Background Dexmedetomidine is a highly selective alpha 2-adrenergic receptor agonist, among the most elevated receptor densities located in the pontine locus coeruleus-an essential nucleus involved in the regulation of sympathetic nervous system activity. Labetalol lowers blood pressure primarily through alpha 1-adrenergic blockade, reducing systemic vascular resistance, while simultaneously attenuating reflex tachycardia via its beta-adrenergic blocking properties. This research aimed to evaluate and contrast the effectiveness of dexmedetomidine and labetalol in achieving controlled reduction of BP during DCR surgery. Methodology A prospective, randomized, and comparative investigation was carried out involving 50 participants classified as ASA physical status I or II, according to the ASA, who were enrolled to have DCR surgery under general anesthesia with endotracheal intubation. Participants were randomly placed into two groups (GPs): Gp D received intravenous dexmedetomidine, while Gp L received intravenous labetalol. Results The average intraoperative MAP and HR, as well as values recorded after extubation, were significantly reduced in GP D versus GP L (P<0.05). Additionally, the VAS pain scores at 1, 2 and 3 hours postoperatively were notably reduced in GP D than in GP L (P<0.05). However, at 4 hours postoperatively, VAS scores were notably elevated in GP D versus GP L (P<0.05). Conclusion Dexmedetomidine offers more effective controlled hypotension in participants undergoing DCR surgery, with significantly lower postoperative pain scores compared to labetalol, while showing no significant differences in surgical field quality or drug-related side effects.
Background Modern heart failure management has been transformed by ARNIs (Sacubitril/Valsartan) and SGLT2 inhibitors, which significantly reduce mortality compared to traditional therapies. However, their use during CABG surgery is controversial. While these drugs offer long-term benefits, they carry perioperative risks like vasoplegia or ketoacidosis. Conversely, emerging evidence suggests that maintaining these therapies may actually pre-condition the heart, potentially improving recovery and reducing postoperative hemodynamic instability. Aim To assess the efficacy and safety of sacubitril/valsartan compared to dapagliflozin in improving myocardial function and postoperative hemodynamic performance in patients with ischemic cardiomyopathy undergoing CABG. Methods This Randomized, double-blind, pilot trial enrolled 30 patients with ischemic cardiomyopathy and type 2 diabetes mellitus who were scheduled to undergo elective CABG. The patients were divided into two groups. The first group was administered a dosage of 200 mg of sacubitril/ valsartan twice daily, while the second group was administered 10 mg of dapagliflozin once daily for a period of one month prior to surgery. Transthoracic echocardiography was used to assess the ejection fraction (EF) prior to treatment, preoperatively, and postoperatively. Furthermore, hemodynamic parameters and inotropic support requirements were monitored during the first 24 hours postoperatively. Results Baseline demographic and clinical characteristics were comparable between groups. There were no statistically significant differences in EF between groups at baseline, preoperative, or postoperative assessments. Postoperative heart rate, mean arterial blood pressure, and the need for inotropic support with Levophed (nor-epinephrine bitartrate) and epinephrine were comparable in both groups. Conclusion Both sacubitril/valsartan and dapagliflozin were well tolerated in patients with ischemic cardiomyopathy undergoing CABG. While no statistically significant differences were found, sacubitril/valsartan demonstrated a consistent trend toward improved hemodynamic stability and reduced inotropic requirements. Larger trials are warranted to validate these findings and determine clinical superiority.
Background The External Oblique Intercostal plane (EOI) block is an innovative regional anesthesia technique with significant potential for alleviating pain following upper abdominal procedures. Objective To compare the analgesic effect of EOI in postoperative analgesia in upper abdominal surgeries with patient control analgesia. The 2ry objective was to evaluate total postoperative opioid usage, incidence of postoperative nausea and vomiting and the time until the initial request for analgesia as measured by the visual analogue scale (VAS). Methods This prospective, randomized research involved 40 patients underwent surgeries with subcostal incisions. Participants have been allocated into two groups: Group EOI (n= 20) received ultrasound-guided external oblique intercostal plane block and Group PCA (n=20) received patient-controlled analgesia postoperatively. Standardized general anesthesia was administered to all patients. Postoperative analgesia, opioid consumption, pain scores (VAS), and complications were recorded and compared among the two groups over a 24-hour period. Results We found that total nalbuphine consumption, which was statistically lower in EOI block group than PCA group (13.75 +/- 4.28 vs 78.80 +/- 2.19, p= 0.001). Additionally, the 1st call to rescue analgesia (hours) was longer in EOI (6.45 +/- 1.28 VS 1.23 +/- 0.55) than in PCA groups. Conclusion for upper abdominal operation the EOI provided effective postoperativeanalgesia and decreased the opioid consumption.
