Effect of pneumoperitoneum on cardiac output and gasrtic inramucosal PHi in obese and nonobese patients

This study was designed to investigate the effect of pneumoperitoneum [PP] on cardiac output [CO] and gastric intramucosal PHi [PHi is the predictor of splanchnic blood flow] in obese and non obese patients under general anesthesia. Thirty patients scheduled for laparoscopy cholecystectomy divided according to their body mass index >/= 30kg/m[2] obese and < 30kg/m[2] non- obese into 2 groups. After anesthesia and intubation, gastric tonometer catheter was inserted into the stomach and gastric intramucosal PHi was measured at 20 min after induction [baseline], 20 min after pneumoperitoneum [PP] and 15 mm after desuflation. Patients haemodynamic parameters were measured non invasively. Stroke volume [SV], heart rate [HR], cardiac output [CO] and mean arterial blood pressure [MABP] were recorded at 20min after induction [base line value], 2 and 20min after PP and 15min after desuflation. In this study we observed significant increase in MABP and HR in obese and non obese patients after PP. In both groups SV was significantly reduced after PP. Cardiac output [CO] was significantly increased at 2 and 20min after PP in obese patients while non obese patients experienced biphasic pattern in CO i.e. initial decrease at 2 min after PP., followed by gradual restoration of CO at 20mm after PP. At 15 min after desuflation CO started to return near to its base line value in both groups. The gastric intramucosal PHi mean values were insignificantly reduced at 20 min after PP and they were within the normal limit and start to return to its base line mean value at 15 min after desuflation in both obese and non obese patients. In conclusion pneumoperitoneum at 12minHg did not affect gasric intramucosal PHi i.e. splanchnic blood flow in obese and non obese patients. Moreover, the gastric intramucosal PHi was not affected by the changes in the cardiac output. Furthermore, obese patients well tolerated pneumoperitoneum without experiencing fall in cardiac output as that noticed in non obese patients who have a biphasic pattern of cardiac output during pneumoperitoneum [initial decrease followed by partial restoration and increase in CO]

Effect of dexmedetomidine premedication on the intraoculor pressure and metabolic control in type 2 diabetic patients undergoing cataract operation

This study was designed to evaluate the effect of dexmedetomidine [DEX] on the blood glucose control and insulin requirements in type 2 diabetic patients. Besides its effect on the intraocular pressure [IOP] in same patients, during cataract operations. Twenty patients with type 2 diabetes of ASA physical state II were randomly allocated into two equal groups. DEX group received 0.6 ug/Kg I.V. dexmedetomidine premedication and control [saline] group. Received i.v. 0.9% saline. Patients received standard general anesthesia. Insulin was given by continuous i.v. infusion syring pump 1.25 U/h. and intermittent bolus doses to maintain blood glucose range 5.5-11.1 mmol/ L. Blood glucose levels were measured every 15 minutes intra operatively. Cortisol, growth hormone and C-peptide were also measured IOP was measured with schioltz tonometer The results of this study demonestrated that the total insulin requirement and the blood sugar concentrations were significantly lower in DEX group than control group throughout the study period. There were no significant differences between the two groups in the cortisol levels. Though growth hormone levels were significantly increased in DEX. group but still within the normal physiological limits. C-peptide levels were significantly, lower in DEX group than in control group. In addition DEX significantly reduced the IOP in DEX group than in control group. From these data we can conclude that i.v. dexmedetomidine premedication improves blood glucose control and decreases insulin requirements and intraoculor pressure so it improves the operating conditions for type 2 diabetic patients undergoing cataract operation

Effect of preoperative low dose of ketamine administered epidurally or intravenously on postoperative proinflammatory interleuldn-6 response

This study was done to compare the effect of preoperative epidural versus intravenous administration of low dose of ketamine on postoperative interleukjn6 [IL-6] Production and its contribution to postoperative pain. Twenty minutes before induction of anesthesia forty five patients which were randomly assigned into 3 equal groups: 0.5mg/kg ketamine administered epidurally [epid.ket.group] 0.5mg/kg ketamine administered intravenously [i.v. ket.group] and control group received i.v. 5 ml 0.9% saline. All patients received general anesthesia using isoflurane-nitrous oxide and i.v. fentanyl as needed. Postoperatively they received intermittent controlled i.v. pethidine analgesia as needed. Analgesic effects were evaluated using visual Analog Scale [VAS] pain score at 4,8,12h post operatively, time to first request for analgesic, and total first postoperative 24 hours pethidine consumption The IL-6 serum level was recorded at 4, 8 and 12 hours Postoperatively. The results of this study demonstrated that patients in epid.ket.group exhibited less severe postoperative pain [lower VAS pain score], longer duration of analgesia, lower pethidine consumption and lower IL-6 serum levels than i.v.ket.group. In conclusion preoperative epidural administration of low dose of ketamine is more effective than intravenous ketamine in attenuating the proinflammatory IL-6 response to surgery which may contribute to its more effective postoperative pain relieve