Ain-Shams Journal of Anesthesiology

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EISSN : 2090-925X
Total articles ≅ 159
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, Nishant Sahay, Rajnish Kumar, Neeraj Kumar
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-2; doi:10.1186/s42077-021-00164-4

Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-7; doi:10.1186/s42077-021-00162-6

Abstract:
Background Acute kidney injury (AKI) with sepsis increases mortality significantly. The pathophysiology of AKI during sepsis is complex and multifactorial. Lower heart rate is associated with better survival in patients with multiple organ dysfunction syndrome (MODS), a disease mostly caused by sepsis. In our study, we hypnotized that use of ivardrabine as heart rate reducing agent in septic patient with renal impairment may improve renal function. Results Fifty patients with sepsis with early renal impairment were divided in 1: 1 ratio to receive Ivabradine (group I) or not (group C). The average age of the included patients was almost 45 years, chest disorders were the main cause of sepsis in both groups. There were statistically significant differences between both groups in terms of reduction of heart rate group (I) (68.13 ± 3.34) versus (group C) (87.04 ± 3.23) and (P < 0.001) also, improvement in eGFR by Cystatin c in group (I) (103.32 ± 6.96) versus (group C) (96.25 ± 6.36) and (P < 0.001) also vasopressor dosage consumption (P < 0.001). As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (P = 0.390), need for hemodialysis (P = 0.384), and mortality (P = 1.000). Conclusions We concluded that Ivabradine as an adjuvant therapy in septic patients with renal impairment is promising agent to reduce such impairment. Trial registration Pan African Clinical Trial Registry: Identification number for the registry is PACTR201911806644230.
Omer Mohammed Mujahid, Samarjit Dey, Suresh Nagalikar, Prateek Arora, Chandan Kumar Dey
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-3; doi:10.1186/s42077-021-00167-1

Abstract:
Background Patients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty. Case presentation We report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation. Conclusion Single-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.
, Koray Bas
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-7; doi:10.1186/s42077-021-00160-8

Abstract:
Background After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical diseases. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have led to the development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Patients who undergo TOEPVA at our institution between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Results Seven patients were operated successfully by this technique, none of which required conversion to conventional open surgery. Two patients required atropine and one patient required ephedrine during insufflation. Conclusion After induction of anesthesia with propofol, remifentanil, and rocuronium and anesthesia managed by desflurane co-administered with continuous infusion of remifentanil provide feasible and safe anesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anesthetist has a great value to improve patient management.
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-7; doi:10.1186/s42077-021-00163-5

Abstract:
Background Colonoscopy is one of the commonly performed procedures for the diagnosis of colonic disorders. Several sedation regimens are administered during colonoscopy. To date, the propofol-based sedation regimen is commonly used, although it may have some risks. I studied the efficacy of dexmedetomidine–lidocaine combination as a substitution for propofol for sedation in colonoscopy procedures. It is a prospective randomized controlled study; 62 patients were recruited and divided into two equal groups: group P is the propofol group which included patients who received sedation with IV propofol using a loading dose of 50–100 mg of propofol and were continued on propofol IV infusion 25–75 μg/kg/min and group D-L is the dexmedetomidine–lidocaine group where patients received a loading dose of dexmedetomidine 1 μg/kg infused over 10 min followed by infusion of dexmedetomidine 0.2–0.7 μg/kg/h and lidocaine 1 mg/kg IV followed by an infusion of 1.5 mg/kg/h. The primary outcome was the median patients’ satisfaction scores after recovery assessed by the Likert 5-item scoring system. Other outcomes included postprocedure pain score, mean arterial blood pressure, saturation, heart rate during the procedure, amount of fentanyl and midazolam used during the procedure, and the number of apneic attacks. Results Patients in both groups were satisfied by the procedure, and the median and 1st–3rd IQ satisfaction scores were 5 (4.0–5.0) in group P and 4 (4.0–5.0) in group D-L; however, this difference was statistically significant (P value = 0.014), reflecting more satisfaction in patients who received propofol. Patients in group D-L required significantly more doses of midazolam and fentanyl to achieve an adequate sedation score, had a more significant drop in heart rate, and had significantly more postoperative pain scores than those in group P. Patients in group P had significantly more apneic attacks and lower intraprocedural oxygen saturation levels than those in group D-L. Conclusion Dexmedetomidine–lidocaine combined IV infusion was found to be effective and safe for sedation in colonoscopy with less side effects in terms of apneic attacks and desaturation, although patient satisfaction was significantly higher in the propofol group, yet as per the sedation scores this was considered to be clinically non-significant. Trial registration The study was registered by the Australian New Zealand Clinical Trials Registry (trial ID: 12620000249954).
Ghada Mohamed Samir, Omar Mohamed Ali Mohamed Omar, Madiha Metwally Zidan, Hazem Abd El Rahman Fawzy, Marwa Mamdouh Mohamed El Far
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-8; doi:10.1186/s42077-021-00161-7

