BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated. AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery. METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio), RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001). CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care.

BACKGROUND: Pain is a major postoperative complication worldwide, which in turn impairs normal body performance and increases postoperative morbidity, hospitalisation, and the susceptibility to infections which also lead to chronic pain development. AIM: The purpose of this study was to evaluate the efficacy of intravenous ketorolac versus nalbuphine as analgesia after adenotonsillectomy surgery to determine the optimal procedure for pain control and postoperative reduction of analgesic use. METHODS: A group of 100 pediatric patients undergoing tonsillectomy or adenotonsillectomy were assigned as follows to two equal groups: Group A: 50 patients received intravenous ketorolac 0.9 mg/Kg. Group B: 50 patients received intravenous nalbuphine 0.25 mg/Kg. RESULTS: FLACC (Face, Legs, Activity, Cry, Consolability) pain score was measured after recovery from anaesthesia (postoperative). There was a statistically significant difference concerning pain score between group ‘A’ and group ‘B’ as pain score in 'A' (ranging from 3.18 ± 0.87 to 4.68 ± 0.74) is lower compared to 'B' (ranging from 3.90 ± 0.76 to 5.54 ± 0.73) and probability value < 0.05 except at 90 & 120 min which was observed statistically insignificant. There was no serious postoperative complication detected in either group. CONCLUSION: It is concluded that intravenous ketorolac is more effective than intravenous nalbuphine in reducing pain intensity and postoperative analgesic requirements after adenotonsillectomy in children.

This study was aiming at identifying the varieties, causes, treatment and prevention of post lumbar instrumental fixation complications, which was done on a study population of 50 cases, without stratification on bases of sex or age, excluding the patients with known chronic debilitating diseases. Regarding the patients’ population, our demographics shows a clear role of obesity in the pathogenesis of spondylolisthesis in general, regardless of age or sex, the mean BMI was above 30, and this does indeed agree with most studies as mentioned before. Analyzing our results, we found the most affected levels to be L4-5, and L5-S1, which coincides with other studies discussed before, we also found significant dominance of back pain as a presenting complaint, while neurological deficits were rare, by analyzing the etiologies of pathological findings in our patients we found isthmic lythesis followed by spondylolisthesis as the most common etiologies respectively among the studied population.Regarding the positive finding requiring further management in our study, the most common finding was failed prosthesis, and adjacent segment failure, other less frequent findings include Sacroiliac dysfunction, posterior cage migration, screw malpostioning, infection, Dural tear, CSF leak, pseudarthrosis, and one patient with pseudo-meningocele.32 patients (64%) were managed surgically, while the other 18 patients (36%) were managed conservatively, 40 patients had improved complaints, while 10 cases didn’t improve, our results should be seen in the light that our sample size was small, which can be a great limiting factor.