Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238465
R. Bondok, D. Salah, Wael Sayed
Background There has been a growing interest in the topical use of tranexamic acid (TXA) for the prevention of bleeding during different surgeries. Patients with liver cirrhosis may develop upper gastrointestinal (UGI) bleeding, which arises because of portal hypertension, which includes gastroesophageal varices and portal hypertensive gastropathy. The aim of this study was to evaluate the efficacy of the local application of TXA in reducing blood loss, transfusion requirements, and shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding. Patients and methods A total of 100 patients with end-stage chronic liver disease presenting with UGI bleeding were randomly assigned to two groups to receive a standard protocol for UGI bleeding management, in addition to nasogastric lavage with either normal saline only (group S) or normal saline with TXA (group S+TXA). The lavage was repeated till its measured hematocrit (Hct) was less than 1%. The duration to reach this Hct was recorded. The volume of washes and transfusion requirements for each group were also recorded. Results Hemodynamic stability was observed in group S+TXA with less bleeding. The volumes of washes were significantly lower in group S+TXA. Time to reach Hct less than 1% in washed fluid was significantly shorter in group S+TXA (81.5±20.7 min) compared with group S (230.1±29.9 min). Transfusion requirements were significantly low in group S+TXA (765±184 ml) compared with group S (1345±278 ml). Duration to perform emergency upper endoscopy was shorter in group S+TXA (667±198 min) compared with group S (1094±163 min). Conclusion Local application of TXA during nasogastric lavage was efficient in reducing blood loss and transfusion requirements and in shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding.
{"title":"Local application of tranexamic acid to reduce upper gastrointestinal bleeding in patients with liver cirrhosis","authors":"R. Bondok, D. Salah, Wael Sayed","doi":"10.4103/1687-7934.238465","DOIUrl":"https://doi.org/10.4103/1687-7934.238465","url":null,"abstract":"Background There has been a growing interest in the topical use of tranexamic acid (TXA) for the prevention of bleeding during different surgeries. Patients with liver cirrhosis may develop upper gastrointestinal (UGI) bleeding, which arises because of portal hypertension, which includes gastroesophageal varices and portal hypertensive gastropathy. The aim of this study was to evaluate the efficacy of the local application of TXA in reducing blood loss, transfusion requirements, and shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding. Patients and methods A total of 100 patients with end-stage chronic liver disease presenting with UGI bleeding were randomly assigned to two groups to receive a standard protocol for UGI bleeding management, in addition to nasogastric lavage with either normal saline only (group S) or normal saline with TXA (group S+TXA). The lavage was repeated till its measured hematocrit (Hct) was less than 1%. The duration to reach this Hct was recorded. The volume of washes and transfusion requirements for each group were also recorded. Results Hemodynamic stability was observed in group S+TXA with less bleeding. The volumes of washes were significantly lower in group S+TXA. Time to reach Hct less than 1% in washed fluid was significantly shorter in group S+TXA (81.5±20.7 min) compared with group S (230.1±29.9 min). Transfusion requirements were significantly low in group S+TXA (765±184 ml) compared with group S (1345±278 ml). Duration to perform emergency upper endoscopy was shorter in group S+TXA (667±198 min) compared with group S (1094±163 min). Conclusion Local application of TXA during nasogastric lavage was efficient in reducing blood loss and transfusion requirements and in shortening the time for emergency endoscopy in cirrhotic patients presenting with UGI bleeding.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"10 1","pages":"54 - 59"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87600422","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: 10.4103/1687-7934.238451
A. Alzeftawy, A. El-Daba
Background Awake endotracheal intubation using the fiberoptic bronchoscope is the gold standard in morbidly obese patients. It needs special skills and high training. The disposable Airtraq laryngoscope had been used for difficult intubation. It can have some advantages compared with the fiberoptic bronchoscope during awake orotracheal intubation. Patients and methods In this study, 60 morbidly obese patients were randomly assigned to be intubated awake with either the fiberoptic bronchoscope (30 patients) or the Airtraq laryngoscope (30 patients). Time needed for intubation, the number of intubation attempts, success rate, and complications were assessed in the two groups. Results The time needed for intubation was significantly shorter in the Airtraq group compared with the bronchoscope group. As regards the number of attempts, there was a nonsignificant difference between the two groups. All patients were intubated successfully with a nonsignificant incidence of complications between the two groups. Conclusion The Airtraq laryngoscope can be used safely as the fiberoptic bronchoscope for awake orotracheal intubation in morbidly obese patients.
