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 & objectiveː Anesthetic management of pediatric cataract surgery is special as most of these surgeries have to be completed under general anesthesia, and airway management and adequate ventilation take precedence and special care. We compared spontaneous ventilation vs. controlled ventilation, using laryngeal mask airway (LMA) with or without muscle relaxation showing their impact on different parameters in pediatric cataract surgery. Methodology: This prospective study included 150 ASA-I and II children, who underwent elective cataract surgery. The patients were randomly divided into three groups: Group-A, B and C to receive spontaneous ventilation, unparalyzed controlled and paralyzed controlled ventilation through LMA, respectively. Evaluation of the effect of ventilation on position of the eyes during surgery in relation to depth of anesthesia, intra-ocular pressure (IOP), surgeon’s satisfaction, consumption of sevoflurane, emergence agitation, respiratory parameters and intra-operative hemodynamic stability were the main outcome measures registered. Resultsː Pressure-controlled ventilation using laryngeal mask improved dynamic compliance with statistically significant lower incidence of eye movements (p = 0.001) and lower IOP measurements despite decreased sevoflurane consumption and higher BIS values (p < 0.001). It led to better surgeon satisfaction and less postoperative agitation (p < 0.001) without any statistically significant differences in hemodynamic parameters or EtCO2, in comparison to spontaneous ventilation. Conclusionː Pressure-controlled ventilation through laryngeal mask airway with low-dose muscle relaxants and titrated anesthesia under bispectral index monitoring is an acceptable safe clinical practice. However, ventilation without neuromuscular blockade could be an alternative with adequate monitoring. Abbreviations: LMA – laryngeal mask airway; EtCO2 – End-tidal carbon dioxide level; BIS – Bispectral index; IOP – Intra-ocular pressure; Key words: Ventilation; Laryngeal Mask Airway; Eye Movement; Positive-Pressure Respiration; Child; Humans; Lens Capsule, Crystalline / surgery; Pediatrics / methods Citation: El-Sherbiny SM, EL-Deeb AH, Gaafar WM, Ismail OM, Messeha MM. Impact of spontaneous vs. controlled ventilation with laryngeal mask airway in pediatric cataract surgery. Anaesth. pain intensive care 2022;26(3):360-367. DOI: 10.35975/apic.v26i3.1911 Received: September 06, 2021, Reviewed: April 21, 2022, Accepted: May 01, 2022

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.

Background: External dacryocystorhinostomy (DCR) is still considered the golden standard for lacrimal surgery. It is a painful procedure that involves intra- and extra-ocular dissection with a high prevalence post-operative nausea and vomiting (PONV). Aims: This study was designed to evaluate the effects of preoperative oral pregabalin on postoperative pain and analgesic requirements in patients undergoing DCR surgery. Design: A prospective randomized double-blind clinical trial. Patients and methods: 100 American Society of Anesthesiologists (ASA) physical classes I and II patients in an age ranging from 18 to 65 years of either sex, had DCR surgery. Patients were divided randomly into two equal groups (each = 50). In pregabalin group, they received two capsules of pregabalin (one at the night of the surgery, the other at 2 hours before the surgery), while patients in control group received two identical placebo capsules. Hemodynamics were monitored, postoperative VAS scores, the time of first analgesic request, total pethidine requirements, and the incidence of PONV were recorded as well. Statistical analysis: A prospective analysis of the collected data was performed using the SPSS program for Windows (version 22). Results: The pregabalin group exhibited a significant lower incidence of postoperative pain, pethidine consumption and nausea, without any statistically significant differences regarding hemodynamic parameters in comparison to control group. Conclusion: Preoperative oral administration of pregabalin can be a promising modality for alleviation of postoperative pain and reduction in postoperative opioid consumption.