Objective The aim was to compare analgesic effect of ketamine versus pregabalin as adjuvant to post-thoracotomy epidural analgesia in the National Cancer Institute. Patients and methods This randomized controlled trial involved 60 adults planned for thoracotomy under general anesthesia for management of lung cancer. They were randomly assigned into one of two groups. Group K (n=30) received three doses of ketamine 0.5 mg/kg intravenously, that is, after induction of anesthesia and at 6 and 30 h postoperatively. Group P (n=30) received oral pregabalin 150 mg 2 h before surgery and at 6 and 30 h postoperatively. The endpoints were pain reduction using visual analog score (VAS) score, frequency of rescue morphine doses, hemodynamic parameters, and adverse effects in the first 48 h. Results VAS score was significantly lower in ketamine group than that in the pregabalin group from 8 up to 48 h postoperatively. In group P, VAS score decreased after 16 h (P<0.001) and continued to decrease up to 48 h. Rescue analgesia was required after 2 h by 11 (36.7%) patients in group K and 15 (50%) patients in group P (P=0.297). The two drugs were accompanied by hemodynamic stability. Patients in group P were more sedated 2 h after surgery compared with those in group K (P=0.006). No cases of nausea and vomiting or psychological adverse effects related to ketamine use were recorded. Conclusion Ketamine and pregabalin are good alternatives for augmentation of the efficacy of thoracic epidural analgesia following thoracotomy in patients with lung cancer. Ketamine has the advantage of more rapid action and higher efficacy in addition to less sedation in early postoperative period.
{"title":"Ketamine versus pregabalin as an adjuvant to epidural analgesia for acute post-thoracotomy pain","authors":"Ahmed H Bakeer, N. Abdallah","doi":"10.4103/asja.asja_37_16","DOIUrl":"https://doi.org/10.4103/asja.asja_37_16","url":null,"abstract":"Objective The aim was to compare analgesic effect of ketamine versus pregabalin as adjuvant to post-thoracotomy epidural analgesia in the National Cancer Institute. Patients and methods This randomized controlled trial involved 60 adults planned for thoracotomy under general anesthesia for management of lung cancer. They were randomly assigned into one of two groups. Group K (n=30) received three doses of ketamine 0.5 mg/kg intravenously, that is, after induction of anesthesia and at 6 and 30 h postoperatively. Group P (n=30) received oral pregabalin 150 mg 2 h before surgery and at 6 and 30 h postoperatively. The endpoints were pain reduction using visual analog score (VAS) score, frequency of rescue morphine doses, hemodynamic parameters, and adverse effects in the first 48 h. Results VAS score was significantly lower in ketamine group than that in the pregabalin group from 8 up to 48 h postoperatively. In group P, VAS score decreased after 16 h (P<0.001) and continued to decrease up to 48 h. Rescue analgesia was required after 2 h by 11 (36.7%) patients in group K and 15 (50%) patients in group P (P=0.297). The two drugs were accompanied by hemodynamic stability. Patients in group P were more sedated 2 h after surgery compared with those in group K (P=0.006). No cases of nausea and vomiting or psychological adverse effects related to ketamine use were recorded. Conclusion Ketamine and pregabalin are good alternatives for augmentation of the efficacy of thoracic epidural analgesia following thoracotomy in patients with lung cancer. Ketamine has the advantage of more rapid action and higher efficacy in addition to less sedation in early postoperative period.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"71 1","pages":"287 - 292"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75626976","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: 10.4103/1687-7934.238477
Waleed Abdalla, M. Ammar
Introduction Although it is considered safe, spinal anesthesia has many side effects, including hypotension, and bradycardia. Increased activity of chemoreceptors (Bezold–Jarisch reflex) may play a role in this. The release of serotonin has been suggested as a possible trigger for Bezold–Jarisch reflex. Granisetron, a selective 5-HT3 receptor antagonist, may play a role in preventing hypotension and bradycardia. Aim The aim of this study was to assess the effects of granisetron on hypotension, bradycardia, shivering, nausea, and vomiting after spinal anesthesia in patients undergoing elective lower-abdominal surgeries. Patients and methods This study was designed as a randomized, double-blind, placebo-controlled trial. Fifty-four American Society of Anesthesiologists I–III patients, ages 25–55 years, scheduled for elective lower-abdominal surgeries under spinal anesthesia were included in this prospective study and were divided into two equal groups. Group G received 1 mg intravenous granisetron diluted in 0.9% normal saline to a total volume of 5 ml, and group C received 5 ml normal saline 5 min before undergoing spinal anesthesia. The mean arterial blood pressure, the heart rate, nausea, vomiting, and shivering were assessed. Results The reduction in mean arterial blood pressure and heart rate was significantly lower in group G compared with group C. Regarding the incidence of complications, hypotension, bradycardia, nausea, and shivering were significantly lower in group G compared with group C. No significant difference was observed with regard to the incidence of vomiting. Conclusion In lower-abdominal surgery, intravenously 1 mg granisetron before subarachnoid block decreased the incidence of hypotension and bradycardia significantly, besides being effective for the prevention of nausea, vomiting, and shivering.
