Ketofol versus Dexmedetomidine for preventing postoperative delirium in elderly patients undergoing intestinal obstruction surgeries: a randomized controlled study.

PURPOSE: Postoperative delirium (POD) is considered the most common postoperative neurological complication in elderly patients. The aim of this study was to evaluate the efficacy of the administration of ketofol versus dexmedetomidine (DEX) for minimizing POD in elderly patients undergoing urgent exploration for intestinal obstruction. METHODS: This prospective double-blinded randomized clinical trial was conducted on 120 elderly patients undergoing urgent exploration for intestinal obstruction. Patients were randomly allocated to one of the three groups: Group C (control group) patients received normal saline 0.9%, group D received dexmedetomidine, and group K received ketofol (ketamine: propofol was 1:4). The primary outcome was the incidence of POD. Secondary outcomes were incidence of emergence agitation, postoperative pain, consumption of rescue opioids, hemodynamics, and any side effects. RESULTS: The incidence of POD was statistically significantly lower in ketofol and DEX groups than in the control group at all postoperative time recordings. Additionally, VAS scores were statistically significantly decreased in the ketofol and DEX groups compared to the control group at all time recordings except at 48 and 72 h postoperatively, where the values of the three studied groups were comparable. The occurrence of emergence agitation and high-dose opioid consumption postoperatively were found to be significant predictors for the occurrence of POD at 2 h and on the evening of the 1st postoperative day. CONCLUSION: The administration of ketofol provides a promising alternative option that is as effective as DEX in reducing the incidence of POD in elderly patients undergoing urgent exploration for intestinal obstruction. TRIAL REGISTRATION: This clinical trial was approved by the Institutional Review Board (IRB) at Zagazig University (ZU-IRB# 6704// 3/03/2021) and ClinicalTrials.gov (NCT04816162, registration date 22/03/ 2021). The first research participant was enrolled on 25/03/2021).

Transcranial Doppler role in prediction of post-dural puncture headache in parturients undergoing elective cesarean section: prospective observational study.

PURPOSE: Post-dural puncture headache (PDPH) may be resulted from significant changes in cerebral blood flow, which could be visualized by Transcranial Doppler (TCD). This study was performed to investigate if TCD can be used to predict the occurrence of PDPH in high-risk patients. METHODS: This prospective observational study was conducted on ninety ASA I and II pregnant females undergoing elective cesarean section (CS) under spinal anesthesia. TCD was performed to all patients within 24 h before the operation, at 24 h and 48 h in the post-operative period to measure mean velocity (MV) and Gosling pulsatility index (PI) in the right middle cerebral artery. For 5 days postoperatively, all patients were assessed and the PDPH patients were identified, their pre- and post-puncture TCD measurements were compared with the corresponding measurements of PDPH-free patients and ROC analysis was done to evaluate the predictive value of TCD parameters. RESULTS: 17 patients (18.8%) developed PDPH. PDPH group was significantly higher regarding MV and significantly lower with regard to PI at all times except for the pre-spinal PI. The MV values in all patients showed statistical significant increase within the first 48 h after CS as compared with those before delivery. In PDPH group there was high statistical significant decrease in PI values at 24 h and 48 h compared to the pre-puncture values. The pre-puncture MV was the parameter of the best accuracy for predicting PDPH with a cutoff of MV > 68.4 cm/s and the post-puncture PI at 24 h was the best predictive of PDPH with a cutoff value of < 0.75. CONCLUSION: TCD might prove a useful tool in predicting PDPH suggesting that higher pre-puncture MV with a cutoff value > 68.4 cm/s and post-puncture lower PI at 24 h with a cutoff < 0.75 are the best predictive parameters. TRIAL REGISTRATION: This clinical trial was registered with ClinicalTrials.gov (NCT03464253).