{"title":"Awake orotracheal intubation using fiberoptic bronchoscope versus Airtraq laryngoscope in morbidly obese patients","authors":"A. Alzeftawy, A. El-Daba","doi":"10.4103/1687-7934.238451","DOIUrl":"https://doi.org/10.4103/1687-7934.238451","url":null,"abstract":"Background Awake endotracheal intubation using the fiberoptic bronchoscope is the gold standard in morbidly obese patients. It needs special skills and high training. The disposable Airtraq laryngoscope had been used for difficult intubation. It can have some advantages compared with the fiberoptic bronchoscope during awake orotracheal intubation. Patients and methods In this study, 60 morbidly obese patients were randomly assigned to be intubated awake with either the fiberoptic bronchoscope (30 patients) or the Airtraq laryngoscope (30 patients). Time needed for intubation, the number of intubation attempts, success rate, and complications were assessed in the two groups. Results The time needed for intubation was significantly shorter in the Airtraq group compared with the bronchoscope group. As regards the number of attempts, there was a nonsignificant difference between the two groups. All patients were intubated successfully with a nonsignificant incidence of complications between the two groups. Conclusion The Airtraq laryngoscope can be used safely as the fiberoptic bronchoscope for awake orotracheal intubation in morbidly obese patients.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"25 1","pages":"177 - 181"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74056257","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}
N. Elshalakany, A. El-shaer, A. Rabie, A. Moharram, A. Elsofy
Background and aim The purpose of this study was to evaluate the anesthetic and analgesic effects of dexmedetomidine as adjuvant in spinal anesthesia for patients undergoing inguinoscrotal surgery. Patients and methods A total of 70 adult male patients (American Society of Anesthesiologists I or II) scheduled for inguinoscrotal surgery were randomized into two equal groups using a computer-generated randomization table and received 3 ml plain hyperbaric bupivacaine 0.5% diluted in 0.5 ml normal saline in group C or plus dexmedetomidine (5 µg) in group D. Anesthesia, analgesia, and sedation qualities; hemodynamic changes; and adverse effects were recorded. Results The studied groups showed no significant difference regarding demographic data. The highest sensory level (T8) was the same in both groups, but there were statistically significant differences between the two groups (P<0.05) regarding quality of anesthesia, times of onset, and duration and regressions of sensory and motor blocks (rapid onset and delayed offset of sensory and motor blocks in group D). Postoperative pain score (visual analog scale) and rescue analgesic requirements were lower in group D compared with group C, and excellent analgesic quality was higher in group D. Sedation score intraoperatively and up to 60 min postoperatively was significantly higher in group D compared with group C. Regarding hemodynamics, mean arterial blood pressure and heart rate showed a statistically significant difference intraoperatively and till discharge to ward (P<0.05). Regarding adverse effects, two patients in group C compared with three patients in group D had incidence of hypotension (mean arterial blood pressure˂55 mmHg). Conclusion Dexmedetomidine as an adjuvant to hyperbaric bupivacaine in spinal anesthesia seems to be a profound intrathecal anesthetic, analgesic, and sedative agent, with preservation of hemodynamic stability and minimal adverse effects.
{"title":"Dexmedetomidine as adjuvant to hyperbaric bupivacaine in spinal anesthesia for inguinoscrotal surgery","authors":"N. Elshalakany, A. El-shaer, A. Rabie, A. Moharram, A. Elsofy","doi":"10.4103/asja.asja_65_16","DOIUrl":"https://doi.org/10.4103/asja.asja_65_16","url":null,"abstract":"Background and aim The purpose of this study was to evaluate the anesthetic and analgesic effects of dexmedetomidine as adjuvant in spinal anesthesia for patients undergoing inguinoscrotal surgery. Patients and methods A total of 70 adult male patients (American Society of Anesthesiologists I or II) scheduled for inguinoscrotal surgery were randomized into two equal groups using a computer-generated randomization table and received 3 ml plain hyperbaric bupivacaine 0.5% diluted in 0.5 ml normal saline in group C or plus dexmedetomidine (5 µg) in group D. Anesthesia, analgesia, and sedation qualities; hemodynamic changes; and adverse effects were recorded. Results The studied groups showed no significant difference regarding demographic data. The highest sensory level (T8) was the same in both groups, but there were statistically significant differences between the two groups (P<0.05) regarding quality of anesthesia, times of onset, and duration and regressions of sensory and motor blocks (rapid onset and delayed offset of sensory and motor blocks in group D). Postoperative pain score (visual analog scale) and rescue analgesic requirements were lower in group D compared with group C, and excellent analgesic quality was higher in group D. Sedation score intraoperatively and up to 60 min postoperatively was significantly higher in group D compared with group C. Regarding hemodynamics, mean arterial blood pressure and heart rate showed a statistically significant difference intraoperatively and till discharge to ward (P<0.05). Regarding adverse effects, two patients in group C compared with three patients in group D had incidence of hypotension (mean arterial blood pressure˂55 mmHg). Conclusion Dexmedetomidine as an adjuvant to hyperbaric bupivacaine in spinal anesthesia seems to be a profound intrathecal anesthetic, analgesic, and sedative agent, with preservation of hemodynamic stability and minimal adverse effects.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"122 1","pages":"264 - 271"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78321887","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: 10.4103/1687-7934.238450
