Spinal anesthesia in transurethral resection of prostate: a study of the least effective dose

The effect and suitability of lower doses of bupivacaine spinal anesthesia supplemented with intrathecal fentanyl in patients undergoing transurethral resection of prostate [TURP] were evaluated. double blind randomized clinical trial. 45 elderly men undergoing TURP under spinal anesthesia were randomized into the following 3 groups; Group I received 10mg bupivacaine, group II received 7.5mg bupivacaine plus 20 micro g fentanyl and group III received 5 mg bupivacaine plus 20 micro g fentanyl. Neural block was assessed by using pin prick and modified Bromage scale. Both sensory and motor blocks were longer in group I >II >III, motor block was also more dense. Hypotension occurred in significantly more patients and was more persistent in group I compared with groups II and III and significantly more ephedrine was administered to patients in group I whereas significantly more patients in group III required IV fentanyl supplementation to treat intraoperative discomfort. More patients complained of postoperative nausea and vomiting [PONV] and pruritis in groups II and III while more patients complained of shivering in group I. Anesthetic management was well rated by both surgeons and patients in group I and II. Anesthetic management was adequate and satisfactory in both groups I and II, but group II had the additional advantage of lower incidence of hypotension

Effect of dexmedetomidine premedication on the intraoculor pressure and metabolic control in type 2 diabetic patients undergoing cataract operation

This study was designed to evaluate the effect of dexmedetomidine [DEX] on the blood glucose control and insulin requirements in type 2 diabetic patients. Besides its effect on the intraocular pressure [IOP] in same patients, during cataract operations. Twenty patients with type 2 diabetes of ASA physical state II were randomly allocated into two equal groups. DEX group received 0.6 ug/Kg I.V. dexmedetomidine premedication and control [saline] group. Received i.v. 0.9% saline. Patients received standard general anesthesia. Insulin was given by continuous i.v. infusion syring pump 1.25 U/h. and intermittent bolus doses to maintain blood glucose range 5.5-11.1 mmol/ L. Blood glucose levels were measured every 15 minutes intra operatively. Cortisol, growth hormone and C-peptide were also measured IOP was measured with schioltz tonometer The results of this study demonestrated that the total insulin requirement and the blood sugar concentrations were significantly lower in DEX group than control group throughout the study period. There were no significant differences between the two groups in the cortisol levels. Though growth hormone levels were significantly increased in DEX. group but still within the normal physiological limits. C-peptide levels were significantly, lower in DEX group than in control group. In addition DEX significantly reduced the IOP in DEX group than in control group. From these data we can conclude that i.v. dexmedetomidine premedication improves blood glucose control and decreases insulin requirements and intraoculor pressure so it improves the operating conditions for type 2 diabetic patients undergoing cataract operation

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

Comparison between allergic and non-allergic rhinitis patients as regards clinical and allergic aspects in Riyadh

Hundred patients with nasal symptoms of sneezing runny nose nasal itching and nasal blockage were investigated. The patients were divided using skin prick test into two groups i.e. allergic group and non-allergic group according to negative or positive skin reactions to a list of variable allergens. Medical history and clinical examination alone seemed to be inadequate in differentiating the two groups, although alternating nasal blockage and sneezing were more prominent in the allergic group. In the allergic group, sensitivities to indoor allergens, i.e. house dust mixture, cat, cockroaches as well as pollens of some grasses weeds and trees, were very important. Among the non-specific precipitating factors, dust, smokes, strong smells and stress seem to be important

Conservative treatment of epistaxis versus nasal cautery in children

Fifty children suffering from repeated attacks of primary nasal bleeding from the little's area of the nasal septum are the subject of this study. Half of the cases were treated by chemical cautery, the other half were treated by local nasal dressing and application with panthenol and an antibiotic ointment. e.g. terramycin. Recurrence of epistaxis was less in the second group [12%] when compared with that in the first group of cases [44%] within 6-month period of follow up after treatment

Modified body osteotomy in management of mandibular prognathism

Six patients were treated by modified vertical ostectomy of the body of the mandible. The selection of vertical ostectomy operation for these cases was based on the presence of extremely long protruded mandible to the extent that any other operation as ramus techniques was inappropriate solution. The presented modified ostectomy of the body of the mandible overcomes the disadvantages of the original operation introduced by Dingman 1944. It provides better visibility of the surgical field, better access to excise any desired amount of bone, allows maximal bony contact for better bone healing and helps in strong anchorage of jaw segments to each other. This modified technique has been used successfully in six patients with extreme prognathic lower jaw ranging from 1.2 - 2.8 cm