Background Early and precocious determination of acute kidney injury (AKI) is essential to prevent morbidity and mortality following coronary artery bypass grafting (CABG). Evaluation of the perioperative renal function is substantial using novel biomarkers other than the late traditional method of using serum creatinine. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker investigated for early detection of AKI in patients undergoing coronary artery bypass grafting, and its role has to be determined in this study. Results Twenty-five patients undergoing elective CABG were enrolled in this cohort study and were assigned into two groups: group I include the patients that did not develop AKI (no AKI group) and group II include the patients that developed AKI (AKI group). Acute kidney injury based on Kidney Disease: Improving Global Outcomes (KDIGO) classification had been developed in 7 patients (28%). Plasma NGAL levels at 6 h were higher in patients who developed AKI compared with those who did not (302 ± 88.02 vs. 116.50 ± 17.33 ng/m, p value < 0.001). The cut-off value of plasma NGAL levels measured 6 h postoperatively was 145 ng/ml and the area under the receiver-operating characteristic (ROC) curve was 0.965. Results of this study showed that plasma NGAL is a robust early biomarker of AKI, which preceded the rise in serum creatinine by many hours. Conclusion This study revealed that earlier diagnosis of acute kidney injury in patients undergoing CABG can be achieved by measuring postoperative plasma NGAL concentration at 6 h.
High-normal blood pressure is associated with visit-to-visit blood pressure variability. Additional research is required to replicate the reported results in prospective studies and evaluate approaches to reduce blood pressure variability observed in clinical settings among patients with high-normal blood pressure to reduce the subsequent complications of blood pressure variability.
Background Over the years, sevoflurane has been proven to be the most effective inhalational anesthetic for induction and maintenance of general anesthesia in pediatrics. However, one of the downsides of utilizing sevoflurane anesthesia in pediatrics is emergence agitation (EA). A variety of drugs have been evaluated for prophylaxis against the occurrence of EA. Both magnesium and ketamine were evaluated in controlling this phenomenon; however, the usefulness of using intraoperative magnesium and ketamine infusions in preventing EA is still debatable. Methods Fifty-two children aged 4–7 years who were having elective lower abdominal or pelvic surgeries under sevoflurane anesthesia were enrolled then allocated randomly into one of two groups (n = 26 each). The magnesium group (M) included 26 patients who received intravenous (IV) loading dose of magnesium 15 mg/kg before the surgical incision followed by IV infusion 10 mg/kg/h over the duration of surgery, while the ketamine group (K) included 26 patients who received an IV loading dose of ketamine 1 mg/kg before the surgical incision, then IV infusion 1 mg/kg/h over the duration of surgery. For each patient, the agitation score (Pediatric Anesthesia Emergence Delirium [PAED] scale) and pain score, as well as the time to endotracheal tube (ETT) removal, regain of mental orientation, and transfer from the post-anesthesia care unit (PACU) to ward were all documented. Results Intraoperative magnesium sulfate infusion showed a lower PAED score on immediate arrival to PACU than intraoperative ketamine infusion, with less time to tracheal extubation, recovery of mental orientation, and discharge from PACU with a P value below 0.001, while there was no statistical significance between both groups as regards PAED score after 30 min in PACU, pain score, or perioperative vital data. Conclusions Magnesium sulfate was found superior to ketamine in lowering the severity of the postoperative agitation in pediatric patients undergoing abdominal or pelvic surgeries under sevoflurane anesthesia. Also, patients restored their consciousness and mental orientation faster in the magnesium group compared to ketamine. This has increased the PACU stay in the ketamine group.
Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for earlystage breast cancers. Objectives The aim of this work is to evaluate the Effectiveness of Ultrasound Guided Pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in Modified Radical Mastectomy Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 15 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PEC 1 block.
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