{"title":"Systemic granisetron can minimize hypotension and bradycardia during spinal anesthesia in patients undergoing elective lower-abdominal surgeries: a prospective, double-blind randomized controlled study","authors":"Waleed Abdalla, M. Ammar","doi":"10.4103/1687-7934.238477","DOIUrl":"https://doi.org/10.4103/1687-7934.238477","url":null,"abstract":"Introduction Although it is considered safe, spinal anesthesia has many side effects, including hypotension, and bradycardia. Increased activity of chemoreceptors (Bezold–Jarisch reflex) may play a role in this. The release of serotonin has been suggested as a possible trigger for Bezold–Jarisch reflex. Granisetron, a selective 5-HT3 receptor antagonist, may play a role in preventing hypotension and bradycardia. Aim The aim of this study was to assess the effects of granisetron on hypotension, bradycardia, shivering, nausea, and vomiting after spinal anesthesia in patients undergoing elective lower-abdominal surgeries. Patients and methods This study was designed as a randomized, double-blind, placebo-controlled trial. Fifty-four American Society of Anesthesiologists I–III patients, ages 25–55 years, scheduled for elective lower-abdominal surgeries under spinal anesthesia were included in this prospective study and were divided into two equal groups. Group G received 1 mg intravenous granisetron diluted in 0.9% normal saline to a total volume of 5 ml, and group C received 5 ml normal saline 5 min before undergoing spinal anesthesia. The mean arterial blood pressure, the heart rate, nausea, vomiting, and shivering were assessed. Results The reduction in mean arterial blood pressure and heart rate was significantly lower in group G compared with group C. Regarding the incidence of complications, hypotension, bradycardia, nausea, and shivering were significantly lower in group G compared with group C. No significant difference was observed with regard to the incidence of vomiting. Conclusion In lower-abdominal surgery, intravenously 1 mg granisetron before subarachnoid block decreased the incidence of hypotension and bradycardia significantly, besides being effective for the prevention of nausea, vomiting, and shivering.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"48 1","pages":"247 - 252"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75764996","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: 10.4103/1687-7934.238486
M. Zaky, A. Saleh
Objective The aim of this study was to compare the adequacy and outcome of controlled hypotensive anesthesia using remifentanil or magnesium sulfate during functional endoscopic sinus surgery (FESS). Patients and methods The study included 104 patients with chronic rhinosinusitis assigned for FESS. They were randomly divided into two equal groups: group R received remifentanil loading dose of 1 μg/kg over 60 s, followed by 0.15 μg/kg/min infusion, and group M received magnesium sulfate loading dose of 40 mg/kg over 10 min, followed by 15 mg/kg/h infusion. Hemodynamic variables were noninvasively monitored and expressed every 15 min. Operative field bleeding and subsequently its visibility were graded using a six-point scale. Recovery time was estimated as the time until the patient achieves a modified Aldrete scoring of 11 or more. The degree of sedation was assessed using the Brussels Sedation Scale. Results The mean collective heart rate and mean arterial pressure measures were signifi cantly low in group R compared with group M. The mean amount of collected blood loss and total field visibility scale score were significantly lower with remifentanil than with magnesium sulfate. The frequency of patients who achieved early recovery was significantly higher with remifentanil with significantly shorter time to achieve modified Aldrete scoring of 11 or more compared with magnesium sulfate. Conclusion Controlled hypotensive anesthesia minimized bleeding and provided excellent fi eld visibility during FESS. Remifentanil provided superior outcome manifested as signifi cant reduction in operative field bleeding, better field visibility, and shorter operative time compared with magnesium sulfate. In addition, remifentanil provided early recovery without postoperative sedation and thus allowed FESS to be conducted as a day-case surgery.
{"title":"Hypotensive anesthesia during functional endoscopic sinus surgery: a comparative study of remifentanil versus magnesium sulfate infusion","authors":"M. Zaky, A. Saleh","doi":"10.4103/1687-7934.238486","DOIUrl":"https://doi.org/10.4103/1687-7934.238486","url":null,"abstract":"Objective The aim of this study was to compare the adequacy and outcome of controlled hypotensive anesthesia using remifentanil or magnesium sulfate during functional endoscopic sinus surgery (FESS). Patients and methods The study included 104 patients with chronic rhinosinusitis assigned for FESS. They were randomly divided into two equal groups: group R received remifentanil loading dose of 1 μg/kg over 60 s, followed by 0.15 μg/kg/min infusion, and group M received magnesium sulfate loading dose of 40 mg/kg over 10 min, followed by 15 mg/kg/h infusion. Hemodynamic variables were noninvasively monitored and expressed every 15 min. Operative field bleeding and subsequently its visibility were graded using a six-point scale. Recovery time was estimated as the time until the patient achieves a modified Aldrete scoring of 11 or more. The degree of sedation was assessed using the Brussels Sedation Scale. Results The mean collective heart rate and mean arterial pressure measures were signifi cantly low in group R compared with group M. The mean amount of collected blood loss and total field visibility scale score were significantly lower with remifentanil than with magnesium sulfate. The frequency of patients who achieved early recovery was significantly higher with remifentanil with significantly shorter time to achieve modified Aldrete scoring of 11 or more compared with magnesium sulfate. Conclusion Controlled hypotensive anesthesia minimized bleeding and provided excellent fi eld visibility during FESS. Remifentanil provided superior outcome manifested as signifi cant reduction in operative field bleeding, better field visibility, and shorter operative time compared with magnesium sulfate. In addition, remifentanil provided early recovery without postoperative sedation and thus allowed FESS to be conducted as a day-case surgery.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"2 1","pages":"124 - 130"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89449962","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: 10.4103/1687-7934.238469
