Photon Journal of Anesthesia

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Comparative Study of the Effect of Sugammadex versus Neostigmine on Hemodynamics and Recovery Profile in Pediatric Cardiac Surgery 

Radwan Rabea Sabry Obayyaa , Maha Ahmed Abo-ZeidSalimb *, Gamal Z. El-Morsic , Mohammed Ahmed A. Sultanc 

a M.B.B.Ch, Resident in anesthesia and surgical intensive care department, Mansoura University Hospitals, Egypt 

b M.D. Lecturer of anesthesia and surgical intensive care, Faculty of Medicine – Mansoura University, Egypt 

c M.D. Professor of anesthesia and surgical intensive care, Faculty of Medicine – Mansoura University, Egypt 

Keywords: rocuronium, neostigmine, atropine, sugammadex, infant 

Corresponding Author: Maha Ahmed Abo-ZeidSalim 


Background:Fast-tracking cardiac surgery involves early extubation, mobilization and discharge forreducing the perioperative morbidity. Cholinesterase inhibitors are ordinarily used to reverse the residualnondepolarizing neuromuscular blockers (NMBs) but, theyhad many side effects.Sugammadex selectively binds to amino-steroids NMBs resulting in an inert complex. Purpose: to compare the effect of either sugammadex or neostigmine-atropine as areversal of rocuroniumon the hemodynamic stability and the recovery criteria.The primary outcome was the heart rate (HR) recorded 30 seconds after injection of the reversal of the NMBs. The secondary outcomes were the entropy values, perioperative HR, mean blood pressure (MBP) and the anesthetic recovery profile by the modified Aldretescore. Patients and methods:Forty infants aged one to two years old underwent closed cardiac surgery were allocated to receive sugammadex 2 in S group(n=20) or a combination of neostigmine 40 and atropine 15 in N group(n=20) as a reversal ofrocuroniumwhen two twitches oftrain of four ratio (TOF)appeared. Then when TOF was ≥ 0.9, the patients were extubated. Results: The extubation time was significantly less in S group. There was a significant increase at 30seconds after injection of the reversal, immediately and for the first 10 minutes after extubation in the MBP values and extended for the first 15 minutes in the HR values in the N group. The values of the response entropy were significantly higher in S group at 30 seconds after reversal injection and immediately after extubation. Conclusion: Sugammadex provide rapid and effective reversal after pediatric cardiac surgery throughshorter extubation time with more hemodynamic stability than neostigmine-atropine combination which is the basic goal for fast-tracking cardiac surgery. 

Citation: Radwan Rabea Sabry Obayya, Maha Ahmed Abo-ZeidSalim, Gamal Z. El-Morsi, Mohammed Ahmed A. Sultan, 2019 Comparative Study of the Effect of Sugammadex versus Neostigmine on Hemodynamics and Recovery Profile in Pediatric Cardiac Surgery. Photon Journal of Anesthesia. Photon 106, 170-183 

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Photon Ignitor: ISJN 76155719D901406102019 

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Evaluation of the Cardio Protective Effect of Ketamine-Dexmedetomidine in Open Heart Surgery

Doaa G. Diab, Mahmoud S. Elmansy, Ahmed G. Morsy, Olfat M. Ismail 

Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine - Mansoura University, Egypt 


Myocardial protection - Ketamine-Dexmedetomidine – open heart surgeries  

Corresponding Author: Dr. Doaa Galal Diab MD Assistant Prof. of Anesthesia and Surgical Intensive Care Faculty of Medicine- Mansoura University. 

Mahmoud Sobhy Elmansy. MD, Lecturer of Anesthesia and Surgical Intensive Care 

Ahmed Gamal Morsy M.Sc, Resident of Anesthesia and Surgical Intensive Care Olfat 

Mostafa Ismail, MD, Professor of Anesthesia and Surgical Intensive Care 


Background: Myocardial protection refers to many perioperative techniques used to prevent post-operative cardiac dysfunction and to decrease the effect of ischemic reperfusion injury. The Objective is to evaluate the cardio protective effect of the Ketamine-Dexmedetomidine in open heart surgeries. Methods: This prospective randomized study was conducted over 1 year from (October 2016 to October 2017) on 50 adult patients of either sex, aged 30 to 70 years, ASA II & III, BMI less than 40 kg/m2 and Pre-operative cardiac enzymes (cTnI & CK-MB) within normal average range. Patients were randomly allocated using closed envelop method into two groups each group 25 patients 1. Ketamine-Dexmedetomidine group:(n = 25) (KD gp) Dexmedetomidine infusion dose of 0.4 mcg/kg/hr. from start of operation till skin closure. Ketamine infusion dose of 2 mg/kg/hr. from the start till skin closure. 2. Propofol group:(n = 25) (P gp) Propofol infusion at a dose of 2 mg/kg/hr. from the start till skin closure. Results: Demographic data of the studied groups were presented with no statistical significant difference between both groups. The results showed that (KD) group recorded a significant lower HR and blood pressure in the pre-bypass, period,lower level of myocardial enzymes (cTnI & CK-MB), decreased total fentanyl requirement, earlier onset of postoperative extubation and shorter ICU stay than (P) group. Conclusion: the use of Ketamine-Dexmedetomidine in cardiopulmonary bypass surgeries offers more cardioprotective effect than Propofol. 


