BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

BACKGROUND: The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg/kg, calculated according to ideal body weight basis, for the reversal of moderate rocuroniuminduced neuromuscular blockade in laparoscopic bariatric surgery. METHODS: One-hundred and eighty morbidly obese patients were randomly assigned into three groups according to sugammadex dose administrated (based on IBW after reaching T2 of TO F): Group I: patients were given 1.5 mg/kg. Group II: patients were given 2 mg/kg. Group III: patients were given 4 mg/kg. Both sugammadex and extubation times were recorded. RESULTS: Sugammadex time was significantly longer in groups I and II versus III (P=0.000, 0.005 respectively). Difference between groups I and II was insignificant. The extubation time was insignificantly different in the three groups (P>0.05). CONCLUSIONS: A dose of sugammadex of 1.5 mg/kg calculated according to IBW successfully reversed moderate rocuronium-induced NMB in laparoscopic bariatric surgeries. (Cite this article as: Abd EL-Rahman AM, Othman AH, El Sherif FA, Mostafa MF, Taha O. Comparison of three different doses sugammadex based on ideal body weight for reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery. Minerva Anestesiol 2017;83:138-44. DOI: 10.23736/S0375-9393.16.11349-5)

BACKGROUND: The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg/kg, calculated according to ideal body weight basis, for the reversal of moderate rocuroniuminduced neuromuscular blockade in laparoscopic bariatric surgery. METHODS: One-hundred and eighty morbidly obese patients were randomly assigned into three groups according to sugammadex dose administrated (based on IBW after reaching T2 of TO F): Group I: patients were given 1.5 mg/kg. Group II: patients were given 2 mg/kg. Group III: patients were given 4 mg/kg. Both sugammadex and extubation times were recorded. RESULTS: Sugammadex time was significantly longer in groups I and II versus III (P=0.000, 0.005 respectively). Difference between groups I and II was insignificant. The extubation time was insignificantly different in the three groups (P>0.05). CONCLUSIONS: A dose of sugammadex of 1.5 mg/kg calculated according to IBW successfully reversed moderate rocuronium-induced NMB in laparoscopic bariatric surgeries. (Cite this article as: Abd EL-Rahman AM, Othman AH, El Sherif FA, Mostafa MF, Taha O. Comparison of three different doses sugammadex based on ideal body weight for reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery. Minerva Anestesiol 2017;83:138-44. DOI: 10.23736/S0375-9393.16.11349-5)

BACKGROUND: The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg/kg, calculated according to ideal body weight basis, for the reversal of moderate rocuroniuminduced neuromuscular blockade in laparoscopic bariatric surgery. METHODS: One-hundred and eighty morbidly obese patients were randomly assigned into three groups according to sugammadex dose administrated (based on IBW after reaching T2 of TO F): Group I: patients were given 1.5 mg/kg. Group II: patients were given 2 mg/kg. Group III: patients were given 4 mg/kg. Both sugammadex and extubation times were recorded. RESULTS: Sugammadex time was significantly longer in groups I and II versus III (P=0.000, 0.005 respectively). Difference between groups I and II was insignificant. The extubation time was insignificantly different in the three groups (P>0.05). CONCLUSIONS: A dose of sugammadex of 1.5 mg/kg calculated according to IBW successfully reversed moderate rocuronium-induced NMB in laparoscopic bariatric surgeries. (Cite this article as: Abd EL-Rahman AM, Othman AH, El Sherif FA, Mostafa MF, Taha O. Comparison of three different doses sugammadex based on ideal body weight for reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery. Minerva Anestesiol 2017;83:138-44. DOI: 10.23736/S0375-9393.16.11349-5)

Background Cancer in children is a potentially curable disease, particularly in developed countries. Conventional chemotherapy is essentially an integral part of treatment, either alone, or as a part of multimodality therapy including surgery & radiotherapy. How to deal with pain is an integral part of symptom management in pediatric cancer patients in general, with especially great importance in the context of palliative care in developing countries, in which curability lags behind that of developed countries. Proper recognition of underlying pathophysiology and various causes of pain are so essential for pain management, and for ameliorating suffering in the realm of holistic care for children with cancer. The aim of this study is to address and meticulously analyze the spectrum of pain characteristics in children with cancer at an institutional university cancer center to unravel pain profile in these patients as an experience for a developing country. Patients & Methods A hospital based, prospective study was conducted, involving pediatric cancer patients, who presented with pain due to cancer itself or its treatment in the period from 2013 Jul to 2015 Jan. Evaluation of patients' documented pain cycles for pain cause, type, and location & also for pain treatment characteristics was done. Results A total of 286 pain cycles was documented comprising 2216 treatment days (range 3-56 days). Disease-related pain was the most frequent cause of pain in our study. Oral mucosa was the most frequent site for treatment-related pain & strongly correlated with NHL diagnosis. Leukemia was strongly correlated with "the extremities" as a location of bone pain. Visceral pain was most often associated with lymphomas. Neuropathic pain was the least frequent type of pain, however, associated with higher initial pain intensity scores & longer pain cycle duration. Conclusions Children with cancer in the developing countries still have more disease-related pain than their counterparts in the developed countries. Pain experience in pediatric oncology may indirectly reflect presentations of childhood cancer, and could be a surrogate profile for tumor location, metastatic sites, the degree of treatment intensity, likewise the context of the disease state either at diagnosis, during treatment, or at progression.

