Verapamil as an adjunct to local anaesthetic for brachial plexus blocks

Background: Upper extremity surgeries are recently performed under regional anesthesia. Regional anesthesia of the upper extremity has several advantages over general anesthesia, such as improved postoperative pain, decreased postoperative narcotic consumption, and reduced recovery time. Supraclavicular approach of the brachial plexus block has gained importance for surgical and interventional pain management purposes. Supraclavicular brachial plexus block provides an ideal condition for surgery of the upper limb, maintains hemodynamic stability, decreases postoperative pain and allows for early ambulation. However, the duration of the supraclavicular brachial plexus block is limited by the duration of action of the local anesthetic used in the block

Aim of the Work: The aim of this study is to evaluate whether additional anesthetic effects could be derived from addition of verapamil into local anesthetics injected into brachial plexus sheath

Patients and Methods: This study was a prospective, randomized, controlled, double blind study had been carried out in Matareya Teaching Hospital on 60 adult patients with a physical status ASA I and II classification scheduled for upper limb surgeries for 6 months. Patients were randomly classified using sealed envelopes into two equal groups [group I and group II] each of 30 patients. Group I: 30 patients who received 40 ml of 1% lignocaine [20ml] with 0.25% bupivacaine solution [20ml], Group II: 30 patients who received 40 ml of 1% lignocaine[20ml] with 0.25% bupivacaine solution with 2.5mg verapamil [20ml]

Results: Onset of sensory blockade time was marginally faster in Group II [12 +/-1.8minutes] as compared to Group I [12.6 +/- 1.4 minutes]. However this difference was statistically not significant. The increase in duration of sensory blockade in Group II [209.90 +/- 13.22 minutes] as compared to Group I [183.80 +/- 11.68 minutes] was statistically significant [p < 0.001]. Increase in duration of motor blockade in Group II [172.00 +/- 9.32 minutes] as compared to Group I [168.20 +/- 8.91 minutes] was statistically not significant [p = 0.112]

Conclusion: we conclude that adding 2.5 mg verapamil with 0.25% bupivacaine solution [20ml] with 1% lignocaine [20ml] to brachial plexus block can prolong sensory anesthesia without significant effect on duration of motor block, onset of sensory and motor block

Evaluation of therapeutic procedures provided in the pediatric surgery unit at alexandria university pediatric hospital

Objectives: Statistical analysis of the pediatric surgery unit at Alex and ria University Children's Hospital [AUCH] retrospective survey from January 2009 to December 2011 and a prospective survey during the year of 2012, AUCH Pediatric Surgery Unit is a tertiary health care facility that serves four provinces [Alex and ria, Behira, Kafr El Sheikh and Marsa Matrouh], AUCH Pediatric Surgery Unit is the first pediatric surgical center established in Egypt by Professor Doctor El Sayed El Akkary in 1973. AUCH Pediatric Surgery Unit receives an average of 7200 cases in the outpatient clinic per year and its schedule has 4 operating list per week and emergency 24 hours a day seven days a week. The most common cause of neonatal admission to the unit during the year 2012 was anorectal malformations found in 68 cases followed by Tracheo-oesophageal fistula [TOF] in 53 cases, almost a case per week, The overall mortality among operated cases done to 1491 case during the year 2012 was 5% with 95% of cases cured and discharged, which is considered an excellent rate of cure and discharge compared to the overall mortality. Study Design: Retrospective survey: from year 2009 till year 2011. Prospective survey: starting from January 2012 till the end of December 2012. Results: Part I: Results of the retrospective survey: A total of 1798 patients were registered in the unit admission records for these three years. Part II: Results of the prospective survey the total number of admissions to the pediatric surgical unit during year 2012 was 1491 patients.Conclusion: 1. Noticeable improvement in registration and recording from 2009- 2012. 2. Electronic recording is an important next step to help medical researching and future study. 3. Electronic records are very important in decision making, fund raising and upgrading of services. 4. Pediatric Surgery Unit in AUCH is a tertiary health care training center due to large volume of cases at national and international levels. 5. Mortality is mainly neonatal, so efforts should be directed to further reduce. Key words: - Statistical analysis, - Demographic characteristics, - Pediatric surgery unit, Alex and ria university children hospital

