Introduction:
The sphenopalatine ganglion (SPG) is one of four parasympathetic ganglia in the head. The purpose of this pilot study was to assess the efficacy of blocking the SPG with local anesthetic and its effect on cerebral hemodynamics. Validation of the selected blocking technique and the data obtained in this study will then be used in future studies to understand how opioids may influence the effects of the SPG on the cerebral blood vessels. We hypothesize that blocking the SPG with local anesthetics would lead to a change in the tone of the cerebral vessels and may affect the cerebral blood flow.

Methods:
IRB approval and informed consent was obtained. This is a double-blinded cross-over pilot study. Five out of ten healthy adult volunteers have been recruited. A cross over between the use of a placebo (normal saline N.S.) and a local anesthetic (Lidocaine, 0.2-0.5 mg/Kg in a liquid form) was administered on the same volunteer to determine changes in cerebral hemodynamics between treatment groups. The attempt to block the SPG was done by the application of a local anesthetic on the intranasal mucosa with continuous monitoring of the cerebral hemodynamics via Trans-cranial Doppler (TCD). EKG, non-invasive arterial pressure, end-tidal carbon dioxide (PeCO2), and oxygen saturation (SpO2) were monitored. The ipsilateral middle cerebral artery (MCA) was located through the temporal acoustic window using a 2 MHz TCD. During normal breathing, the baseline values were recorded. Thereafter, pressure was applied for few seconds on the side of the neck to compress the carotid artery followed by sudden release. This maneuver elicits the Transient Hyperemic Response Test [THRT] of the MCA. After the application of one of the treatments via Q-tip on the site of the SPG, the first set of measurements for one hour were recorded, and a second set of measurements were taken for another hour after applying the second medicine.

Results:
We could not find an effect on the cerebral hemodynaminc when lidocaine was applied on the SPG using a modified transnasal approach

Conclusion:
Replication of the modified technique to the traditional transnasal block of the SPG with lidocaine has no effect on cerebral hemodynamic .

Introduction:
On-thyroid illness (NTI) is a temporary condition that can affect patients undergoing open heart surgeries. Preoperative oral T3 for patients undergoing valvular heart surgeries has been studied in few trials with no beneficial clinical outcome. The aim of this study was to test different doses of oral T3at different duration of administration on the clinical parameters and the prevention of NTI for patients undergoing valvular heart surgeries.

Patients and methods:
A total of 45 patients undergoing valvular heart surgeries were randomly allocated into three groups: group I (n=15) received 50µg /day of oral T3 for three successive doses before induction of anesthesia; group II (n=15) received 50µg of oral T3 as a single dose three hours before induction of anesthesia; and group III (N=15) did not receive T3 tablets. Systolic, diastolic and mean blood pressure and heart rate were recorded before the start of treatment 48 hours (T0) and 24 hours (T1) prior to surgery, Pre induction of anesthesia (T2), post induction of anesthesia (T3) and at weaning from CPB (T4). Systolic pulmonary artery pressure was measured at T0 by TTE, T3 and T4 by TEE. Number of patients who needed inotropic support and pacemaker and doses of inotropic support needed were recorded at T4. TSH, freeT4 and freeT3 were measured at T0, T2 and 24 hour after admission to the ICU (T5).

Results:
Blood pressure was significantly higher in group I (P<0.05) at T3 and T4.SPAP was significantly lower in group I compared with other groups at T4 (37.6±4.5 vs 41.3±3.9 vs 43.3±3.5 mm Hg respectively, P value<0.05). The doses of adrenaline at T4 was lower in group I compared with groups II and III (.01±0.02 vs0.04±0.01 vs. 0.07±0.01 ug/kg/min, respectively, P value <0.01). At T2 free T3 was significantly higher in group I compared with groups II and III (3.3±0.49 vs2.8±0.49vs2.3±0.37 pg/ml, respectively, P value<0.01). At T5 free T3 was significantly higher in group I compared to groups II and III (3.1±0.53 vs 2.36±0.31 vs 1.93±.027 pg/ml, respectively.P value <0.01) and TSH was significantly lower in group I compared to groups II and III (3.72±0.35 vs 4.94±0.63 vs 6.81±0.48 uIU/ml, respectively. P value <0.01)

Conclusion:
Three successive doses of 50 µg /day of oral triiodothyronine given 48 hours before induction of anesthesia, maintained blood pressure with lower inotropic support and lower systolic pulmonary artery pressure and prevented NTI in patients undergoing valvular heart

Background:
ateral positioning decreases upper airway obstruction in sleeping, anesthetized and muscle relaxed individuals presumably secondary to gravitational effects.

