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   2014| October-December  | Volume 7 | Issue 4  
    Online since November 28, 2014

 
 
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ORIGINAL ARTICLES
Specialty choices among graduating medical students in University of Calabar, Nigeria: implications for anesthesia practice
Oboko O Oku, Afiong O Oku, Teresa Edentekhe, Queeneth Kalu, Bassey E Edem
October-December 2014, 7(4):485-490
DOI:10.4103/1687-7934.145673  
Background Despite its strategic role in health-care delivery, anesthesia does not attract medical manpower in developing countries, more so among medical trainees. This has resulted in an alarming lack of physician anesthetists. This study aims to determine the rate of selection of anesthesia as a specialty choice and factors that influence medical students when choosing specialties. Patients and methods A cross-sectional study was conducted on final-year medical students in the University of Calabar. A semistructured self-administered questionnaire was distributed to a total of 105 final-year students who had undergone their posting in anesthesia. Summarization of data was done using frequencies/proportions and graphs, and significance level was set at P-value less than 0.05. Results The mean age of respondents was 27.2 ± 4.15 years. Of the students, 72 (69%) were male, whereas 33 (31%) were female. Of them, 96 (91%) indicated interest in specializing, 34 (32%) preferred obstetrics and gynecology, 20 (19%) wanted pediatrics, 13 (12%) preferred family medicine and three (3%) preferred anesthesia. Factors that influenced choice of specialty among the graduating students included: personal interests in 85 students (81%), future job opportunities in the field in 66 students (63%) and requirement of specialized skill in 65 students (62%). In all, 46 respondents (44%) reported that their anesthesia posting experience was interesting, whereas 27 respondents (28%) reported it as very educative. The duration of the posting was rated very short by 25 students (24%). Conclusion With less than 5% of the graduating medical students indicating interest in anesthesia specialization, improvement in training facilities and provision of incentives to intending trainees are strongly recommended.
  3 3,032 298
Profile of patients admitted to pediatric intensive care unit, Cairo University Hospital: 1-year study
Hanaa I Rady
October-December 2014, 7(4):500-503
DOI:10.4103/1687-7934.145680  
Introduction Care of the critically ill patients is resource-intensive, and 15-20% of hospital budgets are spent in the ICUs. Objectives This study aimed to analyze the epidemiologic patterns of pediatric critically ill patients presenting to the pediatric intensive care unit (PICU) and the etiologies of PICU admission of different age groups. Materials and methods This descriptive study of all children aged less than 14 years presenting with critical illnesses to the PICU was conducted in a tertiary medical Hospital, in Cairo, from 2011 to 2012. All patients transferred to the PICU were included without distinction. Demographic data of critically ill children admitted to the PICU were analyzed. Etiologies of the PICU admissions were analyzed by various age groups. Results There were 532 critically ill children admitted to the PICU. Respiratory system diseases, foreign body inhalation removal, and encephalopathy were the predominant etiologies of admission 49.6, 11.9, and 11.5%, respectively. Mortality rate was the highest in infants below 1 year of age (43.9%). Predominant length of ICU stay was around 7 days. Conclusion The present study shows the etiologies of pediatric patients admitted to ICUs. The epidemiologic analysis of patients admitted to PICU can serve as basis for developing dedicated protocols for critical care and redistributing the ICUs' resources.
