Mahmoud Almustafa - Academia.edu (original) (raw)

Papers by Mahmoud Almustafa

American Journal of Applied Sciences, 2009

Problem statement: The purpose of this study was to evaluate the onset and duration of sensory an... more Problem statement: The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as operative analgesia and adverse effects of Dex Metedo Midine (DXM) or fentanyl given intrathecally with plain 0.5% bupivacaine for spinal anesthesia. Approach: seventy six patients classified as American Society of Anesthesiologists (ASA) status I, II and III scheduled for vaginal hysterectomy, vaginal wall repair and tension free vaginal tape were prospectively studied. Patients were randomly allocated to receive intrathecally either 10 mg isobaric bupivacaine plus 5 µg dexmetedomidine (group D n = 38) or 10 mg isobaric bupivacaine plus 25 mg fentanyl (group F n = 38), the onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, and side effects were recorded. Results: Patients in group D had significant longer sensory and motor block times than patients in group F. the mean time of sensory regression to S1 was 274±73 min in group D and 179±47 min in group F (P < 0.001). The regression time of motor block to reach modified Bromage 0 was 240±60 min in group D and 155±46 min in group F (P< 0.001). The onset times to reach T10 dermatome and to reach peak sensory level as well as onset time to reach modified Bromage 3 motor block were not significantly different between the two groups. Conclusion: In women undergoing vaginal reconstructive surgery under spinal analgesia, 10 mg plain bupivacaine supplemented with 5 µg dexmetedomidine produces prolonged motor and sensory block compared with 25 µg fentanyl.

Anaesthesia, pain & intensive care, Mar 2, 2023

Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents in spinal anesthesi... more Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents in spinal anesthesia and is believed to increase quality of sensory and motor blocks. Our aim was to assess the effects of dexmedetomidine as an adjunct on block quality of spinal anesthesia in orthopedic procedures. Methodology: A systematic review of randomized control trials was conducted to assess the effect of intrathecal dexmedetomidine added to local anesthetic agents on the block quality of spinal anesthesia in orthopedic surgeries. PubMed, Google scholar, and Medline databases were searched for randomized controlled clinical trials. Studies met our inclusion criteria, if they used intrathecal 5 µg dexmedetomidine as an additive to 2.5−3 ml (12.5−15 mg) bupivacaine or ropivacaine, and these were included in our meta-analysis. Results: Eight trials comprising 510 patients matched our inclusion criteria. Time to one sensory segment block regression (mean difference 139.72 min; 95% confidence interval (CI) 35.18−244.26; P = 0.009), two sensory segments block regression (mean difference 54.8 min; 95% CI [31.36−78.24]; P < 0.001), and Bromage score of zero (mean difference 93.66 min; 95%CI [30.20−157.12]; P = 0.004) were significantly prolonged in dexmedetomidine group. There were no significant differences between dexmedetomidine group and control group in duration of surgery (P = 0.33) or time till block reaches T10 dermatomal level (P = 0.30). Finally, time to reach Bromage score of III following injection was significantly shorter in dexmedetomidine group (mean difference 2.62 min; 95%CI [−5.12−−0.13]; P = 0.04). Conclusion: Dexmedetomidine was found to achieve extended motor and sensory block when needed, bearing in mind higher cost and potential side effects.

Middle East journal of anaesthesiology, 2009

To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-o... more To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-obese patients undergoing abdominal surgeries. We prospectively evaluated the levels of the serum concentration of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil), in 42 morbidly obese and 40 non obese patients who were scheduled for elective abdominal surgery under sevoflurane anesthesia at the Jordan University Hospital, Amman, Jordan. Measurement of liver enzymes was done in the recovery room, and on the first, 3 and 7 days after sevoflurane anesthesia, and the results were compared between the morbidly obese and non obese patients. ALT, AST, GGT and LDH increased significantly in the morbidly obese than they did in non obese patients. In morbidly obese patients TBil increased gradually peaking 7 days after anesthesia, LDH increased in th...

