ABSTRACT
Objective@#To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. @*Methods@#Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). @*Results@#Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). @*Conclusion@#Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.
ABSTRACT
Objective@#To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. @*Methods@#Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). @*Results@#Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). @*Conclusion@#Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.
ABSTRACT
@#More studies are now focusing on vitamin E as an anticancer agent for its good effects in many in-vitro studies. Current studies proposed that vitamin E might be a suitable candidate as an alternative treatment for cancer due to its antioxidant properties. Vitamin E act as an antioxidant by their long-chain polyunsaturated fatty acids, and thus the integrity of membranes in the cells is maintained and consequently retain the bioactivity of the cells. This mini review will focus on the activity of vitamin E as an antioxidant to protect against cancer in in-vitro, in-vivo, and clinical studies. Although most studies reported great outcomes for the anticancer activity of vitamin E, there were some conflicting data. To date, studies on effects of vitamin E are still undergoing where researchers are still debating on the positive and negative effects of vitamin E as an anticancer therapeutic action.
ABSTRACT
L'ostéonécrose maxillo-mandibulaire induite par les bisphosphonates (ONBP) est un effet indésirable décrit pour la 1 ère fois en 2003. La gestion de cette pathologie reste difficile compte tenu de la gravité de cette pathologie et la complexité de ses lésions. A travers une étude marocaine sur 36 cas, les auteurs soulignent l'intérêt des mesures préventives et l'importance d'études prospectives avec un échantillonnage significatif, afin de mieux préciser les facteurs de risque associés à la survenue d'une ONBP et de déterminer les catégories des patients à risque nécessitant une adaptation de la prise en charge
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnosis , Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Case Reports , Disease Management , MoroccoABSTRACT
This is a retrospective study of 44 cases of testicular cancers treated at the Radiation and Isotopes Center ofKhartoum (RICK).The mean age was 29.9 years. Six patients (13.6%) had undescended testicles; 24 patients (54.4%) presented with stages three and four. Only 20 patients (45.4%) survived for five years and . more
Subject(s)
Electromagnetic Radiation , Isotope Labeling , Sudan , Testicular NeoplasmsABSTRACT
Background: attention Deficit Hyperactivity Disorder [ADHD] is one of the most common neuropsychiatric disorder that affects children and young adults and cause significant functional impairment. Although there are effective medications and psychobehavioural therapies that help with management of ADHD, the medications can have significant side effects, which limit their use. There is need to explore other treatment options. transcranial magnetic stimulation [TMS] and repetitive transcranial magnetic stimulation [rTMS] are recent safe and non-invasive investigative and therapeutic tools
Aim of the work: to study the effect of repetitive transcranial magnetic stimulation on a sample of children with Attention-Deficit/Hyperactivity Disorder
Methods: the sample was consisted of [35] child; their ages were ranged from 6 to 12 years old after diagnosed clinically according to DSM-5 through a designed semi structured interview and through application of Conner's teacher-28 and parent-48 rating scales as ADHD combined type. Females were [11] children with percentage 31.4%, while males were [24] children with percentage 68.6%. All patients on the sample were not receiving any medical or behavioral therapy for ADHD
Results: means scores of inattention, hyperactivity and impulsivity were reduced significantly in the post 5 days and 2 weeks follow up [P-values > 0.001[, started to rise again in its evaluation after 4 weeks but not reaching its values before rTMS sessions. the percentage of severe cases in each scale category was dramatically decreased immediately and 2 weeks after rTMS sessions and started to rise again in its evaluation after 4 weeks but to lower percent than before rTMS sessions [70%, 100% and 60% had severe inattention, hyperactivity and impulsivity respectively before rTMS, reduced to 0%, 0%, 10% immediately and 2 weeks after rTMS but increased to [20%, 40% and 40%] after 4 weeks. no patient experienced any significant adverse effects during the study, except 3 children reported mild headache that resolved spontaneously within an hour without medication
