Enhanced recovery program [erp] versus traditional care after elective left side colorectal cancer surgery

Aims: We aimed to study the effect of ERAS protocol after left side colorectal cancer surgery in comparison with patients were subjected to traditional care

Methods: Retrospective study comparing 2 groups of patients who underwent elective left side colorectal cancer surgery. Group A: 25 patients admitted between November 2014 and April 2015 subjected to ERAS, and Group B: 25 patients admitted between January 2008 and August 2008 received traditional care. Both groups were consecutive cases. The notes were examined to determine the following outcome measures: Short-term morbidity, Length of stay, 30 days Readmission rate and Mortality

Results: 25 patients with ERAS matched with 25 traditional recovery cases for baseline demographics. 96% started oral fluids on D1 in group A compared to 8% in group B, 96% in group . A tolerated full diet on D6 compared to 72% in group B. Bowel movements by D5 was group A 92% compared to only 36% in group B. Total LOS mean for group A was 7 days vs 12.48 in group B [p=0.005]. Complications occurred less frequently in group A compared to group B [anastomotic leak with 8% [n=2] in group A versus 16% [n=4] in group B, prolonged ileus with 8% [n=2] in group A versus 16% [n=4] in group B [p = 0.663]. Mobility on D1 40% [n=10] in group A was an independent factor which decreased LOS, as all stayed< 5 days [p=0.002] and developed less complications [4% [p=0.027]]

Conclusion: ERAS didn‘t affect complications rate significantly following left side colorectal surgery, however reduced LOS as it improved tolerating oral intake and bowel movement. Mobility D1 can be independent pridector of reduced both complications and LOS and should be encouraged for all patients

influence of bilateral superficial cervical plexuses block [BSCBs] as pre-emptive analgesia on patient satisfaction after thyroid surgery

Superficial cervical nerve block may reduce post-thyroidectomy pain. The aim of this study was to evaluate the influence of BSCBs as pre-emptive analgesia on patient satisfaction post- thyroidectomy surgery. Fifty adult patients were randomly allocated to one of the two groups, to receive either 20 mL isotonic sodium chloride solution [Saline group] or 20 mL bupivacaine 0.25% [Bupivacaine group] as BSCBs before induction of general anesthesia. Thyroid surgery was performed according to a standardized procedure by the same surgeon. Patients were transferred to the PACU where they stayed for 2 h, then were transferred to the ward. Morphine was administered in PACU following a standardized protocol [1-2 mg repeated every 10 minutes until the pain was controlled] if the VAS score was >/= 40 mm. Postoperative pain: was assessed by visual analogue scale [VAS], with 100 being the worst pain and 0 being no pain, by a nurse trained in pain assessment when patient is fully awake and extubated [H0], before discharge from the PACU [H+2], and every 4 h until 24 h after the end of surgery. Was evaluated the day after surgery by the anaesthetist using a 5- point verbal score [0: poor; 1: moderate; 2 good; 3: very good; 4 excellent. Total amount of morphine used in PACU and after 24hours. All adverse effects were recorded. There were no significant statistical differences between both groups as regard demographic data, duration of anesthesia and duration of surgery. The main outcome variables were pain scores [VAS], the proportion of patients given morphine at PACU and 24-h after surgery as well as the amount of morphine required. The Bupivacaine group had a smaller proportion of patients given morphine [24% vs. 72%; P = 0.0016] and [40% vs. 84%] in PACU and 24 hour after surgery respectively. Patients given BSCBs had significantly lower VAS with excellent satisfaction. We conclude that bilateral superficial cervical plexus blocks significantly reduce pain intensity and Opioids requirement in the postoperative period after thyroid surgery with excellent patient satisfaction

Role of histamine H2 receptors in cardiovascular function

The purpose of this study was to evaluate the role of histamine receptors [H[2]] in cardiovascular function in rats. The finding in the present study revealed that H[2] receptor blocker rantidine Hcl in a dose 20 mg/Kg reduces the heart rate both invivo and invitro, and abolishes the positive chronotropic action of beta - adrenergic stimulation, induced by isoproterenol infusion in isolated perfused hearts in Langendorff preparation. Moreover, it reduces the basal myocardial flow rate, with normal response to beta - adrenergic stimulation. On the other hand, the inotropic responses were unaffected. Therefore, the sympatho-inhibitory action of H[2]-blocker, suggesting a potential clinical use in conditions associated with enhanced sympathetic tone such as coronary vascular diseases and heart failure

Effect of vitamin C on responses of isolated hearts to B-adrenergic stimulation

The aim of this study was to investigate the possible protective action of vitamin C, in different doses against the oxidative damage induced by excessive beta-adrenergic stimulation by isoproterenol on the isolated perfused rat heart in a Langendroff preparation. The finding revealed that vitamin C in all doses used [100 mg, 200 mg and 500 mg] reduces the positive Chronotropic response of beta- adrenergic stimulation. Also, it improves the myocardial flow rate in response to isoproterenol infusion.On the other hand, the inotropic responsiveness to isoproterenol is only abolished [reduced peak developed tension] with the large dose of vitamin C 500 mg. Therefor, the benefits of vitamin C against the deletarious effects of excessive beta- adrenergic stimulation of the heart have been demonstrated, although the disadvantageous actions of the large doses of vitamin C should be safeguarded