T. Shabana, S. Anis, F. Abdelmalek
Background Although terlipressin is being used perioperatively in recipients of liver transplantation to improve splanchnic hemodynamics and postoperative renal functions, its associated antidiuretic effect has not been specifically investigated in this group of patients. The aim of this study is to assess the effect of terlipressin infusion started intraoperatively and continued for 48 h postoperatively in recipients of living donor liver transplantation on serum sodium and water/sodium excretion. Materials and methods Thirty patients with end-stage liver disease and portal hypertension scheduled for living donor liver transplantation were randomized into two groups including 15 patients each. Group 1 (control): patients did not receive terlipressin. Group 2: terlipressin was administered as an infusion at a rate of 2 µg/kg/h continued for 48 h after postoperative ICU admission. Comparisons were performed between both groups in terms of serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Results There were no significant changes between the control group and the terlipressin group in serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Conclusion Terlipressin infusion started intraoperatively at a rate of 2 µg/kg/h and continued for 48 h postoperatively in recipients of living donor liver transplantation did not result in significant changes in serum sodium and sodium/water excretion.
{"title":"Perioperative terlipressin infusion in living donor liver transplantation: effects on sodium and water balance","authors":"T. Shabana, S. Anis, F. Abdelmalek","doi":"10.4103/1687-7934.238450","DOIUrl":"https://doi.org/10.4103/1687-7934.238450","url":null,"abstract":"Background Although terlipressin is being used perioperatively in recipients of liver transplantation to improve splanchnic hemodynamics and postoperative renal functions, its associated antidiuretic effect has not been specifically investigated in this group of patients. The aim of this study is to assess the effect of terlipressin infusion started intraoperatively and continued for 48 h postoperatively in recipients of living donor liver transplantation on serum sodium and water/sodium excretion. Materials and methods Thirty patients with end-stage liver disease and portal hypertension scheduled for living donor liver transplantation were randomized into two groups including 15 patients each. Group 1 (control): patients did not receive terlipressin. Group 2: terlipressin was administered as an infusion at a rate of 2 µg/kg/h continued for 48 h after postoperative ICU admission. Comparisons were performed between both groups in terms of serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Results There were no significant changes between the control group and the terlipressin group in serum sodium, urine sodium, urine osmolarity, and the urine : sodium osmolarity ratio. Conclusion Terlipressin infusion started intraoperatively at a rate of 2 µg/kg/h and continued for 48 h postoperatively in recipients of living donor liver transplantation did not result in significant changes in serum sodium and sodium/water excretion.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"13 1","pages":"173 - 176"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84409430","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_110_16
M. Hussein, R. Mostafa
Background Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Multiple drugs have been used to prevent its occurrence. Ondansetron and aprepitant block the emetic effect of serotonin and neurokinin, respectively. Corticosteroids are well known for their anti-inflammatory effects, but the basis behind their use as antiemetics is not well understood. Objective The aim was to investigate the effect of combining aprepitant with ondansetron and dexamethasone compared with ondansetron and dexamethasone alone on PONV in patients undergoing laparoscopic cholecystectomy. Patients and methods A total of 60 patients with American Society of Anesthesiologists physical status I/II undergoing laparoscopic cholecystectomy (with preoperative two or more Apfel four-point risk factors) were recruited into the study and were randomly divided into two equal groups. In both groups, dexamethasone was administered intravenously at the beginning of surgery, and ondansetron was administered intravenously at the end of surgery. In the aprepitant group, oral aprepitant was given 2 h before anesthesia with a sip of water. The primary outcome measure was complete response (no PONV and no rescue antiemetics) up to 24 h postoperatively. The secondary outcome measure was the amount of rescue postoperative analgesics given during the first 24 h postoperatively. Results There was a statistical significant difference between the two groups in complete response at the sixth hour after surgery. In the aprepitant group, none of the patient experienced a verbal numeric rating scale score greater than 3. Moreover, none of the patients of the aprepitant group had received rescue antiemetics during the first 24 h after surgery compared with the control group. In addition, no difference existed regarding postoperative pain score, although the score was slightly lower in the aprepitant group. Conclusion Oral aprepitant when combined with intravenous ondansetron and dexamethasone is effective in suppressing early PONV up to 24 h postoperatively.
