outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery

Thoracic epidural anesthesia [TEA] improves analgesia and outcomes after a cardiac surgery. As aging is a risk factor for postoperative pulmonary complications, TEA is of particular importance in elderly patients undergoing coronary artery bypass graft [CABG]. Fifty patients aged 65-75 years; ASA II and III scheduled for elective CABG were included in the study. Patients were randomized to receive either general anesthesia [GA] group alone or GA combined with TEA group. Heart rate [HR], mean arterial pressure [MAP], and central venous pressure were recorded. Total dose of fentanyl micro g/kg, aortic cross clamping, cardiopulmonary bypass [CPB] time, time to first awaking and extubation, arterial blood gases, visual analog scale [VAS] score in intensive care unit were reported. Postoperative pulmonary function tests were done. TEA showed a significant HR and lower MAP compared with the GA group. The total dose of intraoperative fentanyl and nitroglycerine were significantly lower in the TEA. Patients in TEA group have statistically significantly higher PaO[2], lower PaCO[2], increase in Forced Vital Capacity [FVC] and Forced Expiratory Volume in one second [FEV[1]]. TEA reduced severity of postoperative pulmonary function and restoration was faster in TEA group in elderly patients undergoing CABG. Also, it resulted in earlier extubation and awakening, better analgesia, lower VAS

effect of intrathecal magnesium sulphate versus intra venous magnesium sulphate on spinal fentanyl analgesia

This double-blinded, comparative study was designed to compare between the analgesic efficacy and safety of adding magnesium sulphate [MgSO4] intrathecal [I.T] versus intravenous [IV] MgSO4 on spinal fentanyl analgesia [1micro g / kg]. sixty pediatric patients of 6-12 years undergoing surgeries on the lower half of the body eg :inguinal hernia, hypospadius, undescended testis under sevoflurane: nitrous oxide anaesthesia were included. No intra-operative narcotics were administered. Patients were allocated into 3 groups [20 patients each] G[fit] received IT fentanyl micro/kg, G[mgit] received IT fentanyl 1mg /kg plus IT MgSO4 1mg/kg, G[mgiv] received IT fentanyl 1 micro g /kg plus IVMgSO4 20mg/kg as a loading dose, followed by infusion at a rate of 10mg /kg /h. Pain was evaluated by visual analogue pain scale [VAPS]. Duration of post operative analgesia was defined as the interval between intrathecal analgesic mixture administration and the first patient's request for additional analgesia. there was a significant prolongation of the duration of analgesia in group G[mgit] and group G[mgit] compared with group G[fit]. Also there was a significant decrease in VAS in group G[mgit] compared with G[fit]. No differences were noted among groups as regards haemodynamic and Ramsay sedation score. The addition of MgSO4 either intratheeaily or intravenously proiongd the spinal opioid Analgesia in humans and it is safe even in high doses. So the MgSO4 could be of clinical importance for pain management

Incidence of rubella, herpes simplex, and cytomegalovirus antibodies in mentally retarded children

This work was done on 48 children with unclassifiable mental retardation, in addition to 48 normal healthy children as a control. All cases were in vestigated for the presence of rubella, herpevirus and cytomegalovirus lgG antibodies using ELISA technique. lgG antibody levels for test and control groups respectively were 2.14 +/- 1.62 and 2.62 +/- 1.75 for rubella, 1.140 +/- 628 and 1.472 +/- 0.381 for herpes virus and 0.401 +/- 0.208 and 0.368 +/- 0.164 for CMV denoting that there is no significant difference in antibody levels between test and control groups. Similarly, it was found that there is no significant difference in the level of these antibodies between cases with microcephaly and normocephaly, cases with and without deafness and cases with and without ophthalmic defects in test group cases. Accordingly, we can say that there is no clinical association between any of these viruses [evaluated by lgG antibody levels] at one hand and mental retardation or its manifestation, represented by microcephaly, deafness and ophthalmic defects, on the other hand