II patients, aged 20-60 years, scheduled for maxillofacial surgery were randomly assigned to receive either DEX 1 mg/kg before induction of anesthesia for over 10 min followed by 0.2-0.5 mg/kg/h infusion during maintenance (DEX group; n = 35 patients) or SNP 0.25 mg/kg/min infusion after induction of anesthesia (SNP group; n = 35 patients) to maintain mean arterial blood pressure (MAP) between 50 and 65 mmHg. Hemodynamic variables and end-tidal isoflurane concentration were recorded, quality of surgical field was assessed by the same surgeon who was blinded of the selected hypotensive agent, and intraoperative fentanyl consumption and recovery time were recorded. Results Heart rate was significantly lower (P < 0.05) in DEX group. Both drugs were effective in achieving the desired level of hypotension (MAP: 50-65 mmHg). However, the time needed to reach the target MAP was significantly shorter in the SNP group than in the DEX group. End-tidal isoflurane concentration and intraoperative fentanyl consumption were significantly lower in the DEX group than in the SNP group, and the quality of the surgical field was better in the DEX group compared with the SNP group, but the time for recovery was significantly longer in the DEX group than in the SNP group. Conclusion We concluded that DEX is an effective and safe agent with anesthetic benefits for controlled hypotension, and that compared with SNP DEX offers the advantage of better quality of the surgical field and decreased anesthetic and fentanyl requirements intraoperatively. However, DEX was associated with significantly longer time to reach the target MAP and delayed recovery from anesthesia compared with SNP.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87313926","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 : 2016-04-01DOI: 10.4103/1687-7934.182262
A. Shoukry, A. Hennawy, M. Bassiony, M. Sallam, Ramy Mahrous
Introduction Pre-eclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. Acute kidney failure occurs in about 20% of patients with severe pre-eclampsia. Magnesium sulfate is the medication of choice for the prevention of eclamptic seizures in women with severe pre-eclampsia and for the treatment of women with eclamptic seizures. This medication is renally excreted and hence significant renal impairment can result in exaggerated toxicity. Phenytoin was specifically developed as an anticonvulsant and is the most widely prescribed drug for epilepsy worldwide. The aim of this study is to compare magnesium sulfate with phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury. Patients and methods Forty pregnant women were enrolled in the study; all patients had American Society of Anesthesiologists (ASA) physical status of II or III and were proved to have severe pre-eclampsia with acute kidney injury. Patients were allocated randomly into one of two groups (20 patients each). Group A (magnesium sulfate group) included 20 patients who received magnesium sulfate for prophylaxis against eclampsia. Group B (phenytoin group) included 20 patients who received phenytoin for prophylaxis against eclampsia. For each patient, the following data were collected: age, gestational age, body weight, height, occurrence of magnesium or phenytoin toxicity, occurrence of fits, and fetal outcome. Results In terms of the occurrence of fits, we found a statistically significant difference between the magnesium group and the phenytoin group as five patients in the phenytoin group developed fits, whereas none of the patients in the magnesium group developed fits. In this study, we did not find a statistically significant difference between the magnesium group and the phenytoin group in the incidence of magnesium or phenytoin toxicity and fetal outcome. Conclusion The results of this study showed that prophylaxis against eclampsia in severely pre-eclamptic patients with acute kidney injury using magnesium sulfate (adjusted dose) resulted in no toxicity and no fetal effects besides fewer incidences of fits compared with phenytoin.
