Background: Tracheal intubation is a noxious stimulus that tends to provoke a marked sympathetic response which is potentially deleterious in some patients. Various methods have been used to minimize and attenuate these potentially harmful responses. Aim of the study: The present study compared the efficacy and safety of two different doses (150 mg and 300 mg) of oral pregabalin premedication on attenuation of the hemodynamic pressor response to airway instrumentation, perioperative hemodynamic stability, preoperative sedation, and postoperative pain reduction. Patients and methods: This prospective, observational study consisted of 60 adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized into three groups of 20 patients each. Group I (P0) received an oral placebo, group II (P150) received 150 mg of oral pregabalin and group III (P300) received 300 mg of oral pregabalin 1 h prior to induction. All patients were assessed for pre-operative sedation, perioperative hemodynamic changes, Post-operative pain and analgesic consumption. Results: Regarding the efficacy of the preoperative administration of oral pregabalin, a dose dependent attenuation in the increased in heart rate, systolic, and diastolic blood pressure, and mean arterial blood pressure resulting from laryngoscopy and intubation was observed (300 mg > 150 mg), along with a subsequent decrease in intraoperative fentanyl supplementation. On anxiolysis, patients were more comfortable and asleep in the pregabalin groups as compared with the control group, in which more patients were awake and agitated. Post-operative pain and analgesic consumption were effectively reduced by (150 mg and 300 mg) pregabalin in a dose-dependent manner. Postoperative nausea and vomiting were significantly lower with the administration of pregabalin compared with the placebo group (P < 0.008). Additionally, pregabalin increased the incidence of dizziness and visual disturbances in a dose-dependent manner. Con- clusion: Oral pregabalin premedication adequately sedated patients and attenuated the hemodynamic pressor response to airway instrumentation in a dose-dependent manner. Premedicated patients were haemodynamically stable perioperatively without recovery time prolongation or side effects, except dizziness with 300 mg of oral pregabalin. Additionally, oral pregabalin reduced postoperative pain and analgesic consumption in a dose-dependent manner.
Background: The aim of our study was to assess of tracheal intubation by different doses of propofol preceded by fentanyl for successful tracheal intubation and to see its effectiveness in blunting pressors response in children aged 2-10 years.
Background: Pneumonia is a common and serious infectious disease that can cause high mortality. Lung ultrasonography is being increasingly utilized in emergency and critical settings. The role of Lung Ultrasound (LUS) in the diagnosis and follow-up of pneumonia is becoming more and more important. Aim of the Work: To compare the diagnostic accuracy of LUS against a referent Chest X-Ray (CXR), chest contrastenhanced Computerized Tomography (CT) scan and/or clinical criteria for diagnosis and follow-up of pneumonia in critically ill adult patients. Patients and Methods: We enrolled 32 (11M, 21F) multimorbid patients aged 61.31 ± 12.13 years from March 2016 to October 2016. Each participant underwent CXR and bedside LUS within 6 hours from Intensive Care Unit (ICU) admission. LUS was performed by skilled clinicians, blinded to CXR results and clinical history. The final diagnosis (pneumonia vs. no-pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT. Diagnostic parameters of CXR and LUS were compared. Results: 28 patients (87.5%) out of 32 patients with positive LUS had a final diagnosis of pneumonia. LUS was falsely positive in two cases (6.2%) and false negative in two patients (6.2%). The sensitivity and the specificity of LUS were 87.5% (95% CI 78.9-92.7%) and 89.3% (95% CI78.3-91.9%) respectively. Conclusion: The study supports that LUS when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. Intensivist and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.
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