Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238455
A. El demerdash, S. Anis, Heba A. Labib, S. Ibrahim, Alaa Koraa
Background Protein–energy malnutrition is very common among patients with end-stage renal disease undergoing maintenance hemodialysis therapy. Aim The aim of this prospective randomized study was to compare the effect of enteral nutrition (EN) and intradialytic parenteral nutrition (IDPN) on malnourished hemodialysis patients receiving nutritional support admitted in the intensive care unit. Patients and methods A total of 135 patients between 18 and 60 years of age admitted in Ain shams University Hospitals’ intensive care units and on regular hemodialysis were randomly allocated to three groups of 45 each. Group A received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 nephrosteril 7%, and trace elements and vitamins). Group B received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 aminosteril N-Hepa 8%, and trace elements and vitamins). Group C received only EN. The following evaluations were carried out: biochemical evaluation, which included serum albumin, prealbumin, transferrin, and urinary urea nitrogen evaluation every 20, 4, 8, and 0 days, respectively, and after 6 weeks at the end of the study, and anthropometric parameter measurement, which included BMI, mid-arm circumference, and dialysis malnutrition score (DMS). Results Serum albumin, prealbumin, BMI, and DMS significantly increased (P≤0.001) at the end in all groups. Serum transferrin increased only in groups A and B (P≤0.001), and there was a nonsignificant increase in group C (P≤0.05). No significant difference was found at the end between group A and group B as regards serum albumin (P=0.056), serum prealbumin (0.062), serum transferrin (0.0942), BMI (0.455), and DMS (P=0.840). Serum albumin, prealbumin, transferrin, and BMI showed a significant difference (P≤0.001) in group C at the end of the study in comparison with groups A and B with lower SD. Conclusion IDPN, either aromatic or branched amino acid, in addition to EN showed the same and greater improvement compared with patients who received only EN.
背景:蛋白质能量营养不良在接受维持性血液透析治疗的终末期肾病患者中非常常见。目的:本前瞻性随机研究的目的是比较肠内营养(EN)和分析内肠外营养(IDPN)对重症监护病房接受营养支持的营养不良血透患者的影响。患者和方法将135名年龄在18岁至60岁之间、在艾因沙姆斯大学医院重症监护室接受常规血液透析治疗的患者随机分为三组，每组45人。A组给予肠内和IDPN(葡萄糖250 ml 25%，脂质250 ml 10%，肾固醇250 ml 7%，微量元素和维生素)。B组给予肠内和IDPN(葡萄糖250 ml 25%，脂质250 ml 10%，氨基甾醇N-Hepa 250 ml 8%，微量元素和维生素)。C组仅注射EN。分别于研究结束后第20、4、8、0天和第6周进行生化评价，包括血清白蛋白、白蛋白前、转铁蛋白和尿尿素氮的评价;人体测量参数测量，包括BMI、中臂围、透析营养不良评分(DMS)。结果各组患者血清白蛋白、前白蛋白、BMI、DMS均显著升高(P≤0.001)。血清转铁蛋白仅在A、B组升高(P≤0.001)，C组升高不显著(P≤0.05)。试验结束时，A组与B组血清白蛋白(P=0.056)、血清白蛋白前(P= 0.062)、血清转铁蛋白(P= 0.0942)、BMI(0.455)、DMS (P=0.840)差异无统计学意义。研究结束时，C组血清白蛋白、前白蛋白、转铁蛋白、BMI与SD较低的a、B组比较差异有统计学意义(P≤0.001)。结论除EN外，芳香或支链氨基酸的IDPN均比仅接受EN的患者有相同且更大的改善。
{"title":"Comparative study between enteral and intradialytic parenteral nutrition in hemodialysis patients","authors":"A. El demerdash, S. Anis, Heba A. Labib, S. Ibrahim, Alaa Koraa","doi":"10.4103/1687-7934.238455","DOIUrl":"https://doi.org/10.4103/1687-7934.238455","url":null,"abstract":"Background Protein–energy malnutrition is very common among patients with end-stage renal disease undergoing maintenance hemodialysis therapy. Aim The aim of this prospective randomized study was to compare the effect of enteral nutrition (EN) and intradialytic parenteral nutrition (IDPN) on malnourished hemodialysis patients receiving nutritional support admitted in the intensive care unit. Patients and methods A total of 135 patients between 18 and 60 years of age admitted in Ain shams University Hospitals’ intensive care units and on regular hemodialysis were randomly allocated to three groups of 45 each. Group A received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 nephrosteril 7%, and trace elements and vitamins). Group B received enteral and IDPN (250 ml dextrose 25%, 250 ml intralipid 10%, 250 aminosteril N-Hepa 8%, and trace elements and vitamins). Group C received only EN. The following evaluations were carried out: biochemical evaluation, which included serum albumin, prealbumin, transferrin, and urinary urea nitrogen evaluation every 20, 4, 8, and 0 days, respectively, and after 6 weeks at the end of the study, and anthropometric parameter measurement, which included BMI, mid-arm circumference, and dialysis malnutrition score (DMS). Results Serum albumin, prealbumin, BMI, and DMS significantly increased (P≤0.001) at the end in all groups. Serum transferrin increased only in groups A and B (P≤0.001), and there was a nonsignificant increase in group C (P≤0.05). No significant difference was found at the end between group A and group B as regards serum albumin (P=0.056), serum prealbumin (0.062), serum transferrin (0.0942), BMI (0.455), and DMS (P=0.840). Serum albumin, prealbumin, transferrin, and BMI showed a significant difference (P≤0.001) in group C at the end of the study in comparison with groups A and B with lower SD. Conclusion IDPN, either aromatic or branched amino acid, in addition to EN showed the same and greater improvement compared with patients who received only EN.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"20 1","pages":"68 - 75"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84986242","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 : 2017-01-01DOI: 10.4103/1687-7934.238449
A. Moharram, A. E. El Midany
