Effect of Low-dose Ketamine Infusion on Opioid Consumption in Children Undergoing Open Cardiac Surgery: A Randomized Controlled Double-Blind Study.

OBJECTIVE: This study was designed to evaluate the effect of low-dose ketamine infusion on the perioperative consumption of opioids in pediatric open cardiac surgery. DESIGN: A randomized, controlled, double-blinded single-center study was conducted. SETTING: The study took place in a tertiary care children's hospital. PARTICIPANTS: Patients of both sexes aged 2-12 years who underwent cardiac surgery were included. INTERVENTIONS: Patients in the ketamine group received a bolus of 0.3 mg/kg of ketamine before skin incision followed by continuous intraoperative infusion of 0.25 mg/kg/h and postoperative infusion of 0.1 mg/kg/h for 24 h. Patients in the control groups received volumes of normal saline either bolus or continuous infusion like that of the ketamine group. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the total dose of fentanyl consumed over the first 24 hours postoperatively. Secondary outcomes were intraoperative fentanyl consumption, time to extubation, modified objective pain score, and incidence of vomiting, pruritus, diplopia, or hallucinations. A total of 80 patients were recruited but the final analysis was done on 35 patients in the ketamine group and 34 in the control group. Fentanyl consumption during surgery and in the first 24 hours postoperatively was significantly lower in the ketamine than the control group. Patients in both the ketamine and control groups had similar times to extubation. Modified objective pain scores were significantly lower in the ketamine group than the control group. None of the patients in either group had diplopia or hallucinations. CONCLUSIONS: Low-dose ketamine infusion in children undergoing open cardiac surgery reduced intra- and postoperative opioid consumption and postoperative pain scores. Moreover, ketamine did not cause diplopia or hallucinations.

Developing a strategy based on weighted mean of vectors (INFO) optimizer for optimal power flow considering uncertainty of renewable energy generation.

In recent years, more efforts have been exerted to increase the level of renewable energy sources (RESs) in the energy mix in many countries to mitigate the dangerous effects of greenhouse gases emissions. However, because of their stochastic nature, most RESs pose some operational and planning challenges to power systems. One of these challenges is the complexity of solving the optimal power flow (OPF) problem in existing RESs. This study proposes an OPF model that has three different sources of renewable energy: wind, solar, and combined solar and small-hydro sources in addition to the conventional thermal power. Three probability density functions (PDF), namely lognormal, Weibull, and Gumbel, are employed to determine available solar, wind, and small-hydro output powers, respectively. Many meta-heuristic optimization algorithms have been applied for solving OPF problem in the presence of RESs. In this work, a new meta-heuristic algorithm, weighted mean of vectors (INFO), is employed for solving the OPF problem in two adjusted standard IEEE power systems (30 and 57 buses). It is simulated by MATLAB software in different theoretical and practical cases to test its validity in solving the OPF problem of the adjusted power systems. The results of the applied simulation cases in this work show that INFO has better performance results in minimizing total generation cost and reducing convergence time among other algorithms.

Role of topical vancomycin in reduction of postoperative infections in head trauma patients: A developing country experience.

BACKGROUND: Postoperative cranial wound infections are a major cause of morbidity, mortality, and financial burden, especially in developing countries. METHODS: We prospectively studied 86 patients in a randomized trial; 39 patients received one gram of topical vancomycin powder in the subgaleal space while 47 matched control patients did not. Both groups received identical intraoperative and post-operative care. The primary outcome variable was the postoperative wound infections rate factored by cohort. Secondary outcomes were the timing of infection and the rate of adverse events. RESULTS: Adding topical vancomycin was associated with a significantly lower rate of infection than the standard of care alone (2.6% [1/39] vs. 14.9% [7/47], P =.004). No adverse reactions occurred. CONCLUSION: Topical vancomycin is safe, and effective in the prevention of surgical site infections following craniotomy. These findings have broad consequences for neurosurgery practice, especially in developing countries with high incidence of head trauma.

Outcomes of Chiari Malformation III: A Review of Literature.

PURPOSE: Chiari malformation type III (CM III) is the rarest type compared to other types of CMs. CM III usually reported as sporadic case reports which reflect the rarity of this anomaly. We report two cases of operated CM III at our institute with a reasonable outcome and reviewed the literature to illustrate the variability of prognosis and related hydrocephalus. MATERIALS AND METHODS: We operated two cases of CM III in our hospital followed by ventriculoperitoneal shunt (VPS) placement with an accepted neurological outcome at 10 and 6 months follow-up. We reviewed the literature for other cases of CM III with focusing on prognosis to illustrate the real image of reported prognosis and related hydrocephalus. RESULTS: After follow-up for 10 and 6 months, respectively, both cases had mild developmental delays. In this review, we report 51 cases of CM III over the last 30 years since 1989, there was slight male predilection, hydrocephalus was evident in 27 cases which was almost managed with VPSs and was evident in seven deaths. CONCLUSION: CM III is a rare anomaly which usually carries a bad prognosis, but death is not ultimate, and there may be a minority who carry good prognosis. This bad prognosis pushes some parents to refuse surgery otherwise repair should be done. With good pre- and postoperative care, physical therapy, and follow-up, the outcome is reasonable.

Telovelar Approach to Pediatric Fourth Ventricle Tumors: Feasibility and Outcome.

AIM: To describe our institution’s experience with the telovelar approach as well as factors governing radicality and outcome for pediatric fourth ventricle tumors. MATERIAL AND METHODS: During March 2015â€"January 2017, 44 children with fourth ventricular tumors were operated using the telovelar approach. Radicality, neurological outcome, complications, and survival rates were evaluated. Statistical analysis was performed to determine factors associated with radicality and neurological outcome. RESULTS: Gross tumor removal was achieved in 37 patients (84.1%). All patients required cerebrospinal fluid (CSF) diversion through a ventriculoperitoneal shunt. Six patients (13.6%) developed cerebellar mutism, 4 patients (9.1%) developed bulbar paralysis (lower cranial nerve palsy), and 13 patients (30.2%) had tumor recurrence. Medulloblastoma was associated with the highest risk of cerebellar mutism (p=0.040). A poor prognosis (according to overall and progression-free survival rates) was associated with subtotal resection (p=0.020), large cell/anaplastic medulloblastoma and anaplastic ependymoma (p=0.038), highrisk medulloblastoma (p=0.005), and CSF seeding (p < 0.001). CONCLUSION: The telovelar approach provides an adequate anatomical exposure of the fourth ventricle and allows early visualization and protection of its floor (brainstem). It facilitates adequate radicality and is associated with a lower incidence of cerebellar mutism and other approach-related complications. The working angle, particularly to the rostral part of the fourth ventricle, can be increased by removing the posterior arch of the atlas.