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Background: We aimed to assess the ability of caval/aorta diameter index in comparison to inferior vena cava (IVC) collapsibility index to predict postinduction hypotension. Methods: This prospective observational study included adult patients undergoing elective non-cardiac surgery under general anesthesia. Before a standardized induction of anesthesia, ultrasonographic measurement of the IVC maximum and minimum diameter and aortic diameter during systole were obtained using M-mode. The IVC collapsibility index and Caval/aorta diameter index were then calculated. The primary outcome was comparison of the ability of the Caval/aorta diameter index and IVC collapsibility index in predicting postinduction hypotension (defined as systolic blood pressure <90 mmHg or >30% reduction from the baseline) using area under receiver operating characteristic curve (AUC) analysis. Results: Ninety-six patients were analyzed from whom 54 (56%) developed postinduction hypotension. The caval/aorta diameter index were lower and the IVC collapsibility index were higher in hypotensive patients in comparison to the nonhypotensive patients. The AUC (95% confidence interval) for the ability to predict postinduction hypotension of caval/aorta diameter index was 0.95 (0.89-0.99) and was comparable to that of the IVC collapsibility index (0.93 [0.87-0.98]). The caval/aorta diameter index showed the highest positive predictive value (98%) at ratio = 0.84. Conclusion: Both caval/aorta diameter index and IVC collapsibility index can accurately predict postinduction hypotension during general anesthesia. The caval/aorta diameter index showed higher specificity than the IVC collapsibility index; at a cutoff value of = 0.84 for the caval/aorta diameter index, the positive predictive value is 98%. [ABSTRACT FROM AUTHOR]

Background and Aims: Infants exposed to major surgery are at risk of injuries to the immature brain because of reduced arterial oxygen saturation. This study compared the effect of volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) on cerebral oxygenation in neonates subjected to repair of tracheoesophageal fistula (TEF) under video-assisted thoracoscopic surgery (VATS). Methods: This randomised controlled study included 30 full-term neonates scheduled for VATS for managing TEF under general anaesthesia. They were randomised to either VC group (n = 15), who received VCV, or PC group (n = 15), who received PCV. Cerebral oxygenation (rScO2) was monitored throughout the surgery with documentation of episodes of cerebral desaturation. Peripheral oxygen saturation, partial pressure of carbon dioxide (PaCO2), and end-tidal carbon dioxide were recorded at baseline, after induction of anaesthesia, and every 30 min till the end of the surgery. Results: rScO2 was significantly higher in the PC group than the VC group at baseline and was significantly higher in the VC group after 15 min (P = 0.041). Later, it was comparable in both the groups up to 60 min after starting the surgery. Cerebral desaturation was significantly more common in the PC group (80%) compared to VC group (33.3%) (P = 0.010). PC group required higher fraction of inspired oxygen and positive end-expiratory pressure to prevent cerebral desaturation. PaCO2 was significantly higher in the PC group than the VC group at 30 and 60 min (P = 0.005 and 0.029). Conclusion: VCV is safer than PCV for cerebral oxygenation during VATS in neonates. [ABSTRACT FROM AUTHOR]

Objective: Endotracheal intubation is associated with hemodynamic response that may be serious in high-risk patients. This study compared oral gabapentin 900 mg alone or with 7.5 mg oral midazolam on the hemodynamic responses to direct laryngoscopy and endotracheal intubation (LETI). Methodology: This randomized, double-blind clinical trial was conducted in operating room complex, National Cancer Institute, Cairo University, Cairo. The study included 60 normotensive adults scheduled for modified radical mastectomy under general anesthesia. The participants were randomly allocated to two equal groups to receive premedication either with oral gabapentin 900 mg (Group G) or gabapentin 900 mg plus 7.5 mg midazolam (Group GM). Sedation was monitored up to the time of induction of anesthesia. Heart rate (HR) and systolic and diastolic blood pressures were recorded up to 30 min of laryngoscopy. Results: In the two groups, systolic and diastolic blood pressure and heart changes were controlled up to 30 min intra-operatively. Systolic and diastolic blood pressure were significantly lower in Group GM compared to Group G. At all times, there was no significant difference in heart rate between the two groups. Conclusion: Oral gabapentin is effective in attenuation of the hypertensive response to laryngoscopy and endotracheal intubation when administered in a dose of 900 mg 90 min before modified radical mastectomy. It is more effective when combined with oral midazolam 7.5 mg. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the effect of transdermal fentanyl (TDF) as an adjuvant to paravertebral block (PVB) for pain control after breast cancer surgery. Patients and Methods: This randomized, double‑blind trial included fifty females with breast cancer scheduled for surgery. They were randomly allocated into one of two equal groups. The TDF group used transdermal fentanyl patches (TFPs) 25 μg/h applied 10 h preoperative then PVB with 20 mL of bupivacaine 0.25% was done before induction of general anesthesia. The PVB group used placebo patches in addition to PVB the same way as TDF group. Postoperative pain was assessed with a visual analog scale (VAS) score up to 48 h. Intravenous morphine 0.1 mg/kg was given when the VAS is ≥ 3 or on patient request. The primary outcome measures were the time to first request for analgesia and the total analgesic consumption in the first 48 h. Results: Relative to the VAS score reading was 30 min. After the end of surgery, VAS score decreased significantly in the two groups up to 48 postoperative hours and was significantly lower in TDF group up to 24 h. The time to first request of additional analgesia was significantly longer, and total dose of morphine consumption was significantly lower in TDF group (P < 0.001, and P = 0.039, respectively). Conclusion: TFPs releasing 25 μg/h is a safe and effective adjuvant to PVB after breast cancer surgery. It provides adequate analgesia with reduction of opioid consumption and minimal adverse effects. [ABSTRACT FROM AUTHOR]