Background Sleep is essential for full mental and physical renewal. Cardiac surgery improves the life expectancy and quality. But unfortunately, some patients lacked that merit as they suffered sleep disturbance. We used validated questionnaire applied to 153 cardiac surgery patients to assess the sleep disturbances after surgery. Results About 70 (45.8%) had valve procedure, 55 (36%) had revascularization, 19 (12.4%) had both procedures and 9 (5.8%) had other procedures. The majority had no post-operative bleeding nor infection. About 78% had sleeping difficulty for one month. About 50% used different medications to fall asleep, mostly analgesics. About 76% slept after 2–6 h irrespective of sleep quality. Some patients had poor sleep quality in the form of nightmares and night terrors. Conclusion Sleep quality was disturbed immediately following cardiac surgery. There was a reduction of night sleep compensated by increased daytime sleepiness. These changes almost reverted one month after surgery.
Background
Occurrence of acute oliguric renal failure in the immediate postoperative period carries important morbidity and mortality after a successful cardiac surgical procedure. Adult cardiac and aortic surgical procedures are especially prone to this complication with the incidence varying between 2% to 15% and the mortality rate as high as 40% to 60%.
Aim of the Work
to compare between furosemide versus mannitol as a renal protection after adult cardiac surgery.
Patients and Methods
This prospective comparative trial was conducted at Academy of Cardiothoracic Surgery Ain Shams University on patients undergoing CABG operation consisting of a total of 50 patients with normal renal function, EF of greater than 40%, normal protein and electrolyte levels.
Results
the study revealed no statistically significant difference between groups according to cystatin-C
Conclusion
The difference between patients given mannitol and patients given furosemide regarding urinary microalbumin, urinary creatinine and serum cystatin-c was insignificant. Addition of mannitol to the priming solution of the cardiopulmonary bypass acts as a renal protector against AKI postoperative. Finally, giving furosemide infusion to patients undergoing cardiac surgery at the beginning of the CPB improves renal perfusion.
Background: Left ventricular ejection fraction is an independent determinant of the outcome of coronary artery bypass surgery. Low preoperative ejection fraction requires special care in terms of pharmacological and mechanical inotropic support. Adrenaline is the most widely used inotropic drug, while levosimendan is a relatively new inotropic drug in the field of cardiac surgery. In this study, we aimed to evaluate the relative efficacy of levosimendan in low ejection fraction patients undergoing coronary artery bypass grafting (CABG). Methods: A retrospective comparative study was performed with 63 patients who underwent isolated on-pump elective CABG with a preoperative ejection fraction below 40%. Patients were allocated to the adrenaline group (n = 35) and levosimendan group (n = 28). Patients were further stratified according to ejection fraction above 30% and below or equal to 30%. The primary outcome was cardiac-related mortality, while other parameters were considered secondary endpoints. Results: EuroSCORE of the adrenaline group was 3.34 ± 1.26 and for the levosimendan group 3.15 ± 1.42 (p value 0.576). Nine patients of the adrenaline group had new postoperative atrial fibrillation compared to seven patients in the levosimendan group (p value 0.948). Two patients of the adrenaline group had postoperative ventricular arrhythmia compared to only one patient in the other group (p value 0.691). The adrenaline group had higher doses of inotropic support compared to the levosimendan group 210.84 ± 23.74 and 157.4 ± 22.69 ng/kg/min respectively
Background
Total knee arthroplasty (TKA) is a major surgery where postoperative pain management not only aims for patients comfort but also is crucial to achieve post-operative ambulation leading to better outcome and preventing post-operative complications. Femoral nerve block is commonly used following Total knee arthroplasty for post-operative pain control but affects the quadriceps muscle strength increasing the risk of falls. Meanwhile, Adductor canal block has only sensory effect while preserving the motor power allowing for functional recovery within the first 24 hours post‑total knee arthroplasty. However, single injection nerve block is limited by its short duration. Adding adjuvants to the local anesthetic has shown prominent results in prolongation of the duration of the nerve block with dexamethasone being the most effective one.
Aim of the Work
to assess the efficacy of perineural dexamethasone as an adjuvant on duration of sensory blockage of Saphenous nerve block - performed by levobupivacaine -after knee arthroplasty surgery.
Patients and Methods
This randomized clinical trial study was carried at Ain Shams university hospitals, starting from March 2019 to August 2019. It included forty adult patients undergoing unilateral total knee arthroplasty who were randomly divided into 2 groups. A group received spinal anaesthesia followed by adductor canal block (ACB) with 19ml levobupivacaine plus 1ml normal saline and the other received spinal anesthesia followed by ACB with 19ml levobupivacaine injection plus 1ml (4mg) dexamethasone. The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding analgesic outcome by recording time for first for analgesic need, total consumption of opioid and pain score during walking and climbing stairs. Side effects were also monitored and compared.
Results
prolongation of ACB when adding dexamethasone perineurally as an adjuvant to levobupivacaine, evident by prolongation of time for first analgesic requirement, decrease in total consumption of opioid in first 24 hours and lower pain score during walking and climbing stairs.
Conclusion
Adding dexamethasone as an adjuvant to ACB showed that it prolonged its duration with decrease in the post-operative pain scores and total morphine consumption.
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