{"title":"Aprepitant for attenuation of postoperative nausea and vomiting with a decrease in postoperative analgesic needs after laparoscopic surgery","authors":"M. Hussein, R. Mostafa","doi":"10.4103/asja.asja_110_16","DOIUrl":"https://doi.org/10.4103/asja.asja_110_16","url":null,"abstract":"Background Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Multiple drugs have been used to prevent its occurrence. Ondansetron and aprepitant block the emetic effect of serotonin and neurokinin, respectively. Corticosteroids are well known for their anti-inflammatory effects, but the basis behind their use as antiemetics is not well understood. Objective The aim was to investigate the effect of combining aprepitant with ondansetron and dexamethasone compared with ondansetron and dexamethasone alone on PONV in patients undergoing laparoscopic cholecystectomy. Patients and methods A total of 60 patients with American Society of Anesthesiologists physical status I/II undergoing laparoscopic cholecystectomy (with preoperative two or more Apfel four-point risk factors) were recruited into the study and were randomly divided into two equal groups. In both groups, dexamethasone was administered intravenously at the beginning of surgery, and ondansetron was administered intravenously at the end of surgery. In the aprepitant group, oral aprepitant was given 2 h before anesthesia with a sip of water. The primary outcome measure was complete response (no PONV and no rescue antiemetics) up to 24 h postoperatively. The secondary outcome measure was the amount of rescue postoperative analgesics given during the first 24 h postoperatively. Results There was a statistical significant difference between the two groups in complete response at the sixth hour after surgery. In the aprepitant group, none of the patient experienced a verbal numeric rating scale score greater than 3. Moreover, none of the patients of the aprepitant group had received rescue antiemetics during the first 24 h after surgery compared with the control group. In addition, no difference existed regarding postoperative pain score, although the score was slightly lower in the aprepitant group. Conclusion Oral aprepitant when combined with intravenous ondansetron and dexamethasone is effective in suppressing early PONV up to 24 h postoperatively.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"35 1","pages":"144 - 148"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73648586","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}
Objective The aim was to evaluate and compare the analgesic efficacy of tramadol versus hyoscine-N-butylbromide intramuscularly given during the active phase of the first stage of labor. Materials and methods This prospective study included 140, American Society of Anesthesiologists I, laboring primigravidae, who were divided into two equal groups: group I (group B) received hyoscine-N-butylbromide (Buscopan) 40 mg intramuscular and group II (group T) received tramadol 100 mg intramuscular. Labor pain was assessed by visual analog scale before and at 30 min, 1 h, 2 h, and 3 h after drug administration. Maternal and neonatal adverse effects, drug-delivery interval, mode of delivery, need for additional analgesia, and postpartum maternal satisfaction were assessed too. Results Baseline visual analog scale scores were comparable between the groups (P>0.05). Pain scores at 30 min, 1 h, 2 h, and 3 h were significantly higher (P<0.001) in group B. Overall, 30 (42.8%) women in group B required additional analgesia versus only seven (10%) women in group T (P<0.001). Drug-delivery interval was significantly (P<0.05) shorter in group B at 175 versus 220 min in group T. Apgar score at 1 min was significantly higher (P<0.05) in group B, whereas the scores at 5 min were comparable (P>0.05). A total of 56 (80%) women in group B had adverse effects versus 54 (77.1%) women in group T (P>0.05). Adverse effects were generally mild (well tolerated). Cesarean delivery percentages were comparable between the groups (P>0.05). Postpartum maternal satisfaction was significantly higher (P<0.001) in group T. Conclusion Although Buscopan is cheap and safe, it is a less effective intrapartum analgesic than tramadol. It offers shorter duration of labor, so it is better recommended for primiparous women.
