scholarly journals Comparative Study between the Effect of Dexmedetomidine or Magnesium Sulphate Infusion on the Recovery Profile and Postoperative Analgesia in Patients Undergoing Laparoscopic Bariatric Surgery

2021 ◽  
pp. 42-52
Author(s):  
Doaa Kelany Ibrahim ◽  
Sameh Abd EL Khalik Ahmed ◽  
Ashraf Elsayed El Zeftawy ◽  
Sabry Mohamed Amin
Keyword(s):  
Bariatric Surgery ◽  
Magnesium Sulphate ◽  
Controlled Study ◽  
Laparoscopic Bariatric Surgery ◽  
Early Recovery ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Recovery Profile ◽  
Group Ii

Background: The increasing incidence of morbid obesity is a crisis in national healthcare which has precipitated an increase in bariatric surgery. Bariatric surgery is an effective treatment for obesity, with a mean percentage of weight loss after 2 years of 68.2% for laparoscopic bariatric surgery. Methods: This prospective randomized controlled study was carried out in Tanta University Hospitals in General Surgery Department on patients scheduled for elective laparoscopic bariatric surgery from July 2019 to June 2020. The study has been approved by the Institutional ethical committee at Faculty of Medicine, Tanta University with approval number (33161/05/19) Results: There was a significant decrease in heart rate, at T2 to T9, in group II (Dexmedetomidine group) and group III (Mg sulphate group) compared to group I (Control group). There was a significant decrease in mean arterial blood pressure, at T2 to T9,  in group II and group III compared to group I. Visual analog scale for pain (VAS) was decreased significantly in group II and group III compared to group I. There was a negative increase in nausea and vomiting in group I than group II and group III. Bradycardia, hypotension and postoperative hypoxemia were insignificantly different among the three groups. Conclusions: In patients undergoing laparoscopic bariatric surgeries, both dexmedetomidine and magnesium sulphate were safe and effective as regards early recovery profile, delayed time for the first request of analgesia and less opioid consumption.

Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

2015 ◽  
Vol 18 (3) ◽  
pp. 098
Author(s):  
Cem Arıtürk ◽  
Serpil Ustalar Özgen ◽  
Behiç Danışan ◽  
Hasan Karabulut ◽  
Fevzi Toraman
Keyword(s):  
Body Temperature ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Extracorporeal Circulation ◽  
Group Iii ◽  
Oxygen Fraction ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

<p class="p1"><span class="s1"><strong>Background:</strong> The inspiratory oxygen fraction (FiO<sub>2</sub>) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO<sub>2</sub>) to reach hyperoxemic levels (&gt;180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO<sub>2</sub> levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO<sub>2</sub> levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO<sub>2</sub> during cardiac surgery.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO<sub>2</sub> adjustment strategies applied to the patients in the groups were as follows: FiO<sub>2</sub> levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Mean PaO<sub>2</sub> was significantly higher in Group I than in Group II at T2 and T3 (<em>P</em> = .0001 and <em>P</em> = .0001, respectively); in Group I than in Group III at T1 (<em>P</em> = .02); and in Group II than in Group III at T2, T3, and T4 <br /> (<em>P</em> = .0001 for all). </span></p><p class="p1"><span class="s1"><strong>Conclusion: </strong>Adjustment of FiO<sub>2</sub> according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO<sub>2</sub> between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO<sub>2</sub> levels in concordance with the body temperature in the <br /> rewarming period.</span></p>

Functional adaptation to reduced renal mass in early development

1982 ◽  
Vol 242 (2) ◽  
pp. F190-F196 ◽  
Author(s):  
R. L. Chevalier
Keyword(s):  
Renal Mass ◽  
Left Kidney ◽  
Extracellular Fluid ◽  
Functional Adaptation ◽  
Fluid Loss ◽  
Group Iii ◽  
Arterial Blood ◽  
India Ink ◽  
Group I ◽  
Group Ii