Suleiman A Adetunji, O. Adekola, I. Desalu, Olushola T. Kushimo
Introduction Early postoperative hypoxemia may occur when patients breathe room air during their initial recovery period. Prolonged hypoxemia can result in delirium, dysrhythmia, and cardiac arrest. Aim The aim of the present study was to compare the performance of face mask compared with that of the nasal prong in the management of early postoperative hypoxemia. Patients and methods All procedures were performed using standard anesthetic and surgical techniques modified to the specific procedures. All patients had peripheral oxygen saturation (SpO2) at least 97% before being transferred to the recovery room. On arrival to the recovery room, 120 patients whose SpO2 decreased up to 94% were randomly allocated to either the face mask or nasal prong groups. They were commenced on oxygen therapy at 4 l/min through either device. A modified visual analogues scale was used to evaluate the level of comfort during oxygen therapy. Results Early postoperative hypoxia occurred in 18.1%. The increase in oxygen saturation after commencement of oxygen therapy was significantly faster with nasal prongs (0.63±1.42 min) than with face mask (1.78±1.10 min) (P=0.001). The maximum SpO2 obtained was significantly higher with nasal prongs (98.77±1.29%) than with face mask (97.63±1.89%) (P<0.001). There was no significant association found between early postoperative hypoxemia and site or duration of surgery, as well as the volume of intravenous fluid (crystalloids) administered intraoperatively (P>0.05). Nasal prongs (91.7%) were significantly more comfortable compared with face mask (61.7%) (P=0.001). We have demonstrated that the use of nasal prongs was more efficient and comfortable compared with face mask in the management of early postoperative hypoxemia.
{"title":"Management of early postoperative hypoxemia: a comparative performance of Hudson face mask with nasal prongs","authors":"Suleiman A Adetunji, O. Adekola, I. Desalu, Olushola T. Kushimo","doi":"10.4103/1687-7934.238469","DOIUrl":"https://doi.org/10.4103/1687-7934.238469","url":null,"abstract":"Introduction Early postoperative hypoxemia may occur when patients breathe room air during their initial recovery period. Prolonged hypoxemia can result in delirium, dysrhythmia, and cardiac arrest. Aim The aim of the present study was to compare the performance of face mask compared with that of the nasal prong in the management of early postoperative hypoxemia. Patients and methods All procedures were performed using standard anesthetic and surgical techniques modified to the specific procedures. All patients had peripheral oxygen saturation (SpO2) at least 97% before being transferred to the recovery room. On arrival to the recovery room, 120 patients whose SpO2 decreased up to 94% were randomly allocated to either the face mask or nasal prong groups. They were commenced on oxygen therapy at 4 l/min through either device. A modified visual analogues scale was used to evaluate the level of comfort during oxygen therapy. Results Early postoperative hypoxia occurred in 18.1%. The increase in oxygen saturation after commencement of oxygen therapy was significantly faster with nasal prongs (0.63±1.42 min) than with face mask (1.78±1.10 min) (P=0.001). The maximum SpO2 obtained was significantly higher with nasal prongs (98.77±1.29%) than with face mask (97.63±1.89%) (P<0.001). There was no significant association found between early postoperative hypoxemia and site or duration of surgery, as well as the volume of intravenous fluid (crystalloids) administered intraoperatively (P>0.05). Nasal prongs (91.7%) were significantly more comfortable compared with face mask (61.7%) (P=0.001). We have demonstrated that the use of nasal prongs was more efficient and comfortable compared with face mask in the management of early postoperative hypoxemia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"3 1","pages":"84 - 90"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73071773","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: 10.4103/1687-7934.238484
A. Said, Heba B El-Serwi
Objectives The aim of this study was to evaluate applicability of nasopharyngeal airway (NPA) for the maintenance of patients’ oxygenation during sevoflurane inhalational anesthesia through NPA against propofol infusion and traditional endotracheal intubation (ETT). Patients and methods The study included 111 patients with obstructive sleep apnea (OSA). Risk of OSA was evaluated preoperatively using the STOP-BANG Questionnaire. Patients were randomly allocated into three groups: group E received propofol infusion (50–150 μg/kg/min) with atracurium (0.3 mg/kg), group S received sevoflurane inhalation (1 MAC) through NPA, and group P was maintained on propofol infusion (50–150 μg/kg/min). The frequency and severity of hypoxemic attacks and the requirement for ETT in groups S and P were compared. Results Sixty-four patients (57.7%) had mild, whereas and 47 patients (42.3%) had an iintermediate OSA grade on STOP-BANG score. At the end of endoscopic retrograde cholangiopancreatography, heart rate, mean arterial pressure, and mean PSaO2 measures were found significantly lower in all patients compared with baseline estimates. Concentration of PSaO2 was significantly lower in group P compared with groups E and S. The frequency of hypoxemic attacks was nonsignificantly higher with NPA compared with ETT and only five patients required ETT. The frequency of procedural sedation-related adverse events was nonsignificantly lower with NPA compared with ETT (27 vs. 32.4%). The frequency till full recovery was significantly longer in group E compared with groups S and P, with a significant difference in favor of group S. Patients’ satisfaction scorings were significantly higher in groups S and P compared with group E. Endoscopist satisfaction scorings were significantly higher in groups S and E compared with group P. Conclusion NPA could be applied for the oxygenation of patients undergoing endoscopic retrograde cholangiopancreatography, even on those having OSA with an acceptable frequency of hypoxic attacks and conversion rate to ETT. Sevoflurane sedation was an advantageous alternative to propofol sedation for an early, easy recovery with less adverse events.