Healthcare, 2022

Anxiety in the perioperative period has significant impact on both the flow of surgery and the po... more Anxiety in the perioperative period has significant impact on both the flow of surgery and the post-operative recovery process. The aim of this cross-sectional study is to determine the prevalence of preoperative anxiety among adult patients undergoing elective surgical procedures at a tertiary teaching hospital and the effect of COVID-19 and COVID-19 vaccines on preoperative anxiety. We used the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to assess patients’ anxiety toward surgery and their need for more information. Patients with APAIS about anesthesia and surgery (APAIS-A-T) total score <10 were considered as the low preoperative anxiety group, while patients with APAIS-A-T ≥11 were considered as the high preoperative anxiety group. The overall APAIS-A-T score of the 794 included patients was 8.5 ± 4.5. The mean APAIS-A-T score was 7.0 ± 3.8 among males and 9.6 ± 4.6 among female patients (p < 0.001). The APAIS-A-T score for those who had previously underwe...

Obesity Surgery

Bariatric surgeries utilise Bougie device to guide stomach resection. The device implementation i... more Bariatric surgeries utilise Bougie device to guide stomach resection. The device implementation is associated with many underreported complications. This study aims to compare nebulised vs. intravenous preoperative dexamethasone in mitigating airway-related Bougie complications after sleeve gastrectomy. This is a prospective double-blinded interventional study conducted by a tertiary hospital. The study involved 105 patients allocated to 3 groups: Group (I) received 8 mg dexamethasone intravenously (IV) preoperatively, group (N) received 8 mg dexamethasone from a nebulizer mask preoperatively, and Group (S) received nebulised normal saline. Outcomes evaluated were postoperative sore throat, odynophagia, change of voice, and nausea and vomiting. Nebulized dexamethasone was found to be significantly superior to IV dexamethasone in terms of postoperative sore throat at zero-hour (p = 0.001) and 1-h intervals (p = 0.011). No significant difference was found at 6- and 24-h intervals. For odynophagia, post hoc analysis showed there was no significant difference between (I), (N), and (S) groups. Incidence of change of voice was significantly lower in (N) and (I) groups compared to (S) group, with p values of 0.0067 and 0.00014, respectively. The incidence of post-operative sore-throat (PONV) in (I) group was significantly lower than incidences in (S) group (p = 0.00002) and (N) group (p = 0.0004). Preoperative nebulized and IV dexamethasone are effective strategies in mitigating complications related to mechanical effects of Bougie insertion. IV dexamethasone was as effective as nebulized dexamethasone in terms of late postoperative sore throat, and was superior in postoperative nausea and vomiting.

International Journal of Environmental Research and Public Health

Vaccination is the most promising strategy to counter the spread of Coronavirus Disease 2019 (COV... more Vaccination is the most promising strategy to counter the spread of Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy is a serious global phenomenon, and therefore the aim of this cross-sectional study was to explore the effect of educational background, work field, and social media on attitudes towards vaccination in Jordan. We compared between medical personnel who were in direct contact with patients and non-medical individuals at Jordan University Hospital in terms of demographics, knowledge about COVID-19 vaccines, rumors received via social media, their trust in these vaccines, and the encouraging factors for vaccination. 646 individuals were enrolled in this study, of which 287 (44.4%) were from medical field, and 359 (55.6%) from non-medical field. 226 (35%) were planning to take the vaccine once available, with a positive response from 131 (45.6%) medical field workers, compared to 94 (26.2%) non-medical individuals (p < 0.001). The social media rumor that was belie...

International Journal of Environmental Research and Public Health

The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious... more The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors’ readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported s...