Conclusion: this study concluded that r TMS over left dorso-lateral prefrontal cortex may be safe and effective way of providing relatively lasting relief of ADHD symptoms especially in children with severe symptoms
ABSTRACT
Objective: To evaluate the antioxidant and antiproliferative effect of methanolic bee pollen extract (BPE) of Malaysian stingless bee [Lepidotrigona terminata (L. terminata)] and its synergistic effect with cisplatin (a chemotherapeutic drug) on MCF-7 cancer cell line. Methods: The antioxidant activity of BPE from L. terminata was measured by using 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) assay. Antiproliferative activity at different concentrations of BPE and cisplatin was determined through using MTT assay on MCF-7 and L929 cell lines. An interaction effect (synergistic, additive and antagonistic) between BPE and cisplatin was determined by CompuSyn software based on MTT assay data. Results: The EC
ABSTRACT
Meat-borne parasites are Sarcocystis species, Toxoplasma gondii, Taenia saginata, Taenia solium and Trichinella spiralis. A total of 300 animals including 100 cattle, 100 goat, and 100 pigs, slaughtered in El-Minia governmental slaughterhouses. From each animal, five samples were taken from different muscles [esophageal, tongue and cardiac] and different organs [liver and brain]. Meat samples were examined macroscopic and microscopic [direct, homogenization and H and E staining] for detection of the above-mentioned parasites. Serum samples were subjected to IHA for detection of T. gondii specific antibodies. This study revealed that Sarcocystis species were the highest parasites that could be detected, with overall prevalence of 80%, which was statistically significant [P
Subject(s)
Animals , Meat Products , Sarcocystis , Toxoplasma , Taenia saginata , Taenia solium , Trichinella spiralis , Meat/parasitologyABSTRACT
Background: Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The phenomenon of deposited indirect bilirubin in basal ganglia as well as in the vestibule-cochlear nucleus causes a neurological syndrome called kernicterus as well as sensorineural hearing loss. Currently, the most sensitive means of assessing neurotoxicity may be auditory brain stem evoked response [ABR], which shows the predictable early effects of bilirubin toxicity
Aim: This study aims to determine the effect of neonatal hyperbilirubinemia on auditory brainstem response [ABR] and evaluate the effect of treatment of hyperbilirubinemia on ABR findings
Subjects and Methods: This case-control study was performed on30 neonates with pathologic hyperbilirubinemia as the jaundiced group chosen from Neonatal Intensive Care Unit of AL Zahraa Hospital of Al-Azhar University and 20 healthy neonates as the control group chosen from Maternity department of the same hospital during the period from September, 2011 to August, 2012. ABR was performed on both groups. The evaluated variable factors were latency time, inter peak intervals time
Results: The mean latencies of waves I, III and V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls and the mean interpeak intervals [IPI] of waves I-III, I-V and III-V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls. A total reversibility to normal thresholds [normal hearing] was displayed by 23 [77.00%] and 25 [83.30%] of jaundiced neonates in the right and left ears respectively, while the remaining 7 [23.00%] and 5 [16.70%] of jaundiced neonates displayed partial reversibility [mild to moderate hearing loss] in the right and left ears respectively [p <0"001]
Conclusions: About 90% of neonates with pathologic hyperbilirubinemia demonstrate ABR changes. Most of these changes [about 77%] revert to normal early after therapy
ABSTRACT
Measuring serum superoxide dismutase [SOD] levels in infants and children having acute or chronic liver disease of different aetiologies, and correlating these levels with disease aetiology in an attempt to clarify the role of SOD as an antioxidant in these diseases. Patients and We prospectively enrolled 58 infants and children and divided them into four groups: Group I, 24 patients with surgical cholestasis; group II, 11 patients with medical cholestasis; group III, nine patients with autoimmune chronic hepatitis; and group IV, 14 patients with viral hepatitis. Forty healthy age- and sex-matched children served as controls. Serum SOD activity was measured in all patients and controls using spectrophotometry. The level of SOD showed a statistically significant increase in patients with medical cholestasis compared to healthy controls [p < 0.0001]. SOD activity of other groups showed no significant difference compared to controls. Significantly increased serum SOD in infants and children with medical cholestasis is probably consequent to its increase in liver tissue in response to the liberation of reactive oxygen species. This suggests that products of free radical reactions might be involved in the pathogenesis and/or progression of medical cholestasis, and that SOD might attempt to minimise the liver injury