Relationship between management styles and nurses retention at private hospitals

Management styles are an essential issue from both theoretical and managerial perspectives. However, success in nursing management is found in being flexible and adaptable to a variety of situations which increase quality of care. One of the best ways to ensure quality of care is to recruit and retain sufficient nursing staff. The study aimed to determine the relationship between management styles and nurses' retention at private hospitals. A descriptive correlational study was conducted in all inpatients units [n= 16] at three private hospitals with bed capacity more than 50 beds namely: El Salama New hospital, Alexandria New Medical Center, and El Shefaa hospital. All nurses with at least 3 months experience in the previously mentioned settings were included in the study [n= 228]. Profile of Organizational Characteristics [POC] developed by Likert et al. was used to measure nurses' perception for management styles in their work unit. The questionnaire consists of 16 items classified into four parts called systems, which are exploitative/authoritative management style, benevolent/authoritative management style, consultative management style, and participative management style. The findings of this study show that more than half of the respondents perceived their manager to have a consultative management style. Alexandria New Medical Center has a greater retention time as compared to other two hospitals. Management style and nurses' retention were significantly interrelated in terms of exploitative/authoritative management style. Recommendation, the researcher recommended that hospital leaders should plan and implement effective strategies to promote nurse retention. This can be done through creating a work environment that is caring and conducive for the nurse's professional practice

relationship between nurses' perception of the organizational work climate and their job empowerment

Organizational climate is set of measurable aspects of challenge working environment perceived directly and indirectly by the employees who are working together within the organization. Each organization has its own unique climate. Therefore organizational climate is one of the most powerful factors enrich the effects of nurses' sense of empowerment. Aim of the study to identify the relation between nurses' perception of the organizational work climate and their job empowerment. A correlation descriptive design was used in this study. Settings the study was conducted in all general medical, surgical units and their specialties with bed capacity 743 beds at Main University hospital. Subjects All nurses were available at time of data collection in the previously mentioned settings were included in the study [n=333]. Tools: two tools were used to collect data in this study namely: Organizational Climate Questionnaire developed by Martein [2006], It consists of thirty statements, classified under ten dimensions. A condition for work effectiveness questionnaire [CWEQ] developed by Lashinger [2001], it composed nineteen [n=19] statements that measure six subscales, namely: access to opportunity, information, support, resources, formal power and informal power. There was a moderate positive significant correlation between organizational climate dimensions and overall nurses' job empowerment subscales, as well as significant difference between both the organizational climate dimensions, and job empowerment subscales in relation to nurses' age, age; years of experiences in the hospital and in the units. In conclusion, enhancing work climate through encouragement of participative decision making, team building, fair compensation and recognition. Nurses managers should increase nurses', level of structure empowerment by identify barriers to accessing information, support, resources, and opportunities within the work environment and implement strategies to provide grater access to power

