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Egyptian Journal of Anaesthesia
Journal Prestige (SJR): 0.285

Citation Impact (citeScore): 1
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This is an Open Access Journal

Open Access journal
ISSN (Print) 1110-1849 - ISSN (Online) 1687-1804
Published by Elsevier

[3203 journals]

Perioperative effects of desflurane versus propofol on hemostasis guided
by thromboelastometry in splenectomy with liver cirrhosis
- Abstract: Publication date: Available online 17 December 2018Source: Egyptian Journal of AnaesthesiaAuthor(s): Hanan F. Khafagy, Yasser M. Samhan, Reeham S. Ebied, Shaimaa S. Abd El-Ghany, Omar M. Sabry, Nadia A. Hussein, Randa I. Badawy, Nashwa N. Talaat, Ahmed H. Helmy, Gehan G. El-FandyAbstractBackgroundCirrhotic patients have impaired hemostasis with variable incidence of hypersplenism necessitating splenectomy. Rotation thromboelastometery (ROTEM) facilitates diagnosis and guides management. This study evaluates perioperative effects of desflurane versus propofol on hemostasis in cirrhotic patients undergoing splenectomy guided by ROTEM and laboratory hemostatic tests.MethodsThirty hepatic Child A patients, ASA II- III, of either sex, aged 25–55 years, undergoing splenectomy were randomly allocated into two equal groups: Group D; anesthetized with desflurane 1 MAC (6%) and Group P; with propofol Target Controlled Infusion 2–5 µg/ml. Six blood samples were collected; preoperatively, after splenic artery ligation, immediately, first, third postoperative day then one month later. The samples were handled to measure complete blood picture, liver and kidney functions, screening coagulation tests (INR, PT and PTT), specific hemostatic factors (P-Selectin/CD62P, fibrinogen and D-dimer) as well as ROTEM criteria; clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) via EX-TEM, IN-TEM and FIB-TEM commercial kits.ResultsThis study displayed postoperative hemoglobin reduction; however, platelet and WBCs as well as CT, CFT and MCF increased versus baseline. Screening and specific hemostatic factors as all other changes were within reference range and comparable between both groups.ConclusionsThe current study concluded comparable effects of desflurane and propofol anesthesia on coagulation parameters within acceptable range as monitored by ROTEM and laboratory coagulation tests in cirrhotic patients with hypersplenism. Thus both anesthetics are considered safe in such patients who have high incidence of coagulopathy.
Diaphragmatic rapid shallow breathing index for predicting weaning outcome
from mechanical ventilation: Comparison with traditional rapid shallow
breathing index
- Abstract: Publication date: Available online 13 December 2018Source: Egyptian Journal of AnaesthesiaAuthor(s): Sherif M.S. Mowafy, Essam F. AbdelgalelAbstractBackgroundRapid shallow breathing index (RSBI) is a well-known weaning index. However; its diagnostic performance is less than satisfactory. Recently, diaphragmatic rapid shallow breathing index (DRSBI) is proposed as a promising tool in weaning outcome prediction. The aim of this study was to evaluate if DRSBI is more accurate than RSBI for weaning outcome prediction.Patients and methodsThis prospective, randomized clinical trial was carried out on 106 mechanically ventilated patients for more than 48 h and ready to wean at their first spontaneous breathing trial (SBT). After one minute of SBT, RSBI and DRSBI were calculated. According to the decision to continue SBT patients were divided into: Group I (53 patients) the decision depends on the RSBI. Group II (53 patients) the decision based on DRSBI. 30 min later, patients were reevaluated for tolerance of SBT then RSBI and DRSBI were calculated. Outcome of the weaning attempt was recorded and ROC analysis was done to evaluate the diagnostic accuracy.Results106 patients were enrolled. Trauma was the commonest diagnosis on ICU admission and traumatic brain injury was the main indication for initiation of mechanical ventilation in the two groups. 33 patients (31.1%) failed to wean (19 patients in group I and 14 patients in group II). RSBI at 1 min and 30 min as well as DRSBI at 1 min and 30 min were highly statistical significant higher in weaning failure patients. RSBI and DRSBI at 30 min were highly statistical significant increased compared to at 1 min. DRSBI at 30 min was the parameter with the best diagnostic accuracy for predicting weaning success with a cutoff value
