Does haloperidol prophylaxis reduce ketamine-induced emergence delirium in children?

Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium [ED]. This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol [49.7%]. There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm [P

Job stress and burnout among academic career anaesthesiologists at an Egyptian university hospital

There is compelling evidence that anaesthesiology is a stressful occupation and, when this stressful occupation is associated with an academic career, the burnout level is high. This study aimed to assess the predictors and prevalence of stress and burnout, associated sociodemographic characteristics, and job-related features. A cross-sectional survey study was carried out at Mansoura University Hospital in Egypt among 98 anaesthesiologists who had academic careers. The English version of the Maslach Burnout Inventory-Human Services Survey [MBI-HSS] scale and the Workplace Stress Scale of the American Institute of Stress were used to measure job stress and burnout. Data were analysed according to the guidelines for data processing and an analysis of the scales used. The participation rate of this study was 73.1%, where 69.4% were encountering job stress, while 62.2% experienced emotional exhaustion, 56.1% depersonalization, and 58.2% reduced personal capacity. There was a significant positive correlation between job stress and MBI-HSS subscales. Residents and assistant lecturers were the most affected group. The strongest significant single predictor of all burnout dimensions was a lack of job support. Stress and burnout among academic anaesthesiologists were caused by the lack of job support; this was especially true among residents and assistant lecturers. We can conclude that a well-organised institutional strategy to mitigate the heavy professional demands of academic anaesthesiologists' will relieve their stress and burnout

Assessment of current undergraduate anesthesia course in a Saudi university

The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations [OSCEs], in conjunction with portfolio and multiple-choice questions [MCQ]. The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5[th] year medical students in our university, as well as study the influence of gender on student performance in anesthesia. We examined the performance of 154, 5[th] year medical students through OSCE, portfolios, and MCQ. The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one [P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam]. In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark. This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel

Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol

A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery [FESS]. Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 microg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 microg/Kg/h infusion during maintenance [DEX group], or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance [E group] to maintain mean arterial blood pressure [MAP] between [55-65 mmHg]. General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables [MAP and HR]; arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia [Aldrete score >/= 9] were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded. Both DEX group and E group reached the desired MAP [55-65 mmHg] with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP [55-65 mmHg] were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score >/= 9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group. Both dexmedetomidine or esmolol with sevoflurane are safe agents for controlled hypotension and are effective in providing ideal surgical field during FESS. Compared with esmolol, dexmedetomidine offers the advantage of inherent analgesic, sedative and anesthetic sparing effect

Effect of hydration on geriatric patient submitted to orthopedic surgery

Background: The aim of this present study was to evaluate the effect of perioperative hydration on morbidity and mortality among geriatric patients submitted to orthopedic operations

Methods: The study was carried out on geriatric patients subjected to orthopedic surgery in Mansoura University Emergency Hospital. It included two groups: a retrospective group and a prospective one. The retrospective group patients were considered as the control group. It included 310 patients who represent geriatric patients subjected to orthopedic surgery at Mansoura University Emergency Hospital during the last three years. Patients data obtained from the file records were collected. The Prospective group included 100 patients representing geriatric surgical orthopedic patients in the last six months. At the time of admission to the orthopedic department, they were clinically examined, laboratory investigations were done and received i.v. fluids till the time of the operation. Postoperatively and for three days, they were subjected to fluid regimen in the form of 500 ml of Ringers lactate every 12 hours and 500 ml of 5% glucose every 12 hours during the first day. During the second day, 500 ml of Ringer s lactate every 12 hours and 500 ml of 5% glucose every 24 hours. In the third day, they received 500 ml of Ringers lactate every 24 hours and 500 ml of 5% glucose every 24 hours. They were followed clinically by heart rate, arterial blood pressure and amount of urine output every 6 hours and laboratory by serum creatinine and arterial blood gases after 72 hours. Morbidity and mortality among this group were record-ed and, together with the data as those of retrospective group patients. compared statistically to the retrospective group

Results: our study showed no statistically significant difference between the two groups as regards hospital stay and morbidity while mortality in prospective group showed zero incidence compared to [5.8%] incidence in retrospective group patients. Prospective group patients postoperative heart rate were, although within normal, significantly decreased when compared to the basal while their mean arterial blood pressure showed no statistically significant change a part from at the sixth and twelfth hours where significant reduction was noticed. Seventy-two hours postoperative serum creatinine in Prospective group patients was significantly reduced compared to the basal value while serum electrolytes showed no statistically significant change. Seventy-two hours postoperative ABG in Prospective group patients showed no statistically significant change in PaCO2, PH and HCO3 levels while PaO2 and SaO2 were significantly increased when compared to the basal value

Conclusion: From our study we concluded that perioperative hydration of geriatric orthopedic patients reduces mortality among those patients

Intrathecal hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients

Background: The aim of this study was to compare the effects of hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients subjected to orthopedic surgery

Methods: This study was carried out on 60 patients aged above 60 years undergoing orthopedic lower limb surgery. The studied patients were randomely classified into 2 groups. Bupivacaine group [BG] [n-30]: 3 ml of hyperbaric bupivacaine 0.5% [15 mg] was injected. Ropivacaine group [ RG] [n=30]: 2 ml of isobaric ropivacaine 0.75% [15 mg] added to 1 ml glucose 5% [to give 3 ml solution containing 5 mg ropivacaine + 17 my glucose/ml]. The patients in both groups were observed for: Sensory block duration, level and recovery], degree of motor block [according to Bromage score], the hemodynamic parameters [including MAP, HR, CVP and SpO2], analgesia [assessed by VAS] and side effects

Results: we found that there was a significant decrease in MAP in BG at 5, 15 and 30 minutes compared with the basal value but in RG there was insignificant differences in MAP compared with the basal value. There was insignificant difference as regards time of onset of sensory block or peak sensory level reached in both BG and RG. There was no difference in potency of motor block or adequacy of sensory block between both groups. There was a significant difference in the duration of sensory and motor block as there was faster recovery from motor and sensory block in RG. Also, there was a significant difference in duration of analgesia between RG and BG. The duration of analgesia in BG was longer than in RG

Conclusion: Intrathecal administration of either 15 mg hyperbaric ropivacaine or 15 mg hyperbaric bupivacaine was well tolerated and provided similar effective anaesthesia for lower limb orthopedic surgery. Ropivacaine showed more hemodynamic stability than bupivacaine especially during the first 30 minutes after intrathecal injection. Both ropivacaine and bupivacaine produced the same potency of motor and sensory block with more rapid recovery with ropivacaine. So for these results ropivacaine may prove useful when surgical anaesthesia is desired especially in geriatric hypertensive patients whom are more liable for hemodynamic instability