Background: Controlled hypotension is required for middle ear surgeries to achieve a bloodless operative field and improve its quality, both magnesium sulfate and nitroglycerine used to produce deliberate hypotension. Aim of the work: This study aimed to compare the efficacy of magnesium sulfate and nitroglycerin in inducing controlled hypotensive anesthesia as a primary outcome and using propranolol if tachycardia occurred as a secondary outcome, in middle ear surgeries. Patients and Methods: The study was carried out on 40 adults' patients were randomly classified into two equal groups, twenty patients each: Group [M]: Received an intravenous [IV] bolus of magnesium sulfate 30 mg/ kg in 100 ml saline over 10 min followed by infusion of 10 mg/kg/h. Group [N]: Received nitroglycerin IV infusion 0.5-10 mcg/kg/min. Propranolol 1-2.5 mg IV had been given to both groups if there was tachycardia. Results: Both drugs induced hypotension with statistically significant difference in systolic and mean blood pressure [BP] and there was highly significant increase in heart rate [HR] in nitroglycerin more than magnesium sulfate and high doses of propranolol were administrated in nitroglycerine group. Postoperative pain was significantly increased in nitroglycerin than magnesium sulfate groups which had more analgesic effect. Conclusion: Both drugs induced hypotension. However, magnesium sulfate was better as it provided optimum surgical field, less tachycardia, need less dose of propranolol with less post-operative pain in comparison to nitroglycerin.

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Background: Regional anesthesia in pediatric surgery alone or combination with light general anesthesia provides several advantages, the most significant is intra-and post-operative pain relief. Aim of the work: This study aimed to compare spinal to caudal anesthesia in children undergoing lower abdominal surgeries regarding [sensory and motor block as a primary outcome], hemodynamics and postoperative pain as a secondary outcome. Patients and Methods: This study was a prospective randomized comparative clinical single-blind study. It included 40 children [ASA I or II] of both sexes, aged [3-9 years] undergoing lower abdominal surgeries. Patients were randomly assigned into one of two groups [20 patients in each group]. group [S] undergo spinal anesthesia, group [C] undergoes caudal anesthesia. To assess the following parameters; sensory and motor block, heart rate, mean arterial blood pressure and postoperative pain. Results: Spinal anesthesia has a rapid onset of sensory block, more intensity than caudal anesthesia, but of shorter duration. Caudal anesthesia provides more time of motor block than spinal anesthesia. There was no statistically significant difference between groups regarding mean arterial pressure, but caudal anesthesia has more tachycardia than spinal anesthesia, and caudal anesthesia provides better postoperative analgesia more than spinal anesthesia. Conclusion: Regional anesthesia in pediatrics is an effective and safe option. Caudal and spinal are both effective, however caudal have relatively more duration of postoperative analgesia and motor block than spinal anesthesia.