{"title":"Tramadol versus hyoscine-N-butylbromide as intrapartum analgesics during the first stage of labor","authors":"Ashraf AbouSlemah","doi":"10.4103/asja.asja_53_16","DOIUrl":"https://doi.org/10.4103/asja.asja_53_16","url":null,"abstract":"Objective The aim was to evaluate and compare the analgesic efficacy of tramadol versus hyoscine-N-butylbromide intramuscularly given during the active phase of the first stage of labor. Materials and methods This prospective study included 140, American Society of Anesthesiologists I, laboring primigravidae, who were divided into two equal groups: group I (group B) received hyoscine-N-butylbromide (Buscopan) 40 mg intramuscular and group II (group T) received tramadol 100 mg intramuscular. Labor pain was assessed by visual analog scale before and at 30 min, 1 h, 2 h, and 3 h after drug administration. Maternal and neonatal adverse effects, drug-delivery interval, mode of delivery, need for additional analgesia, and postpartum maternal satisfaction were assessed too. Results Baseline visual analog scale scores were comparable between the groups (P>0.05). Pain scores at 30 min, 1 h, 2 h, and 3 h were significantly higher (P<0.001) in group B. Overall, 30 (42.8%) women in group B required additional analgesia versus only seven (10%) women in group T (P<0.001). Drug-delivery interval was significantly (P<0.05) shorter in group B at 175 versus 220 min in group T. Apgar score at 1 min was significantly higher (P<0.05) in group B, whereas the scores at 5 min were comparable (P>0.05). A total of 56 (80%) women in group B had adverse effects versus 54 (77.1%) women in group T (P>0.05). Adverse effects were generally mild (well tolerated). Cesarean delivery percentages were comparable between the groups (P>0.05). Postpartum maternal satisfaction was significantly higher (P<0.001) in group T. Conclusion Although Buscopan is cheap and safe, it is a less effective intrapartum analgesic than tramadol. It offers shorter duration of labor, so it is better recommended for primiparous women.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"31 1","pages":"201 - 206"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74082374","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: 10.4103/1687-7934.238444
K. Elnaghy, I. Nasr
Context Obese patients undergoing laparoscopic gastric sleeve operations are sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for intraoperative management of those patients. Dexmedetomidine is a highly selective α2 agonist with anesthetic and analgesic sparing properties that makes it an adjuvant in general anesthesia. Aim The aim of this study was to assess the effect of intravenous administration of dexmedetomidine during laparoscopic gastric sleeve operations on desflurane requirements, perioperative hemodynamic changes, and also postoperative recovery. This study was based on entropy to monitor the depth of anesthesia. Patients and methods Eighty patients of American Society of Anesthesiologists II and III who were scheduled for laparoscopic gastric sleeve operations were randomly allocated to two groups of 40 patients each. Dexmedetomidine at a loading dose of 1 μg/kg was given over 10 min before anesthesia induction, followed by 0.5 μg/kg/h maintenance throughout the operation in group II, and saline (placebo) was given in group I at the same volume and rate. Routine induction with propofol, fentanyl, and cisatracurium was carried out. Anesthesia was maintained with desflurane that was adjusted to maintain adequate depth of general anesthesia with response entropy between 40 and 60 and a difference of less than 10 with the state entropy. Desflurane inspired fraction and desflurane expired fraction were monitored. Results End-tidal concentration of desflurane was significantly low at 15, 30, 45, and 60 min of operation. End-tidal concentration of desflurane decreased by 13.2–21.8% with the use of dexmedetomidine in comparison with group I. Systolic blood pressure, diastolic blood pressure, and heart rate were significantly decreased with the use of dexmedetomidine at different time intervals throughout the operation in comparison with group I and in comparison with the baseline in group II. Perioperative fentanyl consumption was significantly low with the use of dexmedetomidine in group II in comparison with group I. It was 325±55 μg in group II in comparison with 178±45 μg in group I. There was no significant difference between the two study groups as regards the extubation time. Pain score was significantly higher in group I in comparison with group II on admission to the postoperative acute care unit, and at 1 and 2 hlater. Conclusion In conclusion, the use of dexmedetomidine as preanesthetic medication followed by infusion during laparoscopic sleeve gastrectomy reduces desflurane requirement, maintains hemodynamic stability due to attenuation of stress response, and reduces the fentanyl requirement during intraoperative and early postoperative period, with decreased risk for respiratory depression in the postoperative acute care unit for morbidly obese patients who are at great risk for obstructive sleep apnea and oxygen desaturation.
