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Abdominal sepsis patients suffer from profound intravascular fluid deficit due to concomitant inflammatory response and capillary leakage. It is reported that anti-inflammatory properties of sedative agents can control inflammatory cascade in many experimental septic conditions. We aimed to investigate the best sedative drug for inflammatory responses and capillary leak in patients with abdominal sepsis. In this prospective randomized study, 60 patients with abdominal sepsis who underwent abdominal surgery and required post-operative sedation and mechanical ventilation were randomized into 3 groups in a 1:1:1 ratio. Group D (sedated with dexmedetomidine), group P (sedated with propofol), and group M (sedated with midazolam). This study was held in intensive care units of Assiut University Hospitals with primary outcome was serum IL-6 and IL-1β. Secondary outcomes were capillary leak index, lactate clearance, vasopressor requirements, total intake, total output, and fluid balance. Dexmedetomidine significantly reduced levels of IL-6 and IL-1β through 48 hours compared to both midazolam and propofol. Dexmedetomidine caused a significant decline in capillary leak index (p < 0.05) through 48 hours and significant higher lactate clearance (p = 0.03) in first 24 hours compared to both midazolam and propofol. Dexmedetomidine group had a significantly lower intake in first 24 hours and comparable vasopressor requirements through 48 hours. Dexmedetomidine group had a significantly higher output, lower serum creatinine levels and lower positive fluid balance compared to propofol and midazolam. Dexmedetomidine reduced inflammatory response and capillary leak in mechanically ventilated patients with abdominal sepsis with better lactate clearance and less fluid intake. [ABSTRACT FROM AUTHOR]

Background: The serotonergic system is known to be involved in control of post-anesthetic shivering. Our hypothesis was that prophylactic granisetrone (serotonin antagonist) might reduce incidence of post-spinal anesthesia shivering in cesarean section.Methods: Parturient scheduled for elective cesarean delivery under spinal anesthesia were allocated to receive 0.9% saline (Group I, n = 71), 1 mg granisetron (Group II, n = 69), or 0.7 mg granisetron (Group III, n = 72) before the spinal block. Assessment parameters included; hemodynamics, tympanic membrane temperature, neonatal Apgar score, shivering score, patient satisfaction scores about shivering prophylaxis and adverse effects.Results: Clinically significant shivering was recorded in 55/71 patients (77.5%) in group I, 11/69 (15.9%) in group II and 21/72 (29.2%) in group III (P = 0.000). The intensity of shivering was significantly lower in patients who received granisetron 1 mg compared with granisetron 0.7 mg or saline (P = 0.000). Patients who received prophylactic granisetron 1 mg reported lower mean intraoperative arterial pressure and heart rate values and consumed higher doses of iv ephedrine compared with 0.7 mg granisetron or saline placebo (P < 0.05). Pruritus significantly decreased from (22.5%) in control group to (0%) in granisetron groups (P = 0.000). Nausea was reported in 8 vs 10 and four in group I, II and III, respectively (P < 0.03). Sixteen vs eight and six patients vomited in group I, II, and III, respectively (P < 0.03). Higher patient satisfaction scores were recorded in group II (9.83 ± 0.29, P < 0.03) and III (9.14 ± 1.04, P < 0.04), compared with control group (8.23 ± 1.14).Conclusion: Prophylactic granisetron effectively reduced incidence and severity of perioperative shivering in a dose dependent manner, compared to placebo controls. [ABSTRACT FROM AUTHOR]

