2016) Postoperative analgesia of ultrasound guided rectus sheath catheters versus continuous wound catheters for colorectal surgery: A randomized clinical trialAbstract Purpose: The purpose of this study was to evaluate the postoperative analgesia and morphine requirements of ultrasound guided rectus sheath catheters versus continuous wound catheters in midline open colorectal surgery patients. Methods: Sixty patients of both sexes aged 40-65 years were randomized into 2 equal groups to receive postoperative analgesia through either a wound catheter continuous infusion (group I) or rectus sheath catheters (group II). The trial is registered in the Australian New Zealand Clinical Trials Registry: ACTRN12615000636550. Results: Heart rate and mean arterial blood pressure increased significantly in group I at 12 and 24 h as compared to time 0 and 48 h (P < 0.05). There was a significant increase in heart rate and mean arterial blood pressure in group I as compared to group II at all-time intervals (p < 0.05). There was a significant decrease in Visual analogue score at rest and with movement and in group II as compared to group I at all-time intervals (p < 0.05). Concerning the need for rescue analgesia, 8 patients (26%) in group I required rescue analgesia; 7 patients of them required only one dose and one patient required two doses. In group II two patients (6.6%) required rescue analgesia, and both required one dose. The total morphine consumption was lower and the patient satisfaction was better in group II compared with group I (p = 0.005). There were no serious complications in the two groups.

Background: Sepsis-induced myocardial dysfunction (SIMD) occurs in 50% of septic patients and is characterized by reduced ejection fraction (EF), cardiac index, impaired contractility, and diastolic dysfunction (DD). In sepsis-induced cardiomyopathy (SICM), EF shows initial significant deterioration on the 1st day, then final improvement at the end of the study. This study evaluated the value of different parameters measured with trans-thoracic echocardiography (TTE) in the diagnosis and prognosis of SIMD in the surgical intensive care unit (SICU). Methodology: This prospective cohort study was conducted on 100 patients, aged from 18 to 50 years admitted to SICU being affected by sepsis or septic shock. TTE parameters [EF, tricuspid annular systolic excursion (TAPSE), inferior vena cava (IVC) diameter, E/A ratio and grading of DD and hemodynamic parameters [mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP)] on admission, three day post-admission and after one week. Results: The mortality rate was 45%. DD was found in 90%. The mortality group had higher DD, higher HR, and lower MAP than the surviving group, with an insignificant difference in LVEF, TAPSE, IVC, and CVP on the 3rd and 7th days. Sepsis-induced cardiomyopathy (SICM) was found in 31% of surviving patients. DD (grade III had the highest mortality followed by grade I then grade II), HR >110 bpm, and MAP < 65mmHg are independent factors that negatively affect the duration of survival significantly. Conclusion: TTE in patients with sepsis or septic shock is vital for diagnosis and prognosis. DD, tachycardia (HR >110 bpm), and hypotension (MAP < 65mmHg) are independent predictors of mortality in those patients. Patients with SICM (little reversible impairment of LV systolic function) had a good prognosis.  Keywords: Sepsis Induced Myocardial Dysfunction, Diastolic dysfunction, Sepsis, Septic Shock Preregistration: The study was registered in the Ethical Committee of Faculty of Medicine, Tanta University, Tanta, Egypt (approval number: 31728/08/17) Abbreviations: SIMD–Sepsis-induced myocardial dysfunction; SICM–sepsis-induced cardiomyopathy; TTE– transthoracic echocardiogram. EF–Ejection fraction; DD–diastolic dysfunction; MD–Myocardial dysfunction; TAPSE–tricuspid annular systolic excursion; SICU–surgical intensive care unit Citation: El-Oraby MA, Shaban AES, El-Dada AA, El-Badawy AEH. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth pain intensive care 2021;25(2):150-162. DOI: 10.35975/apic.v25i2.1463 Received: 6 November 2020, Reviewed: 30 December 2020, Accepted: 3 February 2021