Improved spinal MRI findings after epidural blood patch administration: A
pediatric case
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Güldane Karabakan, Anıl Özgür, Çetin Okuyaz, Hüseyin Utku Yıldırım, Şebnem Rumeli AtıcıAbstractOrthostatic headache is the leading clinical manifestation of CSF leakage. Anatomic changes due to low CSF pressure can be detected by cranial and spinal magnetic resonance imaging (MRI). We report improved spinal MRI findings in a pediatric case of post-dural puncture headache treated by epidural blood patch administration.In this case, a 7-year-old girl with a history of recurrent lumbar punctures and orthostatic headache for three months is presented. Cerebrospinal fluid (CSF) leak was reported at the level of T5-L1 by magnetic resonance imaging (MRI). An autologous epidural blood patch was performed under sedation with a blood volume of 6 ml. Five days after the procedure MRI showed no CSF signal in the extradural space and dural infolding was found to be disappeared. On the seventh day of the procedure, headache recurred and the procedure was repeated using same amount of blood. After seven months of follow-up, the patient reported no recurrence of headache.To the best of our knowledge, this is the first pediatric case report that presents improved spinal MRI findings following an epidural blood patch. Although MR findings show improvement, it is not a definitive proof of the adequacy of the treatment.
Comparative evaluation of intraperitoneal bupivacaine and bupivacaine
ketamine combined with lung recruitment for reducing postoperative
shoulder pain in laparoscopic cholecystectomy
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Raham Hasan Mostafa, Yehia Mamdouh Hassan MekkiAbstractBackgroundShoulder pain (SP) was first reported after laparoscopic gynecological procedures. It is assumed to be multifactorial in nature. Several methods to reduce SP after laparoscopic cholecystectomy (LC) have been postulated. In this study, we have worked to decrease it using 2 approaches; lung recruitment maneuver and intraperitoneal local analgesic instillation.ObjectivesThis study was designed to assess the clinical efficacy of ketamine as an adjunct to intraperitoneal bupivacaine for the relief of post-operative shoulder pain after LC.Methods and materialThis prospective, randomized, double-blinded study is comprised of 40 patients of either sex, with age range of 20–50 years, planned for elective LC. Just after inflating the pneumoperitoneum, the surgeon sprayed 50 mL of a blinded solution intraperitoneally. Patients were randomly allocated to: group B received a 50 mL solution of intraperitoneal bupivacaine 0.25% and group BK received 0.5 mg/kg ketamine mixed with bupivacaine 0.25%.ResultsThis study showed that ketamine bupivacaine admixture had made dramatic decline in shoulder pain VAS scores specifically at the 24th hour; 15 patients in the BK group had either VAS score zero or 1 when compared to B group whom their lowest score at the 24th hour was 4. Also, there was more decrease in postoperative analgesic consumption in BK group. No psychomimetic side effects or sedation were noticed in both groups.ConclusionsWe conclude that intraperitoneal instillation of low dose ketamine to bupivacaine 0.25% in elective LC significantly reduced post-operative shoulder pain and analgesic requirement when compared to bupivacaine 0.25% alone.
