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Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

Background: Cancer colon is one of the most common malignancies. After colon cancer surgery patients may experience severe pain. Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. Aim: Our goal was to assess the effect of combined epidural anaesthesia either with propofol or sevoflurane on intraoperative fentanyl consumption and postoperative pain in patients undergoing open surgical resection of colon cancer. Patients and Methods: 48 adult patients suffering from cancer colon scheduled for open surgical resection randomly allocated either to receive epidural-propofol by total intra venous anaesthesia (TIVA) (n = 24) or epidural-sevoflurane anaesthesia (n = 24), intraoperative heart rate and fentanyl consumption and postoperative pain score (verbal analogue scale, 0 - 10) were recorded. Results: In our study we found that the intensity of postoperative pain was low in all patients and the propofol based anaesthesia had relatively lower pain scores up to 24 hrs postoperatively in comparison to sevoflurane based anaesthesia, intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. Conclusions: we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane. Also use of propofol showed better analgesic outcomes postoperatively.

Background and aim Intraoperative use of a single bolus dose of tranexamic acid may not be sufficient to prevent bleeding in the early postoperative period. The present study was carried out to compare the effect of two dose regimens of tranexamic acid in reducing perioperative blood loss and the amount of allogeneic blood transfusion in transurethral resection of prostate. Design prospective, double-blinded and controlled study. Setting Ain Shams University Hospital, Patients and Methods 50 patients electively posted for transurethral resection of prostate were randomly assigned to receive a single bolus dose of tranexamic acid (10 mg/kg) (Group A), a bolus dose of tranexamic acid (10 mg/kg) followed by infusion (1 mg/kg/h) till 4 h postoperatively (Group B). Measurements Total intraoperative blood loss, amount of allogeneic blood transfusion, postoperative drain collections, and hemoglobin and hematocrit levels were recorded at different time intervals. Data obtained after comparing two groups were analyzed using the statistical package for social sciences. Results There was no statistically significant difference among patients in both groups regarding intraoperative blood loss and postoperative blood loss at 6 hrs and 48 hrs postoperatively. However the post-operative blood loss at 24 hrs was significantly higher among patients in group A than patients in group B (P-value= 0.014) . Conclusion Tranexamic acid causes more effective reduction in post-operative blood loss when used as a bolus followed by an infusion continued in the postoperative period in comparison to its use as a single intravenous bolus in transurethral resection of prostate.

Background: Spinal anesthesia is the commonest technique used in Cesarean Section (CS) and most frequently associated with maternal hypotension, for which a lot of techniques have been described to prevent but an effective method is yet to be found. Objectives; The aim was to study the effect of using a sub-anesthetic dose of ketamine to prevent post-spinal hypotension in CS delivery. Methods: This double-blinded randomized controlled study was conducted on 80 participating parturients who were ASA І, П term pregnant. All the parturients received spinal anesthesia. The parturients were then randomly divided into two equal groups (n= 40 in each); ketamine group received a sub-anesthetic dose of ketamine of 0.5 mg/kg IV bolus in 3 ml saline and control group received the same volume of normal saline IV bolus. Heart Rate (HR) and Mean Arterial blood Pressure (MAP) were recorded at baseline (5 minutes prior to the intrathecal injection), at 5, 10, 15 and 20 minutes after the injection and then every 15 minutes till the end of the operation. Incidences of hypotension and severe hypotension were recorded. The total dose of ephedrine was recorded. Ramsay sedation score was recorded at baseline then 5, 10, 15, 30, 45 minutes after injection and then at the end of the operation. Results: Compared to the control group, sedation score was significantly higher among ketamine group at 5, 10 and 15 minutes. MAP and HR were significantly higher among ketamine group at 5, 10, 15, and 20 minutes. Total ephedrine dose was significantly lower among the ketamine group. Mild hypotension and severe hypotension were significantly less frequent among the ketamine group, as all the patients in the control group had an attack of mild hypotension and 55% of this group had an attack of severe hypotension. No significant difference between both the groups regarding diplopia, nystagmus, hallucination, nausea and vomiting. Conclusion: It is concluded that ketamine in a sub-anesthetic dose is an effective agent that can be used in preventing post-spinal hypotension in parturients undergoing CS delivery.

Background Various adjuvants have been used to prolong spinal anesthesia, with the additional advantages of delaying the onset of postoperative pain and reducing postoperative analgesic requirements. Pregabalin is an R-aminobutyric acid analog that binds to the α2-δ subunit of presynaptic voltage-gated calcium channels. Objective The aim of this work is to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours postoperatively Patients and Methods There were limitations to the present study. First, since only 1 dosage of pregabalin was evaluated, we could not determine the most effective dosage. Second, clinically meaningful improvements in recovery were not assessed. Adequate postoperative pain control provides early postsurgical mobilization, shortened hospitalization, and increased patient satisfaction. Third, preoperative pain and anxiety scores were not recorded. Pregabalin might affect the preoperative pain, mood, and anxiety scores, and these factors can be related to the postoperative pain score. Results The mechanisms by which pregabalin premedication prolongs motor and sensory blocks using local anesthetics in spinal anesthesia are not fully understood. There may be several reasons for the prolongation of spinal anesthesia. Gabapentinoids are an r-aminobutyric acid analog that binds to α2-δ subunit of presynaptic voltage-gated calcium channels, and this inhibition decreases postsynaptic excitability by reducing potassium-evoked excitatory transmitter release. These medications provide antiepileptic, anxiolytic, and analgesic features by modulating both GABAergic neurotransmission and calcium influx. Gabapentinoid compounds produce a significant and clinically important improvement in preoperative anxiety scores. Since patients may be anxious in the perioperative period, the anxiolytic effects and euphorigenic effects of pregabalin may be beneficial.

