Is left atrial size related to left ventricular hypertrophy in hypertensives?

The present study was specifically designed to identify the effects of systemic arterial hypertension on the left ventricular and left atrial function analyzed by 2D and M-mode echocardiographic images. The study included two groups: Patient group included 30 hypertensive patients with age ranging from 35-70 years [51.5 +/- 10.4]; 11 males [36.7%] and 19 females [63.3%], were subjected to echocardiographic study including 2-dimensional and M-mode. Control group included 15 healthy volunteers with age ranging 35-70 years [51.2 +/- 9.75]; 7 males [46.7%] and 8 females [53.3%]. Statistically, there was no significant difference as regard the age. All patients in the study were subjected to full history taking with special emphasis on valvular heart diseases, congenital heart diseases, ischemic heart disease, medical therapy; especially antiarrhythmic drugs, thorough clinical examination with special emphasis on pulse rate, rhythm, systolic and diastolic blood pressure excluding patients on congestive heart failure, standard 12-lead ECG and echocardiographic examination including 2D and M-mode imaging. The study showed systemic arterial hypertension lead to impairment of left ventricular diastolic function due to increased after load but also the changes of left ventricular geometry and structure producing left ventricular hypertrophy. Also, the left atrium involved in this process by structural abnormalities of the left atrial chamber as regarding by the echo imaging. Individual with systolic arterial hypertension had; 1-ECG finding of LVH. 2-Echoparameters showed increased LAD, LAV, IVS, PWT, RWT, LVM and diastolic dysfunction. 3-Hypertension patients may have LVH or not which may be due to recent incidence or lower level of blood pressure. Hypertension patients without LVH did not show increase in LAD and LAV. 4-Left ventricular hypertrophy could be divided into concentric or eccentric LVH according to present or absence of increase RWT. However LA size and volume were similar in patients with concentric and eccentric LVH. There were positive correlation between LAD and degree of LVH represented by LVM and RWT also LAD positively correlate with LV internal dimension and DT and negatively correlate with E/A ratio

Comparison between butorphanol, meperidine and placebo in the treatment of postanaesthetic shivering

Postanaesthetic shivering [PS] is distressing for patients and may induce a variety of complications. In this prospective, double-blinded, randomized study, we evaluated the value of butorphanol [Stadol], compared with meperidine [Pethidine] and saline for treating PS. Ninety adult patients were included in the study. Group I [n=30] received IV butorphanol 0.04 mg/kg. Group 2 [n=30] received IV meperidine 0.4 mg/kg. Group 3 [n=30] received IV saline. Treatment that stopped shivering was considered to have been successful. The results demonstrated that, 5 min after treatment both butorphanol and meperidine provided a rapid and potent antishivering effect on PS, with high response rates of 83% and 80% compared with those of saline [0%] [P<0.01]. Thirty minutes after injection, the response rates of butorphanol and meperidine were 93% and 90%, respectively, compared with 17% in the saline group [P<0.01]. The differences between butorphanol and meperidine were not significant. This study concluded that butorphanol may be an alternative to meperidine for treating PS

Evaluation of the effect of preoperative dextrose administration on spinal induced hypotension, uteroplacental and umbilical blood flow during ellective caesarean section

This study was performed to determine if preoperative intravenous dextrose in two different regimens affects the incidence degree and case of treatment of hypotension during spinal anaesthesia for cesarean section, Also we aimed at evaluating the blood flow velocity waveforms [FVWS] of the uterine and umbilical arteries and the neonatal outcome in such cases.Sixty healthy parturients undergoing elective caesarean section under spinal anaesthesia were allocated into three groups [20 parturients in each] to receive intravenously either normal saline [group A], dextrose 5%, in normal saline [group B], dextrose 10% in normal saline [group C] at 125 mL/hr for two hours prior to delivery, Following a bolus of 15 mL/kg normal saline iv spinal anaesthesia was induced with hyperbaric bubivacaine 0, 5% fentanyl and morphine, Hypotension [systolic blood pressure < 100 mmHg or > 20% decrease] was treated with fluids and/or vasopressor. Data collected: Maternal demographics blood glucose concentrations [fasting at time of spinal and at delivery], blood pressure [baseline and at one minute intervals from spinal to delivery] and uterine and umbilical arteries Doppler FVW before preloading and 5 minutes after spinal anesthesia, Neonatal demographics neonatal Apgar scores umbilical blood gas analysis at birth glucose and lactate concentrations at birth. I and 2 hours after birth, There was no difference between the three groups in the rate of hypotension [p=0, 283]. All parturients who experienced hypotension received fluids and there was also no difference between the groups in vasopressor requirement. S/D in the uterine arteries increased significantly after spinal anaesthesia while it didn't change in umbilical arteries. There was no significant difference between the three groups regarding S/D in the umbilical and uterine arteries either before preload or 5 minutes after injection of the anesthestic. Umbilical arterial and venous pH was significantly lower and lactate was higher in group C than group A [P<0.05], after birth neonatal capillary blood glucose was stable in group A. but decreased significantly in group C [P<0.05] and lactate decreased in group C at 2h. We concluded that administration of dextrose 5% at a rate of 5.22 g/h and 10% at a rate of 10.22g/h preoperatively does not affect the hypotension rate uterine or umbilical Doppler FVW. or make it easier to treat hypotension and was potentially harmful to the foetus with the large dose of 10.22 g/h

Post-operative analgesia for arthroscopic menisectomy by intra-articular, neostagmine, morphine and pethidine

Arthroscopic Surgery of the knee is a common day-case surgery depends on the provision of udequate analgesia. In this study sixcty pataients in similar age, weight, sex and duration of operation were allocated randomaly in four groups each of 15 both sex. The first [control group] received 30ml saline intra-articular, the second [morphine group] received 5mg morphine in 30ml saline,k the third [pethidine group] received 50mg pethidine in 30ml saline, and the fourth [neostagmine group] received 750ug neostagmine in 30ml saline. Above knee tournequet was applied for at least 10 minutes after intra-articular injection. Post-operative pain was assessed using an internal visual analogue scale [VAS] and measuring analgesic scale [VAS] and measuring analgesic requirements. All the three treated groups had highly significant lower pain scores compared with the control group. Patients in pethidine group had a significant lower pain scores than those in the morphine group up to 2 hours postoperative, but after that it had a significant increase pain scores than morphine group, also neostagnine group patients had significant lower pain score than morphine group up to 3 hours postoperatively after that it had a significant increase in pain score than morphine group but it had significant increase in pain score than pethidine up to 2 hours postoperative, after that a significant lower pain score than pethidine group. These exact findings explained by pethidine does its effect through its local anesthetic, peripheral opiate receptor systemic and active metabolite effects. Morphine does its effect through a peripheral opiate receptors and active metaboliotes Neostragmine has long lasting analgesic effect than morphine through a peripheral muscarinic respecters