  3 3,458 514
The analgesic efficacy of preincisional peritonsillar versus intravenous ketamine with bupivacaine infiltration for tonsillectomy in children: a randomized double-blind controlled study
Nahla S El Bahnasawy, Mohamed Abu-Samra
October-December 2014, 7(4):514-517
DOI:10.4103/1687-7934.145685  
Objective This study aimed to evaluate the postoperative analgesic efficacy of either preincisional peritonsillar infiltration of ketamine in combination with bupivacaine, or intravenous ketamine combined with infiltration of bupivacaine. Patients and methods A total of 60 patients were randomized into three groups: intravenous group, in which patients received intravenous ketamine (0.5 mg/kg) in 10 ml plus peritonsillar infiltration of bupivacaine 2 ml (5 mg/ml); infiltration group, in which patients received peritonsillar infiltration of ketamine (0.5 mg/kg) in 2 ml plus bupivacaine 2 ml and intravenous 10 ml saline; and placebo group, in which patients received 10 ml intravenous saline and peritonsillar infiltration of 2 ml saline plus 2 ml bupivacaine 2 ml/tonsil. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wilson scale were used to evaluate pain and sedation, respectively. Time to first analgesic request and total analgesic request, total analgesic consumption during 24 h postoperatively, intraoperative blood loss, and adverse effects were evaluated. Results Time to analgesic request was significantly prolonged in the intravenous and infiltration groups (4.3 ± 2.1 and 11.6 ± 3.6 h, respectively) compared with the placebo group (1.2 ± 1.2 h), with significant prolonged time in the infiltration group compared with the intravenous group. Significant lower (CHEOPS) scores and significant lower analgesic consumption were observed in the intravenous and infiltration groups (69 ± 4.1 and 45.1 ± 2.1 mg), respectively, compared with the placebo group (90.6 ± 5.3 mg). Both the intravenous and infiltration groups had comparable pain scores, with statistical significance at 4, 6, and 8 h postoperatively. Dysphagia was significantly higher in the placebo group compared with the intravenous and infiltration groups. No serious complication was reported in the three groups. Conclusion Intravenous or peritonsillar infiltration of ketamine with bupivacaine enhanced post-tonsillectomy analgesia in children. In comparison, the analgesic efficacy of infiltration of ketamine was superior to intravenous administration, without significant side effects.
  3 1,704 202
Assessment of intubating conditions with propofol versus different concentrations of ketofol without muscle relaxation
Omyma Sh M Khalifa, Abeer A M Hassanin
October-December 2014, 7(4):518-523
DOI:10.4103/1687-7934.145688  
Context Ketofol is a new combination formed by mixing ketamine and propofol. Little is known about its intubating characteristics, and therefore this study was conducted to evaluate and compare intubating conditions with propofol versus different concentrations of ketofol without muscle relaxation. Settings and design It was a randomized double-blind study. Patients and methods A total of 60 patients, with ASA I or II status, aged 18-45 years were randomized into three equal groups of 20 patients each. Propofol 'P group' received 2.5 mg/kg propofol, ketofol 2 'keto2 group' received ketofol in concentration 1 : 2, and ketofol 4 'keto4 group' received ketofol in concentration 1 : 4. Hemodynamic and intubating conditions in the form of jaw relaxation, vocal cord position, and intubating response were assessed. Results There was a significant difference in the intubation score (including jaw relaxation, vocal cord position, and intubation response) between the keto2 and keto4 groups when compared with the P group, with the most acceptable intubating condition observed in the keto4 group. Although a good intubation score was detected in the three groups, the grading of this score was different. Comparison of blood pressure and heart rate between groups showed no significant difference. Conclusion Good intubating conditions without using muscle relaxant are possible with 2.5 mg/kg propofol, ketofol in concentration 1: 2 and 1: 4, with the best intubating score in ketofol concentration 1: 4 group. In addition, more hemodynamic stability was achieved in both the ketofol groups
  1 2,097 218
Palatal lidocaine gel as an adjuvant to propofol versus propofol only for sedation during upper gastrointestinal tract endoscopy: a comparative study
Mahmoud Ghallab, Rania M Hussien, Ghada M Samir, Dalia A Ibrhaim
October-December 2014, 7(4):524-529
DOI:10.4103/1687-7934.145693  
Background Lidocaine gel is a palatable preparation of lidocaine 2% that is produced by Amoun Pharmaceutical Co. (Cairo, Egypt). Aim The aim of the study was to evaluate the efficacy of palatable lidocaine gel as an adjuvant to propofol for anesthesia during upper gastrointestinal tract endoscopy in terms of propofol consumption, ease of performance of the procedure, and recovery time. Patients and methods A prospective randomized clinical study was conducted on 100 patients undergoing diagnostic esophagogastroduodenoscopy in Ain Shams University hospitals, who were randomized into two groups of 50 patients each. In the first group (X group), 15 mg of palatable lidocaine gel together with intravenous sedation using propofol was used, whereas in the control group (C group) intravenous sedation with propofol only was given. Measurements in both groups included propofol consumption as well as the incidence of apnea and hypoxia, recovery time, and both endoscopist and patient satisfaction. Results Patients in the palatable lidocaine gel group (X group) tolerated the procedure better than those in the control group (C group). The endoscopists encountered less difficulty performing the procedure in the X group. In addition, propofol consumption and the incidence of apnea and hypoxia were lower in the X group, and recovery time was significantly shorter in the X group. The patients in the X group were more satisfied with the mode of anesthesia they received as compared with patients in the C group. The endoscopists were equally satisfied with the mode of anesthesia in both groups. Conclusion The use of palatable lidocaine gel in esophagogastroduodenoscopy decreases propofol consumption, shortens recovery time, and improves patient comfort and tolerance to the procedure, and also reduces the cost.