Aim Open heart surgeries are painful procedures that require a large dose of analgesics. The aim of this study was to investigate the effect of postoperative dexmedetomidine (DEX) on the analgesic requirements in postcardiac surgery patients. Settings and design This prospective, randomized, double-blind study was conducted on 60 patients scheduled for elective coronary artery bypass graft surgery at the Cardiothoracic Surgery Unit, Ain Shams University Hospital. Patients and methods this study, group D (n=30) received DEX diluted to 4 μg/ml and infused at a rate of 0.1–0.2 μg/kg/h, whereas group C (n=30) received an equal volume of saline at an infusion rate of 0.1–0.2 μg/kg/h immediately from the end of surgery and postoperatively in the ICU thereafter. Postoperative analgesia was assessed using the Numeric Pain Intensity Scale, and sedation was assessed using the Modified Ramsay Score at T1, T2, T3, T4, T5, and T6 for the first 24 h, as well as postoperative rescue morphine analgesic requirements. Statistical analysis Analysis of data was performed using the Student t-test for independent samples for parametric data and using the χ2-tests for categorical data. Results There was a significant decrease in the pain scores in group D compared with group C (P<0.001). Morphine rescue analgesia was needed in 10% of patients in group D and in 95% of patients in group C, with a significant reduction in time to extubation and ICU length of stay in group D. The incidence of postoperative nausea and vomiting was lower in group D compared with group C but did not reach statistical significance. Conclusion Adding DEX after coronary artery bypass graft decreased both postoperative analgesic requirement and pain score without hemodynamic effects.
{"title":"Postoperative analgesic effect of dexmedetomidine in patients undergoing cardiac surgery","authors":"A. Moharram, A. E. El Midany","doi":"10.4103/1687-7934.238449","DOIUrl":"https://doi.org/10.4103/1687-7934.238449","url":null,"abstract":"Aim Open heart surgeries are painful procedures that require a large dose of analgesics. The aim of this study was to investigate the effect of postoperative dexmedetomidine (DEX) on the analgesic requirements in postcardiac surgery patients. Settings and design This prospective, randomized, double-blind study was conducted on 60 patients scheduled for elective coronary artery bypass graft surgery at the Cardiothoracic Surgery Unit, Ain Shams University Hospital. Patients and methods this study, group D (n=30) received DEX diluted to 4 μg/ml and infused at a rate of 0.1–0.2 μg/kg/h, whereas group C (n=30) received an equal volume of saline at an infusion rate of 0.1–0.2 μg/kg/h immediately from the end of surgery and postoperatively in the ICU thereafter. Postoperative analgesia was assessed using the Numeric Pain Intensity Scale, and sedation was assessed using the Modified Ramsay Score at T1, T2, T3, T4, T5, and T6 for the first 24 h, as well as postoperative rescue morphine analgesic requirements. Statistical analysis Analysis of data was performed using the Student t-test for independent samples for parametric data and using the χ2-tests for categorical data. Results There was a significant decrease in the pain scores in group D compared with group C (P<0.001). Morphine rescue analgesia was needed in 10% of patients in group D and in 95% of patients in group C, with a significant reduction in time to extubation and ICU length of stay in group D. The incidence of postoperative nausea and vomiting was lower in group D compared with group C but did not reach statistical significance. Conclusion Adding DEX after coronary artery bypass graft decreased both postoperative analgesic requirement and pain score without hemodynamic effects.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"282 1 1","pages":"15 - 19"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86580181","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 : 2017-01-01DOI: 10.4103/asja.asja_111_16
A. Aly, Mohamed Ghanem
Background Self-pressurized air-Q intubating laryngeal airway (air-Q SP) is a supraglottic airway device with a noninflatable cuff that does not need continuous monitoring of the cuff pressure. As the ProSeal laryngeal mask airway (PLMA) is considered the ‘state-of-the-art’ supraglottic device, we conducted this randomized trial to evaluate the safety and efficacy of air-Q SP compared with that of PLMA in pediatric patients. Patients and methods The study included 70 pediatric patients aged from 4 to 15 years undergoing elective surgery under general anesthesia who were randomized to either the air-Q SP group or the PLMA group. The primary outcome parameter in this study was the oropharyngeal leak pressure, and the secondary outcome parameters were ease of insertion, time of insertion, first attempt insertion success rate, number of gastric insufflations, fiberoptic glottic view, and complications related to the supraglottic airway device use. Results There was no significant difference between air-Q SP and PLMA regarding first insertion success rate, ease of insertion, oropharyngeal leak pressure, number of gastric insufflations, number of manipulations required to adjust the airway, and complications. Time to insert the air-Q SP was significantly shorter than that of PLMA (13.2±4.2 vs. 17.5±4.8 s, P=0.03). The fiberoptic view was significantly better with air-Q SP than with PLMA (P=0.018). Conclusion The performance of air-Q SP is comparable to that of PLMA as a primary airway device during general anesthesia in pediatric patients, with a shorter insertion time and better fiberoptic view for air-Q SP.
