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Background Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4 ) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. Methods A randomized double-blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 μg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. Results VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. Conclusion Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4 . No significant adverse effects to the parturients or newborns.

Background Studying the impact of chronic kidney disease on neurocognitive functions is a critical element for providing optimal care to these children who might suffer from its detrimental consequence on their psychosocial life. Aim The aim of the study was to assess the cognitive functions in adolescents with end-stage renal disease (ESRD) under regular hemodialysis compared with healthy controls. Patients and methods We studied 40 adolescents – 20 patients with ESRD on regular dialysis and 20 controls closely matched with the patient in terms of their age, sex, and educational level. Patients were recruited from the pediatric dialysis unit, Menoufia University hospitals, with dialysis durations ranging from 0.5 to 8.5 years with mean 3.25±2.28 years. They were assessed using Raven’s Progressive Matrices tests (for fluid intelligence), and a computerized battery composed of Spatial Span (visual–spatial working memory task), Tower of London task (measuring planning and problem-solving ability), and the Go/No Go task (a task assessing response inhibition, set shifting, and attention). We, furthermore, assessed disease-related variables impacting the cognitive functions of the patients. Results The average age of the patients was 14.4±3.315 years, and that of the controls was 13.7±1.46 years. The fluid IQ for the patients was significantly lower than the controls (P Conclusion Our findings provide evidence that the fluid intelligence and cognitive function of adolescents with ESRD on dialysis fall within the low average on most tasks. Furthermore, hypertension and anemia potentially place children with ESRD at an increased risk for neurocognitive deficits, which consequently places them at risk for poor long-term educational and occupational outcomes.

Background The nasal soft tissue envelope affects the final rhinoplasty result, and can limit the expected improvement. Currently, no dependable and objective test exists to measure the thickness of the nasal skin and underlying soft tissue. Objectives This paper presents a simple, yet reliable method to determine the thickness of the soft tissue envelope. An algorithm is presented for treatment of the dermis and/or soft tissue apart from surgery of the underlying osseocartilaginous structures. Methods Seventy-five patients presenting for primary rhinoplasty underwent visual and ultrasound assessment of their nasal soft tissue envelope. At preoperative evaluation, the Obagi "skin pinch test" was used to assess the thickness of the nasolabial fold and whether or not the skin was oily. Patients were classified based on the pinch thickness. At time of surgery prior to injection of local anesthesia, ultrasonic assessment was done at the nasolabial fold, keystone junction, supratip, and tip to measure the thickness of the nasal dermis and underlying soft tissue. Results Patients determined to have thin, normal, and thick skin by the "skin pinch test" were found to have a nasolabial fold dermal thickness with an average of 0.7 mm (0.4-1.2 mm), 1.1 mm (0.8-1.8 mm), and 1.4 mm (0.7-2.0 mm). Patients determined to have thin, normal, and thick skin were found to have a dermal thickness at the keystone junction with an average of 0.3 mm (0.2-0.4 mm), 0.5 mm (0.3-1.1 mm), and 0.9 mm (0.6-1.2 mm), respectively. This difference in thickness also translated to the supratip and tip areas measured. However, all areas were also affected by the oiliness of the skin. Soft tissue thickness (SMAS and muscle) underlying the dermis was variable. Patients of non-Caucasian background were more likely to have a thicker soft tissue layer. Conclusions The "skin pinch test" is an easy and reliable way for the surgeon to evaluate the thickness of the nasal soft tissue envelope. The rhinoplasty surgeon can make decisions pre- and postoperatively to treat patients with difficult soft tissue envelopes. LEVEL OF EVIDENCE 4.

Introduction Laparoscopic surgery is a common daily performed procedure. It has the advantages of small incision, better cosmetic aspects, less postoperative pain, and rapid recovery to daily activities. Pneumoperitoneum and increased intraabdominal pressure can induce many pathophysiologic disturbances, requiring the anesthesiologist to be well alert during the operation for necessary management. Patients and methods This is a prospective, observational clinical study. A total of 60 consecutive patients scheduled for gynecological laparoscopic surgery were recruited from the Gynecological and Obstetrics Department. Selected patients were divided into two groups according to the duration in Trendelenburg positioning: group I ( 1 h). A preoperative anesthetic assessment was carried out, and a standardized general anesthesia technique and monitoring were followed for all patients of the two groups. Pneumoperitoneum was generated by the insufflation of gas (CO2) into the peritoneal cavity. Results On the evaluation of the effect of prolonged pneumoperitoneum and position of patents on intraoperative hemodynamics, mean arterial blood pressure was significantly decreased (in group II) at time M3 (average mean blood pressure during Trendelenburg position till recovery). Heart rate also significantly decreased (in group II) at time heart rate 3 (average heart rate during Trendelenburg position till recovery). Intraabdominal pressure significantly decreased in group II at time intraabdominal pressure 4 (average time during positioning), and pulmonary function test parameters were significantly decreased after recovery. Conclusion Prolonged laparoscopic gynecological surgery can markedly affect intraoperative hemodynamics and postoperative respiratory function.