{"title":"Effect of dexmedetomidine infusion on desflurane requirement and perioperative hemodynamic changes during laparoscopic gastric sleeve operations: a study based on entropy","authors":"K. Elnaghy, I. Nasr","doi":"10.4103/1687-7934.238444","DOIUrl":"https://doi.org/10.4103/1687-7934.238444","url":null,"abstract":"Context Obese patients undergoing laparoscopic gastric sleeve operations are sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for intraoperative management of those patients. Dexmedetomidine is a highly selective α2 agonist with anesthetic and analgesic sparing properties that makes it an adjuvant in general anesthesia. Aim The aim of this study was to assess the effect of intravenous administration of dexmedetomidine during laparoscopic gastric sleeve operations on desflurane requirements, perioperative hemodynamic changes, and also postoperative recovery. This study was based on entropy to monitor the depth of anesthesia. Patients and methods Eighty patients of American Society of Anesthesiologists II and III who were scheduled for laparoscopic gastric sleeve operations were randomly allocated to two groups of 40 patients each. Dexmedetomidine at a loading dose of 1 μg/kg was given over 10 min before anesthesia induction, followed by 0.5 μg/kg/h maintenance throughout the operation in group II, and saline (placebo) was given in group I at the same volume and rate. Routine induction with propofol, fentanyl, and cisatracurium was carried out. Anesthesia was maintained with desflurane that was adjusted to maintain adequate depth of general anesthesia with response entropy between 40 and 60 and a difference of less than 10 with the state entropy. Desflurane inspired fraction and desflurane expired fraction were monitored. Results End-tidal concentration of desflurane was significantly low at 15, 30, 45, and 60 min of operation. End-tidal concentration of desflurane decreased by 13.2–21.8% with the use of dexmedetomidine in comparison with group I. Systolic blood pressure, diastolic blood pressure, and heart rate were significantly decreased with the use of dexmedetomidine at different time intervals throughout the operation in comparison with group I and in comparison with the baseline in group II. Perioperative fentanyl consumption was significantly low with the use of dexmedetomidine in group II in comparison with group I. It was 325±55 μg in group II in comparison with 178±45 μg in group I. There was no significant difference between the two study groups as regards the extubation time. Pain score was significantly higher in group I in comparison with group II on admission to the postoperative acute care unit, and at 1 and 2 hlater. Conclusion In conclusion, the use of dexmedetomidine as preanesthetic medication followed by infusion during laparoscopic sleeve gastrectomy reduces desflurane requirement, maintains hemodynamic stability due to attenuation of stress response, and reduces the fentanyl requirement during intraoperative and early postoperative period, with decreased risk for respiratory depression in the postoperative acute care unit for morbidly obese patients who are at great risk for obstructive sleep apnea and oxygen desaturation.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"127 1","pages":"188 - 194"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74495463","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_107_16
Dina Y Kassim, I. Esmat, M. Elgendy
Background Revision total hip arthroplasty (RTHA) is known to entail some risk of hemorrhage during the intraoperative period. Preoperative autologous blood donation (PAD) is one of the most popular alternatives to allogeneic blood transfusion (ABT) in elderly patients undergoing major orthopedic procedures in which a substantial blood loss is expected. The aim of this study was to evaluate the effectiveness of a combination of PAD and intravenous tranexamic acid (TXA) in reducing the need for ABT following RTHA. Patients and methods A total of 60 patients were included in this randomized study that were divided into a study group of 30 patients, who had been transfused autologous blood and a control group of 30 patients who had been transfused only allogeneic blood. Parenteral iron preparation was given to all patients of the study group after each donation. Intraoperatively all patients of the study group received 2 g of intravenous TXA. This study was conducted through laboratory analysis of hemoglobin and hematocrit values during blood donation and for both groups in the preoperative and the postoperative period and the assessment of the amount of transfused blood units in both groups. Results The average values of hemoglobin and hematocrit in the first and the second donation were 11.9±1.2 g/dl, 36.1±3.8%, and 11.9±1.0 g/dl, 35.6±3.5%, respectively. During operative and postoperative periods, the statistical data processing showed that there was a nonsignificant difference between the study and control groups regarding the number of transfused blood units (both autologous and allogeneic) (P=0.578 and 0.089), respectively, and only 10% of patients in the study group needed allogeneic blood. Conclusion PAD combined with intraoperative intravenous TXA administration reduced the number of ABTs in patients who underwent RTHA.