Abstract:
Background The development of acute kidney injury (AKI) is an important indicator of clinical outcomes after cardiac surgery. Elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. This study will investigate the association of preoperative HbA1c levels with AKI after isolated coronary artery bypass grafting (CABG). Results Forty patients undergoing elective CABG were enrolled in this cohort study. Patients are divided into 2 equal groups who underwent isolated coronary artery bypass grafting (CABG): patients with preoperative HbA1c 5.7–6.4% (group A) (prediabetics) and patients with preoperative HbA1c > or = 6.5% (group B) (diabetics). Acute kidney injury according to the Kidney Disease: Improving Global Outcomes criteria developed in 11 patients (27.5%). There was a significant difference between the two groups as regards postoperative urinary NGAL, creatinine level on the 1st day, creatinine level on the 2nd day, urine output on the 1st day, and urine output on the 2nd day (p value was 0.001, 0.002, 0.006, 0.0002, and 0.012 respectively). Postoperative ICU stay duration was statistically significant in the diabetic group (P value 0.009). The need for renal replacement therapy was higher in the diabetic group, but it was not statistically significant between the two groups. Roc analysis shows AUC 0.922 with a significant p value (< 0.0001) and cut of value (≥ 7) with sensitivity 81.82 and specificity 93.10. Conclusion This study revealed that elevated preoperative HbA1c level above 7% showed an increase in incidence of post CABG acute kidney injury along with increase length of postoperative ICU stay.
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-3; doi:10.1186/s42077-021-00159-1

Abstract:
Background Early detection and vigilance of high spinal anesthesia post epidural catheter migration in cesarean section leads to safe conduct of anesthesia. Our case describes the migration of a previously functioning epidural catheter in the subarachnoid space. This migration can be explained by patient posture changes and movements. Case presentation A 32 year – old G2P0 medically free female parturient (height 160cm, weight 65 kg), admitted to the labor ward with a 4 cm cervical dilatation, an epidural catheter was inserted in the L3-4 space, and an aspiration test was negative for CSF/blood through epidural catheter. Epidural catheter was fixed on her back using sterile dressings. Epidural mixture of 0.1% bupivacaine and fentanyl 2 mcg/ml started. Due to fetal distress, cesarean section was urgently planned. She was given a bolus dose through the epidural catheter,10 minutes after skin incision, the patient suddenly started to complain of difficulty of breathing and drowsiness. Moreover, her oxygen saturation suddenly started to drop so rapid sequence induction with cricoid pressure applied and was performed till she was intubated. Her pupils were reactive and dilated. She had stable vital signs. She was reversed with neostigmine and atropine after the use of nerve stimulator. Aspiration from the epidural catheter was performed. A clear 10mls fluid was aspirated. The fluid was sent to the lab for analysis and found to be CSF. Upon extubation, the patient was conscious and obeying commands. She completely recovered the motor power of her upper and lower limbs while she was admitted to ICU for observation and she was discharged the next day without any residual anesthesia. Conclusion Aspiration test and epinephrine test dose is always recommend to be performed prior to local epidural anesthetic for cesarean section even if the function of the epidural catheter was previously established. Careful observation of neurologic signs is also important.
Renu Bala, Priyanka Bansal, Srishti Malhan, Himani Mittal
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-4; doi:10.1186/s42077-021-00157-3

Abstract:
Background Ventriculoperitoneal (VP) shunts are commonly performed procedures for a variety of disorders and are mostly long standing. These patients when present for non-neurological surgeries like gastrointestinal, urology, or caesarean section, there are several concerns like difficult abdominal surgery due to peritoneal adhesions, chances of shunt infection with potential retrograde infective meningoencephalitis, and ventriculitis or shunt failure with recurrent hydrocephalus. Case presentation A 35-year-old male, known case of third ventricular tumour with functional left-sided ventricular peritoneal shunt was scheduled to undergo cholecystectomy for gall bladder stone. Intraoperatively optic nerve sheath diameter was measured as an indicator of raised intracranial pressure. Intraoperative was uneventful. Efforts were taken to prevent rise in intracranial pressure perioperatively. Patient was discharged on third postoperative day. Conclusion A vigilant perioperative care along with adequate team work go a long way in achieving success in patients of ventriculoperitoneal shunts presenting for non-neurological surgeries.
Serap Aktas Yildirim, Hamiyet Ozcan, Ayda Turkoz
Ain-Shams Journal of Anesthesiology, Volume 13, pp 1-6; doi:10.1186/s42077-021-00158-2

Abstract:
Background The primary objective of this study is to compare the effectiveness of the newborn’s penile block performed by the surgeon using the classical landmark method and the penile block performed by the anesthesiologist with ultrasound guidance. Results This prospective, single-blinded, randomized clinical study included a total of forty newborn babies scheduled to undergo elective circumcision. The babies were randomized into two treatment groups of ultrasound (US)-guided penile block (group I; n = 20) and classical landmark method dorsal penile nerve block (DPNB) (group II; n = 20) group. Face, Legs, Activity, Cry, Consolability (FLACC) score was used to determine the block efficacy and postoperative pain and analgesic requirements. Intraoperative and postoperative FLACC scores, intraoperative analgesic needs, discharge time, complications, first oral intake time, and parent’s satisfaction were also recorded. FLACC scores were higher in group II than in group I during the intraoperative periods. Heart rate was higher in group II than in group I, at the incision, and during the procedure (P < 0.05). The number of patients requiring fentanyl was higher in group II than in group I (P < 0.01). FLACC scores were statistically higher in the landmark group at arrival in the PACU (P < 0.01) and after 30 min up to 2 h (P < 0.01). Parent’s satisfaction was significantly higher in US group (P < 0.01) Conclusions Intraoperative analgesic needs and pain scores are lower in newborn babies who performed penile block with ultrasound-guided compared to the landmark method.
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