Background: Peri-operative shivering, a challenging discomfort faced in anesthesiologists' daily practice. Many drugs were used as a prophylaxis, but there was no consensus on ideal or standard drug yet. Aim of the work: To compare the effectiveness and safety of pethidine, granisetron and tramadol in prophylaxis against perioperative shivering after spinal anesthesia. Patients and methods: Sixty adult patients, who underwent spinal anesthesia, were included. They were randomly assigned to granisetron, pethidine or tramadol (20 in each group), and submitted to standard intraoperative monitoring and follow up for postoperative 4 hours. Monitoring included electrocardiography, oxygen saturation, respiratory rate, temperature, non-invasive blood level, conscious level and sedation score. Side effects were documented. Results: Intra-and post-operatively, there was significant reduction of heart rate in granisetron and tramadol groups. Mean arterial pressure significantly decreased in granisetron group at the time from 30 minutes to the end of surgery and during the first two postoperative hours. Respiratory rate significantly decreased in pethidine group during the complete intra-and post-operative period. Granisetron had no sedative effect at all, but sedation was significantly increased among pethidine group. Finally, perioperative shivering was reported in 25%, 15% and 15% of pethidine, granisetron and tramadol groups respectively. Nausea/vomiting was reported in 20%, 10.0%, and 0% of pethidine, tramadol and granisetron groups respectively. Pruritus was confined to 30% pethidine group with significant difference. Conclusion: Granisetron, tramadol and pethidine, all are effective as a prophylaxis against perioperative shivering after spinal anesthesia. However, granisetron seems to be the most suitable drug.

Background: feeding after surgical correction of cleft palate is an important topic; the method of feeding usually affects the surgery outcome and stress of operation in infants. However, no consensus on the method of feeding for children with cleft palate either pre-or post-operative correction. Aim of the work: to investigate the effect of nasogastric tube (NGT) feeding compared with oral feeding on children in the first 48 hours after primary cleft palate repair. Patients and methods: The study was carried out at Al-Azhar University Hospital (Pediatric Surgery Unit);Damietta and specialized kids hospital during the period from January 2015 to Jun 2016. It included 36 children presented for primary repair of cleft palate. All were undergoing full history taking, clinical examination and laboratory investigations to prepare them for surgical intervention. Those patients were divided into 2 equal groups, each group had 18 patients.Then, after intervention, they followed up to examine the effect of method of feeding either by (NGT) (group 1) or oral route (group 2) on the outcome of surgery and postoperative analgesia requirements. Results: both groups were comparable as regard to demographic characteristics, amount of intraoperative fluids and required analgesia and for postoperative surgical outcome and complications. However, there was statistically significant decrease of Postoperative morphine, paracetamol and Ibuprofen in NG feeding group when compared to oral feeding group (0.13±0.08,

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients. Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured. Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time. Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.