Nonopioid versus opioid based general anesthesia technique for bariatric surgery: a randomized double-blind study

The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery. Prospective randomized controlled trial. Obese patients [body mass index >50 Kg/m[2]] undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent. Patients were randomized using a computer generated randomization table to receive either opioid or non-opioid based anesthesia. The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol. Primary outcomes were hemodynamics in the form of "heart rate, systolic, diastolic, and mean arterial blood pressure" on induction and 1/2 hourly thereafter. Pain monitoring through visual analog scale [VAS] 30 min after recovery, hourly for 2 h and every 4 h for 24 h was also recorded. Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction. There was no difference in background characteristics in both groups. There were no statistically significant differences in different outcomes as heart rate, mean blood pressure, O[2] saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment. Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one. There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia

Results of open reduction and derotational femoral shortening osteotomy in the treatment of developmental dysplasia of the hip in the child younger than 3 years

Treatment of DDH after walking age is a point of controversy and raise a lot of questions. The material included 17 hips in 14 patients [10 females and 4 mails].Right hip was affected in 8 patients while the left hip was affected in 3 patients; bilateral dislocation in 3 patients. All cases were discovered late when patients started to walk and presented with limping or waddling gait. The age of our patients ranged between 1.5-3 years old. In this age group there are adaptive shortening of the extra-articular soft tissues, acetabular dysplasia, capsular constriction, and increased femoral antiversion. All cases did not receive any previous treatment. Combining derotational femoral shortening osteotomy with open reduction to reduce the incidence of redislocation and avascular necrosis [A VN] were done for all cases. K wire fixation was added between the greater trochanter and the hip bone. The average follow up was 2 years. All patients were evaluated clinically on the basis of rang of motion 9hip stability, limp and pain.Clinically,16 cases were scored excellent according to the modified Mckay criteria.One case developed avascular necrosis. We concluded that Femoral osteotomy [varus derotation and shortening] with open reduction is an effective and recommended approach for treatment of DDH in patients who had begun to walk. The use of K-wire helps maintaining the reduction during femoral osteotomy and during changing of the cast

modification of the lamellar split technique for management of cicatricial entropion

The aim of this study was to evaluate the result of the modified technique in relation to the lamellar split with evertical reposition of anterior lamella technique. The new superficial tarsotomy technique with everting sutures was used in 21 lids, while the original technique was used in 31 lids with cicatricial entropion. A complete success was obtained in the 21 lids treated with the modified technique, while the original technique gave 80.64% as a complete success and 16.13% as a qualified success [an overall success of 96.8%]. Postoperative complications occurred in 19.1% of cases treated with the modified technique, while they occurred in 54.84% treated with the original technique

Evalution of the role of amniotic membrane transplantation in management of cicatricial entropion

This prospective study was carried out on 52 lids of 49 patients with cicatricial entropion. The lamellar split with vertical reposition of anterior lamella was the technique used in these cases, with an overall success of 98.1%. Good cosmetic results were obtained in all cases with a shorter period of healing with a mean of 15.73 +/- 2.63 days

Subacromial decompression using modified acromioplasty

The aim of this work was to study the clinical results of subacromial decompression using modified acromioplasty in cases of shoulder impingement syndrome. Thirty two patients who had shoulder impingement syndrome were included in this study. Twenty patients were females and 12 were males. The average age at the time of operation was 43.2 years; 40.6 years for females and 47.6 for males. There were two indications for operation. One was the persistence of pain in the anterior aspect of the shoulder when the arm was elevated and the second was progression of symptoms despite the use of anti-inflammatory medications and rehabilitation program. All cases were managed operatively with a modified Neer acromioplasty. In the classic anterior acromioplasty as described by Neer emphasis was placed on resection of the inferior prominence of the acromion. Modified acromioplasty was done in two steps; the portion of the acromion that projects anteriorly beyond the anterior border of the clavicle was resected vertically and then an anteroinferior acromioplasty was performed. The follow up period ranged between 6-24 months, average 13 months. Nineteen patients had excellent result, 7 had good result and 6 had no improvement

use of bone graft in reconstruction of the acetabulum in primary hip replacement

Material: Between 1995 and 1998, 28 total hip replacements were performed. Autografting of the acetabulum was performed in all cases. Nineteen patients were females and 9 were males. The youngest patient was 38 years old and the oldest 83. Morselized bone graft was used in 15 hips [53.6%], bone graft and one plate in 8 hips [28.6%] and bone graft and titanium mesh in 5 hips [17.8%]. Acetabular defect was medical cavitary in 15 hips [53.6%], medial cavitary and medial segmental in 3 hips [10.7%], segmental superior in 6 hips [21.5%], segmental superior and anterior in 2 hips [7.1%], and segmental superior and posterior in 2 hips [7.1%]. Method: Posterior approach was used in all cases. Bone graft from the patient's own femoral head was cut into small pieces about 0.5 - 1.0cm manually using bone nibbler after removing the articular cartilage, or as a segment of cortico-cancellous graft. Follow-up period: The average follow up period was 3.9 years. The average modified Harris Hip score was 31.7 points and at the end of follow up 69.8. In 26 cases [92.86%] the graft appeared to be incorporated securely to the acetabulum as determined by radiographic examination. There were two failures [7.14%]. In one hip the cup was migrated 22 mm superiorly and the other cup showed upward migration of 8 mm. Femoral head autograft appears to provide a useful technique for the reconstruction of a severely deficient acetabulum during primary hip arthroplasty