Efficacy and Safety of Intragastric Balloon Placements in 1600 Case, an Experience from the Middle East.

BACKGROUND AND PURPOSE: Intragastric balloons are used as a treatment for obesity. Much of the data collected on balloons had been in the context of clinical trials in academic medical centers or as a bridge to bariatric surgery in obesity centers. The aim of this study was to investigate the efficacy and safety of balloon treatment in private practice. STUDY DESIGN: This is an interventional study. SUBJECTS: The study included 1600 patients. PLACE: The study was conducted at the ElKatib Hospital. METHOD: This was a retrospective analysis of 6-month weight loss data and balloon-related complications of patients referred to a private center for obesity treatment. ASSESSMENT: The assessment was carried out by obtaining full patients' history (personal history, present illness, and previous drug history and operations). Laboratory work was done in the form of CBC, blood sugar, and viral markers. Bioenterics Intragastric Balloon (BIB) silicone balloon was used, filled with saline plus methylene blue dye with a volume ranging from 400 to 700 ml. The gained measures were analyzed by using SPSS program, and paired t test and chi-square test were used to compare between groups. RESULTS: A total of 1600 patients were included (368 male (23%) and 1232 female (77%)) with mean age 34.1 ± 10.354, mean body weight 112.45 ± 26.24, and mean body mass index (BMI) 40.32 ± 8.17. There were 46 patients younger than 18 years and 12 patients older than 60 years. There were 109 patients with a BMI ranging from 25 to < 35 and 737 patients with a BMI ≥ 40 kg/m2. A total of 1567 patients who attended weight consultation had a mean weight loss 17.35 ± 11.07 from intragastric balloon implantation. Thirty-three patients from the total sample were not weighted after the removal of the balloon (dropped out). Percentage excess weight loss (% EWL) = 100% × (baseline absolute weight (AW)-last weight)/(baseline AW-initial body weight (IBW)) was found, and weight loss of more than 10% was considered significant. About 49.3% of patients showed significant weight loss > 10%, 24.7% of patients showed weight loss > 20%, while 26% of patients showed no significant weight loss < 10%. CONCLUSION: Intragastric balloons on their own, with an intensive lifestyle program and supportive consultations, resulted in safe and short-term substantial weight loss, and may fill the therapeutic gap between pharmacotherapy and surgery.

Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

BACKGROUND: Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB. METHODS: A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 150, and 300 left lateral positions) before SAB, after SAB, and after delivery of the fetus. RESULTS: Before SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (150 and 300). CONCLUSIONS: Changing position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (150 and 300). TRIAL REGISTRATION: clinicaltrials.gov ( NCT02828176 ) retrospectively registered.

Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain.

OBJECTIVE: Thoracotomy is one of the most painful surgical procedures. The aim of this study was to assess the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for controlling acute thoracotomy pain. DESIGN: A prospective, randomized, observer-blinded, controlled study. SETTING: The study was performed as a single-institution study in the National Cancer Institute, Cairo University, Egypt. PARTICIPANTS: All participants were cancer patients scheduled for thoracotomy. INTERVENTIONS: This study was conducted from February to December 2015. Forty patients scheduled for thoracotomy under general anesthesia were allocated randomly into 1 of 2 groups with 20 patients each. SAPB was performed before extubation with an injection of 30 mL of 0.25% levobupivacaine followed by 5 mL/hour of 0.125% levobupivacaine. In the TEA group, thoracic epidural catheters were inserted preoperatively to be activated before extubation using a lower dose regimen to the SAPB group. Heart rate, mean arterial pressure, and the visual analog pain score (VAS) measurements were recorded for 24 hours. Rescue analgesia using intravenous morphine, 0.1 mL/kg, was administered if the VAS was >3. MEASUREMENTS AND MAIN RESULTS: Compared with preoperative values, the mean arterial pressure in the SAPB group did not change significantly (p = 0.181), whereas it decreased significantly (p = 0.006) in the TEA group. VAS scores and the total dose of morphine consumed were comparable in the 2 groups. CONCLUSIONS: SAPB appeared to be a safe and effective alternative for postoperative analgesia after thoracotomy.