{"title":"Nasopharyngeal airway for oxygenation and sevoflurane inhalation during endoscopic retrograde cholangiopancreatography in patients with obstructive sleep apnea","authors":"A. Said, Heba B El-Serwi","doi":"10.4103/1687-7934.238484","DOIUrl":"https://doi.org/10.4103/1687-7934.238484","url":null,"abstract":"Objectives The aim of this study was to evaluate applicability of nasopharyngeal airway (NPA) for the maintenance of patients’ oxygenation during sevoflurane inhalational anesthesia through NPA against propofol infusion and traditional endotracheal intubation (ETT). Patients and methods The study included 111 patients with obstructive sleep apnea (OSA). Risk of OSA was evaluated preoperatively using the STOP-BANG Questionnaire. Patients were randomly allocated into three groups: group E received propofol infusion (50–150 μg/kg/min) with atracurium (0.3 mg/kg), group S received sevoflurane inhalation (1 MAC) through NPA, and group P was maintained on propofol infusion (50–150 μg/kg/min). The frequency and severity of hypoxemic attacks and the requirement for ETT in groups S and P were compared. Results Sixty-four patients (57.7%) had mild, whereas and 47 patients (42.3%) had an iintermediate OSA grade on STOP-BANG score. At the end of endoscopic retrograde cholangiopancreatography, heart rate, mean arterial pressure, and mean PSaO2 measures were found significantly lower in all patients compared with baseline estimates. Concentration of PSaO2 was significantly lower in group P compared with groups E and S. The frequency of hypoxemic attacks was nonsignificantly higher with NPA compared with ETT and only five patients required ETT. The frequency of procedural sedation-related adverse events was nonsignificantly lower with NPA compared with ETT (27 vs. 32.4%). The frequency till full recovery was significantly longer in group E compared with groups S and P, with a significant difference in favor of group S. Patients’ satisfaction scorings were significantly higher in groups S and P compared with group E. Endoscopist satisfaction scorings were significantly higher in groups S and E compared with group P. Conclusion NPA could be applied for the oxygenation of patients undergoing endoscopic retrograde cholangiopancreatography, even on those having OSA with an acceptable frequency of hypoxic attacks and conversion rate to ETT. Sevoflurane sedation was an advantageous alternative to propofol sedation for an early, easy recovery with less adverse events.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"146 1","pages":"109 - 116"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75015390","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_117_16
S. Seyam
Background Postoperative nausea and vomiting (PONV) are the most common annoying events and complications following general anesthesia and surgery. Emetic incidents can lead to aspiration of gastric contents, wound unsealing, psychological distress, and delayed recovery from anesthesia and discharge times. Aim This study was designed to compare the effects of a single dose of dexmedetomidine or dexamethasone as an adjuvant to ondansetron for reducing PONV after functional endoscopic sinus surgery operation and to assess if there is any advantage of one drug over the other. Patients and methods This study is a prospective randomized single-blind study. The study involved 60 patients with American Society of Anesthesiologists physical status I and II, of both sexes, between 18 and 50 years of age, undergoing elective functional endoscopic sinus surgery operation. At the end of surgery, patients were randomly allocated to receive an intravenous single dose of either 0.1 mg/kg of ondansetron as a control group, or 8 mg of dexamethasone following 0.1 mg/kg of ondansetron, or dexmedetomidine 0.1 μ/kg following 0.1 mg/kg ondansetron. Postoperatively, all the incidents of nausea, retching and/or vomiting were recorded and patients were asked if vomiting had occurred or if the patients felt nauseated with only two possible answers (yes or no). Results There was no significant differences among the three groups regarding the incidence of PONV during the first 24 h postoperatively, with a slight difference in the ondansetron–dexmedetomidine (ondan–dexmed) group, which was less in frequency in relation to the other groups (P<0.211). Regarding the PONV incidence in relation to intraoperative and postoperative medications, there was a highly significant difference among the three groups regarding the severity of PONV. The PONV severity was lower in the ondan–dexmed group in relation to the other groups (P<0.001). The metoclopramide dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The tramadol dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The intraoperative fentanyl requirements was significantly lower in ondan–dexmed group in relation to the other groups (P<0.001). Regarding the first analgesic request, it was significantly delayed in ondan–dexmed group in relation to the other groups (P<0.021). Conclusion A single dose of dexmedetomidine combined with ondansetron is superior to ondansetron alone or ondansetron combined with dexamethazone for preventing PONV in patients undergoing functional endoscopic sinus surgery under general anesthesia.