Laryngeal nerves monitoring versus non-monitoring in thyroid surgery

Thyroid surgery is the most common cause of recurrent nerve [RLN] injury. Deliberate identification of the RLN minimizes the risk of injury. When the nerve is identified and dissected, the reported RLN injury rate during thyroidectomy is 0-2.1%. Continuous intra-operative nerve monitoring during surgery remains a controversial issue. The basic technique involves a skin surface electrode or muscle electrode used to make electromyography [EMG] recordings, which have an audible alarm to alert the surgeon if passive [e.g.stretch during traction] or active nerve stimulation has occurred. We aim to evaluate the use of intra-operative nerve monitoring [IONM] to preserve the laryngeal nerves that may be at risk for injury during thyroid surgery and show the merits of using electrophysiologic laryngeal nerve monitoring during thyroid surgery. This study was conducted as a prospective study on 28 patients whom are thyroidectomy candidates; we elected 14 thyroidectomy candidates in whom we don't use NIM during surgery [Control group A]. These patients were chosen to be evenly matched with another 14 thyroidectomy candidates to monitor the recurrent laryngeal [RLN] and external branch of superior laryngeal [EBSLN] throughout thyroidectomy procedures [NIM group B] to compare the laryngeal nerves risk of injury with and without the use of nerve monitor. Four patients [2 patients in-group A and 2 patients in-group B] were dysphonic after operation. Laryngoscopy revealed unilateral recurrent laryngeal nerve palsy in all except one bilateral in group A. There were no significant differences in RLN paralysis, paresis, or total injury rates between both groups. The number of patients in the presented study was limited to draw a statistical conclusion for significance. The routine application of IONM cannot prevent or reduce recurrent laryngeal nerve injury. However the study signifies the trend towards the use of INOM in expectedly difficult cases and in revision surgery with distorted anatomical relationships and fibrous adhesions

Burnout syndrome and coping strategies among nurse educators at faculty of nursing

Today's educational environment has rapid changes fostering the experience of burnout among educators. Burnout is an undesirable behaviors and continual problems faced by nurse educators because it's negative effects. These effects are tends to be withdraw emotionally from the demands of the job, impaired in the quality of teaching and commitment that lead to give less information and interaction with students. The prevention of burnout is dependent on the extent of the use of coping strategies. Therefore, the specific effort well managed in both behavioral and psychological that nurse manager utilize to master, tolerate, reduce, or minimize stressful events. This study aimed to determine the relationship between burnout syndrome and coping strategies among nurse educators at Faculty of Nursing, Alexandria University. This study conducted on 161 nurse educators working in 9 scientific departments in Faculty of Nursing-Alexandria University. A questionnaire was developed from two validated scales, and used in collecting data pertaining to this study. Namely; Maslach Burnout Inventory Educator Survey [MBI-ES], Ways of Coping Questionnaire [WOCQ]. The main finding of this study were that more than two third of the nurse educators perceived moderate burnout, and they were used self-controlling when they experienced low level of burnout, while confronting was used in case of moderate level of burnout. A statistical significance was found between level of burnout and using of coping strategies in terms of planful problem solving and positive reappraisal. Conclusion, in the light of this study, it is recommended that conducting of orientation program of juniors nurse educators on faculty policies, regulation, as well as innovative teaching methods and evaluation are fostering their professional growth and enabling them to fulfill their role

Assessment of adaptive behavior in children with congenital hypothyroidism detected by neonatal screening and treated early in life. Comparison of effect of low and high doses of L-thyroxine on outcome

This study aimed at the evaluation of adaptive behavior in children with congenital hypothyroidism [CH] detected by neonatal screening and treated early in life with either low or high doses of L-Thyroxine. Thirty one patients ranging in age from 4 to 36 months of age and confirmed to have congenital hypothyroidism by neonatal screening were started on either low dose [8 micro g/kg/day] or high dose [15 micro g/kg/day] L-Thyroxine substitution and were followed up for growth and development. Using the Vineland Adaptive Behavior Scales [VABS], communication, social skills, daily living skills and motor skill acquisition were assessed and both groups were compared with a control group consisting of 30 normal infants and children closely matched for age and sex. The results showed that, in the low dose group, mean results for communication, social, daily living skills and motor acquisition were significantly lower than those for controls. In the high dose group, mean results for communication skills were significantly lower than those for controls, whereas other skills acquisition [social, daily living skills and motor skills] were not significantly lower than those for controls. Patients with thyroid aplasia fared much worse on all VABS parameters. However, those receiving high dose L-Thyroxine were pulled up to normal range. Lengths and weights were comparable to those of controls in both groups. We advocate early and high dose L-Thyroxine [15 micro g/kg/day] for the treatment of congenital hypothyroidism for a better neurodevelopmental outcome. These high doses achieve rapid euthyroidism which is essential in the early critical neonatal period. Levels can be later titrated according to laboratory results, with the aim of keeping levels in upper normal range for T4. Neonatal screening should be carried out as soon as possible afterbirth [3-5 days of life] to achieve the best response