ABSTRACT
Supraventricular and ventricular arrhythmias, as well as conduction disturbances are frequently observed in COPD and two major hypotheses for arrhythmogenesis have been proposed: arrhythmias may be a consequence of hypoxaemia, hypercapnia or acid-base dis-turbances since they increase the electrical heterogeneity within the ventricular wall or arrhythmias may be the result of the autonomic neuropathy that characterizes COPD. In this study, we attempted to non-invasively verify these hypotheses in hypoxaemic COPD patients that are not in respiratory failure by examining how PaO2, PaCO2, pH and HCO[3] correlate with QTd in those patients. 25 COPD patients were subjected for Standard 12-lead ECG for arrhythmia detection and the measurement of QT intervals, chest X-ray, two dimensional echocardiogra-phy and myocardial nuclear imaging to exclude IHD. We found negative significant correlation between O2 tension and the occurrence of fatal arrhythmias; the same as between O[2] tension and QTd value [P values were < 0.0005 in both], with QTd as the dependent variable, and age, pulmonary pressure, duration, Mg, Na, K, Hb PH, CO[2] and O[2] tensions as the independent variables in all subjects, it was shown that only PaO[2] was the predictor of QTd with a P value of 0.02. In stable COPD patients enrolled in our study, new cutoff levels for predicting arrhythmic fatality were proposed for the QTc parameter[395 ms with a sensitivity of 92% and a specificity of 83%] and the QTd parameter [58 ms with a sensitivity of 100% and a specificity of 92%]. There is a high positive significant correlation between the age of patients, duration of COPD and Hb level and the occurrence of fatal arrhythmias where P valuesl were 0.009, < 0.0005 and < 0.0005 respectively; the same as with QTd value where the P values were 0.015, 0.001 and 0.039. There is a positive significant correlation between pulmonary pressure and QTc where the P value was 0.041 and pulmonary pressure with QTd where the P value was 0.028. Conclusion: Our results rule out the electropathy hypothesis and underline autonomic neuropathy as the most possible mechanism of arrhythmias in hypoxaemic, non-respiratory failure, and COPD patients
Subject(s)
Humans , Male , Female , Electrocardiography , Echocardiography , Respiratory Function TestsABSTRACT
This study was carried out to observe thermotolerance ability of Acanthamoeba spp. A total of 32 Acanthamoeba spp. isolates obtained from water taps, sinks, swimming pools and sea water were used. Trophozoites of Acanthamoeba spp. were inoculated onto non-nutrient agar (NNA) seeded with heat-killed Escherichia coli using aseptic technique and incubated for 14 days at 30°C to obtain the cyst. The cysts were subcultured onto new agar plates for thermotolerance test at 37°C and 42°C. The plates were observed until 96 hours after incubation for excystation of Acanthamoeba before being declared negative. Overall, 81.25% of samples were able to excyst at 37°C while 37.5% were able to excyst at 42°C. Thermotolerant Acanthamoeba is associated with high pathogenicity potential.
ABSTRACT
Several extrahepatic manifestations [EHMs] have been reported in the natural history of hepatitis C virus [HCV] infection. Some studies had demonstrated a higher frequency of HCV in patients with idiopathic interstitial pulmonary fibrosis [IPF]. The aim of this study is to investigate interstitial pulmonary changes via high-resolution computed tomography [HRCT] and pulmonary function tests [PFTs] in patients with HCV infection. Forty patients with HCV infection without diagnosis of any pulmonary diseases [group I] and 10 healthy persons [group II] were enrolled in the study. PFT and HRCT were performed in all cases. Findings of interstitial pulmonary involvement were detected in the HRCT of 19 out of 40 patients [47.5%]. A decrease lower than 80% of the predicted value was detected in forced vital capacity [FVC] with restrictive pattern together with post-exercise hypoxia, in 21 [52.5%] patients. There was a significant difference between both groups in the findings of HRCT [x[2] = 7.66, df = 1, p = 0.004] and PFTs [x[2] = 9.05, df = 3,p = 0.002]. According to the Child-Pugh classification, in group I, 15 patients were of class A, 16 were of class B and nine of class C, with no significant difference between classes as regards HRCT findings and PFT values. Six patients were positive for serum cryoglobulins. In these patients, all the parameters were not related to age. Pulmonary interstitial changes are prevalent in HCV-infected patients, irrespective of the severity of their liver condition. It may also occur without respiratory symptoms