背景术后恶心和呕吐(PONV)是全身麻醉和手术后最常见的恼人事件和并发症。呕吐事件可导致胃内容物误吸、伤口打开、心理困扰、麻醉恢复和出院时间延迟。目的:本研究旨在比较单剂量右美托咪定或地塞米松辅助昂丹司琼降低功能性内窥镜鼻窦手术后PONV的效果，并评估其中一种药物是否优于另一种药物。本研究为前瞻性随机单盲研究。本研究涉及60例患者，年龄在18岁至50岁之间，具有美国麻醉医师学会I和II物理状态，接受选择性功能性内窥镜鼻窦手术。在手术结束时，患者被随机分配接受单次静脉注射剂量为0.1 mg/kg的昂丹西琼作为对照组，或在给予0.1 mg/kg的昂丹西琼后给予8 mg地塞米松，或在给予0.1 mg/kg的昂丹西琼后给予0.1 μ/kg的右美托咪定。术后记录所有恶心、干呕和/或呕吐事件，并询问患者是否发生呕吐或患者是否感到恶心，只有两个可能的答案(是或否)。结果三组术后前24 h PONV发生率无显著性差异，昂丹西酮-右美托咪定(昂丹-右美托咪定)组有轻微差异，其发生率低于其他组(P<0.211)。关于术中、术后用药与PONV发生率的关系，三组间PONV严重程度差异极显著。与其他组相比，ondandexmed组PONV严重程度较低(P<0.001)。ondan-dexmed组术后24 h甲氧氯普胺剂量显著低于其他组(P<0.001)。ondan-dexmed组术后24 h曲马多剂量显著低于其他组(P<0.001)。ondan-dexmed组术中芬太尼需要量明显低于其他组(P<0.001)。对于第一次镇痛请求，ondandexmed组较其他组明显延迟(P<0.021)。结论单剂量右美托咪定联合昂丹西酮预防全麻下功能性内窥镜鼻窦手术患者PONV的效果优于单用昂丹西酮或昂丹西酮联合地塞米松。
{"title":"Comparative study between dexamethasone and dexmedetomidine as an adjuvant to ondansetron for the prevention of postoperative nausea and vomiting following functional endoscopic sinus surgery operation","authors":"S. Seyam","doi":"10.4103/asja.asja_117_16","DOIUrl":"https://doi.org/10.4103/asja.asja_117_16","url":null,"abstract":"Background Postoperative nausea and vomiting (PONV) are the most common annoying events and complications following general anesthesia and surgery. Emetic incidents can lead to aspiration of gastric contents, wound unsealing, psychological distress, and delayed recovery from anesthesia and discharge times. Aim This study was designed to compare the effects of a single dose of dexmedetomidine or dexamethasone as an adjuvant to ondansetron for reducing PONV after functional endoscopic sinus surgery operation and to assess if there is any advantage of one drug over the other. Patients and methods This study is a prospective randomized single-blind study. The study involved 60 patients with American Society of Anesthesiologists physical status I and II, of both sexes, between 18 and 50 years of age, undergoing elective functional endoscopic sinus surgery operation. At the end of surgery, patients were randomly allocated to receive an intravenous single dose of either 0.1 mg/kg of ondansetron as a control group, or 8 mg of dexamethasone following 0.1 mg/kg of ondansetron, or dexmedetomidine 0.1 μ/kg following 0.1 mg/kg ondansetron. Postoperatively, all the incidents of nausea, retching and/or vomiting were recorded and patients were asked if vomiting had occurred or if the patients felt nauseated with only two possible answers (yes or no). Results There was no significant differences among the three groups regarding the incidence of PONV during the first 24 h postoperatively, with a slight difference in the ondansetron–dexmedetomidine (ondan–dexmed) group, which was less in frequency in relation to the other groups (P<0.211). Regarding the PONV incidence in relation to intraoperative and postoperative medications, there was a highly significant difference among the three groups regarding the severity of PONV. The PONV severity was lower in the ondan–dexmed group in relation to the other groups (P<0.001). The metoclopramide dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The tramadol dose during the following 24 h was significantly low in ondan–dexmed group in relation to the other groups (P<0.001). The intraoperative fentanyl requirements was significantly lower in ondan–dexmed group in relation to the other groups (P<0.001). Regarding the first analgesic request, it was significantly delayed in ondan–dexmed group in relation to the other groups (P<0.021). Conclusion A single dose of dexmedetomidine combined with ondansetron is superior to ondansetron alone or ondansetron combined with dexamethazone for preventing PONV in patients undergoing functional endoscopic sinus surgery under general anesthesia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"600 1","pages":"156 - 163"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77256016","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: 10.4103/1687-7934.238480
T. Ibrahim, Mostafa K. Abdellatif, F. Osama
Context Postoperative pain management for renal transplant recipients is limited by considerations related mainly to the impaired renal functions. Patient-controlled analgesia (PCA) by fentanyl has been used and provides good pain control. The transversus abdominis plane (TAP) block provides good postoperative analgesia for abdominal surgeries Aims The aim of the present study was to examine the efficacy of the TAP block using 30 ml bupivacaine 0.25% in reducing the postoperative fentanyl requirements in renal transplant recipients Patients and materials This double-blinded, prospective, randomized, controlled study included 50 patients divided into two equal groups: group A, the control group, which included patients who received the TAP injection with only normal saline and kept on PCA fentanyl; and group B, the TAP block group, which included patients who received the TAP block using 30 ml of bupivacaine 0.25% in addition to PCA fentanyl. The primary outcome was the postoperative 24 h fentanyl consumption, whereas other outcomes included pain scores, heart rate, mean arterial blood pressure, and incidence of nausea, vomiting, excessive sedation, and respiratory depression. Results Postoperative 24 h PCA fentanyl consumption was significantly lower in the TAP block group (330.9±36.8) compared with the control group (636.9±40) (P<0.01). The pain scores recorded in the TAP group were significantly lower (P<0.01). Mean arterial blood pressure was also significantly lower in the TAP group; however, differences between the recorded heart rates were nonsignificant (P=<0.01 and 0.6, respectively). None of the patients developed excessive sedation or respiratory depression. Conclusion A TAP block with 30 ml bupivacaine 0.25% provides excellent postoperative analgesia for renal transplant recipients and significantly reduced the 24 h postoperative PCA fentanyl requirements and the pain scores.