Dexmedetomidine added to propofol for drug-induced sleep endoscopy in
adult patients with obstructive sleep apnea: Randomized controlled trial
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Essam F. AbdelgalelAbstractBackgroundThe aim of this study was to evaluate if the addition of dexmedetomidine to propofol could improve the success and reduce the complications during drug induced sleep endoscopy in obstructive sleep apnea patients.Patient and methodsFifty adult patients scheduled for drug induced sleep endoscopy were randomly allocated to one of two groups. Group P (25 patients) received propofol loading dose of 0.5 mg/kg over 3 min then continuous infusion in a dose of 25–75 mcg/kg/min. Group PD (25 patients) received propofol infusion as group P and dexmedetomidine intravenous infusion with a loading dose of 0.5 mcg/kg over 5 min then continuous infusion in a dose of 0.2–0.7 mcg/kg/h. The primary outcome was successful completion of the procedure. The secondary outcomes included the time to start endoscopy, procedure duration, the incidence of adverse events and surgeons and patients satisfaction.ResultsSuccessful completion of the procedure was significantly higher in group PD (96%) compared to group P (72%). The total propofol dose needed/patient (mg) was significantly more in group P compared to group PD (173.5 ± 41.6 versus98.4 ± 19.8 with shorter recovery time in group PD. Both surgeons and patients satisfaction were significantly higher in group PD compared to group P. The incidence of cough and gag reflexes were significantly higher in group P compared to group PD. Heart rate (HR) was significantly lower in group PD compared to group P at 5, 10, 15, 20, 25 and 30 min from the start of the studied drugs. Respiratory rate (RR) was significantly lower in group P compared to group PD at 5, 10, 15 and 20 min from the start of the studied drugs (p 
Dexmedetomidine infusion during caesarean section under general
anaesthesia: Evaluation of maternal awareness using BIS, maternal and
neonatal outcomes
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Emad Eldeen A. Ibrahim, Mokhtar M. Amer, Mohamed E. Abuelnaga, Wafaa I. Abd-ElaalAbstractStudy objectivesThe present study investigated the effect of dexmedetomidine infusion on bispectral index and hemodynamic values for patients undergoing cesarean section under general anesthesia as well as the postoperative maternal and fetal outcomes.Design and settingThis is randomized controlled study done in operating rooms and postoperative recovery area.Patients44 Adult healthy pregnant females scheduled for elective Caesarian section delivery under general anesthesia were divided randomly in to two equal groups. Dexmedetomidine group and control group.InterventionsUnlike control group, Dexmedetomidine group: patients were given intravenous loading dose of DEX 1 mcg/kg before induction of anesthesia then intravenous infusion of DEX 0.4 mcg kg−1 hr−1 throughout surgery.MeasurementsThe BIS values; heart rate, blood pressure and MAC were monitored at 15 designated points of sequential events during anesthesia. The maternal sedation in the first postoperative hour was reported every 15 min. Apgar score of the neonates was assessed by the pediatrician 1 min and 5 min interval. All patients were asked about awareness or recall at the time of discharge and 6 h after.ResultsBIS values, blood pressure, heart rate and MAC were significantly lower in DEX group at most different time intervals. Both groups of the study were matched as regard as Apgar score at 1 min. and 5 min. Alderete score was significantly lower in DEX group 15 min after extubation. However, both groups were matched 30 min after extubation. Sedation score was higher in Dex group at 5 and 15 min postoperatively. 10 patients in the control group needed extra dose of fentanyl.ConclusionsDexmedetomidine is useful adjuvant during general anesthesia for CS as it attenuates hemodynamic responses to surgical stress, reduces needs for analgesic and anesthetic drugs together with favorable maternal and neonatal outcome.