To determine whether reduced renal mass in the newborn results in acceleration of normal renal development, the response to unilateral nephrectomy (N) before 36 h of age was compared with sham-operated (S) guinea pigs during the period of most rapid nephron maturation. Studies were performed at 7-13 days (group I) and 19-25 days (group II). Mean arterial blood pressure (AP), left kidney glomerular filtration rate (LKGFR), and urine sodium excretion (UNaV) were measured. Superficial single nephron GFR (sSNGFR) and proximal fractional water reabsorption (FRH2O) were measured by micropuncture, and the number of glomeruli (NG) was determined by India ink perfusion. In view of the susceptibility of the neonate to extracellular fluid loss, groups I and II were plasma infused to maintain euvolemia and group II was compared with 19- to 25-day-old hydropenic animals (group III). Increase in body weight with age was unaffected by neonatal N. In group IN, the compensatory increase in sSNGFR was greater than SNGFR for deeper nephrons, which normally contribute most to GFR at this age. In group IIN there was an 80% adaptive increase in LKGFR that could not be entirely explained by the rise in SNGFR. Since NG in group IIN was greater than in group IIS and similar to that in adulthood, the enhanced adaptation in LKGFR in group IIN may be due in part to earlier recruitment of a population of underperfused glomeruli. FRH2O did not change significantly with age and did not differ in N and S groups. Animals in group III developed a rise in hematocrit during the experiment, and AP, LKGFR, and UNaV were lower in group IIIN than in group IIN. It is concluded that following N at birth, the sequence of renal functional maturation is accelerated while glomerulotubular balance is preserved. As a result of these adaptative changes, homeostasis is maintained and body growth proceeds without impairment.

Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 139-143 ◽  
Author(s):  
Waldemar A. Carlo ◽  
Lucia Pacifico ◽  
Robert L. Chatburn ◽  
Avroy A. Fanaroff
Keyword(s):  
Respiratory Failure ◽  
Computer Program ◽  
Computer Assisted ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Assisted Management

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P &lt; .005; and group III, 46/63, 73%, P &lt; .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

The effect of MgSO4 addition and the increasing doses of calcium and phosphorus during ending drying period on the occurrence of hypocalcaemia and hypophosphataemia in dairy cows

2013 ◽  
Vol 16 (4) ◽  
pp. 655-662 ◽  
Author(s):  
R. Bodarski ◽  
S. Kinal ◽  
J. Preś ◽  
M. Słupczyńska ◽  
J. Twardoń
Keyword(s):  
Blood Serum ◽  
Magnesium Sulphate ◽  
Group Iv ◽  
Dry Period ◽  
Urine Ph ◽  
Inorganic P ◽  
Group Iii ◽  
Group I ◽  
Salt Addition ◽  
Group Ii

Abstract The aim of the presented study was the estimation of optimal Ca and P levels applied before calving together with anionic salt addition, as an element of hypocalcaemia and hypophosphataemia prevention. The experiment was carried out during the dry period on 48 cows with similar milk yield in the previous lactation. Cows were divided into four groups. In group I (control) the amount of minerals was in accordance to NRC standards. In experimental groups (groups II-IV), two weeks before calving, cows received 140 g/day/head of hydrated magnesium sulphate to achieve dietary cation- anion difference at the level of about 50 mEq/kg DM. In groups II and III cows received calcium carbonate (100 g/day) 10 days a.p. (antepartum) (group II), or 5 days a.p. (group III), while cows in IV group received dicalcium phosphate (100 g/day) for 5 days a.p. Application of MgSO4 × 7H2O significantly affected the urine pH of cows from group III and IV 4-5 d. before calving - 6.45 and 6.81, respectively. The acidification of urine was observed after calving in group IV (7.13). In cows from group II (100 CaCO3 10 days a.p.) urine pH decline was not found (7.97-7.75). In that group the incidences of hypophosphatemia were noted (blood serum inorganic P level 1.41-1.46 mmol/l). Addition of magnesium sulphate prevented hypocalcaemia occurrence - 4-5 d. before calving the concentration of ionized Ca in blood serum was 1.11, 1.13 and 1.16 mmol/l (respectively for group II, III and IV). Reproductive functions were significantly improved after the application of CaCO3 and CaHPO4 for 5 days a.p. in comparison with control and group II - progesterone concentration in the blood serum on the 45th day of lactation was 1.396 - 1.409 vs 0.799 - 0.401. The correlation between progesterone and inorganic P level in serum was almost significant. Based on the obtained results a treatment optimal in prevention of hypocalcaemia and hypophosphataemia is the application of 50 g CaCO3 and 50 g of CaHPO4 for the last 5 days of the dry period together with MgSO4 × 7H2O given for 14 days a.p.