肾移植受者术后疼痛管理主要受限于肾功能受损的考虑。芬太尼患者自控镇痛(PCA)已被使用，并提供良好的疼痛控制。经腹面(TAP)阻滞为腹部手术提供良好的术后镇痛目的本研究的目的是研究使用0.25%布比卡因30ml TAP阻滞对肾移植受者术后芬太尼需求量的降低效果。本研究采用双盲、前瞻性、随机对照研究，50例患者分为两组:A组为对照组，仅用生理盐水注射TAP，持续使用PCA芬太尼;B组为TAP阻断组，其中包括在PCA芬太尼基础上使用30 ml 0.25%布比卡因进行TAP阻断的患者。主要终点是术后24小时芬太尼用量，其他终点包括疼痛评分、心率、平均动脉血压、恶心、呕吐、过度镇静和呼吸抑制的发生率。结果TAP阻断组术后24 h芬太尼用量(330.9±36.8)明显低于对照组(636.9±40)(P<0.01)。TAP组疼痛评分明显低于对照组(P<0.01)。TAP组平均动脉血压也显著降低;然而，记录的心率之间的差异无统计学意义(P分别<0.01和0.6)。没有患者出现过度镇静或呼吸抑制。结论30 ml 0.25%布比卡因TAP阻滞对肾移植受者术后镇痛效果良好，可显著降低术后24 h PCA芬太尼需用量和疼痛评分。
{"title":"Efficacy of the transversus abdominis plane block using 30 ml bupivacaine 0.25% in reducing postoperative fentanyl requirements in renal transplant recepients","authors":"T. Ibrahim, Mostafa K. Abdellatif, F. Osama","doi":"10.4103/1687-7934.238480","DOIUrl":"https://doi.org/10.4103/1687-7934.238480","url":null,"abstract":"Context Postoperative pain management for renal transplant recipients is limited by considerations related mainly to the impaired renal functions. Patient-controlled analgesia (PCA) by fentanyl has been used and provides good pain control. The transversus abdominis plane (TAP) block provides good postoperative analgesia for abdominal surgeries Aims The aim of the present study was to examine the efficacy of the TAP block using 30 ml bupivacaine 0.25% in reducing the postoperative fentanyl requirements in renal transplant recipients Patients and materials This double-blinded, prospective, randomized, controlled study included 50 patients divided into two equal groups: group A, the control group, which included patients who received the TAP injection with only normal saline and kept on PCA fentanyl; and group B, the TAP block group, which included patients who received the TAP block using 30 ml of bupivacaine 0.25% in addition to PCA fentanyl. The primary outcome was the postoperative 24 h fentanyl consumption, whereas other outcomes included pain scores, heart rate, mean arterial blood pressure, and incidence of nausea, vomiting, excessive sedation, and respiratory depression. Results Postoperative 24 h PCA fentanyl consumption was significantly lower in the TAP block group (330.9±36.8) compared with the control group (636.9±40) (P<0.01). The pain scores recorded in the TAP group were significantly lower (P<0.01). Mean arterial blood pressure was also significantly lower in the TAP group; however, differences between the recorded heart rates were nonsignificant (P=<0.01 and 0.6, respectively). None of the patients developed excessive sedation or respiratory depression. Conclusion A TAP block with 30 ml bupivacaine 0.25% provides excellent postoperative analgesia for renal transplant recipients and significantly reduced the 24 h postoperative PCA fentanyl requirements and the pain scores.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"118 1","pages":"258 - 263"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87628883","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_109_16
Sanaa M. El Fawal, W. Abdelaal, Walid H. Nofal
Objective The aim of this study was to compare the effects of volatile anesthetics isoflurane and sevoflurane on intraoperative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Patients and methods A total of 64 children classified as American Society of Anesthesiologists class I or II, aged between 2 and 16 years, who were scheduled for tonsillectomy and adenoidectomy were included in this prospective randomized double-blind study. The patients were randomized into two groups, isoflurane group and sevoflurane group, with each including 32 patients. They received balanced general anesthesia with isoflurane concentration 1.2% or sevoflurane concentration 2%. In all patients, the amount of intraoperative blood loss in milliliters was measured by the suction bottle, as well as by weighing the used sponges for each patient. The duration of operation and recovery time were recorded. Results Isoflurane caused significantly lower amount of perioperative bleeding compared with sevoflurane (P=0.03). No significant difference was observed between the two groups in terms of age, BMI, and operation duration, Conclusion Anesthesia with isoflurane can lead to a lower amount of intraoperative bleeding compared with sevoflurane. Therefore, isoflurane may be preferred as an inhalational agent for maintenance of general anesthesia during tonsillectomy and adenoidectomy operations.