Ultrasound guided bilateral rectus sheath block and serum TNF-α and IL-6
after radical prostatectomy: A randomized double blinded study
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Abdelrady Shehata Ibrahim, Waleed Saleh Farrag, Mohamed Galal AlyAbstractBackgroundGeneral anesthesia can affect postoperative cytokine levels, leading to cellular immune inhibition following surgery. The primary objective of this study was to evaluate the effect of bilateral rectus sheath block on serum levels of TNF-α and IL-6 after radical prostatectomy.MethodsFifty patients undergoing radical prostatectomy, under general anesthesia were randomly allocated into two groups. Group RSB: A bilateral single shot of 20 ml plain bupivacaine 0.25% or 20 ml normal saline (Group C) in each side of rectus sheath. Postoperative pain was controlled by morphine as a rescue analgesia. Primary outcome was postoperative serum levels of TNF-α and IL-6. Secondary outcome measures: The total morphine consumption and evaluation of the visual analog pain score at 24 and 48 h postoperative.ResultsBoth TNF-α and IL-6 were significantly lower in the RSB group at 24 h postoperative, the mean value of TNF- α was 76.26 ± 4.07 pg/ml in RSB group and 93.15 ± 6.90 pg/ml in the control group (p 
Lidocaine suppressed hyperinflammation in BALB/c mice model sterile injury
via downregulation of toll-like receptor 4
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Robert Hotman Sirait, Mochammad Hatta, Muhammad Ramli, Carmen Siagian, Bambang Suprayogi, Tigor Paniel SimanjuntakAbstractBackgroundTo study the efficacy of systemic lidocaine in suppressing toll-like receptor 4 (TLR4) protein level in BALB/c mouse with sterile injury.Material and methodsTwenty healthy adult male BALB/c mice were divided into lidocaine and control groups. The sterile injury was performed by breaking the left thigh bone of the mouse without laceration. Four hours after sterile injury the lidocaine group was treated with 2 mg/kg of lidocaine through tail vein injection. The same volume of distilled water was injected into control group instead of lidocaine. Blood was drawn from tail vein before injury, 4 h after sterile injury and 2 h after systemic lidocaine and distilled water administration. TLR4 protein level was examined by enzyme-linked immunosorbent assay (ELISA).ResultsThe TLR4 protein level in mice that sustained hyper inflammation due to sterile injury was significantly decreased in the lidocaine group. (p 
Comparative study between intravenous dexmedetomidine and clonidine as
premedication in pediatric patients undergoing spinal anesthesia
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Reena, Amit KumarAbstractTitleComparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.BackgroundMany techniques and drug regimens, with partial or greater success, have been tried from time to time to eliminate the anxiety component and to prolong the postoperative analgesia during regional anesthesia. In pediatric patients, anxiety and lack of cooperativeness for the regional procedure is the major problem in providing spinal anaesthesia. Alpha2-adrenergic agonists have both analgesic and sedative properties, when used as an adjuvant to regional anesthesia. They eliminate the anxiety, provide conscious sedation, lower the level of agitation and improve patient satisfaction. We designed a prospective, randomized, double-blind study, to evaluate and compare the efficacy of intravenous dexmedetomidine with clonidine as a premedication drug during spinal anaesthesia using intrathecal bupivacaine.Materials and methodsIn this prospective, randomized, double-blind study, 60 pediatric patients 4–10 years of age of the American Society of Anesthesiologists status I, scheduled for uro-genital surgery under spinal anesthesia, were randomly allocated into two groups of 30 each. Group DE received dexmedetomidine 1 μg kg−1 and group CL received clonidine 1 μg kg−1 diluted in 20 ml of normal saline intravenously over 10 min, 40 min before subarachnoid anaesthesia with 0.5% hyperbaric bupivacaine. The patients were monitored every 5 min for 1st 20 min and then every 10 min interval vitals were noted. Acceptable sedation score, parental separation anxiety level and degree of mask acceptance were assessed. Highest level of sensory blockade, time of two segment regression and time of first request of analgesic were also noted. Data was analyzed using Fisher’s exact test or Chi-square test and the value of P  0.05). However, parental separation anxiety score and mask acceptance score, were better in DE than CL group (p  0.05). Duration of analgesia was also prolonged in DE group.ConclusionDexmedetomidine is superior to clonidine as a premedication drug in pediatric patients undergoing spinal anesthesia.