{"title":"Comparison of the performance of the self-pressurized air-Q intubating laryngeal airway with the LMA–ProSeal in pediatric patients under general anesthesia: a randomized controlled trial","authors":"A. Aly, Mohamed Ghanem","doi":"10.4103/asja.asja_111_16","DOIUrl":"https://doi.org/10.4103/asja.asja_111_16","url":null,"abstract":"Background Self-pressurized air-Q intubating laryngeal airway (air-Q SP) is a supraglottic airway device with a noninflatable cuff that does not need continuous monitoring of the cuff pressure. As the ProSeal laryngeal mask airway (PLMA) is considered the ‘state-of-the-art’ supraglottic device, we conducted this randomized trial to evaluate the safety and efficacy of air-Q SP compared with that of PLMA in pediatric patients. Patients and methods The study included 70 pediatric patients aged from 4 to 15 years undergoing elective surgery under general anesthesia who were randomized to either the air-Q SP group or the PLMA group. The primary outcome parameter in this study was the oropharyngeal leak pressure, and the secondary outcome parameters were ease of insertion, time of insertion, first attempt insertion success rate, number of gastric insufflations, fiberoptic glottic view, and complications related to the supraglottic airway device use. Results There was no significant difference between air-Q SP and PLMA regarding first insertion success rate, ease of insertion, oropharyngeal leak pressure, number of gastric insufflations, number of manipulations required to adjust the airway, and complications. Time to insert the air-Q SP was significantly shorter than that of PLMA (13.2±4.2 vs. 17.5±4.8 s, P=0.03). The fiberoptic view was significantly better with air-Q SP than with PLMA (P=0.018). Conclusion The performance of air-Q SP is comparable to that of PLMA as a primary airway device during general anesthesia in pediatric patients, with a shorter insertion time and better fiberoptic view for air-Q SP.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"41 1","pages":"149 - 155"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80670825","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}
Introduction Laryngoscopy as well as tracheal intubation causes changes in the hemodynamics of the patient owing to stress response. C-MAC videolaryngoscope (VL) is a relatively recent development that improves the success of tracheal intubation. Aim The aim of this study was to compare and evaluate the effects of dexmedetomidine for attenuation of hemodynamic responses during laryngoscopy using Macintosh laryngoscope versus C-MAC laryngoscope. Patients and methods A total of 60 patients, ASA II, 18–60 years old, scheduled for different surgeries under general anesthesia with BMI up to 40 kg/m2 were included in the study. Patients were divided into two groups (30 patients each) and were appropriately positioned, and intubation was done. Hemodynamic stress response to intubation was recorded, and plasma epinephrine level was estimated at baseline and at 1 and 5 min after intubation. Success rate, duration, attempts of intubation, and SpO2% were assessed. Results Plasma epinephrine level (ng/ml) at baseline and at 1 and 5 min after intubation showed no statistically significant difference in both groups, but there were highly significant differences at 1 and 5 min after intubation compared with baseline values (P<0.0001 and <0.0007, respectively) in each group. Intubation time was longer in ML (17±4.47 s) compared within VL (12±3.4 s). There were no significant differences between both groups after intubation regarding hemodynamic changes, SpO2, or EtCO2. Conclusion The stress response in both laryngoscopic techniques appears to be the same as detected by the nonsignificant difference in plasma epinephrine levels and hemodynamic changes in both groups, so 1 μg/kg dexmedetomidine is not enough to obtund the stress response completely. C-MAC VL is an efficient and suitable intubating device and provides excellent visualization of laryngeal structures in shorter time with less intubation attempts than Macintosh (Techron Surgical, Sialkot, P, Pakistan) laryngoscopy.
