Background: Immune balance is mandatory for proper postoperative (PO) courses and wound healing. Cesarean section is the commonest surgical procedure for females. The choice of anesthetic procedure may affect the mother and fetal outcomes. Objectives: Evaluation of the impact of general (GA) versus spinal anesthesia (SA) on parturient' cytokines' serum levels. Patients and methods: 73 and 59 parturients received GA and SA, respectively. Fetal APGAR scoring was determined at 1-min & 5-min PO. PO pain severity was evaluated using the numeric rating scale and the duration of analgesia was calculated. Blood samples (S1, S2, S3) were obtained for ELISA estimation of serum interleukins and tumor necrosis factor-α (TNF-α). The study outcome is the effect of the anesthetic procedure on serum cytokines levels. Results: Cytokines' levels were significantly higher in S2 and S3 than in S1 samples of all parturients with significantly higher levels in samples of GA patients. Percentages of change in serum cytokines' levels were higher with GA than with SA. Receiver operating characteristic (ROC) curve defined serum levels of TNF-α as the most cytokine affected by the anesthetic procedure. APGAR scores were significantly higher at 1-min and the duration of PO analgesia was significantly longer with SA. Conclusion: SA can lessen the surgery-induced release of inflammatory cytokines, while GA augments this effect. Moreover, neonatal and maternal outcomes were superior with SA than with GA.
The pregnant mother is subjected to major changes in her anatomy and physiology to can feed and accommodate the growing baby. Such changes initiate subsequently after gestation have an influence on body organs. It is essential to discriminate between normal physiological changes and pathological changes. The anesthetist is considered a substantial part in the management of risky pregnancies, and must be a member of the multidisciplinary team who is assigned to concern for seriously ill parturient. Considerations must be taken to physiological modifications during treatment. The aim of this work is to highlight the risk factors and etiology of obstetric emergencies and how to manage them based on recent updates and guidelines.
Postoperative management of pain in pediatric population is of major concern as it reduces the incidence of complications and leads to earlier hospital discharge. to evaluate efficacy of ultra-sound guided transverses abdominus plane block versus local anaesthetic wound infiltration versus ultra-sound guided ilioinguinal /iliohypogastric nerve block with or without using of dexmedetomidine as an additive to bupivacaine, in the management of the postoperative pain in pediatric patients undergoing unilateral inguinal hernia repair. This prospective randomized blinded, controlled, clinical study,in which 140 Patients were randomized into four groups, The primary targets of this current study were FLACC score for pain and measuring the mean paracetamol consumption in 24 hours. Regarding comparison between the four groups involved in our study , the postoperative analgesia is more effective with TAP group [ the gold standard ] than groupII,groupIII and groupIV, the latter is being the least effective in postoperative pain control . Also the postoperative consumption of paracetamol in TAP group is lower than other groups.Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores. As regard demographic data were not significantly different between the groups . Vital parameters [heart rate, systolic and diastolic blood pressure, respiratory rate per minute] were also not significantly different between the groups. ultra-sound guided transverses abdominus plane block is more effective in postoperative analgesia when compared to local anaesthetic wound infiltration and ultrasound guided ilioinguinal /iliohypogastric nerve block. Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores.
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