Comparison between Glidescope, Airtraq and Macintosh laryngoscopy for
emergency endotracheal intubation in intensive care unit: Randomized
controlled trial
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Essam F. Abdelgalel, Sherif M.S. MowafyAbstractBackgroundEmergency endotracheal intubation in intensive care is a major challenge that can be associated with life-threatening complications. The aim of this study was to evaluate the success of the first attempt of endotracheal intubation and incidence of complications using Macintosh laryngoscopy, Airtraq or Glidescope during emergency intubation in intensive care.Patients and methodsOne hundred twenty adult intensive care patients of ASA physical status III and IV who required emergency endotracheal intubation were randomly allocated into 3 groups. Group M (40 patients) were intubated using Macintosh laryngoscopy. Group G (40 patients) were intubated using Glidescope. Group A (40 patients) were intubated using Airtraq. The primary outcome was the success of the first attempt of endotracheal intubation. Secondary outcomes included the number of intubation attempts, duration of intubation, glottic view as assessed by Cormack-Lehane grade (C&L grade) and incidence of complications.ResultsSuccess of the first attempt of endotracheal intubation was significantly higher in both groups G and A compared to group M (p 
Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Jehan Ahmed Sayed, Emad Zarief Kamel, Mohamed Amir F. Riad, Sayed Kaoud Abd-Elshafy, Ragai Sobhi HannaAbstractPurposeTo investigate the implication of dexmedetomidine and magnesium sulphate addition to bupivacaine in caudal anesthesia in paediatric lower abdominal surgeries.Study designRandomized controlled trial.SettingPaediatric University Hospital.Subjects120 children undergoing surgeries in the lower half of the body under general anaesthesia with a supplementary caudal block using 1 ml/kg bupivacaine 0.25%.MethodsParticipants were randomly allocated into four groups; group C (saline as an additive to bupivacaine), group MG (50 mg magnesium sulphate added to bupivacaine), group D (1 µg/kg dexmedetomidine added to bupivacaine), and group MGD (the same doses of both dexmedetomidine and magnesium sulphate were added to bupivacaine). Time to first analgesia request (1ry outcome), and pain assessment by The Face, Legs, Activity, Cry, Consolability (FLACC) score just after recovery, then every 30 min in the early two hours, then at the 4th, 6th, 12th,18th, and 24th hours were compared between the groups.ResultsTime to first analgesia request was significantly longer in the three study groups compared to group C with p 
Limb girdle muscle dystrophy and caesarian delivery: Anesthetic management
and brief review of literature
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Sumit Soni, Amarjyoti Hazarika, Balbir KumarAbstractLimb girdle muscle dystrophy (LGMD) is group of rare hereditary disorders primarily involving hip and shoulder muscles. Due to scarcity of literature, definite anesthetic management strategy is lacking. We, report the successful management of 28 yr parturient with LGMD for elective caesarian delivery under spinal anesthesia. The anesthetic management is discussed with brief review of literature.
Anesthetic considerations for laparoscopy for rectal cancer in patient
with amyotrophic lateral sclerosis: A case report
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Bo-Ra Kim, Young-Bok Lee, Su-Jin Kim, Young-Wan KimAbstractAmyotrophic lateral sclerosis, which is also known as motor neuron disease, is a chronic neurodegenerative disease characterized by progressive muscular weakness, respiratory muscle disability, and eventual death. Previous epidemiologic studies have shown no association between cancer and amyotrophic lateral sclerosis. Colorectal cancer arising in patients with amyotrophic lateral sclerosis has rarely been reported. Here, we report a case involving rectal cancer arising in a patient with amyotrophic lateral sclerosis who subsequently underwent curative laparoscopic surgery and adjuvant chemotherapy. Amyotrophic lateral sclerosis causes the deterioration of respiratory function by compromising expiratory and inspiratory muscles; accordingly, patients with amyotrophic lateral sclerosis are at high anesthetic risk, especially with respect to general anesthesia. Careful airway management is essential, and intraoperative neuromuscular monitoring is important. A depolarizing muscle relaxant such as succinylcholine should not be used because of the potential risk of developing hyperkalemia or rhabdomyolysis. Thus, a nondepolarizing muscle relaxant (rocuronium) was used at a low dose in this case. In addition, fentanyl for postoperative patient-controlled analgesia should be used cautiously because fentanyl can cause respiratory muscle rigidity, which may reduce postoperative respiratory function in patients with amyotrophic lateral sclerosis.
