Introduction: Postoperative delirium is a common complication of cardiac surgery. This study aimed to assess the effect of supplementing dexmedetomidine infusion with oral melatonin in prevention of postoperative delirium after coronary artery bypass graft surgery. Methods: 110 patients of both sexes above 60 years of age were included. Anesthetic management was standardized. Patients were randomly allocated into one of the two study groups, dexmedetomidine/melatonin (DM) group or dexmedetomidine (D) group. Patients in the DM group received oral Melatonin tablet 5 mg the night before surgery and same dose was repeated every 24 hours for 3 postoperative days. After completion of surgery and upon ICU arrival, patients in both groups received a bolus of 0.4 µg/kg dexmedetomidine followed by 0.2-0.7 µg/kg/h infusion, for 24 maximum hours. Delirium was assessed for 5 days postoperatively at 12 hr intervals using confusion assessment method (CAM) for ICU and after discharge from ICU to surgical ward using CAM. Delirious patients were treated with IV haloperidol. Results: No significant differences between studied groups regarding baseline, preoperative, intraoperative and postoperative characteristics. Incidence of delirium was significantly lower, onset significantly more delayed, and duration was significantly shorter in group-DM as compared to group-D. No significant differences between all cases, cases who had delirium, and cases who did not have delirium in the two groups as regards extubation time, ICU stay, and hospital stay. Conclusion: supplementing dexmedetomidine with melatonin decreases incidence, delays onset, and shortens duration of postoperative delirium in patients above 60 years of age undergoing CABG surgery.

Background Skin grafting, both partial and complete thickness, is frequently used in reconstruction of traumatic soft tissue defects. It is of great value not only for functional and anesthetic purposes in the field of plastic surgery, but also for other surgical specialties. Of all the problems in the early postoperative period, pain is considered the most important, ameliorating it can lead to significant reduction in postoperative morbidity and faster recovery of the skin donor site. Objective To evaluate use of dexamethasone as adjuvant for bupivacaine in subcutaneous local anesthesia infiltration for skin graft donor sites, on quality of pain relief and total dose of analgesic requirements in the early hours postoperatively. Methods Ninety-five patients were randomly allocated to receive local bupivacaine infiltration (group LB) (48 patients), or dexamethasone plus bupivacaine (group LB + D) (47 patients) in skin donor site after skin harvesting. In addition to basic demographic data, patients were compared for numerical rating scale (NRS), total dose of morphine including morphine equivalents, time to 1st breakthrough pain (over an observational period during the first 12 h postoperatively) and duration of surgery. Results Numerical rating scale figures were significantly better (P < 0.05) in group (LB + D) than group (LB) in the first 7 h postoperatively. Likewise, consumption of morphine or its equivalents was considerably less, as well as time to first breakthrough pain. Duration of surgery was not significantly different between both groups. Conclusion Addition of dexamethasone to bupivacaine provided effective analgesia for patients undergoing skin grafting surgery, with less need for rescue analgesia in the early postoperative period to bupivacaine alone.

Background Polytrauma patients are at a higher risk of delayed gastric emptying. To assess the gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery. Methods A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia was carried out. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed for qualitative and quantitative assessment of the gastric antrum in a supine position and right lateral decubitus (RLD) position. This was followed by routine placement of the nasogastric tube to aspirate and calculate the volume of the stomach contents. Results Of the 45 polytrauma patients, the risk assessment of aspiration and the anesthesia technique changed in 14 patients (31.1%) after the gastric ultrasound examination. A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented. Conclusion Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique and reduce the risk of aspiration pneumonia. Trial registration This trial was registered at ClinicalTrials.gov. registry number: NCT04083677 on September 6, 2019.

Background This study compared dexmedetomidine versus ketamine as regard sedation and anxiolysis produced by giving them through intranasal route to pediatric patients undergoing adenotonsillectomy. This study was double-blinded randomized comparative prospective interventional clinical study done in Ain Shams University Hospital (El Demerdash Hospital) on 76 pediatric patients who underwent adenotonsillectomy, and they were randomly allocated equally into two main groups; group D received 2 μg/kg intranasal dexmedetomidine and group K received 5 μg/Kg intranasal ketamine 30 min before the operation, and the aim of this study was to compare the efficacy of intranasal dexmedetomidine versus intranasal ketamine for anxiolysis and sedation to alleviate stress, agitation, and anxiety in children before general anesthesia and for promoting good level of sedation for them. Results Results of this study as regards sedation level that was assessed by modified Ramsay sedation score showed that there was statistically significant difference between both groups at 10, 20, and 30 min from intranasal application of the drug (P value < 0.05), the median (IQR) of sedation score at 10, 20, and 30 min preoperative in group D was (2 (2 – 2)), (3 (3 – 4)), (4 (4 – 5)) compared to (2 (2 – 3)), (3 (2 – 3)), (4 (3 – 4)) in group K respectively which revealed that there was better and effective sedation in group D more than in group K, this difference was statistically significant but clinically insignificant as both drugs produced an acceptable level of sedation and decreased the level of anxiety in children. Conclusion Both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and time of onset of sedation, and also there was little decrease in heart rate and mean arterial pressure which is favorable during such surgeries; also, there was accepted level of cannulation and parental separation scores, and the parents were highly satisfied with the procedure and were grateful for us due to alleviating stress and anxiety from them and from their children.

Background Patients with reduced ejection fraction (EF) undergoing CABG are more likely to develop postoperative morbidity and mortality. It is controversial about which cardioplegia solution, temperature, and method of administration ensure optimal cardiac muscle preservation during CABG surgery. Aim of the study The aim of the study was to compare intermittent antegrade warm blood cardioplegia with cold crystalloid cardioplegia during CABG in patients with low EF (30–40%). Methods Patients (n = 100) undergoing elective isolated on-pump CABG were prospectively randomized into group I (n = 50) which received antegrade cold crystalloid cardioplegia and group II (n = 50) which received antegrade warm blood cardioplegia. Blood samples were collected immediately and 12 and 24 h postoperatively. CK-MB and cardiac troponin I were measured and compared between the two groups. Other indicators such as use of inotropic support and use of intra-aortic balloon counter pulsation (IABC) were also documented. Results Preoperative demographic and clinical variables were matched in both groups. However, postoperative CK-MB and troponin I were higher in group I compared to group II. There was less need for inotropic support and IABC with better postoperative course in group II than in group I. Conclusion There was a significant reduction in the release of cardiac enzymes and less need for inotropic support with better postoperative outcome in patients who received antegrade warm blood cardioplegia versus cold crystalloid cardioplegia.