Khaled R. Al-Zaben

Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery.

Background The present study was designed to assess whether an intraoperative administration of dexmedetomidine would decrease the intraoperative and postoperative analgesic requirements for paediatric patients undergoing hypospadius surgery. Methods Forty-eight children (American Society of Anesthesiologists-1) aged 1–12 years undergoing hypospadius repair under general anaesthesia were randomly assigned into dexmedetomidine or placebo groups, D and P, respectively. Group D received a loading dose of dexmedetomidine 1 μg kg−1 after induction of anaesthesia, followed by a continuous infusion at a rate of 0.7 μg kg−1 h−1. Group P received a volume-matched 0.9% saline. Both groups received fentanyl for intraoperative analgesia and intravenous morphine and oral paracetamol for postoperative analgesia. For both groups, heart rate, blood pressure and fentanyl requirements were recorded intraoperatively. During their stay for 2 h in the recovery room, heart rate, blood pressure, pain scores, behaviour scores and total morphine requirements were recorded. After discharge from postanaesthesia care unit, paracetamol requirements over 24 h were also recorded. Results Intraoperatively, the dexmedetomidine-treated group had significantly fewer fentanyl requirements, slower heart rate and lower mean arterial blood pressure (P < 0.001). In the postanaesthesia care unit, this group also consumed significantly less morphine, had lower pain scores, lower behaviour score in the immediate postoperative period, lower heart rates and mean arterial blood pressures when compared with the placebo group (P < 0.001). Group D consumed significantly less paracetamol than group P in the ward over 24 h. Conclusion Intravenous administration of dexmedetomidine intraoperatively during hypospadius repair in children reduces intraoperative and postoperative analgesic requirements and lowers heart rate and blood pressure.

Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra‐umbilical surgery: a randomized controlled double‐blinded study

Data are still insufficient about the effects of different concentrations of caudal dexmedetomidine when used to prolong postoperative analgesia in children. The aim of this study was to assess the analgesic efficacy and side effects of two doses of caudal dexmedetomidine (1 and 2 μg·kg−1) co‐administered with bupivacaine in terms of postoperative pain scores and requirement of postoperative analgesia over 24 h in children undergoing infra‐umbilical surgery.

Effects of experimental acute myocardial infarction on blood cell counts and plasma biochemical values in a nude rat model (Crl:NIH-Fox1RNU)

To determine the clinical pathology parameters in nude rats (Crl:NIH-Fox1RNU) following experimental induction of acute myocardial infarction (AMI), 50 male adult nude rats weighing 250–350 g were used. Complete blood count, total and differential leukocyte counts, plasma total protein, albumin, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase were determined before (time zero, T0), 1, and 5 days following experimental induction of AMI. Lactate dehydrogenase, creatinine kinase (CK), and creatinine kinase MB fraction (CK-MB) were determined at T0, 6, and 24 h following AMI. There were no significant changes in the hematological parameters at any sampling point. Among all plasma biochemical parameters studied, only CK and CK-MB were significantly elevated 6 h following induction of AMI. These data will aid scientists and researchers in the interpretation and better application of their results when using nude rats for AMI studies.

Remifentanil consumption in septoplasty surgery under general anesthesia. Association with humane mu-opioid receptor gene variants

Objectives: To evaluate the influence of the ORM1 variants in codon 118 on the intra-operative remifentanil consumption under general anesthesia. Methods: A prospective gene association study, performed at the Jordan University Jordan, Amman, Jordan from September 2013 to August 2014. It includes patients who underwent septoplasty surgery under general anesthesia. All patients received standard intravenous anesthesia. Anesthesia maintained with fixed dose of Sevoflurane and variable dose of Remifentanil to keep the systolic blood pressure between 90-100 mm Hg. The Remifentanil dose was calculated and correlated with ORM1 genotype variance. Results: Genotype and clinical data were available for 123 cases. The A118A genotype was seen in 96 patients (78%), the A118G genotype was seen in 25 patients (20.3%), and only 2 patients had genotype G118G (1.6%). The G118G variant was removed from the statistical analysis due to small sample size. There was a significant effect of ORM1 genotype variant and the amount of remifentanil consumed. The A118A genotype received 0.173 ± 0.063 µg kg-1 min-1 and the A118G genotype received 0.316 ± 0.100 µg kg-1 min-1 (p<0.0001). Conclusion: The ORM1 gene has a role in intra-operative remifentanil consumption in patients who underwent septoplasty surgery under general anesthesia. The A118G gene required higher dose of remifentanil compared with the A118A genotype.

Post-Operative Nausea, Vomiting and Pain Score in Post Anesthesia CareUnit (PACU) at Jordan University Hospital

A prospective interview based survey on the incidence of postoperative nausea and vomiting of 1007 inpatients aged 1-80 years was conducted during 6 month period. Nausea, vomiting episodes and the need for anti-emetic medication were recorded for 24 hours postoperatively. The highest incidence of vomiting sequel was observed in neurosurgical patients. The most predictive factors associated with an increased risk for nausea and vomiting were: female gender (51/72), young age 19-35 year old, and body weight 61-80kg.