Background: Intravenous lidocaine infusion (IVLI) reduces postoperative pain and hastens the return of bowel function., Objectives: We aimed to compare the effects of adding lidocaine infusion to enhanced recovery pathway (ERP) on acute rehabilitation protocol., Study Design: This study uses a double-blind, randomized design with allocation concealment in a 2-armed parallel group format among patients undergoing open radical cystectomy (RC)., Setting: The study was conducted at Assiut University Hospital, Asyut, Egypt. The study duration was March 2017 to July 2018., Methods: After ethics committee approval, 111 patients, American Society of Anesthesiologists (ASA) physical status II-III, aged 45-65 years, scheduled for open RC with urinary diversion under an ERP, were randomly selected in a double-blind manner to receive IVLI 2 mg/minute for 4 hours or an equal volume of normal saline solution 0.9%. Postoperative pain scores, rescue analgesic consumption, times to return of bowel sounds, first flatus, first defecation, resuming of regular diet, length of hospital stay, in-hospital complications, and patient satisfaction were recorded., Results: Patients in the lidocaine group experienced significantly lower pain scores after surgery at 6 hours (P = 0.005) and 12 hours (P = 0.001) at rest, and in the first 18 hours during mobilization (P < 0.05), with less paracetamol (P = 0.04) and meperidine (P = 0.02) consumption than in the control group. Between the lidocaine and the control group, mean times to return of bowel sounds (23.7 vs. 26.7 hours; P = 0.001), first flatus (76.5 vs. 86.5 hours; P = 0.001), first defecation (92.7 vs. 106.9 hours; P = 0.001) and resuming of regular diet (80.7 vs. 92.8 days; P = 0.001) were significantly shorter in the lidocaine group. Length of hospital stay, in-hospital complications, and patient satisfaction were similar in both groups., Limitations: Limitations of this study include lack of previous research that compare the additive effects of IVLI to ERP in patients undergoing open RC. Also, the inability to measure the serum lidocaine concentration in our patients., Conclusions: Adding IVLI to ERP improved postoperative analgesia and bowel function after open RC with urinary diversion., Clinical Trial Registration: NCT03047057., Key Words: Lidocaine infusion, ileus, enhanced recovery pathway, acute rehabilitation, open radical cystectomy.

Background: Knee arthroscopy causes minimal trauma, however, good analgesia is required for early rehabilitation and return to normal life in the patients., Objective: We aimed to compare the analgesic effects of intraarticular dexamethasone and dexmedetomidine added to bupivacaine with those of bupivacaine alone., Study Design: This study uses a double-blind, randomized, controlled design with allocation concealment in a 3-armed parallel group format among patients undergoing arthroscopic meniscal surgery., Setting: The study was conducted at Assiut University Hospital in Asyut, Egypt. The study duration was from July 2016 to February 2017., Methods: After the ethics committee approval, 60 patients, with the American Society of Anesthesiologists (ASA) physical status of I or II, 20 - 50 years old, and scheduled for arthroscopic meniscal surgery were randomized in a double-blind manner to receive 18 mL intraarticular bupivacaine 0.25% with either dexamethasone 8 mg (group I), dexmedetomidine 1 ug/kg (group II), or 2 mL of normal saline (group III). The total volume of injectate used in each group was 20 mL. All of the patients received spinal anesthesia. Postoperatively, oral paracetamol 1000 mg was given every 8 hours, and oral tramadol 50 mg was administered, as needed, for rescue analgesia. The visual analog scale (VAS) pain scores, time to first analgesic request, and total dose of postoperative analgesics were recorded for 3 days postoperatively., Results: The VAS scores were lower in groups I and II compared with group III. The time to the first analgesic was significantly shorter in group III compared with groups I and II (P = 0.001). The total dose of rescue paracetamol was higher in group III compared with groups I and II (P = 0.001). No need for tramadol rescue analgesia was recorded in any of the groups. No significant differences between groups I and II were noticed., Limitations: The limitations of this study include the lack of previous research to compare the effect of both intraarticular dexamethasone and dexmedetomidine added to bupivacaine for postoperative analgesia in arthroscopic knee surgery. Additionally, there was a short observation period for the detection of chondrotoxicity, if occurred., Conclusion: The addition of dexamethasone or dexmedetomidine to a solution of bupivacaine 0.25% provided better analgesia than using bupivacaine alone., Clinical Trial Registration: NCT02818985., Key Words: Intraarticular, knee arthroscopy, bupivacaine, dexmedetomidine, dexamethasone, postoperative pain.