Background Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. Methods A randomized double‐blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 μg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. Results VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. Conclusion Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4. No significant adverse effects to the parturients or newborns.

Objective  To record circulatory volume changes, hyponatraemia, decrease in plasma osmotic pressure, changes in blood picture and coagulation profile in correlation with the size of myoma during hysteroscopic myomectomy. Design  A cross‐sectional prospective comparative study. Setting   Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects   Fifty patients undergoing hysteroscopic myomectomy where a balanced general anaesthetic technique was used. Interventions   Patients were divided into two groups according to the size of the submucous myoma. Group A included 25 patients having small submucous myomas (3 cm or less). Group B included those having larger myomas (more than 3 cm). Hysteroscopic myomectomy was done using glycine 1.5% as an irrigating solution for all cases. Haemodynamic measurements included pulse, mean arterial blood pressure and central venous pressure (CVP). Cardiodynamic measurements using non‐invasive thoracic electrical bioimpedence (TEB) included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), end diastolic volume (EDV), end diastolic index (EDI), ejection fraction (EF), peak flow (PF), peak flow index (PFI) and systemic vascular resistance (SVR), arterial blood gases (PaO2, PaCO2), oxygen saturation by pulse oximeter and end tidal CO2 by capnogram. Serum sodium and potassium concentration, blood osmolarity, prothrombin time (PT), prothrombin concentration (PC), partial thromboplastine time (PTT), haemoglobin concentration (HB), haematocrite value (HCT) and platelet count (PLT) were also measured. Absorbed fluid volume and intrauterine pressure (IUP) were also measured. Main outcome measures   Changes in haemodynamics, caerdiodynamics, blood gases and haematological measurements as measured preoperatively and every 15 min for 75 min. Results   The trial showed statistically significant variations regarding haematological and biochemical variables, but it was not associated with clinical signs of hyponatraemia. No signs of cardiac overload or cerebral confusion in both groups. Group B was associated with significant hyponatraemia, increased CVP, hypo‐osmolarity, increased PT and PTT, and increased most of the cardiodynamic parameters. Conclusions  Hysteroscopic myomectomy, despite being the most risky hysteroscopic procedure, can be safely performed in most cases following the safety precautions. Intraoperative fluid absorption, especially with large myomas, is the trigger of some systemic changes. The procedure should be performed by an experienced hysteroscopist using a quick technique with the least possible glycine volume and minimal intrauterine pressure to achieve the goal of a safe out‐patient minimal access surgery.

Objectives To record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief. Design A prospective randomized study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used. Interventions Patients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2‐ml intravenous injection. Main outcome measures Each patient recorded the site of pain, and its severity using a 4‐point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same‐ or next‐day discharge was also assessed in all patients. Results The trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P < 0.05). Also, the time to first analgesia was prolonged and there was less need for fentanyl and earlier discharge in groups T and B. Conclusions We concluded that both of the analgesic regimens used were satisfactory, but intraperitoneal bupivacaine showed better analgesic outcomes and is a useful contribution to analgesia in the immediate postoperative period after day‐case laparoscopic surgery.

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Background: Maternal mortality & morbidity are key indicators of women's health globally. ICU admission rate represents as indicator of sever maternal morbidity. The aims of this study were to assess the hospital based rates of maternal morbidities and mortalities in ICU and to estimate indicators of ICU admission. Subject and methods: This study was done in ICU at Woman's Health Hospital, Assiut University. The convenient sample calculated statistically and was 200 women. Three tools were utilized for data collection; Patient socio-demographic data, Indicators for ICU admission and statistical sheet about maternal morbidity and mortality rates for one year. Results: This study revealed that ICU admission rate was (6.08%) and maternal mortality rate was (0.18%). The obstetric critically ill women participated in this study were most of them (68%) admitted for obstetric indications, (18.5%) had mixed obstetric with non-obstetric indications and the rest (13.5%) had non-obstetric indications only. Conclusions: Obstetric causes particularly hypertensive disorders and obstetric haemorrhages are common causes of ICU admissions and maternal mortality. Recommendations: Early diagnosis and proper treatment of high risk obstetric patient to reduce ICU admission rate and maternal mortality.