  1 2,127 197
The effect of adding ketamine to bupivacaine in spinal anesthesia in day-case surgery
Manal M Kamal, Dalia El-Fawy
October-December 2014, 7(4):530-533
DOI:10.4103/1687-7934.145697  
Objectives In this paper, we evaluate the effect of adding ketamine to spinal anesthesia in day-case surgery with regard to the time of onset of block, the duration of the block, hemodynamic variables, postoperative time to full motor power, time to walking, and side effects. Materials and methods Sixty patients scheduled for day-case surgeries under spinal anesthesia were studied in a prospective double-blinded randomized manner. Patients were allocated to receive either 3 ml hyperbaric bupivacaine (0.5%) (group I) or 2 ml hyperbaric bupivacaine (0.5%) combined with ΍ ml ketamine (25 mg) + ΍ ml normal saline (group II). Results The onset time and the duration of the block were shorter in group II than in group I. The postoperative time to walking, the time to full motor power recovery, and the duration of spinal analgesia were shorter in group II. There were no significant differences in hemodynamic variables or side effects. Conclusion Ketamine added to hyperbaric bupivacaine in spinal anesthesia provides a shorter time of onset of block, a shorter duration of the block, and a shorter time to full motor power and to walking postoperatively in day-case surgery.
  1 3,849 380
CASE REPORTS
Sheehan's syndrome with acute renal failure and severe preeclamptic toxemia
Bahaa El-Din Ewees, Hatem S Abdel Hamid
October-December 2014, 7(4):550-553
DOI:10.4103/1687-7934.145720  
Sheehan's syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, which generally occurs after an intrapartum or postpartum bleeding episode characterized by severe hypertension or hemorrhagic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with an early diagnosis of early onset Sheehan's syndrome associated with severe preeclamptic toxemia complicated by acute renal failure.
  - 2,323 188
Anesthetic management of a patient with β-thalassemia and superimposed pneumonia
Anuka Singh, Veena Kachwah, Sheetal Songir, Hemendra Modi
October-December 2014, 7(4):554-556
DOI:10.4103/1687-7934.145725  
Beta-thalassemia is an autosomal hematological disorder that is the result of genetically deficient synthesis of beta-globin chains of hemoglobin. Beta-thalassemia is one of the most common single-gene disorders with >400,000 new borns affected per year worldwide. Patients present with severe microcytic hypochromic anemia, massive hepatosplenomegaly, and bony deformities. Infection is a major complication and the leading cause of death in thalassemia out of which Pulmonary disease was the most common cause of mortality. In this report we aimed to discuss our experience with a case of beta-thalassemia major with massive splenomegaly & superimposed pneumonia in a child presenting for splenectomy.
  - 5,920 431
Anesthesia in an adult patient with patent ductus arteriosus
Hemlata Kapoor, Mohan K Terdal, Meenal Zamre
October-December 2014, 7(4):557-560
DOI:10.4103/1687-7934.145727  
The survival rate of neonates with congenital heart disease has increased manifold due to advancement in both surgical and medical management. A small percentage of adults present with unrepaired or inadequately repaired congenital cardiac defects. They pose a challenge on the operation table due to altered hemodynamics. A comprehensive understanding of the congenital defect and an apt plan of anesthesia are essential for successfully managing such patients.
