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Study Objective: Preoperative anemia results in two- to sixfold increased incidence of perioperative blood transfusion requirements and reduced postoperative hemoglobin (Hb) level. This prospective study was designed to investigate the effect of preoperative intravenous infusion of iron on Hb levels, blood transfusion requirements, and incidence of postoperative adverse events in patients undergoing coronary artery bypass grafting. Design: Prospective randomized trial. Setting: Academic university hospital. Patients: Eighty patients (52–67 years old) underwent coronary artery bypass grafting and received either iron therapy or saline infusion preoperatively. Interventions: Patients were randomly allocated to iron or placebo groups. In the iron group, patients received a single intravenous dose of ferric carboxymaltose (1000 mg in 100 mL saline) infused slowly over 15 min 7 days before surgery. In placebo group, patients received a single intravenous dose of saline (100 mL saline) infused slowly over 15 min 7 days before surgery. Measurements: Patients were followed up with regards to incidence of anemia, Hb level on admission, preoperatively, postoperatively, 1 week and 4 weeks after discharge, aortic cross-clamp time, the number of packed red blood cells (pRBCs) units, the percentage of reticulocytes pre–postoperatively and 1 week later, hospital stay and intensive care unit (ICU) stay length, and the incidence of postoperative complications. Main Results: Iron therapy was associated with lower incidence of anemia 4 weeks after discharge ( P < 0.001). Hb level was significantly higher in the iron group compared to the placebo group preoperatively and postoperatively, and 4 weeks after discharge ( P < 0.001). Iron therapy resulted in shorter hospital and ICU stay ( P < 0.001) and shorter aortic cross-clamp time, reduced pRBCs requirements postoperatively. Percentage of reticulocytes was significantly higher in placebo group than in iron group postoperatively and 1 week after discharge and the incidence of postoperative complications was similar to the placebo group. Conclusions: Preoperative IV iron infusion is a safe and feasible way to manage preoperative anemia. Preoperative administration of IV iron is associated with a higher postoperative Hb level, shorter hospital and ICU stay, and reduced perioperative red blood cell transfusion requirements with insignificant difference in incidence of postoperative complications.

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a b s t r a c tObjective: The serratus intercostal plane block is successfully performed for pain management after breast surgeries. To assess the efficacy and safety of serratus intercostals plane block in comparison with local wound infiltration in women under-going breast surgery. Methods: This prospective study was conducted on 46 female patients undergoing breast surgeries. Patients were divided into two groups: serratus block (SB) group (n = 23): patients received induction with serratus intercostal plane block with 0.4 ml/kg bupivacaine 0.25% plus fentanyl 20 lg, infiltration group (n = 23) received induction with the borders of the surgical wound were infiltrated with 0.4 ml/ kg of bupivacaine 0.25% and 20 lg fentanyl at the end of surgery.VAS pain scores, postoperative patient satisfaction score, time to the first analgesic requirement, total dose of rescue analgesic and the incidence of postoperative complications as vomiting were all recorded. Results: Intraoperative pain scores and postoperative patient satisfaction scores were significantly lower in group SB compared with infiltration group. Total dose of rescue analgesic was significantly lower in SB group compared with Infiltration group. Significant difference between the study groups regarding the incidence of vomiting. Time to the first analgesic dose was significantly longer in group SB compared to Infiltration group. Conclusion: There is considerable evidence that serratus intercostal plane block in addition to general anesthesia provide better postoperative pain control with little adverse effects compared with wound infiltration, indicating that a perioperative serratus intercostal plane block is a feasible and effective method for an improved postoperative pain treatment after breast surgery. Ó 2016 Publishing services by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).After the approval of medical ethical committee of Ain Shams University, this prospective parallel group study was conducted http://dx.

Background Atherosclerosis is a systemic disease affecting the coronary, carotid, and lower limb arteries. Cerebrovascular accidents and lower limb ischemia are devastating postoperative complications. We aimed to evaluate the role of non-selective routine arterial duplex scanning in patients undergoing coronary artery bypass grafting (CABG). Methods This non-randomized clinical trial included 360 patients scheduled for elective isolated CABG who were divided into two groups: low-risk (n = 180) and high-risk (n = 180). Both groups underwent preoperative carotid and lower limb ultrasound screening for associated arteriopathy. Results 16 (8.9%) patients and 22 (12.2%) patients showed ≥70% carotid artery stenosis while 11 patients (6.1%) and 20 patients (11.1%) showed ≥50% lower limb arterial stenosis in the low-risk group and the high-risk group, respectively; though the difference was not statistically significant in both the cases (p > 0.1). Conclusion Routine preoperative peripheral arterial screening by sonography is a feasible and effective strategy to avoid unnecessary post CABG complications. Trial registration NCT03516929, Registered in 24 th of April 2018.