Comparison between the induction of anesthesia using sevoflurane-nitrous oxide, propofol or combination of propofol and sevoflurane-nitrous oxide using laryngeal mask airway [LMA] in hypertensive patients

In a double-blinded trial, 90 patients with stable hypertension were enrolled in this study. Each group consisted of 30 patients. The induction in group S was by sevoflurane 4% + 50% oxygen +50% nitrous oxide by inhalation using the tidal volume technique. The induction in group P was by propofol 2mg/kg IV, and in group PS [combination group] was by propofol 1mg/kg followed by inhalation of 4% sevoflurane.The present study compared hemodynamic changes, laryngeal mask airway [LMA] insertion time and any complications occurred in the induction period between the three groups. LMA insertion time was significantly longer in the sevoflurane group than in the other two groups. Mean arterial blood pressure [MAP] was significantly lower within each group after induction in comparison to before induction. In all the groups, LMA was successfully inserted in all patients. According to patients induction was pleasant in 90% of patients in the propofol group and was 88% in the combination group and 40% in the sevoflurane group. This study concluded that in the combination group there is the advantage of patient satisfaction and rapid induction with no apnea which occurred with propofol and had the advantage of hemodynamic stability encountered with sevoflurane

Patient transportation to post-anesthetic recovery area without supplemental oxygen: repercussions on oxygen saturation and risk factors associated with hypoxemia

Development of hypoxemia in the immediate postoperative period is a common event, even in healthy patients. In spite of what is known, it is a common practice to transport the patient to recovery room without adequate monitoring or administration of supplemental oxygen. To implement preventive measures to decrease the morbidity and mortality associated with this transportation, it is important to be aware of risk factors associated with the increased incidence of this complication. The aim of this work was to evaluate the incidence of changes in oxygen saturation and their relation to some associated risk factors during transportation of patients to recovery room without supplemental oxygen. The present study was performed on 970 patients undergoing elective surgeries. Four different anesthetic techniques were used; general anesthesia, general anesthesia with epidural analgesia, regional anesthesia with sedation and regional anesthesia without sedation. All patients were transported to the recovery area without supplemental oxygen and the peripheral oxygen was measured with a pulse oxymeter just before leaving the operating room. The incidence of mild hypoxemia was 27.7% while that of moderate/ severe hypoxemia was 12.1% of the studied patients. Significant reduction in peripheral oxygen was found in ASA II and III patients [p=0.001], in patients who received general anesthesia [p=0.001], in smokers [p=0.001], and in obese patients [p<0.001]. The incidence of mild hypoxemia was more among males, while incidence of moderate/ severe hypoxemia was more among females. No significant differences were found among different age groups or with different durations of surgery. It was concluded that it is necessary to monitor pulse oxymetry for all patients in the immediate postoperative period and patients with a high risk of developing postoperative hypoxemia must be transported with supplemental oxygen

Sedation for mechanically ventilated postoperative patients in the intensive care unit: comparative study between propofol and dexmedetomidine

Alpha 2 agonist dexmedetomidine is a new sedative and analgesic drug, which has been recently approved by FDA for use in ICU sedation. Dexmedetomidine is pharmacologically much more selective on alpha 2 receptors than clonidine. In the present study dexmedetomidine was compared to propofol as infusion for sedating 20 patients [10 patients in each group] admitted to ICU for postoperative short-term mechanical ventiiatory support [8-10 hrs] after major surgical procedures. Additional analgesics were supplied using nalbuphine iv bolus doses. Depth of sedation was measured continuously by using bispectral index neurosonic 1400 monitor. Hemodynamic and ventilator variables were recorded hourly Depth of sedation was equivalent in both groups by bispectral index scale 56 [44-67] for propofol group versus 49 [42-57] for dexmedetomidine group with non-significant difference [P= 0.41] between both groups. Although dexmedetomidine group showed more alertness and cooperation during ventiiator support and more rapid and easy extubation [extubation time 33 minutes in propofol group versus 32 minutes in dexmedetomidine group] [p= 0.7], but these changes were statistically non-significant Also propofol group required almost three times analgesic doses than for dexmedetomidine group [240 mg versus 80 mg]. No significant difference was found in mean arterial blood pressure or central venous pressure between both groups However heart rate showed significant reduction in dexmedetomidine group than in propofol group [p= 0.026]. No adverse events were recorded when related to the sedative infusions used in this study. It could be concluded that dexmedetomidine is a safe and an effective sedative agent in ICU postoperative patients as it provides safe profile and reduces analgesic requirements

Semi closed loop of spectral entropy and target controlled infusion versus dose based total intravenous anesthesia of propofol and remifentanil

As a step forward towards the installation of a totally computerized anesthesia, we tried to integrate target controlled infusion pump with its ability to determine effect site drug concentration and monitoring of state and response entropy in the patient as a feed back system for fine tuning of intravenous anesthesia, comparing this system with the regular dose based total intravenous. 40 patients included in this study, were randomly arranged in two groups [20 each] They were scheduled for elective ventral hernia surgery. The first group received dose based total intravenous anesthesia [TIVA], the second group received entropy modulated target controlled infusion [TCI]. We measured the amount of propofol and remifentanil used per kg of the patient weight per minute of anesthesia, time to extubation. the time needed from the end of anesthesia till a recovery score [Aldrete score] of 9 or 10. mean blood pressure and heart rate, postoperative pain score and the incidence of intraoperative awareness. It was found that there were no differences between the two groups in hemodynamic or pain data, also no significant difference in the rate of propofol used but there was significant reduction of remifentanil rate [23.11% reduction] in group TCI if compared with the other group. From this work it is concluded that the use of sophisticated TCI machine and sophisticated entropy monitor does not necessanly results in better outcome nor it is cost reasonable

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