{"title":"Comparative study between sevoflurane and isoflurane on the perioperative and postoperative bleeding of adenotonsillectomy patients","authors":"Sanaa M. El Fawal, W. Abdelaal, Walid H. Nofal","doi":"10.4103/asja.asja_109_16","DOIUrl":"https://doi.org/10.4103/asja.asja_109_16","url":null,"abstract":"Objective The aim of this study was to compare the effects of volatile anesthetics isoflurane and sevoflurane on intraoperative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Patients and methods A total of 64 children classified as American Society of Anesthesiologists class I or II, aged between 2 and 16 years, who were scheduled for tonsillectomy and adenoidectomy were included in this prospective randomized double-blind study. The patients were randomized into two groups, isoflurane group and sevoflurane group, with each including 32 patients. They received balanced general anesthesia with isoflurane concentration 1.2% or sevoflurane concentration 2%. In all patients, the amount of intraoperative blood loss in milliliters was measured by the suction bottle, as well as by weighing the used sponges for each patient. The duration of operation and recovery time were recorded. Results Isoflurane caused significantly lower amount of perioperative bleeding compared with sevoflurane (P=0.03). No significant difference was observed between the two groups in terms of age, BMI, and operation duration, Conclusion Anesthesia with isoflurane can lead to a lower amount of intraoperative bleeding compared with sevoflurane. Therefore, isoflurane may be preferred as an inhalational agent for maintenance of general anesthesia during tonsillectomy and adenoidectomy operations.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"8 1","pages":"140 - 143"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83472875","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 Emergence agitation (EA) can occur following recovery from general anesthesia. The patient may exhibit aggressive behavior, disorientation, agitation, and restlessness. If untreated, this complication may result in significant morbidity. EA has been poorly investigated in patients undergoing laparoscopic sleeve gastrectomy. Aim The aim was to assess the efficacy of perioperative dexmedetomidine infusion on EA and quality of recovery after elective laparoscopic sleeve gastrectomy in morbidly obese adult patients. Materials and methods A total of 60 patients undergoing laparoscopic sleeve gastrectomy were randomized into two groups (30 patients each). The dexmedetomidine group (group D, N=30) received dexmedetomidine infusion, whereas the control group (group C, N=30) received normal saline in the same volume and rate as placebo. Propofol, fentanyl, and atracurium were used for induction of anesthesia, and isoflurane was used for maintenance of anesthesia. Postoperative hemodynamic variables, postoperative pain, the need for ‘rescue’ analgesics and antiemetics, and the incidence of agitation were recorded up to 2 h postoperatively. Pain was evaluated using the visual analog scale score in the postanesthesia care unit on arrival, at 5 min, and then every 15 min for 120 min. EA was evaluated at the same time intervals by Richmond agitation-sedation scale (RASS). Pethidine 50 mg intravenously was given for pain (if pain score >4) or severe agitation (RASS score >+1). Results No patients in group D experienced postoperative EA during the second hour postoperatively (RASS ˂1). On the contrary, RASS scores of patients in group C were 2 (2–3) on arrival to postanesthesia care unit and greater than +1 during the remaining time up to 2 h postoperatively, indicating postoperative EA. In group C, 25 (92.5%) patients required rescue analgesia compared with only five (18.5%) patients in group D. Hemodynamic parameters were stable in group D. Conclusion Dexmedetomidine infusion during laparoscopic sleeve gastrectomy for morbidly obese patients is beneficial and effective in preventing postoperative pain and postoperative EA.
{"title":"Dexmedetomidine infusion versus placebo for analgesia and prevention of emergence agitation in morbidly obese patients undergoing laparoscopic sleeve gastrectomy","authors":"M. Hussein, R. Mostafa","doi":"10.4103/asja.asja_59_16","DOIUrl":"https://doi.org/10.4103/asja.asja_59_16","url":null,"abstract":"Background Emergence agitation (EA) can occur following recovery from general anesthesia. The patient may exhibit aggressive behavior, disorientation, agitation, and restlessness. If untreated, this complication may result in significant morbidity. EA has been poorly investigated in patients undergoing laparoscopic sleeve gastrectomy. Aim The aim was to assess the efficacy of perioperative dexmedetomidine infusion on EA and quality of recovery after elective laparoscopic sleeve gastrectomy in morbidly obese adult patients. Materials and methods A total of 60 patients undergoing laparoscopic sleeve gastrectomy were randomized into two groups (30 patients each). The dexmedetomidine group (group D, N=30) received dexmedetomidine infusion, whereas the control group (group C, N=30) received normal saline in the same volume and rate as placebo. Propofol, fentanyl, and atracurium were used for induction of anesthesia, and isoflurane was used for maintenance of anesthesia. Postoperative hemodynamic variables, postoperative pain, the need for ‘rescue’ analgesics and antiemetics, and the incidence of agitation were recorded up to 2 h postoperatively. Pain was evaluated using the visual analog scale score in the postanesthesia care unit on arrival, at 5 min, and then every 15 min for 120 min. EA was evaluated at the same time intervals by Richmond agitation-sedation scale (RASS). Pethidine 50 mg intravenously was given for pain (if pain score >4) or severe agitation (RASS score >+1). Results No patients in group D experienced postoperative EA during the second hour postoperatively (RASS ˂1). On the contrary, RASS scores of patients in group C were 2 (2–3) on arrival to postanesthesia care unit and greater than +1 during the remaining time up to 2 h postoperatively, indicating postoperative EA. In group C, 25 (92.5%) patients required rescue analgesia compared with only five (18.5%) patients in group D. Hemodynamic parameters were stable in group D. Conclusion Dexmedetomidine infusion during laparoscopic sleeve gastrectomy for morbidly obese patients is beneficial and effective in preventing postoperative pain and postoperative EA.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"3 1","pages":"207 - 212"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81835502","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: 10.4103/1687-7934.238468