{"title":"Comparative study between Macintosh versus C-MAC laryngoscopic performance in airway management with dexmedetomidine as stress response attenuator in obese patients","authors":"Abdelazim Hegazy, A. Abd El-Aziz","doi":"10.4103/asja.asja_89_16","DOIUrl":"https://doi.org/10.4103/asja.asja_89_16","url":null,"abstract":"Introduction Laryngoscopy as well as tracheal intubation causes changes in the hemodynamics of the patient owing to stress response. C-MAC videolaryngoscope (VL) is a relatively recent development that improves the success of tracheal intubation. Aim The aim of this study was to compare and evaluate the effects of dexmedetomidine for attenuation of hemodynamic responses during laryngoscopy using Macintosh laryngoscope versus C-MAC laryngoscope. Patients and methods A total of 60 patients, ASA II, 18–60 years old, scheduled for different surgeries under general anesthesia with BMI up to 40 kg/m2 were included in the study. Patients were divided into two groups (30 patients each) and were appropriately positioned, and intubation was done. Hemodynamic stress response to intubation was recorded, and plasma epinephrine level was estimated at baseline and at 1 and 5 min after intubation. Success rate, duration, attempts of intubation, and SpO2% were assessed. Results Plasma epinephrine level (ng/ml) at baseline and at 1 and 5 min after intubation showed no statistically significant difference in both groups, but there were highly significant differences at 1 and 5 min after intubation compared with baseline values (P<0.0001 and <0.0007, respectively) in each group. Intubation time was longer in ML (17±4.47 s) compared within VL (12±3.4 s). There were no significant differences between both groups after intubation regarding hemodynamic changes, SpO2, or EtCO2. Conclusion The stress response in both laryngoscopic techniques appears to be the same as detected by the nonsignificant difference in plasma epinephrine levels and hemodynamic changes in both groups, so 1 μg/kg dexmedetomidine is not enough to obtund the stress response completely. C-MAC VL is an efficient and suitable intubating device and provides excellent visualization of laryngeal structures in shorter time with less intubation attempts than Macintosh (Techron Surgical, Sialkot, P, Pakistan) laryngoscopy.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"9 1","pages":"117 - 123"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79093408","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}
Introduction Primary palmar hyperhidrosis is a disabling problem that affects young age groups and usually continues for years without an effective treatment. It is usually accompanied by plantar hyperhidrosis and to a lesser extent by axillary affection. We have tried to improve the efficacy of percutaneous radiofrequency ablation of upper thoracic sympathetic ganglia via imitating what thoracoscopic surgeons do in endoscopic thoracic sympathectomy. Patients and methods A total of 40 patients with primary hyperhidrosis were randomly classified into two groups. Group Tb (n=20) underwent thermocoagulation of sympathetic chain on vertebral body. Group Th (n=20) underwent thermocoagulation of sympathetic chain on the head and neck of ribs. Hand temperature and dryness were followed up during the procedure and on the following intervals: 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months after the procedure. Results During the procedure, the hands of 50% of patients became warm and dry in group Tb and only 40% remained so till 12 months, whereas in group Th, the hands of 100% of the patients became warm and dry during the procedure till 12 months. Conclusion Thermocoagulation of upper thoracic sympathetic chain on the head and neck of the second and third ribs is more effective than attacking the chain on vertebral bodies in patients with primary hyperhidrosis with no recorded complications.
{"title":"Optimum target in percutaneous upper thoracic thermocoagulation in primary hyperhidrosis","authors":"O. Khalifa, A. Hegab","doi":"10.4103/asja.asja_73_16","DOIUrl":"https://doi.org/10.4103/asja.asja_73_16","url":null,"abstract":"Introduction Primary palmar hyperhidrosis is a disabling problem that affects young age groups and usually continues for years without an effective treatment. It is usually accompanied by plantar hyperhidrosis and to a lesser extent by axillary affection. We have tried to improve the efficacy of percutaneous radiofrequency ablation of upper thoracic sympathetic ganglia via imitating what thoracoscopic surgeons do in endoscopic thoracic sympathectomy. Patients and methods A total of 40 patients with primary hyperhidrosis were randomly classified into two groups. Group Tb (n=20) underwent thermocoagulation of sympathetic chain on vertebral body. Group Th (n=20) underwent thermocoagulation of sympathetic chain on the head and neck of ribs. Hand temperature and dryness were followed up during the procedure and on the following intervals: 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months after the procedure. Results During the procedure, the hands of 50% of patients became warm and dry in group Tb and only 40% remained so till 12 months, whereas in group Th, the hands of 100% of the patients became warm and dry during the procedure till 12 months. Conclusion Thermocoagulation of upper thoracic sympathetic chain on the head and neck of the second and third ribs is more effective than attacking the chain on vertebral bodies in patients with primary hyperhidrosis with no recorded complications.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"57 42 1","pages":"293 - 296"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75440172","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 : 2017-01-01DOI: 10.4103/1687-7934.238483
Hadil Abdel-Hamid, Mai Abdel-Azziz, Ahmed Aly Omar
Background Anesthetic management of a pediatric patient with pulmonary arterial hypertension (PAH) poses an enormous challenge. The objective of this study was to evaluate the ability of dexmedetomidine to reduce the pulmonary artery pressure in pediatric patients with PAH undergoing cardiac surgery. Patients and method Seventy patients diagnosed with PAH were enrolled in this study. The patients were randomized into two groups: group D received dexmedetomidine infusion of 1 μg/kg/h for one hour, which was reduced to 0.5 μg/kg/h throughout the surgery until extubation in the post anesthesia care unit (PACU), and group C received 0.9% normal saline in the same volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded throughout surgery and postoperatively in the PACU. The need for vasodilator and sedative drugs and the time of extubation and ICU stay were recorded for all patients. Results The patients in the dexmedetomidine group showed a significant decrease in PASP and PASP/SSBP ratio during surgery and throughout the first 24 h in the PACU (P<0.001). The dexmedetomidine group required a significantly lower amount of vasodilator drugs than the control group (P<0.001), as well as a lower amount of sedatives (P<0.001). Conclusion We concluded that perioperative use of dexmedetomidine in pediatric patients with pulmonary hypertension reduces the PASP throughout the operative and postoperative period.
