24 research outputs found
Extending labor epidural analgesia using lidocaine plus either dexmedetomidine or epinephrine for emergency cesarean section
No full textAbstractObjectiveWe designed this study to test whether dexmedetomidine 1μg/kg can be an alternative to epinephrine 5μg/ml (1/200.000) as an adjuvant to lidocaine 2% for fastening the extension of labor epidural analgesia into an adequate block for emergency cesarean section (CS).MethodsSixty patients having epidural analgesia for normal delivery who required emergency CS were assigned to either lidocaine–epinephrine (LE) group (n=30) received 19ml of lidocaine 2% and 1ml containing 5μg epinephrine or lidocaine–dexmedetomidine (LD) group (n=30) received 19ml of lidocaine 2% and 1ml containing 1μg/kg dexmedetomidine. If the patient feels any discomfort (VAS >3) during surgery, intravenous fentanyl 25–50μg was given. Sedation level was assessed using five points numerical scale.ResultsBoth groups were comparable regarding the onset time and time to maximum block height, p value >0.05. The number of patients required intraoperative fentanyl was higher in LE group compared to LD group, p value <0.05. The mean total fentanyl supplementation was more in LE group compared to LD group, p value <0.001. Overall sedation score was higher in LD group than in LE group (p value <0.001), and more patients had bradycardia in LD group compared to LE group (p value <0.001). The mean time to two segment regression, mean time to regression to Bromage 0 and mean time to first analgesic requirement were significantly longer in LD group compared to LE group, p value <0.001.ConclusionEpidural dexmedetomidine is comparable to epinephrine as an adjuvant to epidural lidocaine in fastening the onset of surgical anesthesia and resulted in better intraoperative analgesia and in longer duration of sensory and motor block in the settings of converting labor epidural analgesia for emergency CS
Intraoperative lidocaine infusion attenuates tourniquet induced hypertension in patients undergoing anterior cruciate ligament reconstruction under general anesthesia
No full textAbstractObjectiveThis randomized, double blind, controlled study was designed to test whether the intraoperative use of intravenous lidocaine bolus followed by infusion would attenuate the tourniquet induced hypertension (TIH) in patients undergoing anterior cruciate ligament reconstruction (ACLR) under general anesthesia.Methods76 patients were randomly allocated into two equal groups. Lidocaine group (group L), in which patients received lidocaine 2% 1mg/kg IV bolus after induction of anesthesia followed by lidocaine infusion (2mg/kg/h) and placebo group (group P), in which patients received equal volumes of saline. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before induction of anesthesia, before tourniquet inflation (baseline value), every 15min after tourniquet inflation, and after tourniquet deflation. The number of patients who developed TIH was recorded and total amount of propofol and fentanyl used intraoperative was recorded.ResultsSBP, DBP and HR were significantly less after tourniquet inflation in group L compared to group P in most of the time periods after tourniquet inflation (p value<0.05), the number of patients developed TIH was significantly less in group L compared to group P (26% in group L compared to 52.6% in group P) (p value 0.019), and the total amount of propofol and fentanyl used intraoperative was significantly less in group L compared to group P (p value 0.000).ConclusionIntraoperative use of lidocaine bolus (1mg/kg), followed by infusion (2mg/kg/h), started 10min before tourniquet inflation attenuated the TIH in patients undergoing anterior cruciate ligament reconstruction under general anesthesia
The effect of nebulized lidocaine hydrochloride on emergence from sevoflurane anesthesia in children undergoing Tonsillectomy
No full textAbstractBackgroundSevoflurane-related emergence agitation (EA) is considered a significant problem that interferes with children’s recovery; our aim was to evaluate the efficacy of nebulized lidocaine hydrochloride when given before sevoflurane anesthesia in attenuating EA in children undergoing tonsillectomy.Materials and methodsA randomized clinical study was conducted on eighty children ASA I and II who underwent tonsillectomy. The children were randomized to one of two groups according to the nebulizer contents. Lidocaine group (group L) received nebulized solution of 4mg/kg lidocaine hydrochloride and placebo group (group P) received nebulized solution contains 0.9% normal saline.ResultsThe number of agitated patients were significantly lowered in the lidocaine group compared to the placebo group; p value (0.012).ConclusionThe use of nebulized lidocaine before sevoflurane anesthesia for pediatric patients undergoing tonsillectomy attenuated the sevoflurane-related EA with no side effects
Ketamine/propofol versus fentanyl/propofol for sedating obese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)
