The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study.

OBJECTIVE: This study aimed to evaluate the ability to use opioid-free anesthesia (OFA) technique in morbid obese patients. DESIGN: A prospective randomized double-blinded study. SETTING: This study was carried out at Tanta University Hospitals (tertiary hospitals). PATIENTS: Eighty morbid obese patients scheduled for laparoscopic bariatric surgeries. INTERVENTION: Patients were allocated randomly into two groups: Group C, in which fentanyl was used during induction and maintenance of anesthesia, and group OFA, in which dexmedetomidine, ketamine, magnesium, and lidocaine were started before the induction of anesthesia and continued throughout the surgery. MAIN OUTCOME MEASURE: The post-operative morphine consumption in the first 24 hours (primary outcome) and the intraoperative fentanyl consumption (secondary outcome). RESULTS: In comparison to the control group, OFA technique significantly decreased the post-operative morphine consumption (p = 0.003; 95 percent CI: 0.505; 2.396), shortened the time for the first request of rescue analgesia (p < 0.0001; 95 percent CI: 54.14; 99.11), decreased the post-operative pain score 4 and 6 hours after surgery (p < 0.05), and decreased the post-operative nausea and vomiting (PONV) impact scale (p = 0.022). Furthermore, it significantly decreased the intraoperative fentanyl consumption (p < 0.0001) with the improvement of all parameters of the recovery profile (p < 0.05). CONCLUSION: OFA in patients undergoing bariatric surgeries significantly decreased the post-operative morphine consumption, the post-operative pain score, the intraoperative fentanyl consumption, and the PONV impact scale with the improvement of the recovery profile.

In vitro activity of plazomicin against quinolone-resistant gram-negative bacteria isolated from catheter-associated urinary tract infections.

Quinolone resistance among uropathogens is an increasing concern. Plazomicin is a new aminoglycoside that shows promising results against resistant bacteria. However, no study has yet tested its effect specifically on quinolone-resistant organisms. This study aimed to evaluate the in vitro activity of plazomicin and comparator drugs against quinolone-resistant Gram-negative isolates of catheter-associated urinary tract infections (CAUTI). Plazomicin demonstrated high inhibiting activity against Enterobacteriaceae isolates (95.9% at MIC≤ 2 mg/L), with MIC50/90 was 1/2 mg/L. High MICs values were detected against non-Enterobacteriaceae isolates (MIC50/90, 4/32 mg/L). Plazomicin had susceptibility rate of 97.2% against Enterobacteriaceae isolates carrying aminoglycosides modifying enzymes (AME) genes, while other aminoglycosides, amikacin and gentamicin showed reduced activity (32.4% and 25.4%, respectively). In conclusion, plazomicin showed potent in vitro activity against quinolone-resistant Enterobacteriaceae causing CAUTI, regardless of the AME pattern.

Effects of Propofol, Dexmedetomidine, or Ketofol on Respiratory and Hemodynamic Profiles in Cardiac Patients Undergoing Transesophageal Echocardiography: A Prospective Randomized Study.

OBJECTIVES: The authors aimed to evaluate sedation characteristics, as well as cardiorespiratory effects, of propofol, dexmedetomidine, and ketofol used for conscious sedation during transesophageal echocardiography (TEE). DESIGN: Prospective double-blind randomized study. SETTINGS: Tanta University hospitals. PARTICIPANTS: Seventy-five participants with left-to-right shunt requiring diagnostic TEE interventions. Patients were randomized into three groups-P, Dex, and K-to receive propofol, dexmedetomidine, or ketofol, respectively. MEASUREMENTS AND MAIN RESULTS: Time to reach targeted sedation level, duration of the procedure, recovery time, hemodynamic parameters, incidence of oxygen desaturation <90%, as well as the cardiologist's satisfaction were recorded. The time onset and offset of sedation, duration of TEE procedure, and the need for rescue propofol were significantly less in the P and K groups compared with group Dex (p value 0.000*, 0.003*, 0.000*, and 0.000* and effect size 0.39, 0.15, 0.21, and 0.34, respectively). Mean arterial pressure, heart rate, and cardiac output significantly decreased in groups P and Dex compared with either baseline or group K. Hypoxic events were more manifest in group P; whereas group K had better cardiologist's satisfaction than the other two groups. CONCLUSIONS: In the TEE settings, the three agents were capable of attaining the targeted sedation levels , with propofol and ketofol having a faster onset and recovery times compared with dexmedetomidine. Even though dexmedetomidine and ketofol provided a more stable respiratory profile than propofol, ketofol was favorable in providing fewer hemodynamic alterations with better satisfaction scores than both propofol and dexmedetomidine.

Comparison of Intravenous Dexmedetomidine-Propofol Versus Ketofol for Sedation During Awake Fiberoptic Intubation: A Prospective, Randomized Study.

BACKGROUND: Management of difficult airway due to laryngeal mass is a major challenge to the anesthesiologists, and awake fiberoptic intubation (AFOI) would be the technique of choice. OBJECTIVES: The current study aimed at comparing the effects of administration of dexmedetomidine-propofol or ketofol for sedation during AFOI in terms of intubation conditions, hemodynamic stability, and patients and anesthesiologist's satisfaction. METHODS: Eighty adult patients, 18 - 60 years old, ASA (the American Society of Anesthesiologists) physical status I-III, with difficult airway due to laryngeal mass and planned for AFOI were enrolled. Sedation was randomly given to the patients according to their assigned group by either dexmedetomidine-propofol (group D; n = 40) or ketofol (group K; n = 40). Outcome variables included time to reach Ramsay sedation scale (RSS) ≥ 3, intubation time, number of patients in need of rescue propofol, patient's discomfort score, tolerance to endoscopy and intubation, hemodynamic parameters, patients and anesthesiologist's satisfaction, and occurrence of side effects. RESULTS: Time to reach RSS ≥ 3 and intubation time were significantly shorter, and fewer patients required rescue propofol in the K group as compared to the D group (P = 0.000*, and 0.035*, respectively). Higher discomfort score and better tolerance to endoscopy and intubation were noticed in group K than group D, but with no statistical significance (P = 0.132, 0.137, and 0.211, respectively). Patients in group D had significantly lower mean arterial pressure (MAP) and heart rate (HR) after the loading dose till five minutes after intubation (P = 0.000*). There was no significant difference in patients' satisfaction between the two groups (P = 0.687), while anesthesiologist's satisfaction was higher in group K compared with that of group D (P = 0.013*). Cough score as well as incidence of unfavorable respiratory outcomes were not significantly different between the two groups (P = 0.611, 0.348, respectively). CONCLUSIONS: Ketofol and dexmedetomidine-propofol combination were suitable and satisfactory for AFOI. However, ketofol was more advantageous in offering faster onset of sedation, shorter intubation time, stable hemodynamic profile, as well as higher anesthesiologist's satisfaction when compared to dexmedetomidine-propofol.