Background Spinal surgery is associated with high incidence of severe postoperative pain difficult to easy control. Appropriate treatment modalities decreased the postoperative morbidity, increased patient satisfaction, allowed early mobility, and decreased hospital costs. Lidocaine was used as intravenous additives to control intraoperative pain and decrease postoperative pain. As lidocaine, dexmedetomidine infusion associated with lower postoperative pain scores decreased the opioid consumption and its related adverse events. The aim of this double blind randomized prospective comparative study was to compare the efficacy of intraoperative dexmedetomidine versus lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among 66 patients subjected to lumbar fixation surgery and randomized into group D which received dexmedetomidine 1 μg/kg infusion over 10 min as a loading dose then 0.3–0.5 μg/kg/h after induction of anesthesia as maintenance dose and group X which received lidocaine 0.3–0.5 mg/kg/h after induction of anesthesia. Results At 10, 15, 30, and 60 min, the mean arterial blood pressure and heart rate significantly decreased in group D compared to group X, and there was significantly higher total dose of intraoperative analgesic for fentanyl in group X than group D. There was significantly higher numeric rating scale in group X compared to group D at 2, 4, 6, 9, 12, 18, and 24 h postoperative with significant early request of the first analgesia, higher incidence of analgesic needs, and higher dose of postoperative analgesia paracetamol, voltaren, or pethidine in group X compared to group D. Conclusions The intraoperative use of dexmedetomidine IV infusion was an alternative mode to decrease the demands of analgesia following spine surgery.

Background Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube (ETT). Weaning from mechanical ventilation (MV) is a challenge. Its prolongation is related to increased mortality. Aim of the Work is to assess the value of ATC in predicting successful weaning and hastening the weaning process. This study will compare the benefits and effects of ATC versus PSV as weaning modes on spontaneous breathing trials and work of breathing. Patients and Mehtods This prospective non randomized was done on 50 adult patients admitted to the Critical Care Medicine Department in Ain shams University Hospital presenting with ARF and mechanically ventilated for at least 24 hours. They were divided into two groups: Group I “ATC group” Each underwent a 1-hour spontaneous breathing trial, using ATC mode and Group II “PSV group” PSV mode was used. Results In the present study we have found that the use of ATC during a spontaneous breathing trial was as effective as PSV in predicting the ability of patients to maintain spontaneous, unassisted breathing for more than 48 hours after removal of the endotracheal tube. In our study, there was no significant difference in the number of patients who tolerated the spontaneous breathing trial and then extubated between ATC and PSV groups (60 % vs. 56% respectively, p > 0.05). Both modes had comparable sensitivity, and +ve predictive value. Sensitivity was 80.0% versus 75.0% and the positive predictive value was 88.0%, versus 87.0% for ATC versus PSV respectively. The specificity was comparable (76.8% versus 80.0 % in ATC versus PSV respectively). ATC group had higher negative predictive than PSV group (82.0% versus 70.1%, respectively). In our study, criteria for successful extubation were met in 56.0%. In ATC group 60.0% met the criteria for successful extubation vs. 60% in PSV group. In the present study it was found that male patients were the most predominant in both groups (72.0% in ATC group and 68% in PSV group). This is expected as cigarette smoking is prevalent among males and is the single most important and most prevalent risk factor for the development of COPD. In our study, about one third of patients had COPD exacerbation as a cause for ARF. Conclusion In ICU population, ATC was safe, reliable, and can be reasonably used for weaning trials. ATC confers a potential benefit in weaning duration, weaning category, number of Ss, failure of first SBT extubation outcome, ICU length of stay, complication, and mortality rate. In addition, ATC improves the predictive value of RR/TV and IWI in predicting weaning success.