Background:Cesarean section (CS) is the one of the most common surgical procedure in women. There is preoperative stress effect before the delivery of the baby as (intubation and skin incision). There is acute postoperative pain, which may be progressed to chronic pain. All these perioperative stress effects need for various approach of treatment, which including systemic and neuraxial analgesia. The different analgesia modalities may affect and impair early interaction between mother and infant. Preemptive intravenous (I.V.) paracetamol (before induction) may reduce stress response before the delivery of the baby, intraoperative opioids and postoperative pain.Objectives:The aim of this study to compare between the administration of I.V. paracetamol as: Preemptive analgesia (preoperative) and preventive analgesia (at the end of surgery) as regards of hemodynamic, pain control, duration of analgesia, cumulative doses of intraoperative opioids and their related side-effects and to compare between two different protocols of postoperative analgesia and their cumulative doses.Patients and Methods:Sixty patients undergoing elective CS were randomly enrolled in this study and divided into two groups of 30 patients each. Group I: i.V. paracetamol 1 g (100 ml) was given 30 min before induction of anesthesia. Group II: i.V. paracetamol 1 g (100 ml) was given 30 min before the end of surgery. Heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation were recorded. Postoperative pain was assessed by visual analog score. Postoperative pethidine was given by two different protocols: group I: 0.5 mg/kg was divided into 0.25 mg/kg intramuscular and 0.25 mg/kg I.V. Group II was given pethidine 0.5 mg/kg I.V. Doses of intraoperative fentanyl, postoperative pethidine, duration of paracetamol analgesic time, time to next analgesia, and side-effects of opioid were noted and compared.Result:Preemptive group had hemodynamic stability, especially before delivery of the baby P < 0.001. Preventive group had longer duration of paracetamol analgesia and higher intraoperative opioid P < 0.001 and P < 0.01, respectively. Preemptive group had longer time for next analgesia and lower incidences of postoperative side-effects P < 0.001 and P < 0.05. Preemptive group had higher pain scores in immediate postoperative and after 6 h but preventive group had higher pain scores in 4 and 8 h postoperatively P < 0.001 and P < 0.01, respectively.Conclusion:Preemptive paracetamol and immediate postoperative opioid analgesia were more effective than preventive paracetamol.

Background: Recently dexmedetomidine had been successfully used in conscious (moderate) sedation as a good competitive to popular agent (midazolam). Different concentrations of ketamine and propofol combinations (ketofol) were used for procedural sedation and analgesia. Objectives: The study was conducted to compare two techniques of moderate sedation for patients undergoing ERCP, using either dexmedetomidine or ketofol as regards hemodynamic, sedation, pain, respiratory effect, recovery time, patients' and endoscopists' satisfactions, and complications during and after the procedure. Patients and methods: Fifty patients were randomly allocated in one of two groups; dexmedetomidine group D (n = 25) received 1 lg/kg i.v. bolus over 10 min followed by 0.5 lg/kg/h or ketamine/ propofol (ketofol) group KP (n = 25) received 1 mg/kg i.v. bolus followed by 50 lg/kg/min. The level of sedation was adjusted to achieve a Ramasy sedation scale (RSS) score of 4 in both groups of patients. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO 2 ), and facial pain score (FPS) were compared. Time to achieve RSS, modified Aldrete's score (MAS) of 9-10 and the related complications were compared between groups. Patients' and endoscopists' satisfactions were compared. Total amount of rescue sedation was recorded.Results: After loading dose HR and MAP were significantly lower in group D as compared with group KP (p < 0.05). HR was significantly lower in group D during the recovery (p < 0.05). No significant difference between both groups as regards time to achieve RSS, MAS, FPS and total dose of rescue sedation. Personnel restraint was significantly lower in group KP (8% versus 20%) than in group D. Endoscopists' satisfaction was significantly higher in group KP than D group (92% and 80%) respectively. Conclusion: Ketofol (1:1) provided better hemodynamic stability than dexmedetomidine and standard alternative to it in moderate sedation during ERCP.

Background:There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges.Aim of the Study:The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness.Patients and Methods:Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA.Results:Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P < 0.001 and P < 0.01 respectively. The upper dermatomal height of sensory block reached was T9 and T8 in groups B and L respectively. Group B showed more intense motor block than group L. There was no significant difference between both groups as regards postoperative side effects P > 0.05. Group L patients did not stay in PACU, and all patients bypassed it P < 0.001. Bupivacaine group patients showed significantly longer time to ambulate and time to home-readiness than lidocaine group P < 0.001 and P < 0.01 respectively.Conclusion:Both techniques of SSA were clinically efficient as subarachnoid block, and they had less postoperative side effects. Lidocaine spinal was more eligible for fast-tracking anesthesia than bupivacaine spinal with shorter time to ambulate and home-readiness time.

The impact of replacement monosodium glutamate (MSG) with a ratio of 1:1 mixture of salt and sugar on the microbiological quality of deep fat fried chicken breast strips throughout frozen storage (-18°C) for 90 days was assessed. Also, the antibacterial activity of monosodium glutamate and a mixture of salt (sodium chloride) and sugar can (sucrose) in a ratio of 1:1 was determined by disc diffusion assay, the minimum bactericidal concentration (MBC) and the minimum inhibitory concentration (MIC). Results showed that Gram-negative bacteria since the mean values of the inhibition zones were in the ranges of 11.8, 13.4, 15.4, and 16 mm when studying the effect of monosodium glutamate on Escherichia coli, Serratia marcescens, Bacillus cereus, and Staphylococcus aureus, respectively. Also, the mean values of the inhibition zones were in the ranges of 14.2, 15.6, 18.2, and 17 mm when studying the effect of the mix of sugar and salt in a ratio of 1:1 on Escherichia coli, Bacillus cereus, Serratia marcescens, and Staphylococcus aureus, respectively. The average MIC and MBC values of monosodium glutamate against Gram-negative bacteria were 37.5 and 75 µg/ml, respectively, while these values were 32.5 and 65 µg/ml against Gram-positive bacteria, respectively. Also, the average MIC and MBC values of the mix of sugar and salt in a ratio of 1:1 against Gram-negative bacteria were 27.2 and 55 µg/ml, respectively. While these values were 22.5 and 45 µg/ml, respectively against Gram-positive bacteria, respectively. Besides, the results demonstrated that the control of chicken strips possessed the uppermost values of total bacterial count and the least values of total coliform count compared to the remaining treatments. Salmonella and Escherichia coli were not found in both treatments up until the ending of the storage period. The control of chicken strips possessed the least counts of total Staphylococcus aureus, total psychrophilic bacteria, and yeast and mold counts compared to the remaining treatments.