Combined spinal epidural anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body

Dilated cardiomyopathy [DCM] is characterized by ventricular dilatation and impaired systolic cardiac Junction. Anesthetic management, of patients with cardiomyopathy with reduced systolic Junction, is challenging and may be associated with high mortality. The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia [CSEA] in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP [measured at base line and then every 10 min], in addition to cardiac complications during the hospital stay period were studied. patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min [-14.7%], while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min [13.1%]. CVP showed insignificant changes in all readings except at 90 and 100 min which showed significant increase [p< 0.05]. Four patients developed ECG changes in the postoperative period, while no significant changes in EF. combined spinal epidural anesthesia [CSEA] may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely im eventful postoperative recovery with good pain control

Prevalence of CYP2D6 gene duplication in egyptian patients with neuropathic pain

The polymorphic cytochrome 2D6 [CYP2D6] causing ultrarapid metabolism due to presence of multiple copies of active CYP2D6 genes is common in middle east population. The CYP2D6 genotype of Egyptian population was examined using allele- specific polymerase chain reaction [PCR] amplification. Among thirty neuropathic pain patients studied, twenty patients [66.6%] were positive in the duplication assay. Alleles that cause diminished enzyme activity were frequently found like CYP2D6*17 [African gene] [23.3%,] and allele CYP2D6*4 [European gene] which showed a frequency of [16.6%] .None of the patients was homozygous for CYP2D6*4,. strongly suggesting that no poor metabolizer [PM] individuals in the studied population. This is in agreement with earlier phenotyping study among Egyptians. The patients studied showed a rapid and obvious response to oral tramadol [50 mg, tds.] .Results imply that gene deletion may not he the only modulatory factor responsible for the clinical outcome following tramadol therapy