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lung Diseases, Interstitial , Respiratory Function Tests , Tomography, X-Ray Computed , Prospective StudiesABSTRACT
Metabolic alteration following severe trauma cause the body to lose its ability to adopt to starvation. Evidence of that early nutritional support is beneficial. The primary goal of nutritional support for trauma patients is to meet increased energy and protein demands and provide adequate defenses against injury. Hence the effect of using specific balanced enteral nutritional formula on improvement of nutritional status and counteraction of gastrointestinal problem among traumatized patients. The study sample consists of 60 adult male and female patients. They were randomly assigned into either study or control group. Each 30 subject was matched according to age and sex. Subjects of the study group received specific enteral formula in addition to the routine hospital care, while subjects of the control group ones received only routine enteral nutritional feeding in the unit. Two tools were developed by the researcher, the first tool includes demographic information, nutritional assessment data including anthropometric measurements and possible blood tests important in evaluating the nutritional status of the patients. The second tool consists of 4items which reflect gastrointestinal problems as diarrhea, vomiting, constipations, and distention. The study reveal that subjects who received specific enteral, nutritional formula had less GIT problems and there were no statistical significant differences between the two studied groups for almost all study variables except in total protein and calcium. These results generate attention and motivation for further investigation about this topic
Subject(s)
Humans , Male , Female , Intensive Care Units , Enteral Nutrition , Nutritional Status , Vomiting , Diarrhea , Body Mass Index , Anthropometry , ElectrolytesABSTRACT
Voice dysfunction after thyroidectomy is not rare, and is generally reported in terms of recurrent laryngeal nerve [RLN] or superior laryngeal nerve [SLN] injuries. However, voice dysfunction can occur without laryngeal nerves injuries. Prompt recognition of causes of dysphonia is essential so that relevant therapeutic decision allows early management. The aim is to analyze voice change after thyroidectomy for patients with normal pre-operative voice. The study included 30 patients who had developed voice change within 6 months after thyroidectomy. They were subjected to voice evaluation, indirect laryngoscopy, videostroboscopy and electromyography [EMG]. It was found that dysphonia after thyroid surgery was caused by neurogenic causes [RLN and SLN injuries] in 23 patients [76.7%], non-neurogenic causes in 5 patients [16.7%] and combined causes in 2 patients [6.6%]. EMG studies revealed complete denervation in 6 patients [20] and incomplete denervation [paresis] in 19 patients [63.3%]. Post-thyroidectomy dysphonias are not rare. Injuries of the RLN constitute the main cause. Non-neurogenic injury is another contributing factor. Diagnosis is essential for early management through videostroboscopy and EMG which is specific to differentiate between neurogenic and traumatic injuries and to detect complete or incomplete denervation
Subject(s)
Humans , Male , Female , Voice Disorders , Recurrent Laryngeal Nerve/injuries , DysphoniaABSTRACT
The incidence of opportunistic fungal infection has increased dramatically in the past few decades, especially in immunocompromised hosts. Candida albicans the major cause of invasive candidiasis, has become one of the pathogens most frequently isolated from the blood of post-operative and imunocompromised patients in the last decade with a mortality rate of about 50%. Diagnosis of candidemia or hematogenous candidiasis has been problematic due to the low positivity of blood cultures, with the rate of recovery from blood cultures ranged between 40-60%. The development of DNA-based methods for detection of candida provides an alternative and potentially more sensitive means for diagnosing disseminated candidiasis. The aim of the work was detection of candidemia in children with hematological malignancies and determination of Candida species using PCR-REA in comparison with fungal blood culture. Thirty-two [32] children [20 males and 12 females] with hematological malignancies their ages were below 18 years; were admitted at Oncology Unit of Pediatric Department of Tanta University Hospitals and were subjected to complete history taking, thorough clinical examination complete blood