Doaa G. Diab, Mahmoud S. Elmansy, Ahmed G. Morsy, Olfat M. Ismail, 2019. Evaluation of the Cardio Protective Effect of KetamineDexmedetomidine in Open Heart Surgery. Photon Journal of Anesthesia. Photon 106, 153-169 

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Photon Ignitor: ISJN7615-5719D900830092019

Volume control vs. pressure control-volume guaranteed ventilation in obese patient undergoing major abdominal surgery

Tarek Abd Elaziz and Doaa G. Diab 

Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Mansoura, Egypt


Background: Obesity has a deleterious effect on respiratory function, decreasing lung volumes, compliance functional residual capacity, and arterial oxygenation. General anesthesia, upper abdominal surgery and supine position accentuate these abnormalities. Managing ventilation and oxygenation in obese patients undergoing surgery presents many challenges. Volume-guaranteed (PCV-VG) is a dual-control mode of ventilation and an alternative to PC or VC ventilation that has recently been introduced into the operating room. PCV-VG features a user-selected tidal volume target, that is auto-regulated and pressure controlled. The purpose of this study was to determine whether (PCV-VG) can provide better oxygenation, lung mechanics and hemodynamics than (VCV) in obese patients underwent major abdominal surgery. 

Subjects and Methods: A total of 30 patients scheduled for major open abdominal surgery under general anesthesia were enrolled in the study. Mechanical ventilation was started with VCV for 40 min then PCV-VG was applied to all patients with the same parameters. Arterial blood pressures, heart rate were recorded at 20 and 40 min after initiation of each mode. ETCO2, pH, PaCO2, PaO2 and oxygen index were measured after 40 min of intubation during VCV and after 40 min of initiation of PCV-VG. Mean and peak airway pressure were recorded at 20 and 40 min after initiation of each mode. 

Results: PCV-VG mode showed lower peak airway pressure and higher mean airway pressure and statistically significant higher PaO2 than VCV. As regards hemodynamic parameters, ETCO2, PaCO2 and pH, no statistically significant differences were recorded between the two modes. 

Conclusion: PRVG mode is superior to VCV mode in obese patients undergoing major abdominal laparotomy by reducing the peak inspiratory pressure and improving oxygenation with hemodynamic stability. 


Elaziz T.A., Doaa G.D., 2018. Volume control vs. pressure control-volume guaranteed ventilation in obese patient undergoing major abdominal surgery. Photon Journal of Anesthesia. Photon 105, 146-152

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Photon Ignitor: ISJN76155719D889724082018


Intra-articular, Dexmedetomidine, Magnesium sulphate. 


Background: To compare & evaluate the analgesic effect of intra-articular magnesium sulphate and Dexmedetomidine injected post operatively after arthroscopic knee surgery. 

Method: 60 patients of ASA 1 & 2 undergo elective knee arthroscopic surgery under spinal anesthesia. Patients are divided into group M & group D according to intra-particular drug injected. Group M received 500 mg magnesium sulphate and Group D received 75 mcg Dexmedetomidine in 0.9% NS, Total volume 20ml. post-operative pain using VAS score, duration of analgesia. Total no of rescue doses & complication were recorded for 24 hours. 

Results: VAS score was significantly less in Group M (3.1 ± 0.4) compared to Group D at 8 hours. Duration of analgesia was significantly longer (11.2 ± 1.6) & total no of rescue doses was less (2 ± 0) in Group M compared to (7.9 ± 0.5) and (2.9 ± 0.3) in Group D respectively. 

Conclusion: Intra-articular magnesium sulphate provide better analgesia compared to Dexmedetomidine following knee surgery. 


Dr. Oza D.H., Dr. Maheshwari B. and Dr. Parmar Y.J., 2018. Comparison of intra articular magnesium sulphate versus dexmedetomidine for post-operative analgesia after knee arthroscopic surgery. Photon Journal of Anesthesia. Photon 105, 136-145


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Photon Ignitor: ISJN76155719D883903042018

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Use of Dexmedetomidine as a prophylactic rather than treatment for Alcohol withdrawal syndrome – A case series

Batra Viveka*, Malik Sunnya Malik Rastogi ShraddhabChowdhury Iteea

a Rajiv Gandhi Cancer Institute, New Delhi, India 

b Max Super Speciality Hospital, New Delhi, India 

Batra Vivek*, Malik Sunny , Malik Rastogi Shraddha, Chowdhury Itee receive Photon Young Scientist Award-2014 in Anesthesia by Photon Foundation

Keywords: Dexmedetomidine, Alcohol withdrawal syndrome (AWS), opioids

Photon Ignitor: ISJN76155719D736411112014

Citation: Vivek B., Sunny M., Shraddha R M., Itee C., 2014. Use of Dexmedetomidine as a prophylactic rather than treatment for Alcohol withdrawal syndrome – A case series. Photon Journal of Anesthesia, Photon 103,130-132

Abstract We report a case series of continuous use dexmedetomidine intraoperatively in three patients with known history of chronic alcoholism undergoing surgery under general anaesthesia to prevent the symptoms of alcohol withdrawal syndrome post operatively. Although used as a treatment drug, we used dexmedetomidine as a prophylactic measure to prevent alcohol withdrawal syndrome thus opening its path for further studies enlighting its role in pre-emptive anesthesia.

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