Burnout and coping strategies among operating theatre nurses

There is an increasing attention toward investigating job stress and its consequences among nurses working in operating theatres. One of its most common potential negative consequences is burnout. This study aimed to determine the relationship between burnout and coping strategies among operating theatre nurses. It was conducted at Alexandria Governorate Hospitals of the different health care agencies. The subjects comprised 50% of nurses [n=251] who had the responsibilities of carrying out the manual activities in the operating theatres for patients undergoing surgery. Data were collected through two main scales namely Maslach Burnout Inventory and Ways of Coping Questionnaire. The study revealed that the majority of operating theatre nurses had high level of burnout. In addition, the majority of the nurses who were graduated from secondary technical nursing school with five to less than ten years of experienced burnout in different levels. Also, no significant correlations were found between level of burnout and coping strategies used by operating theatre nurses, and between coping strategies used and their demographic characteristics

Laparoscopic cholecystectomy [LC]; A retrospective study of 870 patients

Laparoscopic cholecystectomy [LC] is considered the gold standard for the treatment of cholelithiasis. Nevertheless, possible complications must not be underestimated. From July 1993 to May 1998, 870 patients with cholelithiasis underwent laparoscopic cholecystectomy. There was no operative mortality. One case died on the first postoperative day form causes not related to the procedure. In 31 patients [3.56%], the procedure was changed to laparatomy. Out of these 31 patients, three cases [0.34%] conversion was mandatory due to severe complications: bleeding in the hepatic hilar [which was controlled by ligation of the proximal end of the retracted cystic artery], injury of the common hepatic duct [C.H.D] during dissection of the cystic duct [T-tube drainage with suturing of the C.B.D.], injury of the transverse colon during introduction of the first trocar [primary repair of the transverse colon by suturing of the opening using Vicryl 3/0]. In the remaining 28 patients [3.22%] conversion was carried out selectively. In 21/28 [2.4%] due to unclear anatomy of Callot's triangle, technical difficulties or choledocholithiasis. In 3/28 patients [0.34%] had problems with anaesthesia. In 4/28 [0.46%] due to instrument or equipment malfunction. In the postoperative period there were few complications. In 12/870 [1.38%] patients. 4/12 developed postoperative jaundice [missed stones, complete or partial ligation of the C.B.D.]. In 2/12 patients had a bile leak. 3/12 developed a haemoperitoneum. The remaining 3 patients had different complications, [bilateral pneumthorax, subhepatic collection and a gastric fistula]. In this series 6/870 patients [0.69%] underwent reintervention, all by open laparotomies. This study demonstrates the safety of laparoscopic cholecystectomy. Complications are relatively rare. Conversion must not be considered a failure but a wise decision in the face of major difficulties

Laparoscopic inguinal herniorrhaphy

Remarkable success of laparoscopic cholecystectomy encourage the trials for laparscopic herniorrhaphy. Sevceral types of techniques were used. Our study followed the transabdominal pre peritoneal TAPP. A Prospective study for thirty five patients with 45 inguinal hernias under went TAPP. It was carried on from Jan. 1994 to May 1999, in Al-Zahraa University Hospital in Cairo and in Hamed G. Hospital in Doha Patients were selected without complications. Peak age incidence was between the fourth and fifth decades, with mean age 36 years. There were 6 cases direct and 39 indirect with five cases recurrent. All the patients were selected well and prepared properly preoperative. There were no operative complications, but post operative complications were infected wound and 2 recurrent cases who were treated by the open methods. Most of the patients were delivered on the same day. In conclusion TAPP is feasible and safe procedure for hernia repair with low recurrent rate and early convalescence