背景:小儿肺动脉高压(PAH)患者的麻醉管理是一个巨大的挑战。本研究的目的是评估右美托咪定降低接受心脏手术的小儿PAH患者肺动脉压的能力。患者与方法入选70例确诊为PAH的患者。将患者随机分为两组:D组患者给予右美托咪定输注1 μg/kg/h，持续1 h，术中至PACU拔管前降至0.5 μg/kg/h; C组患者给予相同体积0.9%生理盐水。在PACU中记录术中及术后肺动脉收缩压(PASP)和全身收缩压(SSBP)。记录所有患者的血管扩张剂和镇静药物用量、拔管时间和ICU住院时间。结果右美托咪定组患者术中及PACU前24 h PASP及PASP/SSBP比值均显著降低(P<0.001)。右美托咪定组血管舒张药物用量明显低于对照组(P<0.001)，镇静剂用量也明显低于对照组(P<0.001)。结论右美托咪定在小儿肺动脉高压患者围手术期可降低PASP。
{"title":"The effect of perioperative use of dexmedetomidine on pediatric patients with pulmonary hypertension undergoing congenital cardiac surgery","authors":"Hadil Abdel-Hamid, Mai Abdel-Azziz, Ahmed Aly Omar","doi":"10.4103/1687-7934.238483","DOIUrl":"https://doi.org/10.4103/1687-7934.238483","url":null,"abstract":"Background Anesthetic management of a pediatric patient with pulmonary arterial hypertension (PAH) poses an enormous challenge. The objective of this study was to evaluate the ability of dexmedetomidine to reduce the pulmonary artery pressure in pediatric patients with PAH undergoing cardiac surgery. Patients and method Seventy patients diagnosed with PAH were enrolled in this study. The patients were randomized into two groups: group D received dexmedetomidine infusion of 1 μg/kg/h for one hour, which was reduced to 0.5 μg/kg/h throughout the surgery until extubation in the post anesthesia care unit (PACU), and group C received 0.9% normal saline in the same volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded throughout surgery and postoperatively in the PACU. The need for vasodilator and sedative drugs and the time of extubation and ICU stay were recorded for all patients. Results The patients in the dexmedetomidine group showed a significant decrease in PASP and PASP/SSBP ratio during surgery and throughout the first 24 h in the PACU (P<0.001). The dexmedetomidine group required a significantly lower amount of vasodilator drugs than the control group (P<0.001), as well as a lower amount of sedatives (P<0.001). Conclusion We concluded that perioperative use of dexmedetomidine in pediatric patients with pulmonary hypertension reduces the PASP throughout the operative and postoperative period.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"41 1","pages":"10 - 14"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76282049","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 : 2017-01-01DOI: 10.4103/1687-7934.238467
A. Moharram, A. Shoukry, N. Elshalakany, A. Mostafa
Background This randomized, prospective, double-blind, placebo-controlled study was designed to assess perioperative magnesium sulfate, an N-methyl-d-aspartate receptor blocker, as an anesthetic adjuvant reducing intraoperative anesthetic requirement, with a decrease in postoperative analgesic requirement and less adverse events. Patients and methods A total of 24 patients undergoing video-assisted thoracoscopic surgery were included in two parallel groups − the magnesium group (group M, n=12) received magnesium sulfate 40 mg/kg intravenously before induction of anesthesia followed by 15 mg/kg/h continuous intravenous infusion during the operation. The same volume of isotonic solution was administered to the control group (group C, n=12). Primary outcome measures were postoperative analgesic requirement (doses of morphine and ketorolac). Secondary outcomes included intraoperative anesthetic requirements (fentanyl, sevoflurane, and vecuronium), postoperative visual analog score, Ramsay sedation score, and postoperative adverse events. Results In the magnesium group, there was a reduction in intraoperative fentanyl (P=0.01), sevoflurane (P=0.02), and vecuronium (P=0.008), with a significant reduction in the postoperative dose of morphine (P=0.02), the need for rescue ketorolac (P=0.02), and a significant reduction in visual analog score and Ramsay sedation score compared with group C at 2, 3, 4, 6, and 8 h. There was a significant reduction in the number of patients who suffered an episode of tachyarrhythmia (P=0.03) with a decrease in nausea (P=0.06), vomiting (P=0.06), and pruritus (P=0.3), but did not reach statistical significance in group M compared with group C. Conclusion Magnesium sulfate as an anesthetic adjuvant decreased postoperative analgesic requirement with a decrease in intraoperative anesthetic doses, with less adverse events.