Journal of Multidisciplinary Healthcare

Proximal femoral osteotomy in cerebral palsy patients is a demanding procedure. The fixation of t... more Proximal femoral osteotomy in cerebral palsy patients is a demanding procedure. The fixation of the osteotomy can fail due to the weak osteoporotic bone. The LCP pediatric hip plate with its good grip makes these procedures safe. The aims of the present study are to evaluate the radiological outcome of proximal femoral osteotomy that was fixed with the pediatric LCP in cerebral palsy patients and to raise safety issues regarding its low rate of complications. Patients and Methods: Sixteen patients with cerebral palsy who were operated in our department were included in this retrospective study. Data collected from medical charts and X-ray measurements retrospectively reviewed. Results: In total, 16 patients (21 hips), ie, 9 males and 7 females, were included in this analysis. The mean age at the time of the index surgery was 11.9 years (5.9-18.0). The mean follow-up period was 4.78 years (1.5-8.0). Five patients had bilateral hip involvement and 11 had unilateral involvement. All patients had spastic cerebral palsy. The mean values of varus correction and de-rotation were 25° (0°-45°) and 35° (20°-50°), respectively. Neck shaft angle and the Reimer's migration index were significantly improved postoperatively (p<0.01 for both). Seventeen hips showed complete consolidation within 14 weeks of fixation and four hips needed 16 weeks. These four hips were in three patients who were 16 years of age or older. The correlation between age at surgery and the time needed for consolidation was statistically significant (p=0.005). Avascular necrosis, revision surgeries, failure of fixation, acetabular penetration, screw loosening or fracture of the femur were not seen in this study. Conclusion: The LCP pediatric hip plate can be used safely in CP patients. The plate provides a strong stable fixation on osteoporotic bone with a low rate of complications.

Perioperative Care and Operating Room Management

Indian Journal of Anaesthesia

Background and Aims: The relationship between intra-operative hypotension and post-operative comp... more Background and Aims: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. Methods: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. Results: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. Conclusion: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.

Obesity Surgery

Introduction The usage of bougie devices in guiding the extent of sleeve gastrectomies has been a... more Introduction The usage of bougie devices in guiding the extent of sleeve gastrectomies has been associated with several laryngeal and pharyngeal complications. Despite these being distressing for patients, they draw little attention in current literature. Objectives To study the role of preoperative nebulized dexamethasone in relieving the symptoms related to bougie insertion during laparoscopic sleeve gastrectomy postoperatively. Materials and Methods A prospective interventional study that included 80 patients. The patients were assigned to two groups, 40 patients in each group: the dexamethasone group (D) which received nebulized dexamethasone 8 mg 1 h before surgery and the control group (S) which received saline nebulizer instead. Assessment of postoperative sore throat, nausea and vomiting, odynophagia, and change of voice was used as an outcome comparative tool. Results The patient’s age ranged from 17 to 61 years, and the mean age of patients was 34.51 (± 9.5) years. Patients were composed of 13 (16.3%) males and 67 (83.8%) females. The study found a significant preference of outcome values in the dexamethasone group. Sore throat mean and medians were less at all-time intervals: 0 h ( p < 0.001), 1 h ( p < 0.001), 6 h ( p < 0.004), and 24 h ( p < 0.001). Nineteen patients of the saline group suffered from a change of voice ( p < 0.001), compared to only 4 patients in the dexamethasone group. On the contrary, no significant differences are noted in the incidences of PONV and odynophagia. Conclusion Preoperative nebulized dexamethasone was found to be an effective measure in reducing bougie insertion complications in laparoscopic sleeve gastrectomy.

Annals of Saudi medicine

The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In ad... more The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In addition the predictive value of myocardial perfusion single-photon emission computed tomography (SPECT) before noncardiac in individual patients is uncertain. Evaluate the prevalence and predictors of myocardial ischemia before noncardiac surgery, and determine the postoperative cardiac outcome based on results of myocardial perfusion SPECT. Retrospective. Single tertiary care center. We reviewed the records of adult patients diagnosed with myocardial ischemia by myocardial perfusion SPECT who were undergoing noncardiac surgery. Myocardial perfusion SPECT had been performed within 4 weeks prior to noncardiac surgery requiring general anesthesia. Prevalence of abnormal myocardial perfusion SPECT results on preoperative evaluation; abnormal myocardial perfusion SPECT results as a predictor for postoperative cardiac events such as cardiac death, nonfatal myocardial infarction, and unstable a...

Middle East Journal of Anaesthesiology, Jun 1, 2009

Background: The prolongation of spinal anesthesia by using clonidine through the oral, intravenou... more Background: The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha 2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. Methods: 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C (the control group) received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. Results: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05). The duration of motor block was longer in dexmedetomidine group than control group (199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05). Conclusion: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability.

