Objectives: The objective of this study was to investigate the effects of the preoperative combination of oral Pregabalin and intravenous (IV) magnesium sulfate as analgesic adjuvants in postthoracotomy pain. Patients and Methods: One hundred twenty patients with American Society of Anesthesiologists physical status II were allocated randomly into 1 of 4 groups. Group MP received 300 mg pregabalin orally and an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL normal saline (NS); group P received 300 mg pregabalin orally and 200 mL NS infusion; group M received an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL NS and a placebo capsule; and group C received placebo capsule and an IV infusion of 200 mL NS. All medications were given 1 hour before surgery in all groups. In the first 24 hours postoperatively, total morphine consumption, the Visual Analog Scale (0 to 10)—used as a pain measurement tool—and postoperative nausea and vomiting were assessed. Results: The total morphine consumption in the first 24 hours postoperatively decreased significantly in group MP (28.47±5.76 mg) compared with group P (33.97±6.34 mg), group M (40.87±4.4 mg), and group C (42.2±6.1 mg), respectively. VAS scores were in the accepted range (≤4) in the 4 groups throughout the first 24 hours, as all patients were on patient-controlled analgesia. However, there was a statistically significant difference at 0 and 4 hours postoperatively in favor of groups MP and P. Postoperative nausea and vomiting decreased significantly in groups MP, P, and M in comparison with group C (P<0.001). Conclusions: The combined preoperative single dose of pregabalin and magnesium sulfate is an effective method for attenuating postoperative pain and total morphine consumption in patients undergoing thoracotomy.

Because of the absence of any beneficial effect of meperidine on uterine dystocia, its use in labor should be limited to pain relief in the absence of epidural analgesia.

Background Postoperative delirium (PD) is an acute, transient disorder of consciousness, attention, perception, and cognition. Many theories, such as decreased cholinergic neurotransmission and surgery-induced disturbances in melatonin secretion, were proposed as a potential cause for developing PD especially in the elderly. Previous studies concluded that perioperative rivastigmine significantly reduced the prevalence and severity of PD. Other studies concluded that oral perioperative melatonin was associated with a lower risk of PD. However, the effect of melatonin in patch form was not studied and the effect of perioperative rivastigmine and melatonin patch was not compared. Our aim was to compare rivastigmine patch to melatonin patch regarding the incidence and severity of PD in elderly patients undergoing major orthopaedic surgery. Methods In this double blinded randomized study, 180 elderly patients, ASA I–III, aged 60–85 years undergoing major orthopaedic surgery were divided into two equal groups; group R patients received a rivastigmine patch (4.6 mg) and group M patients received a melatonin patch (7 mg). Both patches were administered 24 h preoperative, on the day of operation and for the following 3 postoperative days. All patients received regional anaesthesia and basic monitoring in the form of NIBP, SPO2, and ECG. Patients were examined for PD using the Confusion Assessment Method (CAM) and level of sedation using the Ramsay Sedation Score (RSS) on the first, second, third, and 7th postoperative day, and for those who develop PD, a CAM-S score was done to assess the severity of PD. Drug-related side effects were recorded. Statistical analyses were performed using a standard SPSS software. Results CAM score was positive in a total of 39 patients. Rivastigmine patch significantly decreased the incidence of PD when compared to melatonin patch (P value 0.047). However, CAM-S indicated that the severity of PD was comparable. Patients were more sedated in the melatonin group. There were no melatonin- nor rivastigmine-related perioperative complications. Intraoperative SBP, DBP, and HR were slightly less in melatonin group, although statistically non-significant. Conclusions Rivastigmine patch is superior to melatonin patch in decreasing the incidence of PD in elderly patients undergoing major orthopaedic surgery; however, both drugs were comparable in decreasing its severity. Trial registration Clinical trails.gov, NCT04189666. December 6, 2019, prospectively registered

No abstract

Background Acute kidney injury (AKI) with sepsis increases mortality significantly. The pathophysiology of AKI during sepsis is complex and multifactorial. Lower heart rate is associated with better survival in patients with multiple organ dysfunction syndrome (MODS), a disease mostly caused by sepsis. In our study, we hypnotized that use of ivardrabine as heart rate reducing agent in septic patient with renal impairment may improve renal function. Results Fifty patients with sepsis with early renal impairment were divided in 1: 1 ratio to receive Ivabradine (group I) or not (group C). The average age of the included patients was almost 45 years, chest disorders were the main cause of sepsis in both groups. There were statistically significant differences between both groups in terms of reduction of heart rate group (I) (68.13 ± 3.34) versus (group C) (87.04 ± 3.23) and (P < 0.001) also, improvement in eGFR by Cystatin c in group (I) (103.32 ± 6.96) versus (group C) (96.25 ± 6.36) and (P < 0.001) also vasopressor dosage consumption (P < 0.001). As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (P = 0.390), need for hemodialysis (P = 0.384), and mortality (P = 1.000). Conclusions We concluded that Ivabradine as an adjuvant therapy in septic patients with renal impairment is promising agent to reduce such impairment. Trial registration Pan African Clinical Trial Registry: Identification number for the registry is PACTR201911806644230.