Hassan Mohamed Ali

Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial

Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns.

Using dexamethasone as an adjuvant to levobupivacaine in epidural anesthesia to change the pain intensity and duration in painless labor

Background and Objective: This is a randomized controlled trial aiming at comparing the effectiveness of levobupivacaine alone versus a levobupivacaine with dexamethasone in the epidural injection for painless labor. Patients and Methods: This is a comparative randomized controlled double-blinded clinical trial with 49 patients were included in this study, all of them were primigravidas and were during vaginal delivery with a cervical dilatation ≥4 cm. Patients were included randomly in one of two groups either Group C (26 cases) with epidural levobupivacaine 0.125% in normal saline or Group D (23 cases) with epidural levobupivacaine 0.125% in normal saline combined with dexamethasone 8 mg. The duration of a second dose request, total dose given, neonatal outcome and adverse effects of epidural were recorded. Results: Group D showed a longer duration of analgesia than Group C (80.5 ± 12.39 min in Group D vs. 61.75 ± 10.74 min in Group C) with a P < 0.05 (0.001). Furthermore, the patients in Group D received smaller dose of levobupivacaine than those in Group C with a statistically significant difference (90.87 ± 33.42 vs. 127.21 ± 40.68 mg with P = 0.002). There were no statistical differences between the two groups regarding hemodynamics, pain score, neonatal outcome, and complications. Conclusion: Dexamethasone in epidural analgesia for painless labor has a prolonged duration of analgesia with no complications for both the mother and the infant.

Cervical epidural puncture guided by fluoroscopy in comparison to acoustic signals: Clinical results

Background and Aim: The increasing cases of the cervical epidural but the practitioners in need for a new method to decrease the safety of the injection and to improve the learning curve of the trainee. Furthermore, it should replace the potentially hazards, conventional one, which is the fluoroscope. Acoustic signals were tested for this purpose. Methods: Thirty-two patients were assigned to have a cervical epidural for pain management using both acoustic signals and fluoroscopy simultaneously. Results: The incidence of success was 100% with no complications. Likewise, the decrease in fluoroscopy shots number was 70%. Conclusions: Acoustic signals are a simple, effective method of cervical epidural insertion. It reduces the usage of fluoroscopy and can be used as a learning tool.

Effect of single compared to repeated doses of intravenous S(+) ketamine on the release of pro-inflammatory cytokines in patients undergoing radical prostatectomy

Background: Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Patients and Methods: This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery. Results: The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml (P < 0.05). Conclusion: S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.

Sonographic evaluation of internal jugular vein diameter and cross-sectional area measurements in correlation with left ventricular end diastolic area as a tool for perioperative assessment of volume status in pediatric patients undergoing cardiac surgery

Aim: The aim of this study is to compare the ultrasound estimation of the cross-sectional area (CSA) and diameter of internal jugular vein (IJV) with left ventricular end diastolic area (LVEDA) for the assessment of intravascular volume in pediatric patients during cardiac surgery. Patients and Methods: The CSA and diameter of the left IJV were defined, using ultrasound machine, and compared with LVEDA, estimated by transesophageal echo, in four times intervals (immediately after induction [T1], before the start of cardiopulmonary bypass [CPB] [T2], immediately after weaning of CPB [T3], and at the end of surgery before transfer to the Intensive Care Unit [T4]) as a tool for intravascular volume assessment in 16 pediatric patients undergoing cardiac surgery. Results: There was a poor correlation between IJV CSA and diameter with LVEDA. r values were 0.158, 0.265, 0.449, and 0.201 at the four time intervals (T1, T2, T3, and T4), respectively. Conclusion: Estimation of the CSA and diameter of the left IJV using ultrasound is not reliable and cannot be used alone to decide further management.

Mixed-mode self-calibrated amplitude control scheme for MEMS vibratory gyroscopes

In this paper, a mixed-mode self-calibrated Automatic Gain Control (AGC) loop for MEMS applications is introduced. In MEMS-based vibratory gyroscope systems, an AGC is used to regulate the vibration amplitude of an inertia mass. Traditional analog AGCs suffer from a limited control range or bulky elements. Here, we present a low gain P-controller (Fine tuning) with digitally-controlled dynamic bias (Coarse tuning) for the AGC loop. The dynamic bias compensates for the low loop gain through the AGC and is generated using an error sense ADC. This approach achieves more than 9bits of uncalibrated oscillation amplitude accuracy over PVT without the need for trimming the gyroscope actuation gain. The power consumption of the designed main amplitude control circuitry is less than 200μW. The overall circuit was built using a standard 0.13μm CMOS technology.