Pediatric Anesthesia, 2015

What is already known • Caudally co-administered dexmedetomidine prolongs the postoperative analg... more What is already known • Caudally co-administered dexmedetomidine prolongs the postoperative analgesic effects of local anaesthesthetics. Data about the effects of different doses of dexmedetomidine are still insufficient. What this article adds • A 1 lgÁkg À1 dose of caudal dexmedetomidine achieved comparable prolongation of postoperative analgesia to 2 lgÁkg À1 with shorter duration of postoperative sedation and a lower incidence of other side effects.

recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain.... more recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. one physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. Methods 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h-1 ropivacaine 0.2% (study group, n = 21) or 5 ml*h-1 saline (control group, n = 21). postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (pcEA) with ropivacaine 0.2%. The main outcome measure was the concentration of authentic ß-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol.

Jordan Medical Journal, 2013

Objectives: To evaluate women’s information about the purpose of the second-trimester ultrasound ... more Objectives: To evaluate women’s information about the purpose of the second-trimester ultrasound scan, their expectations before the scan, the extent to which these expectations are fulfilled after the scan, and their perceptions of the foetus. Methods: A sample of pregnant women (540) attending a second-trimester ultrasound scan at Jordan University Hospital were asked to complete two parts of a questionnaire during a 3-month period in 2011. The first part included patients’ characteristics, the purpose of the scan, and expectations before the scan. The second part included patients’ perceptions of the foetus and how the expectations of the scan were fulfilled. Results: Both parts of the questionnaires were completed by 503 (93%) of the women. Three fourths of the participants were accompanied by their husband or a family member. Sixty (12%) women were referred specifically to rule out congenital anomalies. Comparison between patients’ expectations before and after the scan using the chi-square test showed significant improvement in all expectations variables (P–value < 0.001). Conclusion: A routine second-trimester ultrasound scan is an important event for most participating women. Improvements are required in the provision of pre-ultrasound information.

Jordan Medical Journal, 2013

Objective: Reduction mammaplasty is a common surgical procedure that yields a variable amount of ... more Objective: Reduction mammaplasty is a common surgical procedure that yields a variable amount of tissue for pathologic examination. The purpose of this study was to evaluate the histological diagnoses of the reduction mammaplasty specimens and to determine the incidence of breast lesions in otherwise asymptomatic and healthy Jordanian females. Methods: All reduction mammaplasty specimens of 73 patients over a 10-year period (September 1999-September 2009) at Jordan University Hospital were retrospectively examined. The average number of blocks submitted per breast was 4 (range 3-5). Variables such as age and preoperative mammograms were examined. Results: A total of 143 specimens were evaluated. Normal mammary tissue was present in 36 patients (49%). The most common benign lesion was fibrocystic disease (21%). Precancerous breast lesions were identified in 7 patients (9.6%). No case of carcinoma in situ or invasive carcinoma was encountered in our study. Most of the histopathological lesions were found in patients younger than 35 years of age. Preoperative mammograms were done for 26 patients and all were normal. Conclusions: This study demonstrates the importance of systemic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty. Consequently, thorough sampling and handling of breast reduction specimens should be emphasized.

meja.aub.edu.lb

Horner's syndrome is a triad of miosis, ptosis, and enophthalmos, commonly associated with v... more Horner's syndrome is a triad of miosis, ptosis, and enophthalmos, commonly associated with vasodilatation (facial flushing, anhydrosis and nasal stuffiness). Lumbar epidural analgesia is widely used to control pain during labor and is still the superior technique and preferred ...

Saudi Journal of …

Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure... more Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood ...

Jordan Medical …, 2011

Methods: Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty o... more Methods: Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty over a 10-year period (1999-2008) performed by a single surgeon were studied. The following factors were addressed: age, medical history, medications, smoking habits, Body Mass ...

