Aim :To evaluate the effect of addding hyalourindase to bupivacaine in TAP block for lower abdominal surgeries as postoperative analgesia. Methods : fifty patients aged between 20-60 years who were scheduled for lower abdominal surgeries included in the study and divided into two groups,after approval of ethical committee.This study conducted in Sohag university hospitals from September 2016 to March 2017. Patients were divided into two equal groups and all received spinal anesthesia :-(Group A) 25 patients received 20 ml bupivacaine injected in the plane between internal oplique and transversus abdominis musceles.(Group B) 25 patients received 20 ml bupivacaine added to 750 unit hyalourindase. Patients were monitored for heart rate NIBP and oxygen saturation .In post -anesthesia care unit patients were asked to assess their level of pain based on visual analog scale (VAS) , complications also were observed . Results :Our study showes that addition of hyalourindase to bupivacaine for TAP block resulted in significant reduction in VAS pain score over the post operative 24hrs and reduction of post operative morphine requirments .PDF created with pdfFactory Pro trial version www.pdffactory.com SOHAG MEDICAL JOURNAL Postoperative analgesic efficacy of bupivacaine with hyalourindase Vol. 21 No.3 october 2017 Ghada Mohamed Refat

Aim:The aim of the study is to evaluate the efficacy of 0.5%lidocaine when given intrathecally in perianal surgery in comparison to lidocaine 2% concentration, and to study the effect of change in patient position on sensory anesthesia.Patient and Methods: forty patients aged between 18-70 years with ASA I-II who were scheduled for perianal fistula surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:-(Group I) 20 received 8ml (0.5%) lidocaine (prepared by adding 2ml(40 mg) 2% lidocain to 6ml sterile distilled water ). Subarachnoid block will performed in jack-knife.-(Group II)20 patients received 2ml lidocaine 2% (40mg) with the same technique, After injection patient will turned to lithotomy Position with table in horizontal Level. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L3-4 or L4-5). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GI or GII).Immediately after administration; the patients were turned into the supine or jackknife position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block,hemo dynamic stability; In the post-anesthesia care unit (PACU). Complications also were observed . Results The onset of sensory is faster in hypobaric lidocain but duration and time needed to reach highest sensory level longer in isobaric, onset of motor block is faster in hypobaric but duration of motor block longer in iso baric lidocain hemo dynamic stability more in iso baric . Conclusion The use of hypo baric lidocain reveal early onset for sensory and motor block with early recovery than isobaric and hemo dynamic stability slight more in iso baric lidocain in short stay surgeries as perianal surgeries.

AIM: The aim of this work is to know the pathophysiological mechanism of critically ill obese patients and to recognize the new requirements for their management in the critical-care-setting. The obese patient's category is still increasing in many westernized countries especially the united states (USA). As a result, the peri-operative management of obese patients became routine care. As obese patients are now liable for all types of procedures, it is essential and very important for all anesthesiologists, surgeons, perioperative-health care providers to understand their different multi-organ physiology so as to safely prepare those obese patients perioperatively. A good assessment of those patients pre-operatively can decrease the risk of postoperative complications later on …, in this manuscript, we mention the major considerations for the preoperative assessment of morbidly obese patients. Obesity now became the main cause of increased morbidity and mortality because of acute and chronic medical diseases, like diabetes mellitus, hypertension, cardiovascular problems, renal disorders, arthritis, and certain types of cancer (Mokdad et al. 2003). Obese patients, particularly morbidly ones, have a higher percentage of resource utilization, intensive care unit entrance, respiratory diseases, and respiratory distress syndrome, than do nonobese patients (Westerly and Dabbagh2011). also, obese patients are at higher danger for postoperative complications