  - 3,583 286
LETTERS TO THE EDITOR
Nothing matters when you cannot breathe
Alka Chandra
October-December 2014, 7(4):471-472
DOI:10.4103/1687-7934.145658  
  - 1,289 289
Negative pressure pulmonary edema on induction with face mask
Nita Hazarika, Namita Saraswat, Rajesh Sood
October-December 2014, 7(4):473-474
DOI:10.4103/1687-7934.145661  
  - 1,430 271
ORIGINAL ARTICLES
Euglycemic control: does it affect the incidence of chest infection in ICU patients?
Hesham M Elazzazi, Mahmoud M Okasha
October-December 2014, 7(4):504-508
DOI:10.4103/1687-7934.145681  
Background Acute hyperglycemia in ICU patients is associated with increased risk of nosocomial infections by raised plasma levels of proinflammatory cytokines, stimulates muscle protein degradation, and inhibits protein synthesis, which could contribute to muscle wasting. Euglycemic control with insulin reduced septicemia and the need for prolonged antibiotic therapy, prevented nosocomial infection, accelerated resolution of inflammation, and reduced muscle catabolism. Patients and methods A total of 200 patients of both sex, diabetic or nondiabetic, aging between 20 and 70 years, admitted to the ICU of Ain Shams University Hospitals for more than 2 days who gave written and informed consent, were enrolled in the study. Age, sex, clinical assessment for chest infection, C-reactive protein, chest radiography, random blood sugar, HbA1C, and serum K + were recorded at the time of ICU admission. Patients were divided into two groups according to patient approval. Group I includes euglycemic control group (n = 100 patients), in which blood sugar was kept between 100 and 120 mg/dl using regular insulin infusion; and group II (n = 100 patients), in which the standard of care was an intravenous insulin infusion titrated to maintain blood glucose between 120 and 180 mg/dl. Blood sugar was measured every 1 h in both groups; indicator of chest infection (clinical sings, C-reactive protein, and chest radiography) was carried out daily. Results Regarding all demographic data (age and sex), there were no statistically significant differences between the studied groups (P = 0.744 and 0.730, respectively). With regard to the duration of ICU stay, there was a statistically significant higher rate of ICU stay for more than 7 days among patients of group II (P < 0.001). Comparing between the incidence of chest infection in group I and group II, there was low incidence of chest infection in group I [four patients (4%)], whereas 18 patients (18%) of group II (22 of 200 patients) showed chest infection (P = 0.003). Conclusion We concluded that euglycemic control reduces the incidence of chest infection in ICU patients.
  - 1,334 147
Pressure support ventilation versus spontaneous ventilation in infants undergoing brachial plexus exploration: a comparative study
Sherif M Soaida, Maha G Hanna, Maha M I Youssef, Mostafa Mahmoud
October-December 2014, 7(4):509-513
DOI:10.4103/1687-7934.145683  
Background General anesthesia and muscle relaxants have the potential to decrease or even abolish action potentials, interfering with surgical nerve exploration. Prolonged surgeries in spontaneously breathing infants lead to muscle fatigue, shallow breathing, and CO 2 accumulation. This randomized study aimed to evaluate the efficiency of pressure support ventilation (PSV) in infants undergoing brachial plexus exploration without muscle relaxants in maintaining normal end-tidal CO 2 (EtCO 2 ) and hemodynamics. Patients and methods After the approval of the ethical committee in Kasr Al Ainy University Hospital, and parents' consent, 16 ASA I and II infants (4-12 months) were allocated randomly to two main groups. In group I, PSV was used from the start. In group II, spontaneous ventilation was started, followed by switch to PSV once fatigue occurred; group II was subdivided into group IIa (spontaneous ventilation) and group IIb (PSV). Recorded variables included tidal volume, EtCO 2 , oxygen saturation, respiratory rate (RR), heart rate (HR), blood pressure, and arterial blood sample analysis. Results Systolic and diastolic blood pressure and HR were higher in group IIa than group I (P = 0.0047, 0.0135, and 0.3575, respectively). EtCO 2 and RR were also higher (P < 0.05). Vt was higher in group I (P = 0.0092). Comparing groups IIa and IIb, systolic and diastolic blood pressure, HR, RR, EtCO 2, and PaCO 2 were significantly higher in group IIa (P < 0.05). Vt was higher in group IIb (P = 0.0053). Conclusion PSV in infants undergoing prolonged surgery without muscle relaxants is efficient in maintaining normal EtCO 2 and hemodynamics through avoidance of fatigue and maintaining normal Vt .