American Journal of Applied Sciences, 2009

Problem statement: The purpose of this study was to evaluate the onset and duration of sensory an... more Problem statement: The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as operative analgesia and adverse effects of Dex Metedo Midine (DXM) or fentanyl given intrathecally with plain 0.5% bupivacaine for spinal anesthesia. Approach: seventy six patients classified as American Society of Anesthesiologists (ASA) status I, II and III scheduled for vaginal hysterectomy, vaginal wall repair and tension free vaginal tape were prospectively studied. Patients were randomly allocated to receive intrathecally either 10 mg isobaric bupivacaine plus 5 µg dexmetedomidine (group D n = 38) or 10 mg isobaric bupivacaine plus 25 mg fentanyl (group F n = 38), the onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, and side effects were recorded. Results: Patients in group D had significant longer sensory and motor block times than patients in group F. the mean time of sensory regression to S1 was 274±73 min in group D and 179±47 min in group F (P < 0.001). The regression time of motor block to reach modified Bromage 0 was 240±60 min in group D and 155±46 min in group F (P< 0.001). The onset times to reach T10 dermatome and to reach peak sensory level as well as onset time to reach modified Bromage 3 motor block were not significantly different between the two groups. Conclusion: In women undergoing vaginal reconstructive surgery under spinal analgesia, 10 mg plain bupivacaine supplemented with 5 µg dexmetedomidine produces prolonged motor and sensory block compared with 25 µg fentanyl.

Anaesthesia, pain & intensive care, Mar 2, 2023

Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents in spinal anesthesi... more Background: Dexmedetomidine is used as an adjuvant to local anesthetic agents in spinal anesthesia and is believed to increase quality of sensory and motor blocks. Our aim was to assess the effects of dexmedetomidine as an adjunct on block quality of spinal anesthesia in orthopedic procedures. Methodology: A systematic review of randomized control trials was conducted to assess the effect of intrathecal dexmedetomidine added to local anesthetic agents on the block quality of spinal anesthesia in orthopedic surgeries. PubMed, Google scholar, and Medline databases were searched for randomized controlled clinical trials. Studies met our inclusion criteria, if they used intrathecal 5 µg dexmedetomidine as an additive to 2.5−3 ml (12.5−15 mg) bupivacaine or ropivacaine, and these were included in our meta-analysis. Results: Eight trials comprising 510 patients matched our inclusion criteria. Time to one sensory segment block regression (mean difference 139.72 min; 95% confidence interval (CI) 35.18−244.26; P = 0.009), two sensory segments block regression (mean difference 54.8 min; 95% CI [31.36−78.24]; P < 0.001), and Bromage score of zero (mean difference 93.66 min; 95%CI [30.20−157.12]; P = 0.004) were significantly prolonged in dexmedetomidine group. There were no significant differences between dexmedetomidine group and control group in duration of surgery (P = 0.33) or time till block reaches T10 dermatomal level (P = 0.30). Finally, time to reach Bromage score of III following injection was significantly shorter in dexmedetomidine group (mean difference 2.62 min; 95%CI [−5.12−−0.13]; P = 0.04). Conclusion: Dexmedetomidine was found to achieve extended motor and sensory block when needed, bearing in mind higher cost and potential side effects.

Middle East journal of anaesthesiology, 2009

To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-o... more To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-obese patients undergoing abdominal surgeries. We prospectively evaluated the levels of the serum concentration of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil), in 42 morbidly obese and 40 non obese patients who were scheduled for elective abdominal surgery under sevoflurane anesthesia at the Jordan University Hospital, Amman, Jordan. Measurement of liver enzymes was done in the recovery room, and on the first, 3 and 7 days after sevoflurane anesthesia, and the results were compared between the morbidly obese and non obese patients. ALT, AST, GGT and LDH increased significantly in the morbidly obese than they did in non obese patients. In morbidly obese patients TBil increased gradually peaking 7 days after anesthesia, LDH increased in th...