picture and bone marrow examination. They were tested for candidemia by conventional blood culture, and polymerase chain reaction [PCR] method with appropriate restriction enzyme analysis [REA] of the resultant amplicons. The study revealed that the PCR-REA method detected that 8 patients [25% of the examined Population] had Positive results for candidemia with Candida albicans was the most common species found in 50% of patients with candidemia, while conventional blood culture detected candidemia in only 2 patients [6.25% of the examined population]. However, emergence of other Candida species were noticed. This study also revealed that patients suffering from fever of unknown origin [FUO], severe neutropenia dysphagia, and mucosal barrier injuries are at high risk to develop candidemia. Immunocompromised patients especially those at high risk to develop candidemia such as hematological malignant patients should be examined for candidemia using PCR-REA technique to obtain rapid and accurate results
Subject(s)
Humans , Male , Female , Candidiasis/diagnosis , Polymerase Chain Reaction , Culture Techniques , Child , Immunocompromised Host , Fungi , Restriction MappingABSTRACT
Hepatic fibrosis and cirrhosis develop progressively in extrahepatic biliary atresia despite timely surgical intervention. We aimed to study total hepatic blood flow [hepatic artery and portal vein flow] as a possible predictive factor of outcome of infants having biliary atresia who had underwent Kasai portoenterostomy. Twenty Infants having biliary atresia underwent colored and pulsed Doppler ultrasound studies. They were done before and 2-3 months after portoenterostomy. Hepatic artery, portal vein and single hepatic vein mean flow, mean diameter, mean velocity, hepatic arterial to portal venous flow ratio and total hepatic flow/kg were calculated and correlated to final outcome. The detected mean total hepatic flow and total hepatic flow/kg preoperatively was 685.5 +/- 296 ml/min and 147.1 +/- 51.4 ml/min/kg and post-operatively in those who became anicteric was 854.4 +/- 107 ml/min and 149.5 +/- 37.2 ml/min/kg, 539.2 +/- 337.7 ml/min and 112.1 +/- 78.6 ml/min/kg in those who developed chronic disease and in those who died was 157.6 +/- 79.6 and 30.9 +/- 16.1 ml/min/kg respectively. Unresolving cholestasis in infants having biliary atresia with poor outcome following portoenterostomy is associated with decreased post-operative total hepatic flow. Preoperative total hepatic flow did not correlate with postoperative total hepatic flow
Subject(s)
Humans , Male , Female , Liver Cirrhosis , Disease Progression/diagnosis , Blood Flow Velocity , Hepatic Artery , Prospective Studies , Ultrasonography, Doppler, Color , Infant, Newborn , CholestasisABSTRACT
The present study was carried out to evaluate traditional repair of rectocele [posteriorcolpoperineorrhaphy] versus prolene mesh repair of rectocele.The study was carried out on 40 patients divided into two equal group; [I] and [II]. This study wasconducted in Alexandria University Shatby Maternity hospital from May 2005 to April 2006 with an averagepostoperative follow up period of 6 months.It was found that mesh repair of rectocele is superior over the traditional posteriorcolpoperineorrhaphy. This new technique takes less operative time and complications, less post-operativecomplications and a better improvement of patient symptoms.mesh repair of rectocele is a safe technique with a reasonable success and accepted rate ofcomplications. However, more researches are needed to prove the success of this technique over a longerperiod of follow up. It is probable that no single technique can correct all rectoceles because of their diverseanatomic and functional components. Prolene mesh repair of rectocele has a favorable rate of symptomresolution with a low rate ofdenovo symptoms. The technique appears useful for properly informed patientswhose goals are reduced protrusion, improved defecation and avoidance of dyspareunia
Subject(s)
Humans , Female , Surgical Mesh , Hospitals, University , Surveys and Questionnaires/statistics & numerical data , Comparative Study , Follow-Up Studies , Polypropylenes/adverse effectsABSTRACT