  - 1,587 131
Neurological outcome of normothermic versus hypothermic cardiopulmonary bypass in simple congenital heart diseases
Amal R Reyad, Mohamed Adel F Elgamal
October-December 2014, 7(4):491-496
DOI:10.4103/1687-7934.145675  
Objective We hypothesized that normothermic cardiopulmonary bypass (CPB) may provide equivalent results to hypothermic CPB on neurological outcome. Patients and methods Forty patients were randomized to one of two groups: group 1 that underwent normothermic CPB (>35°C) and group 2 that underwent mild hypothermic CPB (32°C). Perfusion on bypass was performed by a nonpulsatile pump flow with an average flow rate around 2.4 l/m 2 /min. A pH-stat carbon dioxide management strategy was used. The arterial and jugular venous blood gases, mean cerebral blood flow velocity (CBFV), and pulsatile index were measured as basal, after induction of anesthesia, at the onset of CPB, 20-30-40 min after the CPB, at the cessation of CPB, and at the end of the operation. Neurological outcomes were assessed by computed tomography scanning and Wechsler Preschool and Primary Scale of Intelligence preoperatively, at the third postoperative day and 1 month after surgery. Postoperative ICU variables such as duration of mechanical ventilation, time to extubation, and ICU length of stay were recorded. Results There was a significant increase in SjvO 2 and decrease in CeO 2 in the hypothermia group of patients after establishment of hypothermia by 10 and 20 min when compared with the normothermic group (P < 0.05 and <0.01, respectively). The CeO 2 was maximal during normothermic CPB and after rewarming phase of hypothermic CPB. There were no significant changes in computed tomography scanning and Wechsler Preschool and Primary Scale of Intelligence between the studied groups at any time period. There was significant prolongation in duration of postoperative mechanical ventilation, extubation time, and duration of ICU stay in the hypothermic group of patients compared with the normothermic group (P < 0.05). Conclusion During CPB for correction of congenital heart defects, the normothermic and hypothermic CPB were comparable with respect to the neurological outcome. However, normothermia permits shorter time on mechanical ventilation, more rapid extubation, and shorter ICU stay time compared with hypothermia.
  - 1,609 161
Usefulness of preoperative color Doppler study in chronic renal failure patients undergoing renal transplantation having internal jugular vein thrombosis: anesthesiologist's perspective
Manisha P Modi, Kalpana S Vora, Geeta P Parikh, Pranjal R Modi, Veena R Shah
October-December 2014, 7(4):497-499
DOI:10.4103/1687-7934.145676  
Aim The aim of the study was to identify the prevalence of internal jugular vein (IJV) thrombosis and usefulness of preoperative color Doppler study in chronic renal failure patients undergoing live related renal transplant surgery. Materials and methods Two hundred and fifty adult patients of either sex having history of prolonged IJV cannulation were enrolled in this study. They were advised to undergo Doppler neck vessels study. Normal IJV was used to measure central venous pressure during renal transplantation surgery. Results Results are shown as mean±SD. Two hundred and fifty adult patients were included in the study, aged 36 ± 12 years. All patients were cannulated with Mahorkar 16 Fr double-lumen catheter. Duration of catheterization was 52.38 ± 18.91 days. Of the 250 patients, 50 were female patients. The cause of removal was infection, blockage, or maturation of arteriovenous fistula. All patients were clinically asymptomatic. Color Doppler study showed chronic thrombosis either complete/partial in 93 (37.2%) patients. Five (2%) patients had bilateral thrombosis, 80 (86%) patients had partial thrombosis, and 13 (14%) patients had complete thrombosis. The incidence and prevalence were 0.62 and 37.2%, respectively. Right IJV was the common site for insertion [right: 70 (75.2%) and left: 23 (24.7%)]. Conclusion To prevent inadvertent catheter placement and embolism, all patients having history of prolonged IJV cannulation should undergo preoperative color Doppler study.
