Ayat Amer

Zagazig University

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Mohammed Refky

Zagazig University

Ahmed Abd El-Aziz El-Sammak

Zagazig University

Essam Fathi Abd-El Galel

Zagazig University

Mohamed Ezzat Abd El-Fattah

Zagazig University

Mohammed Mekawy

Zagazig University

Doaa Mohamed Faried

Zagazig University

Akmal Abdelsamad

Zagazig University

Mohamed El Sayed

Children's Hospital Mansoura University

Doaa Farid

Zagazig University

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Zagazig University

Cairo University

Children's Hospital Mansoura University

Al-Azhar University

Gulf Medical University

Benha University

Damanhour University

Pharos University in Alexandria

Pediatric Oncology Group

Wave Dragon (Denmark)

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Analgesic Efficacy of Ultrasound Guided Transversus Abdominis Plane Block Versus Caudal Block in Inguinal Hernia Repair Surgery in Pediatrics

Zagazig University Medical Journal (2019)

Mohammed Mekawy Mohammed Refky Doaa Farid Ayat Amer

Background: caudal epidural block (CEB) is the most preferred modality for pediatric regional analgesia because of its effective somatic and visceral pain control, though transversus abdominis plane (TAP) block is an evolving regional anesthetic technique for abdominal wall.Our study aims to compare the analgesic effect of (CEB) versus (TAP) block in pediatrics undergoing inguinal hernia repair surgeries.Patient and Methods: The study enrolled 44 children, aged 3 to 7 years, scheduled for unilateral inguinal hernia repair surgery.Children were divided into 2 equal groups.Group A received ultrasound guided (CEB), while group B received ultrasound guided (TAP) block.We used a multimodal approach of pain control including regional block, intraoperative fentanyl when needed, standard postoperative paracetamol, and rescue ibuprofen when needed.Hemodynamic stability, fentanyl needs, time for first analgesic request, pain scores by Children's Hospital of Eastern Ontario Pain Score (CHEOPS), and ibuprofen requirements were recorded.Results: Both (CEB) and (TAP) groups showed hemodynamic stability, meanwhile there was no need for fentanyl among all patients in both groups, and the time for first analgesia in CEB and TAP groups, was (4.59±0.59)and (7.48±1.35)hours respectively.Furthermore, the ibuprofen requirements and pain scores were statistically significantly higher in (CEB) group than (TAP) group (P-value < 0.05).Conclusion: Both TAP block and CEB provide effective analgesia in children undergoing inguinal hernia repair surgery with TAP block superiority over CEB as evidenced by longer time for first analgesic request, decreased analgesics needs, and lower pain scores.

10.21608/zumj.2019.13760.1265

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Shorter postanesthesia care unit stay with dexmedetomidine infusion during laparoscopic bariatric surgery: a randomized controlled trial

Research and Opinion in Anesthesia and Intensive Care (2017)

Mohamed El Sayed Akmal Abdelsamad Ayat Amer

IntroductionLesser narcotics use during laparoscopic bariatric surgery is needed to decrease the impact on respiratory parameters and reduce analgesic requirements after surgery. Using dexmedetomidine has a role in perioperative pain control in obese patients' recovery in postanesthetic care unit (PACU) and hospital stay. In this study, we hypothesized that dexmedetomidine would delay and decrease opioid requirements during surgery, promoting less time in the PACU and faster, safer recovery.Patients and methodsAfter obtaining ethics committee approval, informed consent to participate in this study was obtained from 56 patients who were scheduled for planned laparoscopic bariatric surgery. Patients were randomly divided into two groups − group D (n=28) received dexmedetomidine 1 µg/kg loading for 10 min and 0.4 µg/kg/h maintenance until extubation, and group N (n=28) received normal saline (placebo) at the same volume and rate. PACU stay time, the total amount of intraoperative fentanyl used, recovery profile, pain score, and the total amount of pethidine used postoperatively were measured.ResultsThe dexmedetomidine group showed significant decrease in intraoperative and postoperative hemodynamics, shorter recovery time, and shorter stay in PACU. Perioperative narcotic use, intraoperative fentanyl use, visual analog scale scores, PACU pethidine dose in the first hour, and total pethidine dose on the first day were significantly less in the dexmedetomidine group. Patient satisfaction at discharge regarding pain management was less in the control group.ConclusionIntraoperative dexmedetomidine infusion with its opioid-sparing effect enhanced recovery in this study population of morbidly obese patients undergoing laparoscopic bariatric surgery with minimal side-effects.

Dexmedetomidine

Pethidine

Post-anesthesia care unit

10.4103/roaic.roaic_103_16

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Different Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Non-Bariatric Surgeries; Randomized Controlled Trial

The Egyptian Journal of Hospital Medicine (2021)

Mohamed Ezzat Abd El-Fattah Doaa Mohamed Faried Essam Fathi Abd-El Galel Ayat Amer Ahmed Abd El-Aziz El-Sammak

Background: Upper abdominal surgeries have been reported to be associated with an increased incidence of postoperative atelectasis.Preventing atelectasis is important for all patients but is more important when caring for obese patients.Objectives: To determine which of the following ventilatory strategies is better in prevention of pulmonary atelectasis in obese patients undergoing non-bariatric surgery: Volume control ventilation "VC", Pressure control Ventilation "PC", Volume control ventilation + Positive End Expiratory Pressure "PEEP", Volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver.Patients and methods: A randomized-controlled trial study was carried out in the operating room (OR) in Zagazig University Hospital including 92 patients.Patients were randomly allocated into four groups.G1: Volume control ventilation "VC", G2: Pressure control Ventilation "PC", G3: Volume control ventilation + Positive End Expiratory Pressure "PEEP", G4: as in G3 + lung recruitment maneuver.Results: There was significant difference between the studied groups as regards PaO 2 /FiO 2 ratio as the 4 th group was highly significant.There was also significant difference between the studied groups as regards atelectasis score with the least atelectasis score in group 4.There was a significant difference in group 4 than the other groups as regards length of stay in PACU, and need for 100% Fio2 in PACU.Finally, there was a significant difference between the studied groups as regards postoperative pulmonary complications with the 4 th group has the least postoperative complication. Conclusion:Our results suggest that volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver had beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in obese patients undergoing non-bariatric upper abdominal surgeries.

Atelectasis

10.21608/ejhm.2021.165505

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