Background Magnetic resonance imaging (MRI) is regularly used to identify or rule out the presence of abnormalities in the central nervous system of children. Objective We compared Melatonin and Chloralhydrate in combination with nasal sevoflurane in children undergoing brain MRI. Despite their frequent use for pediatric sedation, their comparative effectiveness has not been adequately evaluated. This study addresses this gap by comparing both. Methods This randomized controlled trial included 60 male and female participants classified as American Society of Anesthesiologists class I-II, scheduled to undergo a Brain MRI. The subjects were randomly assigned into two groups, each consisting of 30 individuals. Group A received oral Melatonin and nasal Sevoflurane, while Group B received oral Chloralhydrate and nasal Sevoflurane. The primary outcome was Ramsey sedation scale. The secondary outcome comprised duration required to achieve full sedation, the need to use rescue medication, the count of patients who achieved sleep, Sevoflurane concentration, time taken to wake up. Results The analysis showed no significant differences in the number of children who achieved sleep, Ramsay score, and the use of rescue medication. Sevoflurane levels exhibited significant elevation in Group A compared to group B. Sedation occurred more slowly in Group A than in Group B, but the differences were clinically insignificant. However, the Group A participants had significantly faster wake-up time than Group B (p<0.001). Conclusion For children undergoing brain MRI, Melatonin combined with nasal Sevoflurane is a comparable anesthetic technique when compared to Chloralhydrate combined with nasal Sevoflurane. It provides faster recovery.
Background Sepsis, a life-threatening organ dysfunction caused by an uncontrolled immune response to infection, affects millions of people worldwide annually. Early detection and management in the first few hours can improve outcomes. This study aimed to investigate the relationship between sepsis-associated scoring systems and sepsis in BSI patients and the bacterial profiles. Methods In this retrospective cohort study, we gathered data from the hospital's e-medical records from January 2020 to December 2023. Adult patients with positive aerobic blood cultures met the inclusion criteria. Bacterial identification was performed using the BD BACTECTM, Vitek 2 (bioM & eacute;rieux), and MALDI Biotyper (BD-Bruker). Bivariate analysis was used to examine the association between age, gender, kind of bacteria, SIRS, qSOFA, NEWS, treatment room and sepsis, length of stay (LOS), death. Results Sepsis was significantly associated with SIRS (p= 0.00001), NEWS at low, medium, and high scores (p= 0.0001), qSOFA (p= 0.00001), and ICU patients (p= 0.017). There was a significant association between LOS and NEWS (p= 0.015). NEWS at a medium score was significantly associated with death (p= 0.025). 53.3% of the isolates were Gram-negative. 46.9% of the isolates were multidrug-resistant organisms (MDROs), including ESBLproducing K. pneumoniae (81.57%), ESBL-producing E. coli (76.81%), MRSA (63.15%), and carbapenem-resistant A. baumannii (59.45%). Conclusion There was a significant association between NEWS, SIRS, qSOFA, ICU patients, and sepsis. NEWS was found to have a significant association with both LOS and death. CRAB, ESBLproducing E. coli, ESBL-producing K. pneumoniae, and MRSA were all prevalent.
Background The intertransverse process block (ITPB) has been successfully used for various indications such as unilateral chest trauma and unilateral mastectomy, but not for herpes zoster (HZ), for which the paravertebral block (PVB) is a commonly employed technique. We evaluated the efficacy of ITPB in relieving acute HZ-related pain and, preventing postherpetic neuralgia (PHN) in comparison to PVB. Methods This parallel-group randomized controlled study involved 36 adults over the age of 50 with chest wall herpetic eruptions causing moderate to severe pain lasting less than a week. All patients received antiviral treatment within 72 hours. Participants were randomly assigned to one of two groups (ITPB or PVB) using a block randomization method. Pain was assessed using the Numerical Rating Scale (NRS), and the occurrence of PHN was monitored in all patients. Results Regarding the NRS, this study found no statistically significant interaction effect between group and time. Accordingly, the main effects of group and time were reported. Pain scores improved over time in both groups, with no statistically significant difference between them. PHN occurred after 3 months in 3 out of 18 patients (16.7%) in the ITPB group and in 4 out of 18 patients (22.2%) in the PVB group; this difference was not statistically significant (p>0.05). Conclusion ITPB may be comparable to PVB in managing pain associated with herpes zoster and in reducing the incidence of postherpetic neuralgia.
Background Brain injuries induce a progressive loss of muscle mass, and muscle atrophy is a serious complication in patients after head trauma. Muscle atrophy can reach 15.0%-20.8% within the two weeks following stroke and persist for many years after hospital discharge. The aim of this work was to investigate the potential of urinary Titin N-Fragment as a novel biomarker for muscle atrophy in patients with brain injury in the intensive care unit (ICU). Methods This prospective observational study was carried out on 55 adult patients presented to ICU >= 48 hours with isolated brain injury. Results Urinary N-titin levels increased significantly over the first week (42.4 +/- 3.3 to 61.0 +/- 10.3pmol/ mg Cr; 43.2% increase, P<0.001), paralleled by a significant decline in rectus femoris crosssectional area (RF CSA) (5.3 +/- 0.4 to 3.6 +/- 0.7cm2; 31% loss, P<0.001). Mortality reached 38.2%, and overall percentage changes in both N-titin and CSA demonstrated prognostic accuracy for death (AUC= 1.0). Conclusion Urinary titin N-fragment effectively reflected early muscle catabolism in brain-injured ICU patients. Its utility lay in monitoring ICU-AW progression rather than serving as a standalone prognostic tool.