The effects of caudal or intravenous dexmedetomidine on postoperative analgesia produced by caudal bupivacaine in children: a randomized controlled double-blinded study

STUDY OBJECTIVES The aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 μg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries. DESIGN A randomized controlled double-blind study. SETTING University-affiliated teaching hospital. PATIENTS Seventy-five American Society of Anesthesiologists I children, aged 1 to 6 years. INTERVENTION Patients were randomly allocated to 3 groups. All patients received 1 mL/kg caudal 0.25% bupivacaine. In addition, those in group B (n=25) received 10-mL IV saline, those in group B-Dcau (n=25) received 1 μg/kg caudal dexmedetomidine and 10-mL IV saline, and those in group B-DIV (n=25) received 1 μg/kg IV dexmedetomidine in 10-mL saline. MEASUREMENTS Intraoperative mean blood pressure, heart rate, peripheral oxygen saturation, end-tidal sevoflurane, and bispectral index as well as postoperative pain and behavior scores and time to first analgesia were assessed. MAIN RESULTS Group B-Dcau had a significantly longer time to first rescue analgesia than groups B-DIV and B, with mean (SD) values of 14.4 (7.5), 9.18 (2.7), and 6.6 (2.5) hours, respectively (P<.05). Fewer patients in group B-Dcau (n=16) required rescue analgesia during the first 24 hours postoperatively compared to group B (n=24) and group B-DIV (n=20) (P<.05). Groups B-Dcau and B-DIV had lower pain and behavior scores than Group B. Eight patients Group B had agitation compared to 2 in Group B-DIV and 0 in Group B-Dcau. Four patients in Group B-DIV developed bradycardia and hypotension during surgery. CONCLUSIONS Compared to IV administration, caudal administration of dexmedetomidine during caudal bupivacaine anesthesia provided prolonged postoperative analgesia and a greater analgesic sparing effect without significant side effects. This suggests a greater role of neuraxial compared to that of peripheral α-2 adrenoceptors in pain processing.

Fasciocutaneous Flap Reconstruction after Repair of Meningomyelocele: Technique and Outcome

Aims: The objectives of this study are to describe our technique in meningomyelocele (MMC) repair, analyzing the results and complications, as well as to study the effect of delay in operation on the complication rate. Patients and Methods: Between March 1997 and October 2012, 48 patients with MMC were treated at Jordan University Hospital by a combined neurosurgical and plastic surgical team. Patients underwent neurosurgical repair of the neural elements and soft tissue reconstruction using local fasciocutaneous flaps. The patients were further divided into two subgroups (local or referrals from other hospitals). Results: Of all patients, 8 (16.6%) had postoperative complications. When the complication rate was compared between the two groups, in the first group, who had early repair, only 2 out of 19 patients had complications (10.5%), while in the second group, with delayed operation, 6 out of 29 patients developed complications (20.7%). The follow-up of all patients showed that the soft tissue cover maintained good durability with no skin breakdown. Conclusion: We recommend early MMC repair using this rather simple method to provide a reliable soft tissue coverage. A combined approach by a neurosurgical and plastic surgical team in the management of this challenging neonatal emergency is appreciated.

Benign pneumoperitoneum in newborns: which abdomen to open and which one to observe?

Benign pneumoperitoneum in newborns is not a rare condition that should be managed conservatively. Neonatologists and surgical teams should work together to avoid unnecessary and potentially risky procedures.

Ephedrine requirements during spinal anesthesia for cesarean delivery in Jordanian parturients: association with b2 adrenoceptor gene variants.

BACKGROUND Maternal hypotension after spinal anesthesia for cesarean delivery is common. Many studies performed on the β2-adrenoceptor (β2AR) gene variants and their association with vasopressor requirements during and after neuroaxial block have contradictory conclusions. OBJECTIVES The aim of the study was to evaluate the influence of the β2AR in codons 16 and 27 on the incidence of maternal hypotension and ephedrine consumption after spinal anesthesia for cesarean delivery in an Arab ethnic group. DESIGN A prospective gene association study. SETTING Jordan University Hospital from 1 July 2013 to 31 January 2014. PATIENTS AND METHODS We enrolled parturients who underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 10 mg plain bupivacaine along with 25 μg fentanyl. Hypotension was treated with ephedrine and the amount consumed in the first 30 minutes after spinal anesthesia was calculated. The β2AR genotype at codons 16 and 27 was determined. We studied the correlation between the β2AR genotype and the amount of ephedrine consumption after spinal anesthesia. MAIN OUTCOME MEASURES Amount of ephederine used. RESULTS Of 250 patients enrolled in the study, genotype and clinical data were available for 234 cases. Ephedrine was used in 94% of patients. There was a significant effect of β2AR genotype on ephedrine dose in the first 30 minutes after spinal anesthesia in codon 16 and 27. Arg16 homozygotes received less ephedrine (14.0 [11.2] mg) than Gly16 homozygotes (38.6 [25.7] mg) and Arg16Gly heterozygotes (33.42 [22.70] mg) (P<.0001). Gln27 homozygotes received less ephedrine (18.2 [12.8] mg) than Glu 27 homozygotes (47.5 [27.0] mg) and Gln27Glu heterozygotes (48.2 [23.7] mg). (P<.0001). CONCLUSION In an Arab ethnic group, the β2AR gene has a role in maternal hypotension after spinal anesthesia. The Gly16 and Glu27 alleles have a higher incidence of arterial hypotension and required a greater amount of vasopressor to treat hypotension compared with homozygous Arg16 and Gln27 carriers. LIMITATIONS Fasting time and hydration protocol, the use of a fixed dose of ephedrine, and relatively small sample size.

Upper airway obstruction by a fragmented tracheostomy tube: Case report and review of the literature

Highlights • Upper airway obstruction is common in children due to foreign bodies as including seeds, nuts and household particles.• There are a few reports describing fractured tracheostomy as a cause of airway obstruction.• We report the management of a case of foreign body aspiration in the tracheobronchial tree due to a fragmented and migrated tracheostomy tube.