{"title":"Perioperative magnesium sulfate: an adjuvant to patients undergoing video-assisted thoracoscopic surgery","authors":"A. Moharram, A. Shoukry, N. Elshalakany, A. Mostafa","doi":"10.4103/1687-7934.238467","DOIUrl":"https://doi.org/10.4103/1687-7934.238467","url":null,"abstract":"Background This randomized, prospective, double-blind, placebo-controlled study was designed to assess perioperative magnesium sulfate, an N-methyl-d-aspartate receptor blocker, as an anesthetic adjuvant reducing intraoperative anesthetic requirement, with a decrease in postoperative analgesic requirement and less adverse events. Patients and methods A total of 24 patients undergoing video-assisted thoracoscopic surgery were included in two parallel groups − the magnesium group (group M, n=12) received magnesium sulfate 40 mg/kg intravenously before induction of anesthesia followed by 15 mg/kg/h continuous intravenous infusion during the operation. The same volume of isotonic solution was administered to the control group (group C, n=12). Primary outcome measures were postoperative analgesic requirement (doses of morphine and ketorolac). Secondary outcomes included intraoperative anesthetic requirements (fentanyl, sevoflurane, and vecuronium), postoperative visual analog score, Ramsay sedation score, and postoperative adverse events. Results In the magnesium group, there was a reduction in intraoperative fentanyl (P=0.01), sevoflurane (P=0.02), and vecuronium (P=0.008), with a significant reduction in the postoperative dose of morphine (P=0.02), the need for rescue ketorolac (P=0.02), and a significant reduction in visual analog score and Ramsay sedation score compared with group C at 2, 3, 4, 6, and 8 h. There was a significant reduction in the number of patients who suffered an episode of tachyarrhythmia (P=0.03) with a decrease in nausea (P=0.06), vomiting (P=0.06), and pruritus (P=0.3), but did not reach statistical significance in group M compared with group C. Conclusion Magnesium sulfate as an anesthetic adjuvant decreased postoperative analgesic requirement with a decrease in intraoperative anesthetic doses, with less adverse events.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"17 1","pages":"28 - 33"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91292067","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 : 2017-01-01DOI: 10.4103/1687-7934.238448
K. Gupta, Bhawana Rastogi, P. Gupta, I. Singh, Manoranjan Bansal, Vasundhera Tyagi
Background The excellence of subarachnoid blockade (SAB) can be improved with a variety of adjuvants, used either intrathecally or intravenously. Objective The present study aimed to compare the clinical efficacy of intravenous dexmedetomidine with midazolam for hysterectomy under SAB with 0.5% hyperbaric bupivacaine. Materials and methods After approval, 90 adult consenting middle-aged female patients of American Society of Anesthesiologists (ASA) physical status I and II scheduled for hysterectomy under SAB were blindly randomized into three groups of 30 patients each, to receive either intravenous dexmedetomidine 0.5 μg/kg (group I) or intravenous midazolam 0.05 mg/kg (group II) or normal saline (group III), 20 min after the SAB. Patients were assessed for the onset and duration of sensory and motor blockade, maximum cephalic spread, and intraoperative hemodynamic changes as primary endpoints. The study also evaluated the sedation level and visual analogue scale score for postoperative pain as secondary outcome. Results Patients in the dexmedetomidine group showed a higher cephalic level of sensory blockade. Time for two dermatomes’ sensory regression (144.33±19.2 min) and duration of sensory analgesia (270.10±16.6 min) in the dexmedetomidine group was extended, with a statistically highly significant difference among the groups and no hemodynamic variability. Ramsay sedation score was higher in the dexmedetomidine and midazolam groups than in the saline group. Respiratory depression was not observed in any patient. The incidence of postspinal shivering was low in patients of the dexmedetomidine group. Conclusion Midazolam provided only sedation, whereas dexmedetomidine extended the duration of sensory analgesia of SAB, maintained hemodynamic stability, and also provided arousable sedation without respiratory depression.
