Aya Hisham Moussa Ahmad

Purpose of Review: The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients. Methods: We searched PubMed, CENTRAL, Web of Science, and Scopus from inception to August 1, 2023. Our outcome parameters for efficacy were recovery time, pain score, and physician satisfaction while for safety were the related cardiorespiratory, neurological, and gastrointestinal adverse events. Recent Findings: Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I² = 94%) and a significantly less pain score of − 0.72 (95% CI, − 1.10, − 0.34; I² = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I² = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I² = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I² = 15%). Summary: Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.

Background: Continuous Spinal Anesthesia (CSA) is an underused regional anesthesia technique. But with the increased Geriatric population presenting to surgeries, CSA with its relative hemodynamic stability is coming back to anesthetists’ interests. Better control of hemodynamics is advantageous in elderly patients and those with cardiac diseases. Objective: To compare the incidence of hypotension in continuous spinal anesthesia CSA versus single dose spinal anesthesia SDA in octogenarians undergoing hip surgery, the total use of Ephedrine and the incidence of spinal complications. Methods: Forty (40) patients were enrolled in the study and allocated into two groups 20 patients in continuous spinal anesthesia group (CSA) and 20 patients in single dose anesthesia group (SDA). Results: CSA has less effect on hemodynamics in elderly patients with fewer complications. There was a statistically significant difference in MAP between CSA group and SDA group between min 5 & min 40 with p-value

Traumatic femoral fractures are a prevalent orthopaedic issue in elderly adults. General anaesthesia (GA) vs. spinal anaesthesia are still being discussed as the best anaesthetic method for cemented hip arthroplasty (SA). This study compared the impact of spinal anaesthesia versus general anaesthesia in combination with femoral nerve block on the mean arterial blood pressure (MAP) in patients having cemented hip arthroplasty operations. To compare the impact of spinal anaesthesia on elderly patients undergoing cemented hip arthroplasty operations versus general anaesthesia in combination with femoral nerve block on mean arterial blood pressure. The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202,111,575,647,784). At Ain Shams University Hospital, 60 patients receiving total hip arthroplasty were separated into two equal groups, each comprising 30 patients, for the purpose of this prospective randomised comparison study. Patients in Group (A) underwent spinal anaesthesia, while Group (B) received general anaesthesia together with an ultrasound-guided femoral nerve block. This study showed that GA was associated with more stable readings of mean arterial blood pressure (MAP) after anesthesia induction and post cement implantation than SA (p-value = 0.04 and 0.038 respectively). Patients who received general anesthesia (GA) had more stable hemodynamic parameters especially the mean arterial blood pressure (MAP) than those who received spinal anesthesia (SA).

Knee surgeries are needed in a wide range of patients, from young athletes with anterior cruciate ligament injuries up to old patients with comorbidities presenting for arthroscopy up to total knee replacement procedures. The trend is fast track knee surgery with early ambulation and hospital discharge, so analgesic options of neuraxial blocks and main nerve blocks are less attractive due to the unavoidable muscle weakness. In this study, the benefit of pure sensory nerve block could be reached. To compare the postoperative range of motion and the analgesic efficacy of adductor canal block (ACB) alone against adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block in knee surgeries. The study is a randomized, prospective, comparative study where 50 patients subjected to knee surgeries were randomized into two groups: Group (A): patients in this group received ultrasound-guided ACB only; Group (AB): under ultrasound guide, patients in this group received a combined ACB and IPACK block at the start of surgery. Regarding pain control over the first 24hours following surgery, range of motion and walking distance; there were statistical differences between both groups. When demographic information such age, sex, BMI, and ASA scores were examined between the two groups, there was no statistically significant difference between them (p-value > 0.05). Additionally, there was no statistically significant difference between groups in terms of opioid needs or consumption. Regardless of the good analgesic effect of ACB, patients who received a combination of ACB and IPACK blocks have experienced a better pain control, a wider range of motion and a longer walking distance following surgery when compared to patients who received ACB alone.

