The Effect of Adding Dopamine Infusion to Noradrenaline Infusion Combined With Restrictive Hydration on Renal Function and Tissue Perfusion during Open Abdominal Surgeries.

OBJECTIVES: This study was designed to assess the effect of adding dopamine infusion in addition to restrictive hydration combined with noradrenaline infusion on intraoperative renal function and serum lactate levels in comparison to restrictive hydration combined with noradrenaline infusion only and standard hydration during open abdominal surgeries. PATIENTS AND METHODS: One hundred and twenty patients were randomly assigned into three equal groups undergoing major open abdominal procedures. In Group I, dopamine infusion in addition to norepinephrine infusion were administered with restrictive hydration. In Group II, norepinephrine infusion was started before the induction of anesthesia with restrictive hydration. In Groups I and II, Ringer's solution was infused at a fixed rate of 2 mL.kg-1.h-1 until the end of surgery. In Group III, the conventional fluid replacement was introduced according maintenance, fluid deficit and third space loss. The outcome to be assessed was serial measurements of creatinine and serum lactate levels preoperatively, intraoperatively, and just postoperatively in addition to after 24 h. RESULTS: Serum lactate level was significantly low in Groups I and II than that in Group III intraoperatively and postoperatively. In addition, urine output was significantly more in Group I and Group III than in Group II. Creatinine level was higher with significance in Group II than in Group I and III 24 h postoperatively. CONCLUSION: Dopamine infusion, when added to norepinephrine infusion combined with restricted hydration, improved urine output and creatinine level. Tissue perfusion as indicated by serum lactate level was more adequate in Groups I and II than that in Group III.

The effect of continuous propofol versus dexmedetomidine infusion on regional cerebral tissue oxygen saturation during cardiopulmonary bypass.

BACKGROUND: Cerebral oxygen desaturation can arise during various durations of cardiopulmonary bypass (CBP), thus continuous monitoring is necessary. This desaturation may account for distinct neuropsychological deficits. Near-infrared spectrophotometry (NIRS) is a non-invasive method that offers many advantages for monitoring cerebral oxygenation. OBJECTIVES: The aim of this study was to compare the outcome of propofol and dexmedetomidine on cerebral regional oxygen saturation (rScO2) during CPB and on postoperative cognitive dysfunction. PATIENTS AND METHODS: 50 patients anticipated for open heart surgeries were encompassed in the study. Patients were divided into 2 groups, group P (receiving propofol) and group D (receiving dexmedetomidine) during CPB. Both groups were studied for variations in right and left rScO2 as well as postoperative cognitive dysfunction using the Mini Mental State Examination Score (MMSE) test. RESULTS: The results showed no significant difference in both groups of the study, with an increase in rScO2 on the right and left side in T1 compared to T0 and maximum increase in T3-4-5, then a decrease in T6-7. With regard to the cognitive dysfunction there was a decrease in the values at 1 h in both groups without significant difference; after 1 week MMSE values returned to baseline values. CONCLUSION: Propofol and dexmedetomidine infusion used during CPB preserve the rScO2 and do not affect the neurological outcome.

Lornoxicam with Low-Dose Ketamine versus Pethidine to Control Pain of Acute Renal Colic.

OBJECTIVES: This study was established to compare single-dose lornoxicam 8 mg (NSAID) in addition to 0.15 mg.kg-1 ketamine with single-dose pethidine 50 mg, both administered intravenously (IV), on the quickness and extent of analgesia, disadvantage, and consequence on utilitarian situation. PATIENTS AND METHODS: One hundred and twenty patients with acute renal colic pain received in emergency room were included in this prospective, randomized, and double blind clinical study. They were aimlessly designated into one of two groups using a computer-generated table. Group L received lornoxicam 8 mg IV plus 0.15 mg.kg-1 ketamine and Group P received pethidine 50 mg IV. Parameters were noticed at baseline and after 0, 15, 30, and 45 minutes and 1 hour after drug administration. The efficiency of the drug was determined by observing: patient rated pain, time to pain relief, rate of pain recurrence, the need for rescue analgesia, adverse events, and functional status. RESULTS: The visual analogue scale was significantly lower in Group L after 30 minutes in comparison to Group P. In addition, there was statistically significant increase in Group P regarding their need for rescue analgesia after 30 min in comparison to Group L. Group P showed nonsignificantly increased sedation score compared to Group L. CONCLUSION: Patients receiving lornoxicam-ketamine attained greater reduction in pain scores and less side effects with better functional state and also are less likely to require further analgesia than those administered pethidine to control acute renal colic pain.

