Background:We tested the hypothesis that nebulized budesonide would improve lung mechanics and oxygenation in patients with early acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) during protective mechanical ventilation strategy without adversely affecting systemic hemodynamics.Methods:Patients with ALI/ARDS were included and assigned into two groups; budesonide group (30 cases) in whom 1 mg–2 ml budesonide suspension was nebulized through the endotracheal tube and control group (30 cases) in whom 2 ml saline (placebo) were nebulized instead of budesonide. This regimen was repeated every 12 h for three successive days alongside with constant ventilator settings in both groups. Hemodynamics, airway pressures, and PaO2/FiO2 were measured throughout the study period (72 h) with either nebulized budesonide or saline. Furthermore, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) were analyzed serologically as markers of inflammation at pre- and post-nebulization sessions.Results:We found a significant difference between the two groups regarding PaO2/FiO2 (P = 0.023), peak (P = 0.021), and plateau (P = 0.032) airway pressures. Furthermore, TNF-α, IL-1β, and IL-6 were significantly reduced after budesonide nebulizations. No significant difference was found between the two groups regarding hemodynamic variables.Conclusion:Nebulized budesonide improved oxygenation, peak, and plateau airway pressures and significantly reduced inflammatory markers (TNF-α, IL-1β and IL-6) without affecting hemodynamics.Trial Registry:Australian New Zealand Clinical Trial Registry (ANZCTR) at the number: ACTRN12615000373572.

Background: This study is designed to evaluate the relative efficacy of intravenously administered dexmedetomidine and nefopam for control of intraoperative shivering following spinal anesthesia. Materials and methods: A prospective, randomized, double-blind, controlled study was conducted on 100 ASA grade I and II patients of either sex, aged 18-60 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anesthesia. Patients who developed post-spinal anesthesia shivering of grade 3 or 4 were included in the study, and randomly allocated to one of two groups, group D (n = 50), received Dexmedetomidine in a dose of 0.5 lg/kg diluted in 10 ml isotonic saline slowly I.V. (one minute duration), and group N (n = 50), received Nefopam in a dose of 0.15 mg/kg diluted in 10 ml isotonic saline slowly I.V. (one minute duration) when shivering was observed. Time taken for control of shivering, response rate, recurrence rate, hemodynamics, time to first request of rescue analgesic, one-patient cost and adverse effects were recorded. Results: The time taken for control of shivering was statistically significantly shorter in Nefopam group (group N) compared with dexmedetomidine group (group D). The average time taken for disappearance of shivering was 2.35 ± 0.67 min in group N compared with group D (4.63 ± 1.19 min) (p = 0.041). Patients with incomplete response were more in group D (two patients in group D compared with nil in group N), but not statistically significant and recurrence rate was one patient in group D compared with nil in group N. Time to first request to rescue analgesic was significantly prolonged in group N (351.24 ± 19.71 min) compared with group D (192.63 ± 9.08 min). One-patient cost was significantly lesser in group N (about two £/patient) compared with group D (about 168 £/patient). Adverse effects such as bradycardia, hypotension and sedation were observed in Dexmedetomidine group, while pain at injection was noted in Nefopam group. Conclusion: Nefopam is better as compared to dexmedetomidine for control of intraoperative shivering under spinal anesthesia due to its rapid onset, higher response rate, no sedation, lesser hemodynamic alterations, lesser requirements of rescue analgesics and lesser costs.

Background Brachial plexus block is frequently performed for ambulatory upper limb surgery as an alternative to general anesthesia. It can significantly reduce pain, reduce post-operative nausea, and vomiting and allowing for faster discharge from hospital. Performing this block under ultrasound guidance has higher index of safety and can monitor the distribution of local anesthetic (LA) in real time. The aim of this study is to compare the block characteristics among bupivacaine-dexmedetomidine (BD), bupivacaine–nalbuphine8 (BN), and bupivacaine-isotonic saline groups. Results The duration of both the sensory and motor blockade was statistically longer in both BD and BN groups with a longer duration of analgesia compared to the BS group. Also, the BD group showed statistically significant higher sedation scores at different times during the study compared with both the BN and BS groups. Conclusion Adding either dexmedetomidine or nalbuphine to isobaric bupivacaine in US-guided supraclavicular brachial plexus block prolongs both sensory and motor blockade. Dexmedetomidine produces significant sedation when added to bupivacaine.

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Background Patients with liver cirrhosis commonly undergo diagnostic and/or therapeutic upper gastrointestinal endoscopy (UGIE). These fragile patients are at increased risk to develop complications as most sedative drugs are metabolized by the liver. This prospective, randomized controlled trial was performed to compare sedo-analgesia with ketamine-dexmedetomidine combination (KD1) (n = 35) versus dexmedetomidine alone (D2) (n = 35) in cirrhotic patients undergoing UGIE. Results UGIE could be performed effectively and safely with the KD1 (n = 35) group compared with the D2 group as no significant change in hemodynamics (HR and MBP) and O2 saturation (SPO2) from baseline values (P value > 0.05) while the D2 group revealed a statistically significant drop in hemodynamic parameters when compared with the KD1 group (P value < 0.001). Also, the induction time was statistically significantly lower in the KD1 group (3.9 ± 0.9 min) compared to the D2 group (5.2 ± 1.1min) (P value < 0.05). Recovery time was statistically significant faster in the KD1 group (4.5 ± 1 min) versus the D2 group (6.1 ± 1.6 min) with P value < 0.05. Endoscopic procedure was highly effective in KD1 (100%) compared with D2 (71.4%) with P value < 0.001. Supplementary fentanyl was given to 10 patients (28.6%) in the D2 group versus 0% in the KD1 group (P value < 0.001). Regarding post-operative adverse effects, there was statistically significant discomfort in D2 (28.6%) compared with KD1 (5.7%) with P value = 0.02. Also, gagging was statistically significant in D2 (22.9%) compared with KD1 (2.9%) with P value = 0.03. Conclusions The ketamine-dexmedetomidine sedo-analgesia group is highly effective than the dexmedetomidine-alone group in UGIE procedures with rapid induction time, good hemodynamic stability good recovery profile with less post-operative adverse effects. Trial registeration 1. IRB approval: 5 December 2016(Chairperson of Institutional Review Board of Ethics committee of Qena University Hospitals Prof. Ahmed Abuelyosr). The committee reference number is not applicable. 2. This study is registered in the Australian Newzeland Clinical Trial Registry (ANZCTR) at the number 12615000367549. Trial Id: ACTRN12615000367549, universal trial number(UTN): U1111-1165-6212.