Background and study aims: The 2019 coronavirus pandemic (COVID-19) poses a severe worldwide health danger. Delicate ‎diagnostics that accurately predict illness prognosis are required to guide appropriate action. The ‎purpose of this study was to explore if serial procalcitonin (PCT) measurement could predict ‎COVID-19 patient outcomes using PCT clearance (PCT-c) as a dynamic change ‎indicator‎.‎ Patients and Methods: ‎‎‎ ‎ Serial PCT and PCT-c values of 63 COVID-19 Egyptian patients were compared between ‎survivors and non-survivors throughout the first five days of their hospitalization‎ ‎.‎ Results: Serial PCT levels in non-survivors were greater (p <0.001) than in survivors and increased over ‎time. PCT-c levels were lower (p <0.01) and decreased throughout time. The initial PCT value ‎alone predicted in-hospital mortality with 87.3 % accuracy at a 0.80 ng/ml cut-off. Serial ‎measurement improved COVID-19 outcome prediction‎‎‎‎‎‎‎‎‎. Conclusion: Serial PCT measurement is effective in predicting COVID-19 patient outcomes. PCT-c can also ‎be used to determine PCT progressive kinetics‎ ‎‎‎‎‎‎‎‎‎.

Background: In coronavirus disease 2019 (COVID-19), finding sensitive biomarkers is critical for detecting severe cases early and intervening effectively. Aim of the work: To compare and evaluate the value of pretreatment C-reactive protein (CRP), interleukin-6 (IL-6), and their derived immune-inflammatory indices (CRP/albumin (CRP/alb), lymphocyte/CRP (L/CRP), and lymphocyte/IL-6 (L/IL-6)) in the prediction of COVID-19 severity and in-hospital mortality. Methods: This cross-sectional study included 85 confirmed COVID-19 patients, their complete blood count with differential, as well as albumin and IL-6 levels on the day of their hospital admission, were assessed and compared. We followed all patients till their in-hospital death or discharge from the hospital. Results: On admission levels of CRP, IL-6, and CRP/alb were significantly higher (P=0.001) in severe patients and non-survivors, but L/CRP and L/IL-6 were significantly lower (P=0.001) compared to non-severe patients and non-survivors. CRP/alb and L/CRP at cut-offs of 1.65 and 260.86, respectively, were the best predictors for COVID-19 severity, while IL-6 and L/IL-6 at cut-offs of 120 pg/ml and 5.40, respectively, were the best predictors for COVID-19 in-hospital mortality. IL-6 was an independent risk factor associated with severe disease development (odds ratio (OR): 1.033; 95% confidence interval (CI): 1.002-1.066). Conclusions: Pretreatment levels of CRP, IL-6, and their derived indices should be included in the diagnostic work-up of COVID-19 to determine the severity and predict the outcome.

Background: Early detection of COVID-19 patients with potentially severe disease is crucial for predicting the disease's course and prioritizing medical resources, lowering overall disease mortality. Objectives: To explore the role of baseline hemogram-derived ratios and systemic-immune inflammation index (SII), in addition to C-reactive protein (CRP), in predicting COVID-19 severity and prognosis. Methods: In this retrospective study, data were collected from the medical records of 425 COVID-19 patients. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII, together with the CRP, were investigated and compared. Results: NLR, PLR, SII, and CRP increased significantly in severe cases and with ICU admission (p < /em> ≤ 0.001). But, in non-survivors, only NLR and CRP were significantly elevated (p < /em> <0.05). By interpreting area under the receiver operating characteristic curve (ROC-AUC), CRP and NLR were better predictors of disease severity (AUC: 0.7 for both), the need for ICU admission (AUC: 0.763 and 0.727, respectively), and in-hospital mortality (AUC: 0.812 and 0.75, respectively). SII was significantly associated with the risk of severe disease development (odds ratio (OR): 3.143; 95% confidence interval (CI): 1.101-8.976); CRP (OR: 2.902; CI95%: 1.342-6.273) and NLR (OR: 2.662; CI95%, 1.072-6.611) were significantly associated with ICU admission risk; and only CRP was significantly associated with in-hospital mortality risk (OR: 3.988; CI95%: 1.460-10.892). Conclusions: Values of CRP, SII, and NLR at the time of hospital admission could be independent prognostic biomarkers to predict COVID-19 progression.