Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Mohamed H. Bakri,Eman A. Ismail,Ahmed Ibrahim 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3

Background: Postoperative nausea and vomiting (PONV) are common following laparoscopic cholecystectomy (LC). Dexamethasone has been reported to reduce PONV. However, there is insufficient evidence regarding the effect of dexmedetomidine in decreasing PONV. This study was designed to compare the effects of a single dose of dexmedetomidine to dexamethasone for reducing PONV after LC. Methods: Eighty-six adult patients scheduled for LC were randomized to receive either single dose 1 μg/kg of dexmedetomidine (Dexmed group, N = 43) or 8 mg dexamethasone (Dexa group, N = 43) before skin incision. During the first 24 h postoperatively, the incidence and severity of PONV were assessed. Pain and sedation scores were assessed on arrival in the recovery room and early postoperatively. Analgesic and antiemetic consumption during the 24 h after surgery were calculated. Intra-operative and postoperative hemodynamics were recorded. Results: Twenty-one percent of the patients in the Dexmed group developed PONV compared to 28% in the Dexa group (P = 0.6). Severity of PONV was similar between the two groups (P = 0.07). Early postoperatively, pain severity was significantly lower in the Dexmed group, but sedation scores were significantly higher. The first analgesic request was significantly delayed in the Dexmed group (P = 0.02). The total amounts of intraoperative fentanyl and postoperative tramadol administered were significantly lower in the Dexmed group. No difference in ondansetron was noted between the two groups. Mean arterial pressure and heart rate were significantly lower in the Dexmed group after administration of dexmedetomidine. No major side effects were reported. Conclusions: Dexmedetomidine reduces the incidence and severity of PONV, similar to dexamethasone. It is superior to dexamethasone in reducing postoperative pain and total analgesic consumption during the first 24 h after LC.

Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia

Mohamed H. Bakri,Eman A. Ismail,Gamal Ghanem,Mahmoud Shokry 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.5

Background: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. Methods: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. Results: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. Conclusions: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Comparison of the effects of two different styles of orally prescribing prednisolone on postoperative sequelae of surgical extraction of an impacted mandibular third molar: a single-blind randomized study

Mohammed Mousa H. Bakri,Faisal Hussain Alabdali,Rashed Hussain Mahzari,Thamer Jabril Rajhi,Norah Mohammed Gohal,Rehab Abdu Sufyani,Asma Ali Hezam,Ahtesham Ahmed Qurishi,Hamed Mousa Bakri,Fareedi Mukra 대한구강악안면외과학회 2024 대한구강악안면외과학회지 Vol.50 No.1

Objectives: Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don’t have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. Materials and Methods: A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). Results: There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. Conclusion: The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.

Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy: a randomized clinical trial

( Eman A. Ismail ),( Jehan A. Sayed ),( Mohamed H. Bakri ),( Reda Z. Mahfouz ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.2

Background: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery.Methods: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels.Results: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group.Conclusions: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability. (Korean J Pain 2017; 30: 134-41)

Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: a randomized clinical trial

Eman A. Ismail,Sayed Kaoud Abd-Elshafy,Mohamed H. Bakri 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.5

Background: Dexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC). Methods: A total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer’s lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated. Results: Group DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002). Conclusions: In female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer’s lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.