Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

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)