背景翻修型全髋关节置换术(RTHA)在术中有出血的危险。术前自体献血(PAD)是最流行的替代异体输血(ABT)的老年患者接受重大骨科手术，其中大量失血的预期。本研究的目的是评估PAD联合静脉注射氨甲环酸(TXA)在减少RTHA后ABT需求方面的有效性。患者和方法本随机研究共纳入60例患者，分为30例输注自体血的研究组和30例仅输注同种异体血的对照组。研究组所有患者每次捐献后均给予肠外铁制剂。术中实验组所有患者均静脉注射2 g TXA。本研究通过对献血时及两组患者术前、术后血红蛋白和红细胞压积值的实验室分析，以及两组患者输血单位量的评估进行。结果第一次和第二次捐献的血红蛋白和红细胞压积平均值分别为11.9±1.2 g/dl、36.1±3.8%和11.9±1.0 g/dl、35.6±3.5%。在手术期间和术后，统计数据处理显示，研究组与对照组输血量(自体和异体)差异无统计学意义(P=0.578和0.089)，研究组中只有10%的患者需要异体血。结论PAD联合术中静脉给药可减少RTHA患者ABTs的数量。
{"title":"Efficacy of preoperative autologous blood donation and tranexamic acid in revision total hip arthroplasty: a randomized controlled trial","authors":"Dina Y Kassim, I. Esmat, M. Elgendy","doi":"10.4103/asja.asja_107_16","DOIUrl":"https://doi.org/10.4103/asja.asja_107_16","url":null,"abstract":"Background Revision total hip arthroplasty (RTHA) is known to entail some risk of hemorrhage during the intraoperative period. Preoperative autologous blood donation (PAD) is one of the most popular alternatives to allogeneic blood transfusion (ABT) in elderly patients undergoing major orthopedic procedures in which a substantial blood loss is expected. The aim of this study was to evaluate the effectiveness of a combination of PAD and intravenous tranexamic acid (TXA) in reducing the need for ABT following RTHA. Patients and methods A total of 60 patients were included in this randomized study that were divided into a study group of 30 patients, who had been transfused autologous blood and a control group of 30 patients who had been transfused only allogeneic blood. Parenteral iron preparation was given to all patients of the study group after each donation. Intraoperatively all patients of the study group received 2 g of intravenous TXA. This study was conducted through laboratory analysis of hemoglobin and hematocrit values during blood donation and for both groups in the preoperative and the postoperative period and the assessment of the amount of transfused blood units in both groups. Results The average values of hemoglobin and hematocrit in the first and the second donation were 11.9±1.2 g/dl, 36.1±3.8%, and 11.9±1.0 g/dl, 35.6±3.5%, respectively. During operative and postoperative periods, the statistical data processing showed that there was a nonsignificant difference between the study and control groups regarding the number of transfused blood units (both autologous and allogeneic) (P=0.578 and 0.089), respectively, and only 10% of patients in the study group needed allogeneic blood. Conclusion PAD combined with intraoperative intravenous TXA administration reduced the number of ABTs in patients who underwent RTHA.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"41 1","pages":"131 - 139"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91388970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.4103/1687-7934.198264
S. Elfawal, Abeer M. Eldeek, M. Kamal
Background This randomized controlled study aimed to evaluate whether an intraoperative infusion of dexmedetomidine would be a safe and effective substitute to fentanyl intraoperatively, and whether it would be effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy. Patients and methods This study was conducted on 70 pediatric patients, aged 3–7 years, of both sexes, of ASA I and II, who were scheduled for elective adenotonsillectomy. The patients were randomly assigned to two groups: group D (dexmedetomidine infusion group; 35 patients) received intravenous dexmedetomidine (2 μg/kg) over 10 min, followed by 0.7 μg/kg/h until 5 min before the end of the surgery, and group F (intravenous fentanyl group; 35 patients) received intravenous fentanyl 1 μg/kg as a bolus. No premedication was given to any of the patients. The number of patients in each group who needed intraoperative fentanyl, the fentanyl dose, time of administration of fentanyl, duration of surgery and anesthesia, and the time to awakening were recorded. Pain was evaluated using the objective pain scale score in the postanesthesia care unit (PACU), which was managed with rescue intravenous pethidine. Emergence agitation was evaluated in the PACU using two scales: the Pediatric Anesthesia Emergence Delirium scale and the five-point agitation scale described by Cole. Results The time to awakening in group D was significantly shorter compared with that in group F (P<0.05). Group D showed a statistically significantly lower maximum objective pain scale score, lower Pediatric Anesthesia Emergence Delirium score, and lower emergence agitation score compared with group F at arrival at the PACU. There was no statistically significant difference between the two groups as regards preoperative heart rate, but there was significantly lower heart rate in group D than in group F after induction (P<0.05). No side effects were observed during the first 24 h postoperatively in the two groups. Conclusion Dexmedetomidine is a safe and effective analgesic substitute to fentanyl intraoperatively and reduces analgesic requirements postoperatively. It is also effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy.
