BackgroundHypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering.MethodsThis prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications.ResultsGroup C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6), which were comparable to each other.The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients.The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3.ConclusionsIntrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.Trial registrationClinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727; January 2018, “retrospectively registered”.

Background: Anesthesiologists in Egypt as a representative of developing countries with large populations and shortage of trained personnel and extended working hours that may reach 30 continuous hours are susceptible victims of fatigue and sleep deprivation. Objectives: To evaluate and compare differences in cognitive function of anesthesia residents before and after the 24 hours work shift. Methods: Prospective, observational, cohort study that was conducted in tertiary care hospital (Kasr El-Aini Hospital, Faculty of Medicine, Cairo University). Fifty anesthesia residents with 24 hours working shift participated in the study. The cognitive function was assessed before and after the shift using Psychomotor Vigilance Task, Karolinska Sleepiness Scale, Epworth Sleepiness Scale and Trail Making Test before and after the shift. Results: Psychomotor Vigilance Task mean reaction time before and after shift was 302.1 ± 35.2 ms and 371.9 ± 55.4 ms, respectively (P value < 0.001). Karolinska Sleepiness Scale mean before and after shift was 3.34 ± 1.189 and 6.24 ± 1.589, respectively (P value < 0.001). Epworth Sleepiness Scale mean before and after shift was 6.68 ± 2.759 and 14.86 ± 3.423, respectively (P value < 0.001). Trail Making Test mean times in both parts A and B, before shifts were 38.82 ± 8.458 and 63.16 ± 11.557 s, respectively. While, post shifts mean times were 44.86 ± 9.370 and 72.60 ± 12.294 s, respectively (P value < 0.001 for both parts). Conclusions: Sleep deprivation in night shifts increases the day-time sleepiness and affects the anesthesiologist' cognitive processes, such as reaction time, alertness, rapid problem solving, psychomotor skills, attention, mental flexibility, and executive functions.Clinical trial registration ID: clinicaltrials.gov: NCT03784560.

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