  - 1,909 125
Dexmedetomidine versus clonidine as an adjunct to intrathecal small dose ropivacaine in patients undergoing transurethral resection of prostate
Satish Dhasmana, Vinita Singh, Rajesh Raman, Mahendra Pal
October-December 2014, 7(4):534-538
DOI:10.4103/1687-7934.145705  
Context It is important to limit the cephalad spread of local anesthetic above T10 dermatome during spinal anesthesia in patients undergoing transurethral resection of prostate (TURP). This can be achieved by using small dose of local anesthetics in combination with intrathecal additives such as α2 -agonists, which improve the quality of block without altering the height of block. Aims The aim of the study was to compare dexmedetomidine and clonidine when added to intrathecal ropivacaine in patients undergoing TURP. Settings and design The study was designed as a prospective, randomized, and double-blind study. Materials and methods Fifty patients of ASA grade I-III, scheduled for elective TURP, were allocated into two groups. Group I received 7.5 mg ropivacaine+15 μg clonidine and group II received 7.5 mg ropivacaine+5 μg dexmedetomidine. Spinal anesthesia was administered in the sitting position after preloading the patients with 10 ml/kg Ringer's lactate. Onset, duration, and peak sensory level, intensity of motor block, and analgesic requirements were recorded. Results Patients in both groups had comparable baseline and demographic characteristics. Peak sensory block was similar in both groups. Patients in group II had faster onset and longer duration of sensory block. Intensity and duration of motor block were also greater in group II. The quality of intraoperative and postoperative analgesia was better in group II. Conclusion Intrathecal dexmedetomidine with ropivacaine provides faster onset, better operating conditions, and patient comfort in patients undergoing TURP. However, it is associated with delayed motor recovery.
  - 1,965 216
Ultrasound-guided transversus abdominis plane block for radical cystectomy with and without dexamethasone: a prospective, double-blinded controlled trial
Waleed Abdalla
October-December 2014, 7(4):539-544
DOI:10.4103/1687-7934.145709  
Introduction Poor control of pain after major abdominal surgeries is associated with a variety of unwanted consequences. The transversus abdominis plane (TAP) block provides analgesia to the parietal peritoneum and to the skin and muscles of the anterior abdominal wall. Different adjuvants including dexamethasone have been used to intensify the quality and increase the duration of local anesthetics. The aim of the study was to assess the efficacy of TAP block and to measure the effect of adding dexamethasone to bupivacaine on the quality of TAP block. Patients and methods Ninety ASA I-III patients, scheduled for radical cystectomy under general anesthesia, were enrolled in the study and were divided into three groups: group I was given TAP block with 20 ml 0.25% bupivacaine + 2 ml dexamethasone (8 mg)/side (n = 30); group II was given TAP block with 20 ml of 0.25% bupivacaine + 2 ml saline 0.9%/side (n = 30); and group III was given general anesthesia without TAP block (n = 30). The primary outcome was postoperative pain evaluated using the visual analogue scale (VAS) score for pain at 2, 4, 6, 12, and 24 h postoperatively, whereas the secondary outcome was the time to first analgesia (TFA), morphine consumption, and incidence of nausea or sedation. Results Adding dexamethasone to bupivacaine compared with bupivacaine alone resulted in a reduction in the postoperative VAS for pain score, a longer TFA (220.5 ± 25.02 vs. 140.54 ± 15.12 min, P < 0.001), and lesser 24-h morphine consumption (5.11 ± 3.01 vs. 17.20 ± 7.75 mg, P < 0.001). The bupivacaine TAP group compared with the control group showed a significant reduction of the VAS pain score, a longer TFA (140.54 ± 15.12 vs. 35.055 ± 4.15 min, P = 0.01), and lesser 24-h morphine requirement (17.20 ± 7.75 vs. 27.58 ± 8.41 mg, P < 0.001). Both TAP block groups compared with the control group showed a significant reduction of nausea and a lower incidence of sedation. Conclusion TAP block with bupivacaine provided better analgesia with fewer side effects compared with conventional systemic analgesia. Adding dexamethasone to bupivacaine in TAP block added better analgesic effect.