Erector Spinae Block a safe, simple and effective analgesic technique for
major hepatobiliary surgery with thrombocytopenia
- Abstract: Publication date: October 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 4Author(s): Arshad Ayub, Praveen Talawar, Rakesh Kumar, Debesh Bhoi, Ajay Yadav SinghAbstractHepatobiliary surgeries are associated with severe pain, and coagulopathy. Adequate pain control is vital and difficult to achieve for these patients. Epidural analgesia is considered the routine standard technique for the management of both somatic and visceral pain from major abdominal surgeries until now. However, it is invasive, blind and carries the risk of dural or vascular puncture. Coagulopathy found in patients posted for hepatobiliary surgery further increases the concerns. We found ultrasound guided erector spinae plane block as a safe, simple yet an effective alternative to epidural analgesia for postoperative pain management of hepatobiliary surgeries.
Positive end-expiratory pressure with I-gel in children, is it effective
and safe'
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Ghada Kamhawy, Ahmed El-Lilly, Mona Azzam, Maha MiskAbstractBackgroundI-gel is designed to suit the anatomy of hypopharyngeal and perilaryngeal areas in adults without an inflatable cuff. There is insufficient evidence regarding quality of seal of I-gel during PEEP application in pediatric patients. The objective of this study was to evaluate the performance of I-gel usage in children during general anesthesia with PEEP application at a level of 5 cm H2O and assess whether it improves oxygenation.Patients and methodsA total of 42 ASA physical status I, and II children undergoing surgery under general anesthesia were included. Patients were randomly allocated to one of two equal groups to be on Pressure-control ventilation (PCV) with PEEP 5 cm H2O (group I) and PCV without PEEP (group II). I-gel size 2 1/2 was used in children weighing from 25 to 35 kg. Leak volume (LV) and leak fraction (LF) were recorded. Peak Inspiratory Pressure (PIP), expiratory and inspiratory tidal volume as well as minute volume and End tidal CO2 (ETCO2) were also recorded at 5 min, 30 min, and 1 h after I-gel insertion.ResultsLeak volume and leak fraction had no statistical significant differences between both groups. Patients with PEEP had significantly lower (ETCO2), higher PIP, higher inspiratory tidal volume, and higher expiratory tidal volume (p = 0.001) during the post I-gel insertion follow up period. Patients with PEEP also had significantly higher PaO2 and lower PaCO2 levels (p = 0.001).ConclusionsI-gel may be used safely during PCV while applying PEEP of 5 cm H2O in children with an effective seal pressure, improvement in oxygenation and without leak or gastric insufflation.
Nasal fiberoptic intubation with and without split nasopharyngeal airway:
Time to view the larynx & intubate
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Ahmed A. Mohamed El-Tawansy, Osama A. Nofal, Akmal Abd Elsamad, Hala A. El-AttarAbstractBackgroundFiberoptic intubation requires long nasopharyngeal journey and mostly requiring jaw thrust to visualize larynx especially if done under general anesthesia. Use of split nasopharyngeal airway of appropriate length for better glottis visualization has been compared with the classic one.MethodsAdult 68 patients; ASA I and II; undergoing surgery under general anesthesia were allocated randomly and equally into CL group in which classic nasal FOI with jaw thrust was done and NP group in which appropriate length of SNPA was inserted nasally followed by insertion of the scope with the application of jaw thrust if needed. Preprocedural heart rate, blood pressure and saturation and every minute for 5 min and also procedure and endoscopy time required to visualize the larynx (T1 and T3 respectively), carina (T4) and to remove the scope (T5) were recorded.ResultsHeart rate showed a statistically significant increase in CL and NP group during study time compared to pre-procedure reading. The MAP showed also statistical increase but only in CL group. There was a statistical (not clinical) significant increase between the percent of HR and MAP change in the CL group compared to NP group. T1, T3, and T5 in NP group were significantly shorter than in CL group but not for T4. Seven cases after SNPA needed jaw thrust.ConclusionUse of SNPA is safe and effective in reducing time to visualize larynx and intubate trachea. Developing longer specific “Naso-laryngeal (not nasopharyngeal) FOB intubating aid” is assumed to be more appropriate.
