Background: Perioperative use of magnesium sulfate (MgSO4), dexmedetomidine, have been tried in order to provide beneficial clinical effects during general anesthesia (GA). However, few literature discussed it with varying results. Several clinical researches have showed that usage of MgSO4 infusion was associated with a reduction in anesthetic requirement and postsurgical analgesic consumption during GA.Objective: This study aimed to assess the pharmacologic effects of the use of dexmedetomidine and MgSO4 on anesthetic requirement, intra operative haemodynamics stability and postsurgical analgesic effects on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumours. Patients and methods: A total of 110 cases were enrolled in this prospective study. They were randomized into 2 groups: Group D (55 cases) that was commenced on dexmedetomidine, and group M (55 cases) which received MgSO4 Results: The mean values of Boezaart score were significantly decreased in Group D in comparison to group M. In addition, isoflurane and propranolol consumption showed a significant decrease in group D. However, blood loss showed no significant difference when comparing the same groups. Group D expressed significantly longer emergence and extubation times compared to Group M. Conclusion: Dexmedetomidine appears to be superior compared to magnesium sulphate in achieving hypotensive anesthesia during pituitary surgery.

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Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of posttourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded.Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion:Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.

Background: During liposuction procedures, injection of wetting solution containing epinephrine is performed. This may increase the risk of cardiovascular side effects in large volume cases. Magnesium sulfate has cardioprotective effects, and can prevent complications related to epinephrine. The aim of the work:To assess the effect of adding intravenous magnesium sulfate, during the administration of epinephrine containing wetting solution, on the incidence of epinephrine-mediated cardiovascular side effects during liposuction surgery. Patients and Methods:This was a prospective randomized study comprised a total of 94 cases into two equal groups. The epinephrine group included 47 cases that had epinephrine in their wetting solution, and epinephrine-Mg group included the remaining cases that had adrenaline in the wetting solution along with intra venous. administration of MgSO4. Heart rate, blood pressure, arrhythmia incidence, isoflurane, and morphine consumption were recorded.Results: No significant difference was noticed as regard basal and induction heart rate and mean arterial pressure [MAP]. However, the epinephrine-Mg group showed significantly lower readings on subsequent assessment. There was no significant difference among both groups regarding the incidence of arrhythmia; the epinephrine group had more cases with arrhythmia. Isoflurane consumption decreased significantly in the epinephrine-Mg group in comparison with the epinephrine group, while morphine consumption did not significantly differ between them. Conclusion:Based on our findings, intravenous administration of magnesium sulfate decreases heart rate, blood pressure, and inhalational anesthesia consumption during liposuction. However, it has no significant impact neither on the incidence of arrhythmia, nor morphine consumption.

Background: Posterior spinal surgery is considered one of the most painful surgeries. Erector Spinae Block is likely to produce effective pain management as it causes blockade of the dorsal rami . Objective: This study was conducted to assess the efficacy of ESPB in controlling intraoperative and POP and surgical field during lumbar spine fixation. Patients and methods: A total of 70 cases were enrolled, and they were haphazardly divided into two groups; ESPB group which comprised 35 cases who underwent the blockade technique, and the control group which included the remaining 35 cases that underwent surgery without blockade. The primary outcome was POP, while secondary outcomes involved intraoperative bleeding, and surgeon satisfaction. Results: No significant differences were detected among both groups concerning patient demographic features. Operative bed bleeding was significantly decreased in the ESPB group. Also, ESPB group expressed lower pain scores during the initial 6 hours after surgery with no difference detected between both studied groups on subsequent assessment. Surgeon satisfaction was significantly better in the ESPB group. Conclusion: ESPB appears to be safe and efficacious technique not only in decreasing POP, but also in improving operative bed bleeding, and surgeon satisfaction.