Background: Gynecological laparoscopic surgery is commonly performed on an ambulatory basis under general anesthesia. The postoperative quality of recovery (QOR) should be considered one of the principal endpoints after ambulatory surgery. Total intravenous anesthesia (TIVA) with opioids is known to improve postoperative QOR after ambulatory surgery. However, opioids can be associated with an increased incidence of postoperative complications, which can affect postoperative QOR. The primary aim of this study was to compare the patient recovery using the QOR-40 at 24 h postoperative in ambulatory gynecological laparoscopy between opioid-free (OF) TIVA and opioid-based TIVA. Settings and Design: A prospective, randomized, controlled, comparative study was conducted at the day surgery center. Patients and Methods: Eighty females were included in the study. They were randomized into two equal groups: OF TIVA group with dexmedetomidine and propofol or opioid-based TIVA (O) group with fentanyl and propofol. The primary outcome was QOR-40 at 24 h postoperative, and the secondary outcomes were postoperative numerical rating scale (NRS), time to first rescue analgesia, number of rescue tramadol analgesia, and the incidence of postoperative nausea and vomiting. Results: A statistically significant difference in total QOR-40 score at 24 h postoperative was observed between the groups (median [range] QOR-40 of 182.0 [164.0–192.0] in the OF TIVA group and 170.0 [156.0–185.0] in the O group; P = 0.03). OF group had significantly lower time to first rescue analgesia, maximum NRS pain scores, number of rescue tramadol analgesia, and ondansetron use. Conclusions: OF TIVA significantly improves postoperative QOR in patients undergoing ambulatory gynecological laparoscopic surgery.

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Background: Endovenous laser ablation (EVLA) is a new method for treating greater saphenous vein insufficiency. Most of physicians use local anesthesia for needle punctures and tumescent anesthesia (TA) to prevent pain and protects the surrounding tissues from the conduction of heat that would originate from the effects of laser energy on the venous wall. The aim of this study is to compare the use of local tumescent anesthesia alone or combined with ultrasound guided femoral and obturator nerve blocks for treatment of varicose veins by endovenous laser ablation. Methodology: This is a randomized, double blind study included 80 patients scheduled for endovenous laser ablation for varicose veins of the great saphenous vein (GSV) located in the anterior or medial aspect of the leg were prospectively divided into two groups of 40 patients each. Group (A) had EVLA using tumescent anesthesia given by the surgeon. Group (B) had femoral and obturator nerves block before tumescent anesthesia was done. Intraoperative pain associated with applying the tumescent anesthesia and during performing ablation was measured using visual analogue scale. Volume of tumescent was compared in both groups. After finishing the operation, femoral and obturator motor block were evaluated. Postoperative VAS, time of stay in recovery area, patient and doctor satisfaction were also measured.

Background: Prolonged postoperative mechanical ventilation after intracranial surgery is associated with significant morbidity and mortality. Many traditional tools could help in prediction of weaning success as blood gas analysis (ABG), chest radiography, ventilator parameters and rapid shallow breathing index (RSBI). These tools have a significantly higher failure rate. The aim of this study was to describe the role of transthoracic lung ultrasound (LUS) as a clinical tool in predicting weaning of postoperative mechanically ventilated patients after intracranial surgery. Patients and method:130 patients who were scheduled for weaning from mechanical ventilation (MV), were prospectively enrolled in the study, age 20-70 years, of either sex. They were randomly allocated into two groups-group C (n=65) were examined by traditional methods chest X-ray, ABG, ventilator parameters and RSBI, and group US (n=65) were examined by traditional methods plus LUS. Diaphragm thickness (DT) and fraction (DTF), lung aeration and extravascular lung water (EVLW) were assessed by LUS. A failure of weaning was considered when reintubation was needed within 48 hours. Results: The success rate in group US (LUS+ traditional methods) was 84.6% compared to 66.2% in group C (traditional methods only). The value of diaphragm thickness and fraction were significantly more in the weaning success group than in failure group. B-lines detected by LUS in success and failure groups were ≤2, 3 respectively with no significant difference. Conclusion: Lung ultrasound as an added tool could decrease failure rate of weaning in postoperative mechanically ventilated patients after intracranial surgery.