{"title":"Clinical evaluation of intravenous dexmedetomidine and intravenous midazolam for hysterectomy under subarachnoid blockade with 0.5% hyperbaric bupivacaine","authors":"K. Gupta, Bhawana Rastogi, P. Gupta, I. Singh, Manoranjan Bansal, Vasundhera Tyagi","doi":"10.4103/1687-7934.238448","DOIUrl":"https://doi.org/10.4103/1687-7934.238448","url":null,"abstract":"Background The excellence of subarachnoid blockade (SAB) can be improved with a variety of adjuvants, used either intrathecally or intravenously. Objective The present study aimed to compare the clinical efficacy of intravenous dexmedetomidine with midazolam for hysterectomy under SAB with 0.5% hyperbaric bupivacaine. Materials and methods After approval, 90 adult consenting middle-aged female patients of American Society of Anesthesiologists (ASA) physical status I and II scheduled for hysterectomy under SAB were blindly randomized into three groups of 30 patients each, to receive either intravenous dexmedetomidine 0.5 μg/kg (group I) or intravenous midazolam 0.05 mg/kg (group II) or normal saline (group III), 20 min after the SAB. Patients were assessed for the onset and duration of sensory and motor blockade, maximum cephalic spread, and intraoperative hemodynamic changes as primary endpoints. The study also evaluated the sedation level and visual analogue scale score for postoperative pain as secondary outcome. Results Patients in the dexmedetomidine group showed a higher cephalic level of sensory blockade. Time for two dermatomes’ sensory regression (144.33±19.2 min) and duration of sensory analgesia (270.10±16.6 min) in the dexmedetomidine group was extended, with a statistically highly significant difference among the groups and no hemodynamic variability. Ramsay sedation score was higher in the dexmedetomidine and midazolam groups than in the saline group. Respiratory depression was not observed in any patient. The incidence of postspinal shivering was low in patients of the dexmedetomidine group. Conclusion Midazolam provided only sedation, whereas dexmedetomidine extended the duration of sensory analgesia of SAB, maintained hemodynamic stability, and also provided arousable sedation without respiratory depression.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"5 1","pages":"279 - 286"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89956467","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}
Background Functional endoscopic sinus surgery (FESS) is a surgical procedure during which all possible measures to minimize bleeding should be considered, as even small amount of blood may obstruct vision. Controlled hypotension is one of these measures used to limit intraoperative blood loss to provide the best possible surgical field. The aim of this study was to compare the effect of a fixed dose of dexmedetomidine (DEX) and nitroglycerin (NTG) with NTG alone on hemodynamic parameters, NTG dose, surgeon satisfaction, and blood loss during controlled hypotensive anesthesia in FESS. Patients and methods Fifty patients of both sexes, classified as American Society of Anesthesia physical status I and II, aged between 20 and 50 years, and candidates for FESS were randomly allocated into two groups by using the sealed envelope method. Group I (n=25) received hypotensive anesthesia with NTG and group II (n=25) received hypotensive anesthesia with NTG and DEX. DEX 1 μg/kg over 10 min was given, and then infused by a syringe pump at a fixed rate of 0.5 μg/kg/h before induction of anesthesia in group II only. After induction and intubation NTG was infused in both groups and titrated to obtain a target mean arterial blood pressure (MAP) of 55–65 mmHg. The MAP and heart rate (HR) were measured at baseline, and then periodically. The following parameters were also recorded: duration of surgical interference (time from the beginning to the end of surgical intervention), blood loss volume, surgeon satisfaction, time to achievement of the target MAP, time to reversibility of MAP to baseline, and the highest dose of NTG needed to reach target MAP. Results There was no significant difference between two groups regarding demographic data, basal hemodynamics, duration of surgical intervention, American Society of Anesthesia physical status, surgeon satisfaction, and all measurements of MAP except time of intubation, which was significantly less in group II. On the other hand, there was a significant difference between both groups regarding HR, time to achievement and reversibility of MAP, blood loss volume, and the highest dose of NTG needed to reach the target MAP, as all of these measurements were significantly lower in group II. Conclusion DEX (1 μg/kg bolus, followed by 0.5 μg/kg/h infusion) and NTG is superior to NTG alone in rapid achievement of target MAP with lower HR and lower NTG doses and in reducing blood loss volume during FESS.
{"title":"Efficacy of adding fixed dose dexmedetomidine to nitroglycerin for controlled hypotension in functional endoscopic sinus surgery","authors":"Eslam N Nada","doi":"10.4103/asja.asja_49_16","DOIUrl":"https://doi.org/10.4103/asja.asja_49_16","url":null,"abstract":"Background Functional endoscopic sinus surgery (FESS) is a surgical procedure during which all possible measures to minimize bleeding should be considered, as even small amount of blood may obstruct vision. Controlled hypotension is one of these measures used to limit intraoperative blood loss to provide the best possible surgical field. The aim of this study was to compare the effect of a fixed dose of dexmedetomidine (DEX) and nitroglycerin (NTG) with NTG alone on hemodynamic parameters, NTG dose, surgeon satisfaction, and blood loss during controlled hypotensive anesthesia in FESS. Patients and methods Fifty patients of both sexes, classified as American Society of Anesthesia physical status I and II, aged between 20 and 50 years, and candidates for FESS were randomly allocated into two groups by using the sealed envelope method. Group I (n=25) received hypotensive anesthesia with NTG and group II (n=25) received hypotensive anesthesia with NTG and DEX. DEX 1 μg/kg over 10 min was given, and then infused by a syringe pump at a fixed rate of 0.5 μg/kg/h before induction of anesthesia in group II only. After induction and intubation NTG was infused in both groups and titrated to obtain a target mean arterial blood pressure (MAP) of 55–65 mmHg. The MAP and heart rate (HR) were measured at baseline, and