Healthcare, 2022

Anxiety in the perioperative period has significant impact on both the flow of surgery and the po... more Anxiety in the perioperative period has significant impact on both the flow of surgery and the post-operative recovery process. The aim of this cross-sectional study is to determine the prevalence of preoperative anxiety among adult patients undergoing elective surgical procedures at a tertiary teaching hospital and the effect of COVID-19 and COVID-19 vaccines on preoperative anxiety. We used the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to assess patients’ anxiety toward surgery and their need for more information. Patients with APAIS about anesthesia and surgery (APAIS-A-T) total score <10 were considered as the low preoperative anxiety group, while patients with APAIS-A-T ≥11 were considered as the high preoperative anxiety group. The overall APAIS-A-T score of the 794 included patients was 8.5 ± 4.5. The mean APAIS-A-T score was 7.0 ± 3.8 among males and 9.6 ± 4.6 among female patients (p < 0.001). The APAIS-A-T score for those who had previously underwe...

Obesity Surgery

Bariatric surgeries utilise Bougie device to guide stomach resection. The device implementation i... more Bariatric surgeries utilise Bougie device to guide stomach resection. The device implementation is associated with many underreported complications. This study aims to compare nebulised vs. intravenous preoperative dexamethasone in mitigating airway-related Bougie complications after sleeve gastrectomy. This is a prospective double-blinded interventional study conducted by a tertiary hospital. The study involved 105 patients allocated to 3 groups: Group (I) received 8 mg dexamethasone intravenously (IV) preoperatively, group (N) received 8 mg dexamethasone from a nebulizer mask preoperatively, and Group (S) received nebulised normal saline. Outcomes evaluated were postoperative sore throat, odynophagia, change of voice, and nausea and vomiting. Nebulized dexamethasone was found to be significantly superior to IV dexamethasone in terms of postoperative sore throat at zero-hour (p = 0.001) and 1-h intervals (p = 0.011). No significant difference was found at 6- and 24-h intervals. For odynophagia, post hoc analysis showed there was no significant difference between (I), (N), and (S) groups. Incidence of change of voice was significantly lower in (N) and (I) groups compared to (S) group, with p values of 0.0067 and 0.00014, respectively. The incidence of post-operative sore-throat (PONV) in (I) group was significantly lower than incidences in (S) group (p = 0.00002) and (N) group (p = 0.0004). Preoperative nebulized and IV dexamethasone are effective strategies in mitigating complications related to mechanical effects of Bougie insertion. IV dexamethasone was as effective as nebulized dexamethasone in terms of late postoperative sore throat, and was superior in postoperative nausea and vomiting.

International Journal of Environmental Research and Public Health

Vaccination is the most promising strategy to counter the spread of Coronavirus Disease 2019 (COV... more Vaccination is the most promising strategy to counter the spread of Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy is a serious global phenomenon, and therefore the aim of this cross-sectional study was to explore the effect of educational background, work field, and social media on attitudes towards vaccination in Jordan. We compared between medical personnel who were in direct contact with patients and non-medical individuals at Jordan University Hospital in terms of demographics, knowledge about COVID-19 vaccines, rumors received via social media, their trust in these vaccines, and the encouraging factors for vaccination. 646 individuals were enrolled in this study, of which 287 (44.4%) were from medical field, and 359 (55.6%) from non-medical field. 226 (35%) were planning to take the vaccine once available, with a positive response from 131 (45.6%) medical field workers, compared to 94 (26.2%) non-medical individuals (p < 0.001). The social media rumor that was belie...

International Journal of Environmental Research and Public Health

The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious... more The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors’ readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported s...

Journal of Multidisciplinary Healthcare

Proximal femoral osteotomy in cerebral palsy patients is a demanding procedure. The fixation of t... more Proximal femoral osteotomy in cerebral palsy patients is a demanding procedure. The fixation of the osteotomy can fail due to the weak osteoporotic bone. The LCP pediatric hip plate with its good grip makes these procedures safe. The aims of the present study are to evaluate the radiological outcome of proximal femoral osteotomy that was fixed with the pediatric LCP in cerebral palsy patients and to raise safety issues regarding its low rate of complications. Patients and Methods: Sixteen patients with cerebral palsy who were operated in our department were included in this retrospective study. Data collected from medical charts and X-ray measurements retrospectively reviewed. Results: In total, 16 patients (21 hips), ie, 9 males and 7 females, were included in this analysis. The mean age at the time of the index surgery was 11.9 years (5.9-18.0). The mean follow-up period was 4.78 years (1.5-8.0). Five patients had bilateral hip involvement and 11 had unilateral involvement. All patients had spastic cerebral palsy. The mean values of varus correction and de-rotation were 25° (0°-45°) and 35° (20°-50°), respectively. Neck shaft angle and the Reimer's migration index were significantly improved postoperatively (p<0.01 for both). Seventeen hips showed complete consolidation within 14 weeks of fixation and four hips needed 16 weeks. These four hips were in three patients who were 16 years of age or older. The correlation between age at surgery and the time needed for consolidation was statistically significant (p=0.005). Avascular necrosis, revision surgeries, failure of fixation, acetabular penetration, screw loosening or fracture of the femur were not seen in this study. Conclusion: The LCP pediatric hip plate can be used safely in CP patients. The plate provides a strong stable fixation on osteoporotic bone with a low rate of complications.

