BackgroundImmune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients.MethodsSixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales.ResultsPostoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B.ConclusionsAdding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

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Background: Readmission to the intensive care unit is associated with increased cost of care and worse patient outcomes Aim :of the study was to determine and explore nurses and physicians perception of causes and risk factors contributing patients readmission to coronary care unit. Design:-descriptive research design was used in this study. Setting: The study was conducted in coronary care units at a University Hospital. Sample: thirty nurses and twenty-five physicians working at the Coronary Care Unit. Tools: semi structured interview questionnaires. Results: thirty-two factors within four broad themes that could lead to readmissions were identified (1) patient factors: Previous comorbidities, Previous acute coronary syndrome, Bad medication compliance and Patient discharged before articulation goal of care (100%). (2) process factors: Unqualified staff member, Resources constraints (100%). ( 3) provider factors: Heavy workloads 90%, Unqualified staff member deal with highly demand patient (86,9). (4) organizational factors: Resources constraints (when patient transfer to ward)100% Conclusion and recommendations: intensive care unit care givers need to look at ways of increasing the knowledge and skills of ICU staff or identify more appropriate environment for managing acutely ill patients

Introduction: Malnutrition is prevalent in intensive care unit patients and is associated with increased morbidity and mortality. Early administration of enteral nutrition to critically ill patients has been associated with a reduced length of hospital stay, enteral nutrition often is complicated by intolerance, as indicated by elevated volumes of gastric residuals. Aim of this study: Was to investigate the effect of implementing gastric residual protocol on critically ill patient outcomes. Design: A quasi-experimental research design was adopted to conduct this study. Setting: The general, trauma and anesthesia intensive care unit at Assiut university hospital. Subjects: A simple random sample of 68 adult critically ill patients who are mechanically ventilated and receiving enteral feeding assigned into two groups (35 patient in control group and 33 patient in intervention group). Results: There was a significant decrease in total amount of GRV, Length of ICU stay, mechanical ventilation duration, and mortality in the intervention groups than control groups, there was significant increase in delivered feeding amount, total calories in intervention groups than control groups p-value <0.05 Conclusion: Implementing gastric residual volume protocol had a positive effect on critically ill patient outcomes. Recommendation: Instruct health team in intensive care unit about gastric residual measurement, and management of high GRV.

Use of music has the potential to positively affect patient perception during intraoperative of surgical treatment. Intraoperative awareness is the most frustrating complication in patient undergoing surgery under general anesthesia. Study Design was Quasi-experimental research design. Three tools were used to conduct this study namily: "Preoperative assessment tool", "intraoperative assessment tool" and "postoperative assessment tool". Method: In a prospective, randomized double blind study, patients were randomized into two equal groups; In C group (n = 25) patients acted as the control and did not listening to music, while in music group (n = 25) patients listening to music. In both groups, auditory evoked potentials index electrodes connected before induction of anesthesia at operative room to detect depth of anesthesia and occurrence of intraoperative awareness. An interview with the patients and their parents to evaluate occurrence of awareness by using a semi-structured in-depth questionnaire. The main results: The results of the current study revealed that there was statistically significant decrease in occurrence of awareness in music group versus the control group (P value =0.000***). Conclusion: The application of music was highly effective in reducing intraoperative awareness.