{"title":"Dexmedetomidine infusion versus fentanyl for analgesia and prevention of emergence agitation and delirium in children undergoing adenotonsillectomy","authors":"S. Elfawal, Abeer M. Eldeek, M. Kamal","doi":"10.4103/1687-7934.198264","DOIUrl":"https://doi.org/10.4103/1687-7934.198264","url":null,"abstract":"Background This randomized controlled study aimed to evaluate whether an intraoperative infusion of dexmedetomidine would be a safe and effective substitute to fentanyl intraoperatively, and whether it would be effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy. Patients and methods This study was conducted on 70 pediatric patients, aged 3–7 years, of both sexes, of ASA I and II, who were scheduled for elective adenotonsillectomy. The patients were randomly assigned to two groups: group D (dexmedetomidine infusion group; 35 patients) received intravenous dexmedetomidine (2 μg/kg) over 10 min, followed by 0.7 μg/kg/h until 5 min before the end of the surgery, and group F (intravenous fentanyl group; 35 patients) received intravenous fentanyl 1 μg/kg as a bolus. No premedication was given to any of the patients. The number of patients in each group who needed intraoperative fentanyl, the fentanyl dose, time of administration of fentanyl, duration of surgery and anesthesia, and the time to awakening were recorded. Pain was evaluated using the objective pain scale score in the postanesthesia care unit (PACU), which was managed with rescue intravenous pethidine. Emergence agitation was evaluated in the PACU using two scales: the Pediatric Anesthesia Emergence Delirium scale and the five-point agitation scale described by Cole. Results The time to awakening in group D was significantly shorter compared with that in group F (P<0.05). Group D showed a statistically significantly lower maximum objective pain scale score, lower Pediatric Anesthesia Emergence Delirium score, and lower emergence agitation score compared with group F at arrival at the PACU. There was no statistically significant difference between the two groups as regards preoperative heart rate, but there was significantly lower heart rate in group D than in group F after induction (P<0.05). No side effects were observed during the first 24 h postoperatively in the two groups. Conclusion Dexmedetomidine is a safe and effective analgesic substitute to fentanyl intraoperatively and reduces analgesic requirements postoperatively. It is also effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"9 1","pages":"485 - 492"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72765627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.4103/1687-7934.198249
Manisha, Babita, T. Lall, Bhupendra K. Singh, K. Sharma, Rajat Dadhich
Background Early awakening is required in spine surgery to perform neurological examination in the early postoperative period. Bispectral index (BIS) monitoring allows reduction in the total amount of anesthetic drugs and decreases the time for emergence and recovery. Thus, BIS monitor helps in reducing the incidence of awareness. Kinetics of propofol allows both induction and continuous intravenous maintenance of anesthesia with rapid recovery of consciousness that aids in performing neurological examination in the early postoperative period. This study was conducted to compare propofol and isoflurane in the maintenance of anesthesia during spine surgery using the BIS monitor. Patients and methods A total of 50 patients (American Society of Anesthesiologists grades I and II) scheduled for spine surgeries were divided into two groups (25 each). Group A received an infusion of propofol 5 mg/kg/h and group B received isoflurane 1% vol. for maintenance to keep the BIS value between 40 and 60. The groups were compared as regards pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, surgeons’ satisfaction, time to recovery, extubation time, and side effects. Results Both groups were well matched for their demographic data and preoperative vital data. There was no significant difference in hemodynamic parameter between the two groups. The mean recovery time was significantly different (P<0.001) between groups, with earlier recovery in the propofol group (8.14±0.805 min) compared with the isoflurane group (9.06±0.766 min). Values for BIS were similar between the two groups during surgery (P>0.05). Incidence of postoperative nausea and vomiting was 35% lower in group A compared with group B. The quality of surgical field was acceptable in both groups but slightly better in the propofol group. No other major complications were noted in our study. Conclusion Propofol-based anesthesia provides early and better recovery with clear headedness for early neurological assessment for spine surgery.
{"title":"A comparative study of propofol and isoflurane for the maintenance of anesthesia in spine surgery using the bispectral index monitor: a randomized control study","authors":"Manisha, Babita, T. Lall, Bhupendra K. Singh, K. Sharma, Rajat Dadhich","doi":"10.4103/1687-7934.198249","DOIUrl":"https://doi.org/10.4103/1687-7934.198249","url":null,"abstract":"Background Early awakening is required in spine surgery to perform neurological examination in the early postoperative period. Bispectral index (BIS) monitoring allows reduction in the total amount of anesthetic drugs and decreases the time for emergence and recovery. Thus, BIS monitor helps in reducing the incidence of awareness. Kinetics of propofol allows both induction and continuous intravenous maintenance of anesthesia with rapid recovery of consciousness that aids in performing neurological examination in the early postoperative period. This study was conducted to compare propofol and isoflurane in the maintenance of anesthesia during spine surgery using the BIS monitor. Patients and methods A total of 50 patients (American Society of Anesthesiologists grades I and II) scheduled for spine surgeries were divided into two groups (25 each). Group A received an infusion of propofol 5 mg/kg/h and group B received isoflurane 1% vol. for maintenance to keep the BIS value between 40 and 60. The groups were compared as regards pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, surgeons’ satisfaction, time to recovery, extubation time, and side effects. Results Both groups were well matched for their demographic data and preoperative vital data. There was no significant difference in hemodynamic parameter between the two groups. The mean recovery time was significantly different (P<0.001) between groups, with earlier recovery in the propofol group (8.14±0.805 min) compared with the isoflurane group (9.06±0.766 min). Values for BIS were similar between the two groups during surgery (P>0.05). Incidence of postoperative nausea and vomiting was 35% lower in group A compared with group B. The quality of surgical field was acceptable in both groups but slightly better in the propofol group. No other major complications were noted in our study. Conclusion Propofol-based anesthesia provides early and better recovery with clear headedness for early neurological assessment for spine surgery.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"47 1","pages":"584 - 592"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73506889","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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