Perioperative Care and Operating Room Management

Indian Journal of Anaesthesia

Background and Aims: The relationship between intra-operative hypotension and post-operative comp... more Background and Aims: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. Methods: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. Results: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. Conclusion: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.

Obesity Surgery

Introduction The usage of bougie devices in guiding the extent of sleeve gastrectomies has been a... more Introduction The usage of bougie devices in guiding the extent of sleeve gastrectomies has been associated with several laryngeal and pharyngeal complications. Despite these being distressing for patients, they draw little attention in current literature. Objectives To study the role of preoperative nebulized dexamethasone in relieving the symptoms related to bougie insertion during laparoscopic sleeve gastrectomy postoperatively. Materials and Methods A prospective interventional study that included 80 patients. The patients were assigned to two groups, 40 patients in each group: the dexamethasone group (D) which received nebulized dexamethasone 8 mg 1 h before surgery and the control group (S) which received saline nebulizer instead. Assessment of postoperative sore throat, nausea and vomiting, odynophagia, and change of voice was used as an outcome comparative tool. Results The patient’s age ranged from 17 to 61 years, and the mean age of patients was 34.51 (± 9.5) years. Patients were composed of 13 (16.3%) males and 67 (83.8%) females. The study found a significant preference of outcome values in the dexamethasone group. Sore throat mean and medians were less at all-time intervals: 0 h ( p < 0.001), 1 h ( p < 0.001), 6 h ( p < 0.004), and 24 h ( p < 0.001). Nineteen patients of the saline group suffered from a change of voice ( p < 0.001), compared to only 4 patients in the dexamethasone group. On the contrary, no significant differences are noted in the incidences of PONV and odynophagia. Conclusion Preoperative nebulized dexamethasone was found to be an effective measure in reducing bougie insertion complications in laparoscopic sleeve gastrectomy.

Annals of Saudi medicine

The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In ad... more The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In addition the predictive value of myocardial perfusion single-photon emission computed tomography (SPECT) before noncardiac in individual patients is uncertain. Evaluate the prevalence and predictors of myocardial ischemia before noncardiac surgery, and determine the postoperative cardiac outcome based on results of myocardial perfusion SPECT. Retrospective. Single tertiary care center. We reviewed the records of adult patients diagnosed with myocardial ischemia by myocardial perfusion SPECT who were undergoing noncardiac surgery. Myocardial perfusion SPECT had been performed within 4 weeks prior to noncardiac surgery requiring general anesthesia. Prevalence of abnormal myocardial perfusion SPECT results on preoperative evaluation; abnormal myocardial perfusion SPECT results as a predictor for postoperative cardiac events such as cardiac death, nonfatal myocardial infarction, and unstable a...

Middle East Journal of Anaesthesiology, Jun 1, 2009

Background: The prolongation of spinal anesthesia by using clonidine through the oral, intravenou... more Background: The prolongation of spinal anesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha 2 agonist, dexmedetomidine has been proved to prolong the spinal anesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block, also prolongs spinal analgesia. Methods: 48 patients were randomly allocated into two equal groups following receiving spinal isobaric bupivacaine 12.5 mg. Patients in group D received intravenously a loading dose of 1 microg/kg dexmedetomidine over 10 min and a maintenance dose of 0.5 microg/kg/hr. Patients in group C (the control group) received normal saline. The regression times to reach S1 sensory level and Bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. Results: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (261.5 +/- 34.8 min versus 165.2 +/- 31.5 min, P < 0.05). The duration of motor block was longer in dexmedetomidine group than control group (199 +/- 42.8 min versus 138.4 +/- 31.3 min, P < 0.05). Conclusion: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability.

