Neuron-specific enolase as a predictive biochemical marker for adverse neurologic outcome after cardiac surgery

Despite significant advances in cardio-pulmonary bypass [CPB] technology, surgical technique, and anaesthetic management, central nervous system complications occur in a large percentage of patients undergoing surgery requiring CPB. A major neurologic complication after otherwise successful surgery represents a devastating outcome for both the patient and the immediate family. The social and economic impact of unemployment and the requirement for long-term rehabilitation or institutional care are significant. Neuron-specific enolase [NSE] is a biochemical brain marker which can be used for the prediction of adverse neurologic outcome after cardiac surgery. This study included 60 adult patients of both sexes scheduled for elective cardiac surgery. Standard CPB technique with membrane oxygenator, nonpulsatile flow, and mean arterial pressure control was used. Neuropsychological evaluation was performed before surgery and post-operatively at discharge and after three months. Neuron-specific enolase[NSE] was measured after induction of anaesthesia, at end of CPB, 24 hours and 48 hours after CPB. After 5 days of surgery 21.8% of patients developed neuropsychiatric dysfunction. However, after 3 months only 10.9% of patients developed neuropsychiatric dysfunction. The NSE values at the end of surgery and 24 hours after surgery in patients who developed neuropychiatric dysfunction were significantly higher than those who did not develop neuropsychiatric dysfunction at 5 days and 3 months after surgery. The serum levels of NSE sampled at the end of surgery or 24 hours after surgery could be of a valid clinical predictor for adverse neuropsychiatric outcome in patients undergoing cardiac surgery

Stress among young Egyptian anesthesiologists

The practice of medicine offers many satisfactions, but there have been increasing sources of stress in the profession and increasing signs of stress- related problems among physicians. Aim of the work: was to explore the main causes of stress among young Egyptian anesthetists and to encourage them to incorporate stress management into their lives. This study was conducted on a sample of 120 anesthetists. They were chosen from both sexes with age range from 25-45 years. Anesthetists were divided into two main groups. Group A included 60 anesthetists working in Alexandria University Hospitals and group B included 60 anesthetists working in Ministry of Health Hospitals. Each main group was subdivided into three subgroups including 20 junior residents, 20 senior residents and 20 specialists. Each participant was allowed to answer a questionnaire booklet of 40 items. The most frequent source of stress among the whole studied sample was available resources and poor management [severely stressful for 76.6%]. This was significantly stressful for residents than specialists. Fallowed by stressful nature of anesthesia [severely stressful for 71.7%], and work overload and its effects on all aspects of life [severely stressful for 71.7%]. Work overload was significantly higher in group A than group B. Interpersonal relationships [severely stressful for 43.3%] was significantly higher in group A than group B and in senior residents than other subgroups. Finally, sources of dissatisfaction [moderately stressful for [99.2%]. Six anesthetists became smokers and 28 increased the rate of smoking after becoming anesthetists. Two anesthetists in the present study used to take psychoactive substances daily, one weekly and four monthly. The other 113 anesthetists never took but 13 of them thought in taking these substances. Two anesthetists claim that they thought in committing suicide weekly and another two monthly. Anesthesia is a stressful branch. Treatment of stress problems when they occur is not enough; prevention should be our aim. So, appropriate stress management skills should be included in the training program for all junior anesthetists