Background:No studies compared parenteral dexmedetomidine with its use as an adjuvant to ophthalmic block. We compared between adding dexmedetomidine to bupivacaine in peribulbar block and intravenous (IV) dexmedetomidine during peribulbar block for cataract surgery.Materials and Methods:A prospective, randomized, double-blind study on 90 patients for cataract surgery under peribulbar anesthesia. Study included three groups; all patients received 10 ml of peribulbar anesthesia and IV infusion of drugs as follows: Group I: Received a mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) + 150 IU hyaluronidase + IV infusion of normal saline, Group II: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + dexmedetomidine 50 μg (1 ml) +150 IU hyaluronidase + IV infusion of normal saline and Group III: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) +150 IU hyaluronidase + IV dexmedetomidine 1 μg/kg over 10 min; followed by 0.4 μg/kg/h IV infusion. We recorded onset, duration of block, Ramsay Sedation Score, intra-ocular pressure (IOP), hemodynamics, and adverse effects.Results:There was a significant decrease in the onset of action and increase in the duration of block in Group II as compared with the Group I and Group III. Mean Ramsay Sedation Score was higher in Group III. The IOP showed a significant decrease in Group II and Group III 10 min after injection (P < 0.01). Heart rate showed a significant decrease in Group III in comparison with the two other groups (P < 0.05). Only two patients in Group III developed bradycardia.Conclusion:Dexmedetomidine as an additive shortens onset time, prolong block durations and significantly decreases the IOP with minimal side effects. IV dexmedetomidine, in addition, produces intra-operative sedation with hemodynamic stability.
Morbidly adherent placenta is asignificant cause of maternal morbidity , mortality and massive obstetric hemorrhage. It is defined as an abnormal placental adherence either in whole or in part of the placenta to the underlying uterine wall. It is a potentially life threatening condition responsible for 7-10% of maternal mortality.Is to evaluate the accuracy of Color Doppler Ultrasonography in antenatal diagnosis of placenta previa accreta in patients with previous cesarean sections. The study included 60 pregnant females after 28 week of gestation from obstetrics and gynecology department of Banha University hospital during a period from (1 st of December 2018 to 30 th November 2019) with suspected history and ultrasonographic findings of placenta accreta. Gray-scale B-mode transabdominal sonography and Color Doppler Ultrasound scans were done. The overall accuracy of diffuse or focal lacunar flow was 73.3%, vascular lakes with turbulent flow 70%, Hypervascularity of serosa bladder interface 62% and markedly dilated vessel over peripheral sub-placental zone 71% in doppler ultrasound. Color Doppler does not appear to improve the accuracy of Gray-Scale so, it is suggested to use both Gray scale ultrasound and Color Doppler in all cases of placenta previa with previous C.S to find out features that suggest presence of placenta accreta.
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