Evaluation of deep topical fornix block versus topical anesthesia in patients undergoing implantable collamer lens procedure

Abstract Background and aim Local anesthesia nowadays became more popular in the ophthalmic surgery, especially in implantable collamer lens (ICL) procedure, with fewer complications and more patient satisfaction. Here we design a study to evaluate deep topical fornix nerve block (DTFNBA) versus topical anesthesia. Methods A double blinded randomized prospective controlled study of 107 eyes that were scheduled for implantable collamer lens procedure was included and divided randomly into two groups, group I topical anesthesia (n = 53), group II DTFNBA (n = 54). The two groups were monitored for pain and patient compliance. Results In group I, receiving topical anesthesia 27 patients (50.09%) reported pain, especially with implantation of the lens, tucking of the lens footplates and peripheral iridectomy that necessitated intracameral lidocaine injection. The others (n = 26) showed different grades of discomfort that was tolerated without the need for intracameral lidocaine. 40 patients (74.07%) in group II (DTFNBA), tolerated the surgery well, and slight discomfort was reported as a sensation of heaviness during the tucking of footplates. None of the patients had pain strong enough to require intracameral injection of lidocaine (p < 0.05). Conclusions Placing the anesthetic in the fornix makes the DTFNBA more effective and reliable block.

Comparative study of hyoscine doses as antisialagogue for patients receiving ketofol sedation undergoing colonoscopy procedures

Objective: To compare the effects of different regimens of hyoscine as antisialagogue in patients undergoing ketofol sedation for colonoscopy procedures. Patients and Methods: In this prospective double-blind randomized controlled trial 200 American Society of Anesthesiologists I-II aged 20–60-year-old undergoing colonoscopy were randomly assigned into four equal groups, group A received 5 mg hyoscine intravenous, group B received 10 mg, group C received 20 mg intravenous, and control group (D) that was received saline. All patients were sedated using ketofol titrated to achieve Ramsey Sedation Score 4, hemodynamic variables and occurrence of increased secretions were evaluated and recorded. Results: Hyoscine in a dose of 10 mg was the optimum dose to achieve least salivation with the least side effect while hyoscine 5 mg was not efficient to achieve dry field or good surgical conditions. However, hyoscine 20 mg achieved dry field and fair surgical conditions in expenses of tachycardia. Conclusion: Hyoscine 10 mg was the least effective dose that significantly reduced hypersalivation in patients receiving ketofol sedation for colonoscopy procedures, this dose was as effective as 20 mg in draying secretion but with significantly less tachycardia.

Difficult airway in a pediatric case of pycodysostosis

Pycodysostosis is a genetic autosomal rare disease with an incidence of 1:1.7 million births; the pathophysiology of the disease is related to mutation of cathepsin K gene. Sleep apnea, respiratory difficulties because of chest and oral abnormalities may cause a challenge to the anesthetist during intubation and/or mechanical ventilation. In this case report we will discuss a case of pycodysostosis with a difficult airway.

Postdural puncture headache after spinal anesthesia in cesarean section: Experience in six months in 2736 patients in Kasr El aini teaching hospital – Cairo University

Abstract Background This is a prospective, single-blinded observational study examined the frequency and severity of postdural puncture headache in the Egyptian female patients following spinal anesthesia for cesarean section. Method All the females scheduled for cesarean section under spinal anesthesia in Cairo university were included and divided into two groups, one with Quinke needle G22 and one with Quinke needle G20, both groups were followed up for 7 days regarding incidence and severity of PDPH. Result The overall incidence of postdural puncture headache was 32.58% in group with Quinke needle G22, while it was 32.86% with the group used Quinke needle G20, PDPH almost relived by the fifth day in both groups, patients rated their headache as mild to moderate on a 10-cm visual analog scale. Conclusions This study is a documentation of the Cairo University teaching hospital experience with PDPH in female patient undergoes spinal anesthesia, and it focus on the incidence and severity related to the needle size and Egyptian population. We recommend the usage of the pencil point needle or a smaller needle in Cairo university hospital regardless the economic, teaching and manufacturing reasons.