Background:Vitreoretinal surgery is associated with undesirable intraoperative and postoperative complications including pain, postoperative nausea and vomiting, and oculocardiac reflex (OCR). Systemic analgesics have side effects and are contraindicated in some cases. We hypothesized that the preoperative sub-Tenon's injection of levobupivacaine with general anesthesia would decrease postoperative pain and intraocular pressure as well as the incidence of complication.Methods:Eighty patients who were presented for vitreoretinal surgery, aged 30–60 years, were enrolled in the study. General anesthesia was administrated to all patients; then, they were randomized into two equal groups (40 each) – Group I: patients received 5 mL placebo solution for sub-Tenon's block and Group II: patients received 4 mL levobupivacaine 0.5% in 1 mL saline for sub-Tenon's block. Postoperative pain was evaluated using a verbal pain scale. Surgeon satisfaction, postoperative analgesic consumption, and perioperative hemodynamics were also reported.Results:Verbal rating pain scores were significantly lower at the first 6 h postoperative in Group II (sub-Tenon's levobupivacaine) compared to Group I (sub-Tenon's placebo). First analgesic rescue time and total dose of analgesic consumption were significantly reduced in Group II compared to Group I. There was a lower incidence of OCR with sub-Tenon's levobupivacaine (Group II), also surgeon satisfaction was significantly superior in the same group.Conclusion:The combination of general anesthesia with sub-Tenon's block using levobupivacaine in retinal surgery patients reduces pain scores after surgery; total analgesia requirement also decreases the incidence of OCR.

Background: Myocardial damage due to ischemia and reperfusion is still unavoidable during coronary surgery. Anesthetic agents have myocardial preconditioning effect. Ketamine has sympathomimetic effect, while dexmedetomidine has a sympatholytic effect in addition to anesthetic, analgesic, and anti-inflammatory properties of both the drugs. This study was carried out to compare ketamine–dexmedetomidine (KD) combination with fentanyl–propofol (FP) combination on the release of cardiac troponin T (cTnT) and outcome after coronary artery bypass graft. Patients and Methods: Ninety adult patients who underwent coronary artery bypass grafting (CABG) were assigned to receive either KD base anesthesia (KD group) or FP anesthesia (FP group). Trends of high-sensitive cTnT, CK-MB, and serum cortisol were followed in the first postoperative 24 h. Other outcomes were vital signs, weaning from cardiopulmonary bypass, tracheal extubation time, and echocardiographic findings. Results: There was a significant lower release of cTnT in KD group than FP group during its peak values at 6 h after aortic unclamping (92.01 ± 7.332 in KD versus 96.73 ± 12.532 ng.L −1 P = 0.032). significant lower levels of serum cortisol levels were noted KD group than in FP group at 6 and 12 h after aortic unclamping P < 0.001. As regard tracheal extubation time, patients assigned to KD group extubated earlier than whom in FP group 202.22 ± 28.674 versus 304.67 ± 40.598 min respectively P < 0.001. Conclusion: The use of KD during on-pump CABG confers better myocardial protective and anti-inflammatory effect than fentanyl propofol.

Background: Cataract surgery is one of the most commonly performed ophthalmic procedures. On choosing the appropriate method of anesthesia for diabetic patients with cataract whether regional or general, one should consider a technique that is associated with less stress response, minimal effect on hemodynamic and essentially associated with a good intraoperative glycemic control. This is yet to be determined. Aims: The aim of this study is to evaluate the use of I-gel as an alternative to local anesthesia (LA) in diabetic patients undergoing cataract surgery. Patients and Methods: This study was conducted on 60 controlled insulin-dependent diabetic patients undergoing cataract surgery. They were randomized to receive either LA by sub-Tenon's block (LA group n = 30) or general anesthesia (GA) using I-gel (GA group n = 30). Mean arterial blood pressure (MBP) and heart rate were monitored. Furthermore, blood glucose level and plasma cortisol level were measured at basal level, after induction of anesthesia or local block, after nuclear extraction, at the end of surgery, and 30, 60, 120, and 240 min postoperative. Results: There was no significant difference in either blood glucose or cortisol levels in both groups. Blood glucose level increased with induction of anesthesia in both groups. The use of I-gel was not associated with increase heart rate or MBP compared to the LA group. Conclusion: Both local and GA using I-gel are relatively safe without marked changes in hemodynamics, blood glucose, or cortisol level in insulin-dependent diabetic patients.

Background: Spinal anesthesia is often associated with significant hypotension due to a sympathetic block and can increase the risk of perioperative cardiac complications. Transthoracic echocardiography (TTE) is widely used throughout medicine as a clinical, diagnostic and research tool. Portability, accuracy, ease of use and a variety of training courses have encouraged its use. Aim: The present study was designed to evaluate the hemodynamic changes of spinal anesthesia by Transthoracic Echocardiography and test its efficacy as a monitoring tool in lower limb surgery. Methods: The study included 50 patients, who were scheduled for lower limb surgery under spinal anesthesia. Two serial TTE studies were performed. One immediately before spinal anesthesia after giving the preload, then at 10 mins after spinal anesthesia. Changes of heart rate (HR), mean arterial blood pressure (MAP), the total doses of ephedrine and atropine, and data regarding highest sensory level and bromage scale were recorded. Results: Echocardiographic monitoring the heart variables have showed marked decrease when MAP was < 70% of basal values. Conclusion: Transthoracic echocardiography has proved its efficacy as a monitoring tool in assessment and guiding the management of hemodynamic changes after spinal anesthesia.

Background: Strabismus surgery may be associated with several undesirable complications as increased incidence of the oculocardiac reflex (OCR), hemodynamic changes, emergency agitation (EA), postoperative pain, nausea, and vomiting. Previous studies suggested that deeper anesthesia monitored by bispectral index (BIS) protects against OCR. This study aims to evaluate the effect of the type of anesthesia on the quality of anesthesia in pediatric patients. Patients and Methods: One hundred American Society of Anesthesiologists physical status classes I and II pediatric patients, aged between 3 and 6 years old of both genders, who were subjected to strabismus surgery under general anesthesia were enrolled in this study. Patients were randomized into two equal groups (each = 50); in the first group, anesthesia was induced and maintained with sevoflurane (Group S), and in the second group, anesthesia was induced and maintained with propofol (Group P). Hemodynamics and BIS were monitored, and OCR and the need for atropine were recorded. Furthermore, EA using the Cravero scale was recorded. Results: The propofol group showed a higher incidence of OCR while the sevoflurane group had a higher incidence of postoperative agitation, pain, nausea, and vomiting, without statistically significant differences regarding hemodynamics. Conclusion: Although sevoflurane anesthesia may be superior to propofol in ameliorating OCR, it has been associated with an increased incidence of postoperative complications.