Although surgery remains as a gold standard line for management of hepatocellular carcinoma [HCC], many cases are not candidates for surgery due to underlying chronic liver disease and limited functional reserve even with recent advances in the field of surgery. At the same time several local ablative techniques have emerged and proved to be minimally invasive and effective measures for in situ control of HCC, of these techniques, radiofrequency ablation [RFA], and percutaneous ethanol injection [PEI]. The aim of the current study was to evaluate the safety and efficacy of RFA and ethanol injection for the treatment of HCC, to reach a protocol for proper management of unresectable HCC and, also to assess the quality of life before and after each technique. In the current study we had two groups of patients with HCC on top of cirrhosis due to hepatitis C virus [HCV] infection, one of them was subjected to RFA [G 1] and the other [G2] was subjected to PEI as therapeutic modalities for their HCC. As regards GI, it included 30 patients with 36 HCC lesions with a mean size of 3.02 cm which were treated by percutaneous US guided RFA using cooled-tip electrodes with a mean of 1-2 sessions of RFA. Studied patients were followed over variable periods that ranged between 6-18 months with a mean of 11.6 months. The responses to therapy were as follows: Complete ablation in 32 out of 36 lesions [88.8%], partial response in 3 out of 36 lesions [8.3%], recurrence in 3 [8.3%] lesions, and newly developed lesions in 7 cases. G2 included 20 patients with 26 HCC lesions with a mean size of 3cm for which we used PEI modality, we found that 21 out of 26 lesions [80.7%] had complete response, 4 out of 26[15.3%] had partial response and one [3.8%] showed local recurrence, and newly developed lesions were seen in 5 cases. The period of follow up ranged from 4-12 months with a mean of 10 months. As regards survival, one year survival rate was 75% in GI and 80% in G2. We concluded that, both RFA and PEI are safe and effective procedures and result in significant improvement in quality of life in patients with unresectable HCC. RFA showed higher rate of complete necrosis and requires fewer sessions than PET in the management of HCC
Subject(s)
Humans , Male , Female , Liver Cirrhosis , Liver Function Tests , Prospective Studies , Catheter Ablation/adverse effects , Acetaldehyde/administration & dosage , Injections, Intralesional/adverse effects , Treatment Outcome , Tomography, X-Ray Computed , Follow-Up Studies , Recurrence , Survival Rate , Liver NeoplasmsABSTRACT
Background:The laryngeal mask airway is used to maintain airway during general anesthesia especially for short day-case procedures. A successful insertion of LMA necessitates adequate mouth opening that allows easy insertion of the mask and adequate depth of anesthesia to prevent adverse responses of coughing, gagging, and laryngospasm. The aim of this study was to compare remifentanil -propofol regimen versus magnesium-propofol regimen for induction of anesthesia for LMA insertion
Methods: Fifty ASA 1-2 patients of both sexes, aged between 18-55years who were undergoing short day-case procedures were randomized to receive a pre-induction of either IV bolus 0.3jiig/kg remifentanil, or IV bolus of 40mg/kg 10% magnesium sulphate. This followed by induction of anesthesia by IV bolus of 2mg/kg propofol followed by LMA insertion. Pre-induction[base line], post LMA insertion vital data [heart rate ,blood pressure, respiratory rate and oxygen saturation] and frequency of post induction apnea were recorded. The degree of jaw relaxation was assessed as relaxed or rigid and the degree ofease of LMA insertion was graded on three-point scale [gradel: easy, grade 2: moderately easy, and grade 3: difficult]
Results: There were no statistically significant differences between both groups as regards the pre-induction vital data. There were statistically significant differences between both groups as regards post-insertion heart rate, respiratory rate and oxygen saturation [P-value< 0.05] and there was no statistically significant difference between both groups as regards post-insertion blood pressure. In general both drugs effectively maintain stable post-LMA insertion vital data. Regarding the incidence of post induction apnea, it was higher in remifentanil group [56%] compared to [20%] in magnesium group. There were no statistically significant differences between both groups as regards jaw tone or patients graded as easy [grade 1] or moderately easy [grade 2] for insertion of LMA but there was statistically significant difference between both groups as regards those patients graded as difficult[grade 3] for insertion of LMA [P-value<0.05]
Conclusion: Both remifentanil-propofol and magnesium-propofol regimens weresuccessfully maintaining vital data stability during LMA insertion, facilitated LMA insertion, and prevented untoward events of coughing, gagging and laryngospasm. The incidence of post induction apnea was higher in remifentanil group compared to in magnesium group. However, the overall ease of LMA insertion was found to be higher with remifentani 1-propofol regimen in comparison to magnesium-propofol regimen. So, both regimens can be used for LMA insertion and the choice of any should be individualized according to the patient's health status