Background: Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria has been proven to be an escalating public health challenge in Egypt owing to its high mortality rate and raised health care costs. Purpose: Detection of carbapenem-resistant gram-negative bacilli among VAP patients, genotypic identification of carbapenemase genes in the isolated strains with evaluation of their impact on patient outcome and detection of carbapenemase-producing enterobacterales by MASTDISCS combi Carba plus disc system. Methods: Broncho-alveolar lavage fluid (BALF) and endotracheal aspirate were collected aseptically from clinically suspected VAP patients. Pathogen identification and antibiotic sensitivity testing were done. Carbapenemase-encoding genes (bla KPC , bla NDM , and bla OXA-48 ) were tested by PCR in all carbapenem-resistant gram-negative isolates. Performance of MASTDISCS combi Carba plus in isolated Enterobacterales was assessed in relation to the PCR results. Results: Eighty-three carbapenem-resistant gram-negative isolates were detected. The most frequent pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa representing 34.9%, 20.5% and 18.1%, respectively. bla KPC was the predominant gene. Patients with persistent mechanical ventilation less than 15 days and Pseudomonas aeruginosa infection were significantly associated with a higher death rate. MAST-Carba plus had the highest sensitivity, specificity, positive and negative predictive values for detecting OXA-48 carbapenemases representing 81.8%, 92.5%, 75% and 94.9%, respectively. Conclusion: Worse outcome in VAP patients was associated with carbapenem-resistant gram-negative bacilli. MASTDISCS combi Carba plus is an efficient simple method for identification of different carbapenemases among enterobacterales.

Objective: To evaluate the efficacy of hyaluronidase as an adjuvant with volume reduction of bupivacaine in ultrasound-guided supraclavicular brachial plexus block for chronic renal failure patients. Design: Prospective double-blinded, randomized study Setting: tertiary institutional clinical care Patients, Participants: carried out on 60 patients with American Society of Anesthesiologists Classification (ASA) of physical status grade III with chronic renal failure with end-stage renal disease (ESRD) scheduled for elective surgery for arteriovenous shunt creation. Intervention: Both groups were US guided. In group I, patients received plain bupivacaine 0.5% (30 ml) by single-injection technique while in group II, patients received plain bupivacaine 0.5% (10 ml) plus 0.9% (5 ml) normal saline containing 500 IU (100 IU/ml) hyaluronidase. Main outcome (primary and secondary):The duration of sensory block, the onset of sensory and motor block, success rate, duration of motor block, total doses of intraoperative rescue analgesia, number of patients needed for postoperative rescue analgesia, and complications were recorded. Results: Hyaluronidase group had a significantly rapid onset of sensory and motor block than that of the bupivacaine group. On the other hand, both groups were similar in the duration of sensory block and motor block. Conclusion: Single injection technique was a sufficient modality of brachial plexus block. Hyaluronidase as an adjuvant to the local anesthetics has been fastened the onset of complete sensory block of ultrasound-guided supraclavicular brachial plexus blocks with minimal effect analgesic consumption postoperatively.

Objective This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR). Patients and Methods This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient’s level of sedation were recorded. Results About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two groups. While at movement, patients in the dexmedetomidine group felt pain at 4 hrs postoperatively with significantly higher VAS than the other two groups. At the same time, the sedation score was significantly lower in the dexmedetomidine group than in the other two groups. 22.2% of cases in the morphine group developed nausea and vomiting with a significant difference between the three groups. Conclusion Despite the absence of substantial side effects, our findings did not suggest enhanced analgesia with the combination of intrathecal morphine and dexmedetomidine.

Background: Nerve blocks have been one of the most common anesthetic methods for abdominal surgeries since the last four decades. Objectives: This study aimed to compare the postoperative analgesic efficacy of bilateral ultrasound-guided quadratus lumborum block (QLB) against bilateral ultrasound-guided Transversus Abdominis Block (TAB) and Ilioinguinal/Iliohypogastric nerve blocks (IINB) in abdominal total hysterectomy. Methods: Sixty female patients scheduled for the surgery of total abdominal hysterectomy under spinal anesthesia participated in this randomized prospective trial. They were randomly assigned to two dual TAB / IINB (n = 30) and QLB (n = 30) groups. Moreover, the visual analog scores (VAS), the total amount of morphine consumed after surgery during the first 24 hours, the number of individuals requiring rescue analgesia, postoperative analgesia duration, and postoperative complications were recorded. Results: Morphine consumption was equal in both groups (P = 0.908). Furthermore, the analgesia duration in the two groups was statistically insignificant (P = 0.879), with mean values of 15.4 and 15.6 hours, respectively. During 24 hours, there was no statistically significant difference in terms of VAS between the two groups (P > 0.05). Conclusions: The QLB might be a viable replacement for TAB/IINB for postoperative analgesia after total abdominal hysterectomy.