No full textAbstractObjectiveThis study was conducted to compare two techniques of sedation for obese patients undergoing ERCP, using either ketofol or fentanyl–propofol as regards propofol consumption, recovery time, patients’ satisfaction, and sedation-related adverse events.Materials and methodsTwo hundred obese patients were randomly allocated to one of two groups; ketamine/propofol (ketofol) group KP (n=100) or fentanyl/propofol group FP (n=100). The level of sedation was adjusted to achieve a Ramsay Sedation Scale (RSS) score of 5.ResultsTotal dose of propofol consumed was significantly higher in group FP compared with group KP (97.08±23.31mg and 57.71±16.97)mg. Recovery time was slightly longer in group KP compared with group FP (11.19±2.59min and 9.43±1.23min, respectively), time needed to achieve Aldrete Recovery Scale Score of 9 was comparable in both groups, and sedation-related side effects as hypotension, bradycardia, apnea, and reduction of SpO2 were more significant in the FP group.In conclusionKetamine/propofol combination 1:4 provided better sedation quality than fentanyl/propofol combination with less side effects and can be safely used for sedating obese patients undergoing ERCP
A randomized controlled study of the effects of adding ultra-low dose naloxone to lidocaine for intravenous regional anesthesia
No full textAbstractObjectiveThis study was designed to evaluate the effect of adding ultra-low dose of naloxone as an adjuvant to lidocaine for intravenous regional anesthesia (IVRA).MethodForty patients undergoing elective short procedures in the upper limb were randomly and blindly divided into two groups of twenty patients each. Group L (n=20) received 3mg/kg of 2% lidocaine diluted with normal saline to 30ml. Group LN (n=20) received 3mg/kg of 2% lidocaine and naloxone 100ng (1ml) diluted with normal saline to 30ml. Onset and recovery time of sensory and motor block, intraoperative and post-operative pain were measured by visual analog score (VAS), and also intraoperative analgesic requirement, time of first requirement of diclofenac postoperatively, total amount of diclofenac needed in 24h, patient’s satisfaction and surgeon’s satisfaction scores were measured.ResultsRecovery of sensory block was significantly longer in group LN (26.7±2.8min) compared to group L (16.3±0.6min); p value (0.000). Also the recovery of motor block was significantly longer in group LN (19.1±1.0min) compared to group L (17.9±1.2min), p value (0.002). Intraoperative fentanyl requirement was significantly less in group LN (15.8±5.0mcg) compared to group L (40.0±10.5mcg), p value (0.000). 1st fentanyl requirement time was significantly longer in group LN (22.4±3.1min) than in group L (14.5±6.1min), p value (0.000). Time of first analgesic requirement post-operative was longer in group LN (78.5±6.8min) compared to group L (40.5±2.0min), p value (0.000). Total amount of diclofenac needed in 24h was significantly less in group LN (57±50mg) compared to group L (120±45mg), p value (0.000).ConclusionThe addition of ultra-low-dose naloxone 100ng to lidocaine for IVRA in upper limb surgery, prolonged the duration of sensory and motor block, and reduced tourniquet pain, as well as intraoperative and postoperative analgesic consumption
The effect of ondansetron in preventing the hypotensive bradycardic events during shoulder arthroscopy done under interscalene block in the sitting position
No full textAbstractPurposeThis study was conducted to test whether blocking the serotonin receptors by intravenous [IV] ondansetron; can help in reducing the hypotensive bradycardic events [HB events] associated with shoulder arthroscopy done in the sitting position under interscalene plexus block [ISB].MethodsOne hundred and fifty patients, scheduled for shoulder arthroscopy in the sitting position under ISB, were randomly assigned to one of three groups receiving either: 4mg ondansetron, or 8mg ondansetron or saline.ResultsIV injection of ondansetron 4mg or 8mg significantly reduced the incidence of HB events from 20.4% in the saline group to 6.1% after injection of 4mg ondansetron and 6% after injection of 8mg ondansetron; p value [0.030].ConclusionIV ondansetron either 4mg or 8mg reduces the HB events during shoulder arthroscopy in the sitting position under ISB
Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS)
No full textAbstractObjectiveMucosal bleeding during FESS often interferes with optimal visualization of the nasal surgical field and can impair the safety and efficiency of the procedure. This study was conducted to evaluate the efficacy of tranexamic acid and Epsilon Aminocaproic Acid to decrease bleeding and improve visualization of the surgical field during FESS.Materials and methodsA total of 90 patients ASA I-II aged from 18 to 50years and undergoing FESS for chronic sinusitis were enrolled in this study. Surgery was performed under general anesthesia patients were randomly assigned to three equal groups (30 patients each), patients in TXA group received intravenous tranexamic acid 10mg/kg diluted in 100ml saline. EACA group received intravenous Epsilon Aminocaproic Acid 100mg/kg diluted in 100ml saline and the control group received IV 100ml normal saline (all infusions were through 10min). The duration of surgery, volume of blood loss, pre and postoperative hemoglobin, MAP and HR, surgical field quality surgeon satisfaction and side effects were recorded.ResultsThe duration of surgery was significantly less in TXA and EACA groups than the control group (121.1±7.1min), (120.8±6.0min), versus (146.1±7.3min) volume of blood loss in TXA group and EACA group was comparable (195.3±32.2ml) and (201.5±30.6ml) but