Background: Gabapentin is used as an anti-epileptic and in chronic pain but can be used also in acute postoperative pain by giving it preoperatively in a single or in two divided doses combined with intrathecal morphine. Objectives: This study aimed to detect the role and value of gabapentin as analgesic in postoperative analgesia. Presentation of the case: A case with orthopedic surgery that had no postoperative pain for 24 hours and needed no analgesia with good (near normal) mobility after taking preoperative gabapentin and intrathecal morphine with spinal anesthesia intraoperative. Results: It is a rare condition in which the patient is pain-free completely for 24 hours without any postoperative analgesia, most researchers stated that patients who received preoperative gabapentin need less postoperative analgesia or morphine but still there is pain. Conclusion: Preoperative gabapentin has a great effect on postoperative pain, decreasing analgesic doses especially morphine with good and early postoperative mobility.

Background: Covid19 infection became one of the most widespread respiratory tract infections worldwide. The pandemic lastly spreading in Egypt made a great challenge for the health workers of different specialties. Anesthetists had to solve difficult problems related to the infected patients requiring surgical interventions and to make the balance between patient safety and medical team protection during the procedure. Objective: This study aimed to check for clear guideline protocol for anesthetic management of Covid-19 cases undergoing cesarean section, here is a case presentation for a twins pregnant patient. Case presentation: Female patient 32 years old diagnosed as covid-19 positive prepared for cesarean section for delivery of preterm twins with CT finding corads 5, clinically presented by acute respiratory distress syndrome (ARDS). The patient received spinal anesthesia associated with tap block, oxygenation was done by closed circuit system of the anesthesia machine with partial closure of adjustable pressure limiting (APL) valve and hypotension was managed by noradrenaline infusion during the procedure. Conclusion: Combined spinal anesthesia with tap block was the most successful modality for anesthesia for cesarean section (CS) in severe cases of covid-19 infected patients.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker.Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker. Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.