Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.

BACKGROUND: Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. METHODS AND RESULTS: A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005). CONCLUSION: Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.

Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor.

Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 µg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra- and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery.

The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block.

AIMS: The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block. SETTINGS AND DESIGN: This is a prospective randomized controlled observer-blinded study. SUBJECTS AND METHODS: This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 µg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 µg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request. STATISTICAL ANALYSIS USED: The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant. RESULTS: Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E. CONCLUSIONS: In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.

Preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25% for management of early postoperative pain following laparoscopic ovarian drilling.

AIM: To assess the effectiveness of combined preincisional local infiltration (at trocar sites) and intraperitoneal instillation of levobupivacaine 0.25% for the management of early postoperative pain following laparoscopic ovarian drilling. MATERIALS AND METHODS: This is a prospective randomized controlled observer-blinded study. The study included 106 infertile patients with the diagnosis of polycystic ovary syndrome (PCOS) who were scheduled to undergo diagnostic laparoscopy and laparoscopic ovarian drilling (LOD) during the period from November 2009 to February 2012 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 53 patients each. Group I comprised patients who received preincisional local infiltration and intraperitoneal instillation levobupivacaine 0.25%. Patients in group II received equal volumes of normal saline 0.9% (NS) at the same sites. The primary outcome measures were visual analog scale pain scores and postoperative analgesic consumption. RESULTS: Postoperative average VAS pain scores, i.m. pethidine consumption and i.v. paracetamol consumption during the first 24 h were highly significantly lower in the levobupivacaine group compared to the NS group (P<0.01). This technique was also associated with significantly higher overall patient satisfaction, shorter hospital stay and more rapid resumption of normal activity (P<0.01) without any significant adverse events. CONCLUSION: The combination of preincisional local infiltration and intraperitoneal instillation of levobupivacaine 0.25% was found to substantially reduce postoperative pain and the consumption of postoperative analgesics during the first 24 h; and shorten hospital stay and time to resume normal activities after LOD. It was also associated with a very high overall patient satisfaction without any significant adverse events.

Efficacy of levonorgestrel-releasing intrauterine system versus oral progestins in treatment of simple endometrial hyperplasia without atypia.

OBJECTIVE: To evaluate the efficacy of 3 progestin treatment regimens in the management of simple endometrial hyperplasia without cytological atypia in premenopausal women. STUDY DESIGN: Prospective randomized comparative study. The study included 90 premenopausal women with histological diagnosis of simple endometrial hyperplasia (EH) without atypia, during the period from January 2010 to March 2012, at TAIBA Hospital in Kuwait. Patients were randomly allocated to 3 groups of 30 patients each receiving medroxyprogesterone acetate (MPA, 10 mg/d; group I), norethisterone (NET, 15 mg/d; group II) for 10 days per cycle, or insertion of levonorgestrel-releasing intrauterine system (LNG-IUS; group III). Patients were reevaluated after 3 months of treatment. Patients with regression and persistence were offered the same medication they were using for another 3 months. The primary outcome of the study was the proportion of patients requiring further treatment for another 3 months. RESULTS: Patients in the LNG-IUS group showed the highest resolution rate (66.67%). Patients in MPA group had a resolution rate of 36.66% where the resolution rate was 40% in patients of NET group. The patients having LNG-IUS showed a regression rate of 33.3%, whereas patients receiving MPA and NET showed a regression rate of 60% and 56.67%, respectively. There was a statistically significant difference between the 3 groups regarding the proportion of patients requiring further treatment for another 3 months (χ(2) = 6.501; P = .0387). CONCLUSION: The LNG-IUS appears to represent an effective superior convenient treatment option for simple EH without atypia.

Pre-emptive analgesia by nerve stimulator guided pudendal nerve block for posterior colpoperineorrhaphy.

OBJECTIVE: To assess the effect of pre-emptive analgesia by bilateral nerve stimulator-guided pudendal nerve block (PNB) on pain intensity and consumption of analgesics following posterior colpoperineorrhaphy. STUDY DESIGN: Prospective randomized observer-blinded study. The study included 130 patients who were scheduled to undergo posterior colpoperineorrhaphy under general anesthesia (GA). They were invited to enroll in the study during the period from October 2009 to August 2011 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 65 patients each: GA alone or GA combined with pre-emptive nerve stimulator-guided PNB with 10 mL of 0.25% bupivacaine in each side. The primary outcome measures were VAS pain scores and postoperative analgesic consumption. RESULTS: Postoperative average VAS pain scores, IM pethidine consumption and IV paracetamol consumption during the first 24 h; were highly significantly lower in the PNB group compared to the GA alone group. This technique was also associated with a significantly higher overall patient satisfaction compared to GA alone, without obvious side effects. CONCLUSION: Pre-emptive analgesia by bilateral nerve stimulator-guided PNB is a simple and useful technique that when combined with GA was found to substantially reduce postoperative pain and consumption of analgesics during the first 24 h postoperatively, and shorten the time to return to normal activities compared to GA alone for patients undergoing posterior colpoperineorrhaphy. The use of PNB was also associated with a high overall patient satisfaction. Thus, the results of the present study may recommend the use of nerve stimulator-guided PNB in posterior colpoperineorrhaphy patients.