each of them has significant less blood loss than the control group (365.1±48.8ml). The postoperative hemoglobin was significantly lower in the control group (11.9±0.4gm/dl) compared to TXA group (12.6±0.2gm/dl) and EACA group (12.4±0.2gm/dl). Both TXA and EACA groups had comparable improved quality of the surgical field with most of patients classified as grade 1 and 2 according to Boezaart scale while the control group had most of patients in grade 3, accordingly the surgeon satisfaction is significantly higher in TXA and EACA groups compared to the control group. No significant difference in side effects between all groups.ConclusionIntravenous tranexamic acid and Epsilon Aminocaproic Acid (EACA) effectively reduce bleeding during FESS and improve visualization of the surgical field and so increase the surgeon satisfaction with no significant difference between both drugs
The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia
No full textAbstractObjectiveWe conducted this clinical study to assess the adjuvant effects of single dose magnesium sulfate (Mg) when administered epidurally during labor with fentanyl and bupivacaine.MethodsEighty healthy nulliparous women in labor requesting epidural analgesia were divided into two groups. Group 1 received bupivacaine 0.125% with magnesium sulfate 50mg and fentanyl 50μg as a loading dose; group 2, received bupivacaine 0.125% and fentanyl 50μg only. Hemodynamic parameters, motor and sensory evaluation, cervical dilation at time of consenting, the progress of labor, the visual analog pain score (VAS), Apgar score, cord blood acid base status, side effects as nausea, vomiting, itching and respiratory depression were recorded. Fetal heart rate tracings were also documented.ResultsEpidural single dose magnesium sulfate added to bupivacaine and fentanyl in labor resulted in significantly faster onset and longer duration of epidural analgesia (169±50min) in comparison to those patients who received bupivacaine and fentanyl only (105±41min), also there was a significant reduction in the number of women requiring additional boluses of bupivacaine when Mg was added (P=0.016). The two groups had no significant differences as regards maternal satisfaction score, maternal and neonatal adverse effects.ConclusionMagnesium sulfate added to bupivacaine and fentanyl for labor epidural analgesia resulted in faster onset, longer duration of action and reduced the break through pain
The effect of combined remifentanil and low dose ketamine infusion in patients undergoing laparoscopic gastric bypass
No full textAbstractBackgroundThe choice of anesthesia in morbidly obese patients remains controversial. We evaluated the effect of continuous low dose ketamine infusion combined with remifentanil and propofol in patients undergoing laparoscopic gastric bypass, on hemodynamic stability, postoperative analgesic requirement and recovery profile.Methods60 patients aged 25–50 years, allocated into 2 groups. Group I: received continuous infusion of (propofol 6–10 mg/kg/h + remifentanil 0.2 μg/kg/min + saline). Group II: received continuous infusion of (propofol 6–10 mg/kg/h + remifentanil 0.2 μg/kg/min+ ketamine 1μg/kg/min). All patients recieved intravenous morphine by patient controlled analgesia (PCA) postoperatively.Mean blood pressure and HR, duration of anesthesia and surgery recorded. Bispectral index, total amount of propofol and remifentanil used intraoperative were measured. In the recovery room, time to response to verbal commands was recorded, subjective pain scores were obtained with a scale from 0–10. Postoperative nausea and vomiting, hallucinations were recorded. Early pain perception and total consumption of morphine in 24 h recorded.ResultsDuring anesthesia, mean arterial blood pressure and heart rate were decreased in group I compared with group II. The amount of propofol required to maintain the target BIS was lower in group II compared with group I . The amount of intraoperative boluses of remifentanil required to maintain hemodynamics was lower in group II compared with group I. The amount of PCA morphine at 2 h in the PACU and the first post operative day were lower in group II compared with group I. Pain scores at 1 h and 2 h postoperatively were lower in group II compared to group I. P value <0.05 was considered significant.ConclusionDuring laparoscopic gastric bypass in morbidly obese patients the co-administration of low dose ketamine and remifentanil by continuous infusion provide more hemodynamic stability, satisfactory recovery profile and adequate postoperative pain relieve
City Architectural Heritage Revival: The Need of a New Applied Approach
No full textEgypt is a nation of 4000 years of civilization, which was known for its ancient architecture that occupied the highest rank of importance, but how long will our neglected heritage sites survive in our recent era? This is a rising debate. This paper is based on a hypothesis whether the conservation of the neglected or isolated heritage sites, particularly in the inhabited areas, can bind the citizens to their past. For this reason, the research provides scenes of many applied conservation practices in other countries. The study calls for developing a new applied approach of conservation that takes the interaction between citizens and the city heritage zones into consideration