Methods:
Children aged 2-6 yr, requiring computed tomography (CT) examination of the head or neck region, were studied using deep sedation with Ketamine/Midazolam 20:1. Exclusion criteria included any type of anatomical or neurologic entity that could influence upper airway shape or size. Axial spiral CT sections of the upper airway were obtained in the supine and lateral positions, with the head and neck axes maintained neutral. Using advanced GE workstation AW4.0, the CT images were processed to render a three-dimensional reconstruction and virtual endoscopic images of the upper airway. Total airway volumes and cross-sectional areas were computed between the nasal vomer and the vocal cords. Two-way paired t tests were used to compare airway sizes between supine and lateral positions.

Results:
The total airway volume (mean ± SD) was 6.6 ± 3.3 ml in the supine position and 9.5 ± 3.1 ml in the lateral position (P < 0.001) in seventeen of 18 children analyzed. Maximal relative percent airway increase was at the region between the tip of the epiglottis and vocal cords.

Conclusion:
This study confirms the well-known clinical observation that sedated children practice less upper airway obstruction in the lateral position when compared with the supine position. This widening occurred at all non cartilaginous areas of the upper airway and was most pronounced in the region at and below the tip of the

Introduction:
ARTIFICIAL colloids, particularly hydroxyethyl starch solutions (HES) with a favorable benefit-risk profile and duration of action, are increasingly used for the compensation of surgical blood loss.1 While commonly used pentastarches like HES 200/0.5 have a prolonged effect on hemodynamic stabilization, a certain risk of accumulation and side-effects is to be expected.2 However, short-acting preparations may bear the risk of an inadequate circulatory volume effect.3 The degree of substitution and the C2/C6 hydroxyethylation ratio, in combination with the molecular weight, are responsible for the pharmacokinetic characteristics of HES solutions. Side-effects like haemostatic interaction and renal dysfunction were found to be associated with increasing values for these pharmacokinetic characteristics.4,5

Methods:
Sixty adult patients scheduled for major thoracic surgery were randomized to receive either 6% HES 130/0.4 (HES 130/0.4 group) or 3% modified fluid gelatin (Gelatin group) or 6% HES 200/0.5 (HES 200/0.5 group) as their colloid during the intraoperative period. The maximum dosage of all colloids was 33 mL/kg. Each group has 20 patients. Hemodynamic data and Doppler derived measurements; Cardiac index (CI), Systolic flow time corrected for heart rate (FTc) and Stroke Volume Index (SVI) were recorded serially at 5 time points during the operation. Laboratory Measurements were recorded at baseline and every day postoperative for five days.

Main Result:
The mean volume of gelatin 3% given was significantly more than the amount of HES 130/0.4 and HES 200/0.5 given (p < 0.05). Volume of colloids infused in HES 130/0.4 was higher than HES 200/0.5 without statistical significance. Doppler derived measurements were comparable in all groups throughout the whole procedure. Platelet count was significantly lower in the Gelatin group in comparison to the other HES groups in the five PODs (p < 0.05). The two HES treated groups were comparable to each other. INR was significantly higher for Gelatin group in comparison to HES 130/0.4 group in the second and third PODs (p < 0.05) but in comparison to HES 200/0.5 group the higher level did not reach statistically significance. Serum creatinine was significantly higher and Creatinine clearance was significantly lower in the Gelatin than in the HES-treated patients on the first and second PODs (p =0.004) with no difference between the two starches.

Conclusions:
The new HES 130/0.4 were as effective as HES 200/0.5 and modified fluid gelatin in intravascular volume expansion in major thoracic surgery. Also administration of the new HES 130/0.4 has more favorable effect on hemostasis and on renal and platelet than Gelatin.

Study Objective:
To compare the effect of metoclopramide versus midazolam on the incidence of nausea and vomiting after cardiac surgery

Design:
Prospective, randomized double blind study. Methods: 45 patients aged from 18-60 years old, ASA physical state П or Ш underwent elective cardiac surgery using cardio-pulmonary bypass (CPB) were assigned to one of three groups (15 patients each) according to the antiemetic drug received, group (І), received intravenous saline 0.9 % 10 ml/kg (control group), group (П), received metoclopramide 0.1mg/kg IV bolus at time of initiation of CPB, then 0.1mg/kg IV after weaning off CPB and every 6 hrs for 24 h postoperative and group (Ш), received a 1 mg IV bolus of midazolam at time of initiation of CPB, then a continuous infusion of midazolam 0.02 mg/kg/h from the time of successfully weaning off CPB until 24 h after surgery. The following parameters were assessed: visual analogue score (VAS), postoperative nausea and vomiting, dose of rescue antiemetic, Ramsay sedation score, fentanyl consumption during 24 hours and side effects.