I. Nasr, K. Elnaghy, Hesham F Soliman
Context This study was designed to compare dexmedetomidine with magnesium sulfate as an adjunctive to total intravenous anesthesia (TIVA) as regards the efficacy and safety as hypotensive agents in scoliosis correction surgery. Patients and methods This prospective randomized double-blinded study included 40 patients of American Society of Anesthesiology II who were scheduled for the correction of scoliosis under TIVA and divided into two groups of 20 patients each. The first group was the Dex group, which was administered dexmedetomidine infusion at a rate of 0.5 μg/kg/h, and the second group was the Mg group, which was administered magnesium sulfate infusion at a rate of 15 mg/kg/h. The target mean arterial pressure (MAP) was 60–70 mmHg. The two groups were compared as regards MAP, heart rate (HR), intraoperative blood loss, blood transfusion, quality of surgical field, need for vasodilators and analgesics, time to extubation, time to recover the hypotension, time to recover the full conscious level, and perioperative serum levels of calcium and magnesium. Results Both groups could achieve the target MAP before skin incision. The Dex group showed more HR stability, less intraoperative blood loss, and less intraoperative blood transfusion with better surgical field quality. Moreover, the need for vasodilators was lesser in this group. However, the Mg group showed faster extubation time, faster reversibility of hypotension, and faster recovery of full conscious level. Need for intraoperative analgesia was comparable between the two groups. Intraoperative and postoperative serum magnesium were higher in the Mg group and intraoperative and postoperative serum calcium levels showed gradual drop in the Mg group compared with the Dex group and the preoperative level in the Mg group. Both electrolytes showed recovery to normal preoperative level 24 h postoperatively without interference. Conclusion TIVA with both dexmedetomidine and magnesium sulfate could achieve the target MAP for hypotensive anesthesia. Dexmedetomidine can control MAP with lesser need for vasodilators and with better control of HR. It provided lesser blood loss and better quality of surgical field. Magnesium sulfate showed faster extubation and recovery of conscious level with faster reversibility of hypotensive state but with the risk for perioperative hypocalcemia.
{"title":"Hypotensive anesthesia for the correction of scoliosis under total intravenous anesthesia: comparison between dexmedetomidine and magnesium sulfate","authors":"I. Nasr, K. Elnaghy, Hesham F Soliman","doi":"10.4103/1687-7934.238468","DOIUrl":"https://doi.org/10.4103/1687-7934.238468","url":null,"abstract":"Context This study was designed to compare dexmedetomidine with magnesium sulfate as an adjunctive to total intravenous anesthesia (TIVA) as regards the efficacy and safety as hypotensive agents in scoliosis correction surgery. Patients and methods This prospective randomized double-blinded study included 40 patients of American Society of Anesthesiology II who were scheduled for the correction of scoliosis under TIVA and divided into two groups of 20 patients each. The first group was the Dex group, which was administered dexmedetomidine infusion at a rate of 0.5 μg/kg/h, and the second group was the Mg group, which was administered magnesium sulfate infusion at a rate of 15 mg/kg/h. The target mean arterial pressure (MAP) was 60–70 mmHg. The two groups were compared as regards MAP, heart rate (HR), intraoperative blood loss, blood transfusion, quality of surgical field, need for vasodilators and analgesics, time to extubation, time to recover the hypotension, time to recover the full conscious level, and perioperative serum levels of calcium and magnesium. Results Both groups could achieve the target MAP before skin incision. The Dex group showed more HR stability, less intraoperative blood loss, and less intraoperative blood transfusion with better surgical field quality. Moreover, the need for vasodilators was lesser in this group. However, the Mg group showed faster extubation time, faster reversibility of hypotension, and faster recovery of full conscious level. Need for intraoperative analgesia was comparable between the two groups. Intraoperative and postoperative serum magnesium were higher in the Mg group and intraoperative and postoperative serum calcium levels showed gradual drop in the Mg group compared with the Dex group and the preoperative level in the Mg group. Both electrolytes showed recovery to normal preoperative level 24 h postoperatively without interference. Conclusion TIVA with both dexmedetomidine and magnesium sulfate could achieve the target MAP for hypotensive anesthesia. Dexmedetomidine can control MAP with lesser need for vasodilators and with better control of HR. It provided lesser blood loss and better quality of surgical field. Magnesium sulfate showed faster extubation and recovery of conscious level with faster reversibility of hypotensive state but with the risk for perioperative hypocalcemia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"33 1","pages":"76 - 83"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85133794","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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