Effect of norepinephrine on diaphragm contractility and blood flow

1990 ◽  
Vol 69 (6) ◽  
pp. 2019-2028 ◽  
Author(s):  
G. S. Supinski ◽  
A. F. DiMarco ◽  
J. Gonzalez ◽  
M. D. Altose
Keyword(s):  
Blood Flow ◽  
Group Iv ◽  
Arterial Flow ◽  
Force Frequency ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Intramuscular Electrodes ◽  
Phrenic Artery ◽  
Group Ii

Recent studies have shown that diaphragm fatigue can be reversed by mechanical augmentation of phrenic arterial flow. The purpose of the present experiment was to determine whether it was possible to pharmacologically augment diaphragm blood flow and reverse fatigue by the administration of norepinephrine. Four groups of studies were performed, all employing our previously described in situ isometric canine diaphragm strip preparation (Supinski et al., J. Appl. Physiol. 60: 1789-1796, 1986). Group I studies examined the effects of norepinephrine on the contractility of the nonfatigued diaphragm in normotensive dogs, group II studies examined the effects of this drug on the contractility of the fatigued diaphragm in normotensive animals, and group III studies examined the effect of this drug on the contractility of the fatigued diaphragm in hypotensive animals. Group IV studies examined the effect of norepinephrine in normotensive animals in which the phrenic artery was cannulated and pump perfused at constant flow. Fatigue was induced in group II, III, and IV studies by rhythmically stimulating the diaphragm via intramuscular electrodes. Norepinephrine had no effect on the contractility of the nonfatigued diaphragm (group I). In normotensive (group II) and hypotensive animals (group III), norepinephrine elicited dramatic increases in arterial blood pressure and phrenic arterial flow and produced a significant upshift in the force-frequency curve of the fatigued diaphragm. However, when phrenic flow was held constant (group IV experiments), norepinephrine failed to augment the contractility of the fatigued diaphragm. These results indicate that 1) norepinephrine can increase phrenic blood flow and augment the contractility of the fatigued diaphragm in both normotensive and hypotensive conditions and 2) this effect of norepinephrine to partially reverse fatigue is secondary to its action to augment diaphragmatic blood flow.

scholarly journals Pharmacodynamics of Rocuronium in Cholestatic Patients with or without Hepatocellular Injury : Normal Onset Time of Initial Dose and Prolonged Duration Time After Repeated Doses

2008 ◽  
Vol 11 (3) ◽  
pp. 15 ◽  
Author(s):  
Jian-jun Yang ◽  
Yong-guang Wang ◽  
Zhuan Zhang ◽  
Zhi-jie Zhang ◽  
Jin Liu ◽  
...  
Keyword(s):  
Initial Dose ◽  
Onset Time ◽  
Controlled Study ◽  
Hepatocellular Injury ◽  
Group Iii ◽  
Recovery Index ◽  
Duration Time ◽  
Group I ◽  
Repeated Doses ◽  
Group Ii

Purpose. A prospective controlled study was designed to observe the pharmacodynamics of rocuronium in cholestatic patients with or without hepatocellular injury. Methods. Sixty patients undergoing abdominal surgery were allocated into three groups: group I had 20 cholestatic patients with hepatocellular injury; group II had 20 cholestatic patients without hepatocellular injury, and group III (control group) had 20 patients without hepatic disease. Anesthetized with propofol and fentanyl, all patients received rocuronium 0.6 mg/kg for initial dose followed by intermittent repeated administration of rocuronium 0.15 mg/kg. The twitch high of adductor pollicis muscle was monitored by acceleromyography. The onset time of the initial dose, the duration time of the initial and the repeated doses, and the recovery index were observed. Results. The onset and the duration time of the initial dose had no significant difference among the three groups (P>0.05). After administration of the 5th dose, the duration time of the repeated doses was significantly prolonged than that of the 2nd dose in group I (31±8 versus 22±4 min) and group II (28±5 versus 21±4 min) (P0.05). The recovery index of rocuronium was longer in group I (48±13 min) and group II (46±9 min) than that in group III (24±5 min) (P

Effects of different polyvinylpyrrolidone iodine concentrations on trismus and swelling following third molar surgery

2020 ◽  
pp. 1-16
Author(s):  
Esra Yüce ◽  
Omur Dereci ◽  
Nazli Altin ◽  
Cansugul Efeoglu Koca ◽  
Murude Yazan
Keyword(s):  
Povidone Iodine ◽  
Maxillofacial Surgery ◽  
Third Molar ◽  
Group Iv ◽  
Controlled Study ◽  
Third Molar Surgery ◽  
Group Iii ◽  
Group I ◽  
Facial Swelling ◽  
Group Ii