BACKGROUND Early detection of post-thyroidectomy vocal cord dysfunction is crucial. This study compared GlideScope® with Macintosh direct laryngoscope (MDL) regarding the accuracy of assessment of post-thyroidectomy vocal cord dysfunction. METHODS One hundred and twenty patients scheduled for elective thyroidectomy, aged 18 - 50 years, of either sex were enrolled in the study. Standard general anesthesia technique was used in all patients. At the end of operation, patients were randomly allocated into one of the following sequences: 1) examined with MDL then GlideScope®, or 2) examined with GlideScope® then MDL. Postoperative tele-laryngoscopic examination was done after 12 hours. The primary outcome of the study was the sensitivity and the specificity of GlideScope® to detect vocal cord dysfunction while the secondary outcomes were the Cormack-Lehane grade of the glottis visualization and the incidence of complications. RESULTS The incidence of vocal cord dysfunction was 15 (12.5%); all cases were unilateral. The GlideScope® was more sensitive (86.7%) and specific (95.2%) with higher diagnostic accuracy (94.2%) for detecting vocal cord dysfunction than MDL. There was a high agreement between the GlideScope® findings and the final diagnosis (kappa 0.754 [95% CI: 0.581-0.928]). Cormack-Lehane score was significantly better by the GlideScope® than by the MDL (P

Background: Prolonged postoperative mechanical ventilation after intracranial surgery is associated with significant morbidity and mortality. Many traditional tools could help in prediction of weaning success as blood gas analysis (ABG), chest radiography, ventilator parameters and rapid shallow breathing index (RSBI). These tools have a significantly higher failure rate. The aim of this study was to describe the role of transthoracic lung ultrasound (LUS) as a clinical tool in predicting weaning of postoperative mechanically ventilated patients after intracranial surgery. Patients and method:130 patients who were scheduled for weaning from mechanical ventilation (MV), were prospectively enrolled in the study, age 20-70 years, of either sex. They were randomly allocated into two groups- group C (n=65) were examined by traditional methods chest X- ray, ABG, ventilator parameters and RSBI, and group US (n=65) were examined by traditional methods plus LUS. Diaphragm thickness (DT) and fraction (DTF), lung aeration and extravascular lung water (EVLW) were assessed by LUS. A failure of weaning was considered when reintubation was needed within 48 hours. Results: The success rate in group US (LUS+ traditional methods) was 84.6% compared to 66.2% in group C (traditional methods only). The value of diaphragm thickness and fraction were significantly more in the weaning success group than in failure group. B-lines detected by LUS in success and failure groups were ≤2, 3 respectively with no significant difference. Conclusion: Lung ultrasound as an added tool could decrease failure rate of weaning in postoperative mechanically ventilated patients after intracranial surgery.

Background: The literature on drugs used for combined general anesthesia and epidural analgesia (CGE) in lumbar operations is scarce. The purpose of the study was to compare the addition of either dexmedetomidine or fentanyl to bupivacaine for epidural analgesia in combination with general anesthesia with regard to efficacy and adverse events in such operations. Materials and Methods: This prospective, randomized, double-blinded study was conducted on 80 patients who were scheduled for an elective lumbar disc operation, age 20–65 years, of either sex and American Society of Anesthesiologists physical status I or II. They were randomly allocated into one of the two groups – group bupivacaine-dexmedetomidine (BD) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg of dexmedetomidine and group bupivacaine-fentanyl (BF) (n = 40): patients who received CGE with 15 mL of bupivacaine 0.20% plus 50 μg fentanyl. The primary outcome was time to first analgesic requirement, whereas the secondary outcomes were the total opioid consumption and pain scores during the first 24 h. The incidence of adverse postoperative (PO) effects related to the study drugs, such as sedation, nausea and vomiting, pruritus, shivering, and respiratory depression, was also documented. Results: Patients in the BD group experienced a significantly prolonged pain-free period, lower total opioid consumption, and lower pain scores than patients in the BF group (P < 0.001). Patients in the BD group showed a significantly lower intraoperative heart rate and mean blood pressure (P < 0.001). Regarding adverse events, there were greater PO sedation scores (P < 0.001) and less frequent episodes of PO nausea and vomiting in the BD group. In addition, patients in the BD group showed less pruritis and shivering. There were no reported cases of respiratory depression in either group. Conclusion: CGE with bupivacaine plus dexmedetomidine provided better PO pain control than bupivacaine plus fentanyl, with fewer adverse events overall.