then periodically. The following parameters were also recorded: duration of surgical interference (time from the beginning to the end of surgical intervention), blood loss volume, surgeon satisfaction, time to achievement of the target MAP, time to reversibility of MAP to baseline, and the highest dose of NTG needed to reach target MAP. Results There was no significant difference between two groups regarding demographic data, basal hemodynamics, duration of surgical intervention, American Society of Anesthesia physical status, surgeon satisfaction, and all measurements of MAP except time of intubation, which was significantly less in group II. On the other hand, there was a significant difference between both groups regarding HR, time to achievement and reversibility of MAP, blood loss volume, and the highest dose of NTG needed to reach the target MAP, as all of these measurements were significantly lower in group II. Conclusion DEX (1 μg/kg bolus, followed by 0.5 μg/kg/h infusion) and NTG is superior to NTG alone in rapid achievement of target MAP with lower HR and lower NTG doses and in reducing blood loss volume during FESS.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"28 1","pages":"103 - 108"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82573896","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 : 2017-01-01DOI: 10.4103/1687-7934.238462
J. Botros, M. Boulos
Background and objective Eye surgeries are very common nowadays. Most surgeries, including cataract surgeries, can be safely performed in an outpatient setting using local anesthesia. Levobupivacaine, a levorotatory isomer of the racemic mixture of bupivacaine, has been used at regional blocks, including local eye blockades. Dexmedetomidine, a potent, highly selective and specific α2-adrenoreceptor agonist, with both sedative and analgesic effects and no respiratory depression, is used as an adjuvant to local eye anesthesia to prolong the analgesic duration of the local anesthetic used. We expected that the addition of dexmedetomidine to levobupivacaine would increase both sensory and motor block durations compared with levobupivacaine alone. Patients and methods In our study, a total of 80 patients of both sexes, aged 50–70 years, belonging to the American Society of Anesthesiologists (ASA) grade I and II, and scheduled for phacoemulsification cataract surgery were randomly allocated into one of two study groups: the levobupivacaine group (group L), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase + 3 ml of 0.5% levobupivacaine+1 ml of normal saline; and the levobupivacaine dexmedetomidine group (group LD), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase+3 ml of 0.5% levobupivacaine+1 ml of dexmedetomidine (100 μg). Results There was no significant difference between the two groups regarding the onset times of lid akinesia, globe anesthesia, and globe akinesia (P > 0.05). The duration of globe anesthesia, lid akinesia, and globe akinesia in the dexmedetomidine group was significantly longer than in the levobupivacaine group (P < 0.001). In group LD, the first analgesic requirement was significantly delayed and the total analgesic consumption in the first 24 h was significantly lower compared with group L (P < 0.0001 for both). Conclusion The addition of 100 μg dexmedetomidine as an adjuvant to 2% lidocaine with 10 IU/ml of hyaluronidase and 0.5% levobupivacaine in peribulbar anesthesia for cataract surgery significantly increases the duration of peribulbar block and improves the analgesic duration, without significant side effects, and significantly decreases the intraocular pressure.
{"title":"Comparative study between a combination of lidocaine and levobupivacaine and that of lidocaine, levobupivacaine, and dexmedetomidine during peribulbar anesthesia for phacoemulsifi cation cataract surgery","authors":"J. Botros, M. Boulos","doi":"10.4103/1687-7934.238462","DOIUrl":"https://doi.org/10.4103/1687-7934.238462","url":null,"abstract":"Background and objective Eye surgeries are very common nowadays. Most surgeries, including cataract surgeries, can be safely performed in an outpatient setting using local anesthesia. Levobupivacaine, a levorotatory isomer of the racemic mixture of bupivacaine, has been used at regional blocks, including local eye blockades. Dexmedetomidine, a potent, highly selective and specific α2-adrenoreceptor agonist, with both sedative and analgesic effects and no respiratory depression, is used as an adjuvant to local eye anesthesia to prolong the analgesic duration of the local anesthetic used. We expected that the addition of dexmedetomidine to levobupivacaine would increase both sensory and motor block durations compared with levobupivacaine alone. Patients and methods In our study, a total of 80 patients of both sexes, aged 50–70 years, belonging to the American Society of Anesthesiologists (ASA) grade I and II, and scheduled for phacoemulsification cataract surgery were randomly allocated into one of two study groups: the levobupivacaine group (group L), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase + 3 ml of 0.5% levobupivacaine+1 ml of normal saline; and the levobupivacaine dexmedetomidine group (group LD), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase+3 ml of 0.5% levobupivacaine+1 ml of dexmedetomidine (100 μg). Results There was no significant difference between the two groups regarding the onset times of lid akinesia, globe anesthesia, and globe akinesia (P > 0.05). The duration of globe anesthesia, lid akinesia, and globe akinesia in the dexmedetomidine group was significantly longer than in the levobupivacaine group (P < 0.001). In group LD, the first analgesic requirement was significantly delayed and the total analgesic consumption in the first 24 h was significantly lower compared with group L (P < 0.0001 for both). Conclusion The addition of 100 μg dexmedetomidine as an adjuvant to 2% lidocaine with 10 IU/ml of hyaluronidase and 0.5% levobupivacaine in peribulbar anesthesia for cataract surgery significantly increases the duration of peribulbar block and improves the analgesic duration, without significant side effects, and significantly decreases the intraocular pressure.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"29 1","pages":"224 - 229"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74526244","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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