  - 2,642 711
The effect of addition of different doses of ondansetron to lidocaine as a component of intravenous regional anesthesia: a randomized double-blinded controlled study
Nahla S El Bahnasawy
October-December 2014, 7(4):545-549
DOI:10.4103/1687-7934.145713  
Background The aim of this study was to evaluate and compare the analgesic effect of adding two different doses (4or 8 mg) of ondansetron to lidocaine for intravenous regional anesthesia (IVRA). Patients and methods Ninety-nine patients were randomly assigned into three groups. IVRA was achieved with lidocaine 3 mg/kg 0.5% (C group) (n = 33), lidocaine 3 mg/kg 0.5% plus 4 mg ondansetron (O1 group) (n = 33) or lidocaine 3 mg/kg 0.5% plus 8 mg ondansetron (O2 group) (n = 33). Times of onset and offset of sensory and motor blockade and the time of tourniquet pain were recorded. Postoperative visual analogue scale, time to first dose, and total amount of supplementary analgesia (diclofenac) were recorded. Results Significantly shorter onset times and longer recovery times of sensory and motor block were recorded in groups O1 and O2 compared with group C (P < 0.05) with no significant difference between groups O1 and O2. Delayed onset of tourniquet pain occurred in groups O1 and O2 compared with group C (P < 0.05) with a significant difference between groups O1 and O2. Eighteen patients required intraoperative fentanyl to control tourniquet pain in group C compared with 10 patients in group O1 and three patients in group O2, respectively. A significantly lower postoperative visual analogue scale score, a longer time to first dose and lower consumption of diclofenac were recorded in groups O1 and O2 compared with group C with a significant difference between groups O1 and O2. No adverse effects were noted in any patients. Conclusion Addition of ondansetron to lidocaine enhanced the performance of lidocaine when used in IVRA, prolonged postoperative analgesia and reduced intraoperative and postoperative analgesia. However, adding 8 mg ondansetron to lidocaine provided better analgesia than 4 mg.
  - 1,965 200
REVIEW ARTICLES
Ovarian hyperstimulation syndrome
Hatem S Abdel Hamid, Aasem Moharram, Rania Magdy
October-December 2014, 7(4):475-479
DOI:10.4103/1687-7934.145665  
Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation induction (OI) therapy. Severe OHSS is estimated to occur in around 1% of all gonadotropin cycles. It is characterized by cystic enlargement of the ovaries and transudation of fluid and proteins from the intravascular compartment into the third space due to increased capillary permeability, considered as a potentially fatal complication of ovarian stimulation. This article aims to revise recent data and trends in the diagnosis and treatment of this potentially serious complication of a rapidly expanding therapy.
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Peripartum cardiomyopathy
Hatem Said, Amr Sobhi
October-December 2014, 7(4):480-484
DOI:10.4103/1687-7934.145670  
Peripartum cardiomyopathy (PPCM) is a rare disorder of dilated cardiomyopathy in which no other cause of heart dysfunction can be identified within the final trimester of pregnancy or within 5 months after delivery. It is relatively rare but can be life threatening. The National Hospital Discharge Survey (1990-2002) estimated that it occurs in one in every 2289 live births in the USA. The disease appears to be more common in African-American women. So this study aims to summarize the most recent management plans in the face of this serious and, relatively not uncommon, complication.
  - 2,551 340
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