Pediatric Anesthesia, 2015

What is already known • Caudally co-administered dexmedetomidine prolongs the postoperative analg... more What is already known • Caudally co-administered dexmedetomidine prolongs the postoperative analgesic effects of local anaesthesthetics. Data about the effects of different doses of dexmedetomidine are still insufficient. What this article adds • A 1 lgÁkg À1 dose of caudal dexmedetomidine achieved comparable prolongation of postoperative analgesia to 2 lgÁkg À1 with shorter duration of postoperative sedation and a lower incidence of other side effects.

recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain.... more recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. one physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. Methods 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h-1 ropivacaine 0.2% (study group, n = 21) or 5 ml*h-1 saline (control group, n = 21). postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (pcEA) with ropivacaine 0.2%. The main outcome measure was the concentration of authentic ß-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol.

Jordan Medical Journal, 2013

Objectives: To evaluate women’s information about the purpose of the second-trimester ultrasound ... more Objectives: To evaluate women’s information about the purpose of the second-trimester ultrasound scan, their expectations before the scan, the extent to which these expectations are fulfilled after the scan, and their perceptions of the foetus. Methods: A sample of pregnant women (540) attending a second-trimester ultrasound scan at Jordan University Hospital were asked to complete two parts of a questionnaire during a 3-month period in 2011. The first part included patients’ characteristics, the purpose of the scan, and expectations before the scan. The second part included patients’ perceptions of the foetus and how the expectations of the scan were fulfilled. Results: Both parts of the questionnaires were completed by 503 (93%) of the women. Three fourths of the participants were accompanied by their husband or a family member. Sixty (12%) women were referred specifically to rule out congenital anomalies. Comparison between patients’ expectations before and after the scan using the chi-square test showed significant improvement in all expectations variables (P–value < 0.001). Conclusion: A routine second-trimester ultrasound scan is an important event for most participating women. Improvements are required in the provision of pre-ultrasound information.

Jordan Medical Journal, 2013

Objective: Reduction mammaplasty is a common surgical procedure that yields a variable amount of ... more Objective: Reduction mammaplasty is a common surgical procedure that yields a variable amount of tissue for pathologic examination. The purpose of this study was to evaluate the histological diagnoses of the reduction mammaplasty specimens and to determine the incidence of breast lesions in otherwise asymptomatic and healthy Jordanian females. Methods: All reduction mammaplasty specimens of 73 patients over a 10-year period (September 1999-September 2009) at Jordan University Hospital were retrospectively examined. The average number of blocks submitted per breast was 4 (range 3-5). Variables such as age and preoperative mammograms were examined. Results: A total of 143 specimens were evaluated. Normal mammary tissue was present in 36 patients (49%). The most common benign lesion was fibrocystic disease (21%). Precancerous breast lesions were identified in 7 patients (9.6%). No case of carcinoma in situ or invasive carcinoma was encountered in our study. Most of the histopathological lesions were found in patients younger than 35 years of age. Preoperative mammograms were done for 26 patients and all were normal. Conclusions: This study demonstrates the importance of systemic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty. Consequently, thorough sampling and handling of breast reduction specimens should be emphasized.

meja.aub.edu.lb

Horner's syndrome is a triad of miosis, ptosis, and enophthalmos, commonly associated with v... more Horner's syndrome is a triad of miosis, ptosis, and enophthalmos, commonly associated with vasodilatation (facial flushing, anhydrosis and nasal stuffiness). Lumbar epidural analgesia is widely used to control pain during labor and is still the superior technique and preferred ...

Saudi Journal of …

Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure... more Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood ...

Jordan Medical …, 2011

Methods: Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty o... more Methods: Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty over a 10-year period (1999-2008) performed by a single surgeon were studied. The following factors were addressed: age, medical history, medications, smoking habits, Body Mass ...