Cross-sectional study about perioperative management of Blood Pressure and
effects of anaesthesia in hypertensive patients undergoing general &
orthopaedic surgery
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Paresh Girdharlal Koli, Yashashri Shetty, Sweta Salgaonkar, Minakshi Dongre, Sankalp AroraAbstractIntroductionHypertension is regarded as an additional risk factor during anaesthesia. There is not enough Indian evidence in literature regarding antihypertensive usage and its implications during perioperative period in patients undergoing general & orthopedic surgery. This drove us to conduct this study.MethodsSingle centre cross-sectional observational study conducted in a General Surgery and Orthopaedics wards of a Tertiary care hospital. The data was collected from the period of first visit by the anaesthetist to 24 h’ postoperative period of the operated hypertensive patients. The variables accounted were of antihypertensive medications, anaesthesia drugs, hemodynamics, blood loss and fluids used. The data was analysed by using descriptive statistics, nonparametric tests and P 
Bilateral suprazygomatic maxillary nerve block versus palatal block for
cleft palate repair in children: A randomized controlled trial
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Mohamed M. Abu Elyazed, Shaimaa F. MostafaAbstractBackground and objectivesAirway obstruction and respiratory compromise are frequently encountered complications of cleft palate (CP) repair. We compared the analgesic efficacy of bilateral suprazygomatic maxillary nerve block (SMB) versus palatal block (PB) in pediatric patients undergoing CP repair.Methods90 patients aged 3–24 months were allocated into three groups: Control group (C): patients received general anesthesia only. Maxillary block group (M): patients received ultrasound-guided bilateral SMB using 0.15 ml/kg bupivacaine 0.25%. Palatal block group (P): 0.5 ml bupivacaine 0.25% was injected bilaterally at greater, lesser and nasopalatine foraminae. CHIPPS score, rescue analgesic consumption and time till tolerance of oral feed were assessed.ResultsOn admission to PACU till 8 h postoperative, CHIPPS score was lower in M and P groups compared to C group. At 6 h and 8 h, CHIPPS score was lower in M group compared to P group. Postoperative rescue analgesic consumption was decreased in M and P groups (0.72 ± 2.22 mg) and (3.73 ± 5.92 mg) compared to C group (8.07 ± 5.47 mg) with significantly lower values in M group compared to P group. Time to first request of rescue analgesia was significantly prolonged in M and P groups (482.50 ± 38.62 min) and (260.00 ± 31.62 min) compared to C group (79.71 ± 30.34 min). Time to feed was lower in M and P groups compared to C group.ConclusionUltrasound-guided bilateral SMB provided better postoperative analgesia and decreased rescue analgesic consumption and time to tolerate oral feeding compared to PB without increased side effects.
