Objective: Evaluation of the effect of different concentrations of fentanyl added to the local anesthetic mixture on the onset and duration of globe anesthesia, after peribulbar block, with the least side effects. Design: Double blinded randomized controlled clinical trial. Setting: Kasr Al Aini hospital, Cairo University. Methods: 60 patients with cataract grade 1-3 in the age group 40-70 years, with American Society of Anesthesiologists (ASA) grade I, II and III, scheduled for elective cataract surgery under regional anesthesia. They were randomly divided into four groups: in Group 1 (Control Group), patients received Lidocaine 2% and Hyaluronidase 15 IU/ml; in Groups 2, 3 and 4 (Fentanyl Groups), the patients received Lidocaine 2% and Hyaluronidase 15 IU/ml in addition to Fentanyl 1 lg/ml, 2 lg/ml and 3 lg/ml respectively. The onset and duration of lid and globe akinesia were assessed. Postoperative Visual Analogue Score was recorded each hour up to 6 h. Results: No statistical significant difference was observed between the four groups in the onset and duration of lid and globe akinesia. There was a significant difference between the control group and the fentanyl groups as regards the duration of analgesia that was significantly prolonged in the groups that received fentanyl at concentrations of 2 lg/ml and 3 lg/ml in these group patients required analgesia after 116 ± 19 min and 144 ± 11 min respectively compared to the control group and the group that received fentanyl at a concentration of 1 lg/ml group who required analgesia after 100-103 min. Conclusion: Adding Fentanyl at concentrations P 2-3 lg/ml to the local anesthetic mixture (Lidocaine and Hyaluronidase) for regional peribulbar block provides safe and effective method in improving postoperative analgesia in patients undergoing cataract surgery.

Objective: Cisatracurium is approximately 3 times more potent than atracurium, devoid of histamine release and cardiovascular side effects and mainly eliminated by Hofmann degradation. Patients with liver disease exhibit abnormal response to most of muscle relaxants. This study was designed to evaluate the dose-response of cisatracurium in patients with mild-moderate liver impairment in comparison with healthy subjects. Methods: Eighty ASA physical status I-II patients of both sexes, scheduled for elective surgical procedures under general anesthesia, were divided according to their preoperative hepatic status and laboratory investigations into two groups; Group I (control group with normal liver functions, n = 40) and Group II (Liver dysfunction group, Child-Pugh Score A or B, n = 40). The doseresponse curve was constructed, ED 50 and ED 95 were estimated. Results: The preoperative laboratory parameters showed statistically significant differences between the two groups regarding serum albumin, total bilirubin, ALT, AST, PT, PC and INR. The operative data showed statistically insignificant difference between the two groups regarding the 1st dose response (p = 0.152), the estimated ED 80 (p = 0.886) and the calculated 2nd dose (p = 0.886) and statistically significant differences between the two groups regarding the 2nd dose response (p = 0.006), the measured ED 50 (p = 0.010) and the measured ED 95 (p = 0.001). In conclusion, the measured ED 50 and ED 95 through two-dose dose-response curve technique were clinically insignificant from using the single-dose technique. The dose-response curve of cisatracurium in patients with chronic liver disease was clinically insignificant in comparison with healthy subjects.

We evaluated segmental splenectomy in 51 patients who required splenectomy to relieve the symptoms of schistosomal splenomegaly, and compared their course with that of 44 patients who underwent total splenectomy in an unrandomized study. We describe a minor modification of our initial technique. Patients having segmental splenectomy had a similar postoperative course to those having total splenectomy. Conversion of a segmental to a total splenectomy was required in two cases due to technical faults. No regrowth of the spleen has occurred in up to 4 years of observation. We noted an increased percentage of T lymphocytes with an increased ratio of T helper to T suppressor cells in patients having segmental splenectomy. Our cumulative experience supports adoption and wider evaluation of segmental splenectomy in schistosomiasis.