Comparative Study between Preemptive and Postoperative Intra-Articular Injection of Levobupivacaine and Tramadol for Control of Postoperative Pain.

BACKGROUND: This study had been formulated to evaluate and compare the analgesic effect of preemptive (PE), postoperative (PO), and combined knee intra-articular injection (IAI) of levobupivacaine and tramadol after knee arthroscopy. MATERIALS AND METHODS: A total of 220 patients assigned for therapeutic knee arthroscopy were divided into four equal groups. Patients in Group C received IAI of 20 mL (0.5%) levobupivacaine preoperative, meanwhile patients in Group PE received IAI of 18 mL (0.5%) levobupivacaine with 100 mg tramadol (2 mL). Patients in Group PO received IAI of 18 mL (0.5%) levobupivacaine with 100 mg tramadol (2 mL) postoperatively, whereas patients in Group PE/PO received IAI of 19 mL (0.25%) levobupivacaine with 50 mg tramadol (1 mL) preoperatively and postoperatively. Numeric rating scale (NRS) had been used to assess pain sensation. Duration till the first request of rescue analgesia and number of requests were recorded. RESULTS: NRS scores were significantly higher in Group C compared to other groups and in Group PE in comparison to PO and PE/PO groups. Frequency of rescue analgesia requests was significantly higher in Group C with significantly higher mean times of requests, while was significantly lower in Group PE/PO with significantly lower mean times of requests when compared to groups PE and PO. CONCLUSIONS: PE levobupivacaine and tramadol IAI provided satisfactory level of PO analgesia after therapeutic arthroscopy. However, combined PE and PO levobupivacaine and tramadol IAI of half dose provided PO analgesia superior to that provided by either PE or PO full-dose IAI.

Transdermal Ketoprofen Patch in Comparison to Eutectic Mixture of Local Anesthetic Cream and Subcutaneous Lidocaine to Control Pain Due to Venous Cannulation.

BACKGROUND: This study was established to compare the analgesic and side effects between transdermal ketoprofen patch 30 mg and eutectic mixture of local anesthetic (EMLA) cream applied to the peripheral venous cannulation site and lidocaine injection before cannulation. PATIENTS AND METHODS: One hundred and five adult patients who had been scheduled for elective general surgery with patients' physical status American Society of Anesthesiologists classes I and II were randomly divided into three groups: Group I (EMLA group) received EMLA cream, Group II (lidocaine group) received subcutaneous infiltration of 1 ml of 2% lidocaine HCl 10 min before cannulation, and Group III (ketoprofen group) received a transdermal ketoprofen patch 30 mg. Groups I and III received their cream or patch 60 min before cannulation. The pain resulting from cannulation by an 18G cannula was assessed by a visual analog scale (VAS) at the time of cannulation and every 2 h for another 6 h for all groups. Signs of inflammation at the site of cannulation (erythema, induration, edema, and blanching) were observed at the site of cannulation for 24 h. RESULTS: Ketoprofen patch, EMLA cream, and lidocaine injection were found to be equal in controlling pain caused by venous cannulation with no significant difference in VAS. Signs of inflammation at the site of cannulation (blanching, erythema, and induration) were very evident in Group I (EMLA) which showed significant difference than in other two groups. CONCLUSIONS: EMLA cream, ketoprofen patch, and lidocaine injection have equal ability to alleviate pain due to cannulation when applied before the procedure, but ketoprofen patch is more superior as it had less local inflammatory effect in comparison to EMLA cream and without double puncture as with lidocaine injection.