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Background: Managing ventilation and oxygenation during laparoscopic bariatric procedures in morbidly obese patients represents many challenges. Aim of the Work: To compare the effect of these modes of ventilation on respiratory parameters in obese patients undergoing laparoscopic bariatric surgeries and whether this influences the need of postoperative ventilation or not Patients and Methods: After approval of ethical committee of faculty of Medicine Ain Shams University and obtaining an informed consent from every patient, this randomized controlled clinical trial study was conducted at Ain Shams University Hospitals operating theatre department on 40 obese adult patients of ASA physical status I-II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic bariatric surgery. General anesthesia with endotracheal intubation and controlled ventilation was conducted in all patients. Patients were divided randomly into two equal groups: Group A; received volume controlled ventilation and Group B; received pressure controlled ventilation. Results: The study found no significant difference between the two groups as regards PaO2 and PaO2:FiO2 preoperatively, after pneumoperitonium, at the end of surgery and postoperatively. As regards PaCO2 there was no statistically significant difference between the two groups in the preoperative measurement while there was statistically highly significant difference between the two groups after pneumoperitonium, at the end of surgery and postoperatively with lower PaCO2 in group (B) that received PCV than group (A) that received VCV. There was statistically highly significant difference between the two groups as regards dynamic compliance after intubation, after pneumoperitonium and at the end of the surgery with higher dynamic compliance in group (B) that received PCV. The results showed no statistically significant difference between the two studied groups regarding the need of post-operative ventilation. Conclusion: No significant difference between pressure controlled ventilation and volume controlled ventilation regarding oxygenation and the need of postoperative ventilation but PaCo2 levels are lower and dynamic compliance is higher with pressure controlled ventilation.

Introduction Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization. Aim The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty. Patients Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study. Methods patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response. Results The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA. Conclusion The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.