Effect of perioperative dexmedetomidine infusion on blood glucose levels
in non-diabetic morbid obese patients undergoing laparoscopic bariatric
surgery
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Raham Hasan Mostafa, Ibrahim Mohamed Ibrahim, Ahmed H. AyoubAbstractBackgroundThis study was designed to assess the clinical efficacy of dexmedetomidine premedication on neuroendocrine stress response by analysis of perioperative fluctuation of blood sugar level during laparoscopic bariatric surgery. Dexmedetomidine when used as an additive to general anesthesia blocks stress response to various noxious stimuli, maintains perioperative hemodynamic stability.Settings and designSixty patients undergoing laparoscopic sleeve gastrectomy were divided randomly into two groups. The dexmedetomidine group (Group D), received dexmedetomidine infusion, while the control group (Group C) received normal saline 0.9% in the same amount and rate as placebo. In group D, dexmedetomidine was given intravenously (IV) as loading dose of 1 μg/kg over 10 min prior to induction. After induction, it was given as infusion at a dose of 0.5 μg/kg/h for maintenance.Perioperative blood sugar levels were analyzed preoperatively, at 30 min after beginning of surgery then hourly till surgery ends, and six h after surgery. Anesthetic and surgical procedures were standardized. All patients were also assessed for intraoperative hemodynamic changes at specific timings, intraoperative narcotic consumption and recovery profile.ResultsPerioperative administration of dexmedetomidine infusion had essentially weakened the stress response. In the C group there was significantly higher blood sugar values compared to group D one hour after start of surgery up to 6 h later. Also, regarding hemodynamics there was significant reduction in heart rate (HR) and mean arterial blood pressure (MAP) in D group.ConclusionsDuring the laparoscopic sleeve gastrectomy, dexmedetomidine premedication has effectively regulated the neuroendocrine stress response of general anesthesia as analyzed by perioperative blood sugar variation. Also, it maintained the hemodynamic stability.
Priming with different doses of metoclopramide preceded by tourniquet
alleviates propofol induced pain: A comparative study with lidocaine
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Tamer Fayez Safan, Ahmed Abdalla Mohamed, Ahmed Shaker RagabAbstractObjectivesTo evaluate the outcome of priming by varying-doses of metoclopramide on propofol injection pain in comparison to lidocaine as a standard control.Methods and materials320 patients were randomly allocated into 4 equal groups: Group C received 50 mg lidocaine and Groups M1-3 received metoclopramide 2.5, 5 and 10 mg, respectively. An elastic tourniquet was applied to the mid of left arm, the priming solution was injected over 10 s and 1-min later, tourniquet was removed and one fourth of the total calculated dose of Propofol was injected over 30 s and pain assessment was made, during initial and at end of injection of Propofol trial dose, using the 4-point verbal rating scale: no, mild, moderate or severe pain. Then, the reminder of the full calculated induction dose of Propofol was completed.ResultsLidocaine and metoclopramide mostly relieved pain of initiation of Propofol injection 174 patients (54.4%) had no pain 94 patients (29.4%) had mild pain and only 68 patients (21.25%) had moderate pain, while no patient had severe injection pain. At the end of injection of the total trial dose, 40% had no pain totally, 31.3% had mild pain, 19.3% had moderate pain and 9.4% had severe pain. Lidocaine provided significantly better analgesia compared to metoclopramide (2.5 mg), while the difference was non-significantly better compared to metoclopramide, 5 and 10 mg. Metoclopramide provided dose-dependent stepwise pain relieve peaking with 10 mg dose that showed significant superiority compared to 2.5 mg dose, but non-significantly compared to 5 mg dose. Moreover, the effect of 10 mg priming dose extended till completion of injection of the trial dose with significant difference Compared to the other two doses of metoclopramide.Conclusionvenous priming with metoclopramide 10 mg with mid-arm tourniquet applied for one minute is effective modality for alleviation of Propofol injection pain else Patients received Lidocaine showed significantly better analgesia compared to those received 2.5 mg metoclopramide.
Retraction notice to Comparative study between dexmedetomidine, magnesium
sulphate and fentanyl as sedatives throughout awake fiberoptic intubation
for patients undergoing cervical spine surgeries Egyptian Journal of
Anaesthesia Volume 33, Issue 4, October 2017, Pages 345-349
- Abstract: Publication date: July 2018Source: Egyptian Journal of Anaesthesia, Volume 34, Issue 3Author(s): Tarek Radwan, Rania Fahmy, Mohamed El Emady, Islam Reda