Background Shivering was found to be a common side effect with spinal anesthesia. It was observed in about 55% of patients with neuraxial anesthesia. It results in increased oxygen consumption and pain which usually interfere with patient’s monitoring. Objectives This study was designed to show the effect of intrathecal injection of magnesium sulfate to control shivering during spinal anesthesia for cesarean section. Study Design This study was a prospective randomized controlled double-blind study using a computer-generated randomization scheme. Methods 84 Women were randomly allocated into 2 groups: Magnesium sulfate group (M); patients received intrathecal 2 ml of 0.5% heavy bupivacaine (10 mg) plus 25 mg MgSO4. Placebo group (P); patients received intrathecal 2 ml of 0.5% heavy bupivicaine (10 mg) plus 0.5 ml normal saline. Vital signs, temperature, shiverig score, sensory level, motor block, and any complications were recorded. Results Shivering score revealed a statistically significant difference between both study groups throughout the whole intraoperative and postoperative periods with lower shivering incidence in the M group. There was a statistically significant difference between both groups regarding temperature readings during the first 30 minutes postoperatively. Intraoperative sensory level block was statistically significant different only 30 minutes after drugs injection. No serious complications were recorded in both groups. Conclusion We concluded that intrathecal Magnesium sulfate is safe and can decrease the incidence and intensity of shivering during cesarean section under spinal anesthesia, without having any serious side effects.

Aim: To estimate the effect of 0.9% saline during bipolar resectoscopy and 1.5% glycine during monopolar resectoscopy on hemodynamic, biochemical and hematological parameters. Material & Methods: A prospective randomized study in a tertiary care university hospital and comprising of 155 patients scheduled for hysteroscopic myomectomy. They were subjected to bipolar resectoscopic myomectomy utilizing 0.9% saline in group A, and monopolar resectoscopic myomectomy utilizing 1.5% glycine in group B. Perioperative measurements of hemodynamic, hematological, and biochemical changes in all cases were reported. Likewise, intrauterine pressure throughout the different procedures was recorded. Main outcome measures: intraoperative difference with regards to fluid volume and subsequent systemic changes specially osmolarity. Results: A significant increase of central venous pressure, end diastolic volume, end diastolic index, stroke volume, stroke index, cardiac output, cardiac index, postoperative prothrombin time and postoperative partial thromboplastin time in both groups with positive correlations between the absorbed fluid volume and these measurements in both groups. Moreover, there was a significant decrease in systemic vascular resistance, postoperative hemoglobin concentration, postoperative hematocrit value ratio, postoperative platelet count and postoperative prothrombin concentration in both groups and there were negative correlations between the absorptive fluid volume and these measurements in both groups. There were significant decrease in serum sodium concentration and postoperative serum osmolarity in glycine group (B) with negative correlations between the absorptive fluid volume and both serum sodium concentration and serum osmolarity in glycine group (B). Conclusions: The use of bipolar resectoscope utilizing 0.9% saline as a distention media is not associated with hyponatremia or hyposmolarity unlike monopolar resectoscope utilizing 1.5% glycine distending media in cases with submucous myoma of considerable size.

Objectives To record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief. Design A prospective randomized study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used. Interventions Patients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2-ml intravenous injection. Main outcome measures Each patient recorded the site of pain, and its severity using a 4-point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same- or next-day discharge was also assessed in all patients. Results The trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P

Objective To describe a simplified laparoscopic approach to cervical cerclage in the early second trimester. Design A case study. Setting Gynaecological Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subject A 31-year-old-patient, para 5, gravida 11, with a history of eight cervical cerclage operations performed using Shirodkar and McDonald techniques. Interventions A laparoscopic abdominal cerclage procedure was carried out by fixation of a Mersilene tape into the cervical isthmus at the 12 o’clock position. The stitch was advanced at each side and passed underneath the round ligament after freeing of the bladder. The stitch was tightened posteriorly after appropriate visualization using a fan-shaped retractor. Main outcome measures Continuation of the pregnancy after 36 weeks. Results The patient delivered a healthy 3150-g female baby at 37 weeks by repeat Caesarean section and the stitch was left in place. Conclusions Laparoscopic abdominal cerclage in the early second trimester is technically feasible without deleterious effects on the mother or the fetus. Randomized studies are required to compare the cost-effectiveness, fetal and maternal safety, feasibility and success of laparoscopic vs. open abdominal cerclage.