Background Cancer in children is a potentially curable disease, particularly in developed countries. Conventional chemotherapy is essentially an integral part of treatment, either alone, or as a part of multimodality therapy including surgery & radiotherapy. How to deal with pain is an integral part of symptom management in pediatric cancer patients in general, with especially great importance in the context of palliative care in developing countries, in which curability lags behind that of developed countries. Proper recognition of underlying pathophysiology and various causes of pain are so essential for pain management, and for ameliorating suffering in the realm of holistic care for children with cancer. The aim of this study is to address and meticulously analyze the spectrum of pain characteristics in children with cancer at an institutional university cancer center to unravel pain profile in these patients as an experience for a developing country. Patients & Methods A hospital based, prospective study was conducted, involving pediatric cancer patients, who presented with pain due to cancer itself or its treatment in the period from 2013 Jul to 2015 Jan. Evaluation of patients' documented pain cycles for pain cause, type, and location & also for pain treatment characteristics was done. Results A total of 286 pain cycles was documented comprising 2216 treatment days (range 3-56 days). Disease-related pain was the most frequent cause of pain in our study. Oral mucosa was the most frequent site for treatment-related pain & strongly correlated with NHL diagnosis. Leukemia was strongly correlated with "the extremities" as a location of bone pain. Visceral pain was most often associated with lymphomas. Neuropathic pain was the least frequent type of pain, however, associated with higher initial pain intensity scores & longer pain cycle duration. Conclusions Children with cancer in the developing countries still have more disease-related pain than their counterparts in the developed countries. Pain experience in pediatric oncology may indirectly reflect presentations of childhood cancer, and could be a surrogate profile for tumor location, metastatic sites, the degree of treatment intensity, likewise the context of the disease state either at diagnosis, during treatment, or at progression.

Background Cancer in children is a potentially curable disease, particularly in developed countries. Conventional chemotherapy is essentially an integral part of treatment, either alone, or as a part of multimodality therapy including surgery & radiotherapy. How to deal with pain is an integral part of symptom management in pediatric cancer patients in general, with especially great importance in the context of palliative care in developing countries, in which curability lags behind that of developed countries. Proper recognition of underlying pathophysiology and various causes of pain are so essential for pain management, and for ameliorating suffering in the realm of holistic care for children with cancer. The aim of this study is to address and meticulously analyze the spectrum of pain characteristics in children with cancer at an institutional university cancer center to unravel pain profile in these patients as an experience for a developing country. Patients & Methods A hospital based, prospective study was conducted, involving pediatric cancer patients, who presented with pain due to cancer itself or its treatment in the period from 2013 Jul to 2015 Jan. Evaluation of patients' documented pain cycles for pain cause, type, and location & also for pain treatment characteristics was done. Results A total of 286 pain cycles was documented comprising 2216 treatment days (range 3-56 days). Disease-related pain was the most frequent cause of pain in our study. Oral mucosa was the most frequent site for treatment-related pain & strongly correlated with NHL diagnosis. Leukemia was strongly correlated with "the extremities" as a location of bone pain. Visceral pain was most often associated with lymphomas. Neuropathic pain was the least frequent type of pain, however, associated with higher initial pain intensity scores & longer pain cycle duration. Conclusions Children with cancer in the developing countries still have more disease-related pain than their counterparts in the developed countries. Pain experience in pediatric oncology may indirectly reflect presentations of childhood cancer, and could be a surrogate profile for tumor location, metastatic sites, the degree of treatment intensity, likewise the context of the disease state either at diagnosis, during treatment, or at progression.

Background: Anthracycline-induced cardiotoxicity in survivors of childhood cancer initially presenting as sub-clinical cardiac abnormalities that, if left undetected or untreated, can lead to clinical cardiac dysfunction. The present study aimed to evaluate the early myocardial changes that develop with anthracycline therapy. Material and Methods: In this prospective study the preanthracycline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were analyzed for cardiac dysfunction. The demographic information, including age, sex, type of anthracycline, and cumulative dose, were recorded, as well. Results: In this study, 115 patients with childhood cancer, including 81 males (70.4%) and 34 females (29.6%) with the mean age of 11.1±3.8 years were enrolled. Their normal baseline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were compared for myocardial changes. Doxorubicin alone was used in 91 (79%) patients while daunorubicin alone in 24 (21%). Only 16 children (14%) received a high dose of anthracycline (cumulative dose > 300 mg/m 2). QTc interval significantly prolonged 6-months after chemotherapy than the baseline readings (P0.001). There was a significant increase in the left ventricular dimensions, and all myocardial functional parameters were significantly deteriorated in children who received anthracycline (P0.001). The incidence of cardiac dysfunction found more in female patients (20/28; 71.4%). Myocardial dysfunction was significantly higher among children who received a high cumulative dose of doxorubicin (P0.001). Conclusion: The incidence of subclinical anthracycline-related cardiac dysfunction is high. Children treated with anthracycline require a long-term follow-up to identify and establish optimal prevention and management strategies that balance oncologic efficacy with long-term safety.