A 23-year-old female underwent uneventful caesarian section, which was followed by massive pulmonary embolism. Pulmonary embolectomy on cardiopulmonary bypass was performed, and was complicated by massive intraabdominal haemorrhage due to a hepatic subcapsular rupture. To our knowledge, this is the first surgically orientated case of postpartum pulmonary embolectomy to be reported in the literature.

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Aim of the work:The main objective will to compare fentanyl with Dexmedetomidine as regards; 1. Their efficacy 2. Provide better quality of surgical field during cochlear implantation. in including deliberate hypotension. 3. The effect of both drugs on postoperative pain. 4. Recovery time. 5. Emergence agitation.. Patient and Methods:The study was conducted after approval of the Ethical committee of Sohag university Hospital and obtaining informed written consent from the parents of the patients. 50 pediatric patients (ASA I or II), undergoing cochlear implantation were randomized into dexmedetomidine (D) group and fentanyl (F) group. Anesthesia was induced by I.V. dexmedetomidine in (D) group at a bolus dose of 2 micg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.7 micg/kg/h until the end of surgery. In (F) group; anesthesia was induced by I.V. fentanyl at a dose of 1 micg/kg over 10 min, then continuous infusion by a rate of .0.1 mg/kg/h. This is followed by I.V. propofol and atracurium for both groups. Both groups were compared as regards the quality of the surgical field, intraoperative hemodynamics, recovery and discharge time, postoperative pain using objective pain score and the need for rescue analgesics and anti-emetics in post anesthesia care unit (PACU). .Results: Dexmedetomidine group showed a slight decrease in heart rate than fentanyl group. These parameters were significantly decreased compared to the baseline throughout the procedure in D group. Modified Aldrete Score is better with D group compared to F group . There was significant difference between both group as regard objective pain score. There was a significant difference between two groups, as the time for recovery was more rapid in D (group) than in F (group) the data is significant. Conclusion : Dexmedetomidine infusion in cochlear implantation in pediatric patients was better in inducing deliberate hypotension. It allowed rapid recovery from anesthesia and reduced need for pain medication in the PACU.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker.Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker. Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.