Abstract Objective: To compare the clinical efficacy of different povidone iodine concentrations for the management of postoperative pain and swelling following mandibular third molar surgery. Methods: The randomised, prospective, double-blind and controlled study was conducted from October 2016 to January 2018 at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Biruni University, Istanbul, Turkey, and comprised individuals aged 18-30 years who underwent surgical removal of pathology-free completely unerrupted mandibular lower third molars. The participants were randomly assigned to four groups: Group I had saline-only controls, Group II was given 0.5% concentration of povidone iodine, Group III had 1% concentration of povidone iodine, and Group IV had 3% concentration of povidone iodine. Facial swelling and trismus were assessed on the 2nd and 7th postoperative days. Data was analysed using SPSS 22. Results: Of the 80 patients, 34(42.5%) were males and 46(57.5%) were females with an overall mean age of 24.6±3.68 years. Each group had 20(25%) subjects. All three concentrations of povidone iodine provided significant reduction in postoperative trismus compared to the controls. Trismus was less in Group III and Group IV compared to Group II up to 7 days after surgery. Conclusion: Irrigation with 3% povidone iodine concentration was found to be more effective in reducing the level of facial swelling after impacted third molar surgery. (Clinical Trials.gov Identifier: NCT03894722) Key Words: Maxillofacial surgery, Third molar, Povidone-Iodine, Swelling, Tismus

scholarly journals Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement

2021 ◽  
pp. 177-188
Author(s):  
Heba Salah Eldin Ismail Gawish ◽  
Amr Arafa Mohammed Elbadry ◽  
Nagat Sayed Mohammed El-Shmaa ◽  
Abdelraheem Mostafa Dowidar
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Femoral Nerve ◽  
Group Iii ◽  
Insignificant Change ◽  
Adductor Canal ◽  
Arterial Blood ◽  
Group I ◽  
Total Knee ◽  
Group Ii

Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA. ‎Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021. Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II. Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II. Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day. Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.

scholarly journals Accident risk in patients with epilepsy

2008 ◽  
Vol 66 (2a) ◽  
pp. 175-178 ◽  
Author(s):  
Karla Teixeira Souza ◽  
Marilisa M. Guerreiro ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Epileptic Seizures ◽  
Outpatient Clinics ◽  
Controlled Study ◽  
Accident Risk ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Patients With Epilepsy ◽  
Prospective Longitudinal ◽  
Structured Questionnaire

OBJECTIVE: To compare the risk of accidents in patients with uncontrolled seizures, in seizure-free patients, and in patients with chronic headache. METHOD: This was a prospective longitudinal case-controlled study with interviews. A semi-structured questionnaire was used in the epilepsy and headache outpatient clinics of the Hospital das Clínicas of UNICAMP. RESULTS: Group I was composed of 48 patients with uncontrolled seizures, group II was composed of 24 seizure-free patients and group III was composed of 32 patients with headache. Thirty-nine patients (81%) in group I, 13 (54%) in group II, and 19 (59%) in group III reported accidents in the last two years. In the first group, 649 accidents (89%) were related to epileptic seizures and the average number of accidents not related to seizures was 1.7. The average number of accidents in groups II and III were both 2.4. CONCLUSION: Epileptic seizure was the most important factor determining the occurrence of accidents in people with epilepsy.

scholarly journals Nephro protection property of double blockade versus single blocked of RAAS in delaying the progression of CKD

2018 ◽  
Vol 5 (3) ◽  
pp. 748
Author(s):  
Arvind Gupta ◽  
Upma Narain ◽  
Romar Dabu
Keyword(s):  
Blood Pressure ◽  
Phase Iii ◽  
P Value ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Protection Property

Background: Dual renin angiotensin aldosterone system blockade using angiotensin receptor blockers in combination with angiotensin converting enzyme inhibitors is reported to improve proteinuria in non-diabetic patients.Methods: A prospective observational study was done on 810 non-diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the nephro protection property of double blockade and single blocked of renin angiotensin aldosterone system in delaying the progression of chronic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0001) was found significant. Similarly, on comparing group II and group III, p value (0.003) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (<0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than monotherapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate. Newer potassium lowering therapies can effectively and safely correct hyperkalemia and maintain normokalemia in patients receiving background treatment with renin angiotensin aldosterone system blockade. However, the use of new potassium binders for cardiovascular and renal risk reduction with combined renin angiotensin aldosterone system blockade therapy will require phase III trials.

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