{"title":"Comparative study between magnesium sulfate and phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury","authors":"A. Shoukry, A. Hennawy, M. Bassiony, M. Sallam, Ramy Mahrous","doi":"10.4103/1687-7934.182262","DOIUrl":"https://doi.org/10.4103/1687-7934.182262","url":null,"abstract":"Introduction Pre-eclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. Acute kidney failure occurs in about 20% of patients with severe pre-eclampsia. Magnesium sulfate is the medication of choice for the prevention of eclamptic seizures in women with severe pre-eclampsia and for the treatment of women with eclamptic seizures. This medication is renally excreted and hence significant renal impairment can result in exaggerated toxicity. Phenytoin was specifically developed as an anticonvulsant and is the most widely prescribed drug for epilepsy worldwide. The aim of this study is to compare magnesium sulfate with phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury. Patients and methods Forty pregnant women were enrolled in the study; all patients had American Society of Anesthesiologists (ASA) physical status of II or III and were proved to have severe pre-eclampsia with acute kidney injury. Patients were allocated randomly into one of two groups (20 patients each). Group A (magnesium sulfate group) included 20 patients who received magnesium sulfate for prophylaxis against eclampsia. Group B (phenytoin group) included 20 patients who received phenytoin for prophylaxis against eclampsia. For each patient, the following data were collected: age, gestational age, body weight, height, occurrence of magnesium or phenytoin toxicity, occurrence of fits, and fetal outcome. Results In terms of the occurrence of fits, we found a statistically significant difference between the magnesium group and the phenytoin group as five patients in the phenytoin group developed fits, whereas none of the patients in the magnesium group developed fits. In this study, we did not find a statistically significant difference between the magnesium group and the phenytoin group in the incidence of magnesium or phenytoin toxicity and fetal outcome. Conclusion The results of this study showed that prophylaxis against eclampsia in severely pre-eclamptic patients with acute kidney injury using magnesium sulfate (adjusted dose) resulted in no toxicity and no fetal effects besides fewer incidences of fits compared with phenytoin.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84828164","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 : 2016-04-01DOI: 10.4103/1687-7934.182261
Rania M. Ali, M. Khairy, D. Mansour
Introduction Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Resuscitated hemorrhagic shock patients are susceptible to the development of a systemic inflammatory response and organ dysfunction. This study aimed to investigate the effects of alpha-lipoic acid (ALA) as an adjunctive therapy that protects against the occurrence of acute lung injury (ALI) and acute kidney injury (AKI) in patients with major PPH. Patients and methods Forty patients admitted to Ain Shams Obstetric ICU with major PPH were randomly allocated into two equal groups: the ALA group received intravenous 1200 mg ALA once daily for 3 days and the placebo group received 500 ml of 0.9% isotone saline solution over 60 min once daily for 3 days. The primary study outcome was the serum levels of thiobarbituric acid reactive species as a marker of oxidative damage and interleukin-6 as a marker of inflammatory response. The secondary outcomes were the incidence of ALI and AKI. Results ALA attenuated the oxidative damage and the inflammatory response as evidenced by the reduction in both thiobarbituric acid reactive species and interleukin-6 levels, respectively (P < 0.001). AKI developed in 5% of patients in the ALA group versus 25% of patients in the placebo group 48 h after ICU admission. The oxygenation index (PaO 2 /FiO 2 ) reached less than 300 in 10% of patients in the ALA group and in 30% of patients in the placebo group. Conclusion ALA decreases markers of oxidative stress and inflammatory response and also has a preventive effect on the progression of ALI and AKI in patients with major PPH.
{"title":"Effect of alpha-lipoic acid on acute lung injury and acute kidney injury in major postpartum hemorrhage","authors":"Rania M. Ali, M. Khairy, D. Mansour","doi":"10.4103/1687-7934.182261","DOIUrl":"https://doi.org/10.4103/1687-7934.182261","url":null,"abstract":"Introduction Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Resuscitated hemorrhagic shock patients are susceptible to the development of a systemic inflammatory response and organ dysfunction. This study aimed to investigate the effects of alpha-lipoic acid (ALA) as an adjunctive therapy that protects against the occurrence of acute lung injury (ALI) and acute kidney injury (AKI) in patients with major PPH. Patients and methods Forty patients admitted to Ain Shams Obstetric ICU with major PPH were randomly allocated into two equal groups: the ALA group received intravenous 1200 mg ALA once daily for 3 days and the placebo group received 500 ml of 0.9% isotone saline solution over 60 min once daily for 3 days. The primary study outcome was the serum levels of thiobarbituric acid reactive species as a marker of oxidative damage and interleukin-6 as a marker of inflammatory response. The secondary outcomes were the incidence of ALI and AKI. Results ALA attenuated the oxidative damage and the inflammatory response as evidenced by the reduction in both thiobarbituric acid reactive species and interleukin-6 levels, respectively (P < 0.001). AKI developed in 5% of patients in the ALA group versus 25% of patients in the placebo group 48 h after ICU admission. The oxygenation index (PaO 2 /FiO 2 ) reached less than 300 in 10% of patients in the ALA group and in 30% of patients in the placebo group. Conclusion ALA decreases markers of oxidative stress and inflammatory response and also has a preventive effect on the progression of ALI and AKI in patients with major PPH.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73756697","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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