Results:
As regard sedation score, most of the patients were cooperative, oriented and sedated during the 1st postoperative day but sedation was observed more in the midazolam group. The mean nausea score and the incidence of postoperative vomiting were less in group II and group III than the control group and this decrease was significant in the midazolam group when compared to the control group at most of the recorded times The incidence of postoperative vomiting and dry retching was 53.3%, 20%, 13.3% in the three groups respectively by the end of the 1st postoperative day. As regard the need for rescue antiemetic, a significant decrease in the need for rescue antiemetic was observed more in group III compared to the other two groups. As regard complications and side effects, no patient in the study groups had any drug related complications or developed any electrocardiographic abnormality.

Conclusion:
This study concluded that midazolam instituted as a continuous infusion in a dose of 0.02 mg/kg/h is a more effective and superior antiemetic as compared with metoclopramide in a dose of 0.1 mg/kg IV every 6 h for the prevention of PONV after cardiac surgery.

Introduction:
High cholesterol serum levels increases risk of coronary artery disease. To reduce this risk, statins, which is not devoid of side effects in ICU patients, have been prescribed to inhibit the enzyme responsible for cholesterol synthesis. It was proposed that Low-level laser therapy (LLLT) may reduce cholesterol and triglyceride serum levels. This randomized, controlled study investigates the influence of LLLT on the noninvasive reduction of cholesterol and triglyceride serum levels in ICU.

Materials and Methods:
Twenty ICU patients, 10 in each group, were enrolled in the study. The study group used ilipo LLLT device with 4 laser pads strapped around patient abdomen emitting 650-660 nm (red) laser light. The control group received sham laser. The laser therapy sessions were done for 55 minutes, twice weekly for two successive weeks with 3 days between sessions. Blood samples were drawn prior to the laser administration. A standard lipid panel was studied before the procedure to establish a baseline and at the end of the second procedure week. The serum triglyceride and total cholesterol and low and high density lipoproteins levels before and after the LLLT were compared.

Results:
The total cholesterol and serum triglycerides levels in the study group revealed a statistically significant mean change of −15.43 and −13.7 respectively between study baseline and endpoint (P <0.05).

Conclusion:
The potential application of the noninvasive chemical-free LLLT for cholesterol and triglyceride reduction tended to show favorable results in ICU patients

Objectives:
To evaluate the effect of preoperative administration of Pentoxyphylline (PTX) on immune response to surgery and postoperative (PO) pain after panhystrectomy.

Patients & Methods:
Forty-five female patients were allocated in 3 equal groups and received intravenous infusion of 100 ml of plain 0.9% NaCl as placebo (control group) or containing 5 or 10 mg/kg PTX, (groups PTX-5 and PTX-10, respectively). Infusion was given before induction of anesthesia with slow rate for 30 minutes. Duration of PO analgesia, total dose of PO morphine rescue analgesia and visual analogue scale (VAS) scores were determined for 24 hours PO. Serum levels of interleukin (IL)-10, IL-6 and tumor necrosis factor (TNF)-α were ELISA estimated preoperatively and at 6, 12 and 24 hours postoperatively during and after their surgical intensive care unit (SICU) stay.

Results:
Mean total VAS pain scores were significantly lower with significantly longer PO duration of analgesia in PTX-10 compared to controls and to PTX-5 group with non-significant difference between PTX-5 and control groups. Total dose of rescue analgesia was significantly lower in PTX-10 group compared to control group and non-significantly compared to PTX-5 group. Both PTX groups showed significantly lower serum levels of TNF-α and IL-6 and significantly higher serum levels of IL-10 compared to control group with significantly lower serum levels of TNF-α and IL-6 and significantly higher serum levels of IL-10 with PTX-10 compared to PTX-5. The effects of PTX on serum IL-6 levels and IL-10 levels were significantly less at 24-hr samples compared to 12-hr samples. Control group showed significantly higher TNF-α and IL-6 and significantly lower IL-10 levels at 24-hr compared to levels 12-hr postoperatively.

Conclusion:
Preoperative PTX infusion modulates the release of nociceptive cytokines with subsequent reduction of PO pain scores and analgesic consumption in a dose dependant fashion.