Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.

Objectives: This study was done to examine the effect of a single, one-time pregabalin dose on postoperative pain, anxiety, and analgesic consumption after vitrectomy performed under the peribulbar block and to assess the satisfaction of the patients as well as the surgeons. Methods: This randomized, double-blinded, placebo-controlled trial was conducted at Magrabi Eye, ENT and Dental Center, Doha, Qatar on 58 adult patients aged 37 - 75 years, who met status I and II of the American Society of Anesthesiologists (ASA) and scheduled for elective vitrectomy, under the peribulbar block (PB). Of the total participants, 30 cases were randomized to receive pregabalin, while the remaining received placebo 90 minutes before surgery. Pain was assessed using a Verbal Analog Scale (VAS) score, and the levels of anxiety were gauged by verbal anxiety score. Results: Patients who received pregabalin had a significantly higher sedation score (3 ± 0 vs. & 2 ± 0.65; P < 0.05), and a significantly less anxiety score (3 ± 1.3 vs. 5 ± 1.6; P < 0.001) compared to the control group. During needle insertion for PB, patients in the pregabalin group experienced less pain compared to the control group (32 ± 15 vs. 44 ± 15; P < 0.05). Pregabalin group showed a significantly higher cooperation rate and patient satisfaction scores (3.2 ± 0.7 and 3.8 ± 0.4, respectively), compared to the placebo group (2.8 ± 0.7 and 3.4 ± 0.5, respectively). The placebo group required intraoperative midazolam more in comparison to the pregabalin group (19 vs. 5; P < 0.001). Moreover, the need for postoperative analgesia was more in the placebo group two hours postoperatively. Conclusions: Pregabalin is a potent premedication in controlling post-surgical pain and anxiety in patients undergoing vitrectomy under the PB.

Background: OSA affects up to quarter of general population. It is associated with morbid obesity with a higher morbidity and mortality rates. STOP Bang questionnaire is a validated method for OSA screening. OSA patients are at high risk of developing airway obstruction, cardiac events, congestive heart failure, stroke and desaturation post operatively. The aim of this study is to evaluate adverse respiratory events in patients undergoing bariatric surgery in relation to risk of OSA using Stop Bang questionnaire. Methods: This prospective double cohort study was conducted in Tanta University Hospital from Marchto August 2017. During the preoperative assessment, STOP-BANG questionnaire was performed. After extubation, patients were transferred to PACU unit. Respiratory complications were assessed thereafter. Based on STOP-BANG score, patients were divided into two groups, high risk of OSA with STOP-BANG > 3 (Group I) and low risk of OSA with STOP-BANG < 3 (Group II). Results: 104 patients were included in this study. Group I had more comorbidities in the form of CAD (15% versus 2%, P < 0.001), dyslipidemia (28% versus 11%, P < 0.001) and diabetes on insulin treatment (38% versus 6%, P > 0.001). Higher number of respiratory complications was noted in high-risk group (31 patients, 59%) compared to (24 patients, 46%) in group II yet, it was not significant. Conclusion: Obese patients with STOP-BANG score > 3 undergoing bariatric surgery are associated with hypertension, dyslipidemia, CAD, and renal insufficiency. High-risk OSA obese patients are at higher risk of developing respiratory compilations like inability to breathe deeply and hypoxia in postoperatively.

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