An Assessment of Changes in the Magnesium Level During Gynecological Abdominal Surgeries

Background: Magnesium (Mg) is the fourth most common cation in the human body and the second most intracellular cation after potassium. It has a fundamental role in several vital functions. As this essential ion is not measured in routine chemistry panels, little is known about its alterations during intraoperative time.Aim: The present study was designed to determine the negative eff ects of postoperative hypomagnesemia during and after surgeries.Subject and Methods: This study was a descriptive interventional study involving 74 patients. All patients underwent gynecological abdominal surgeries, and anesthesia protocols were standardized to comprise general and spinal anesthesia. All the patients were aged between 25 and 45 years, with ASA class I and II. Their total serum Mg level was measured 1 h before and 2 h after the surgery. The total serum Mg, calcium, and albumin level were measured by photometric methods. Data were analyzed using SPSS version 16.0 (Chicago Illinois, (USA). Inferential statistic was done using Vilksonnon-parametric and Pearson’s correlation test. P<0.05 were considered as significant.Results: The mean serum Mg levels were 1.87 (0.32) mg/dl before and 1.55 (0.34) mg/dl after the surgeries (The normal range: = 1.7-2.5 mg/dl). Results illustrated a significant hypomagnesemia after operations. Conclusion: Clinical impact of hypomagnesemia during surgeries needs to be studied further. Moreover, surgeons should be warned about the severity of probable electrolyte imbalances induced by perioperative events to decrease associated morbidities. Keywords: ASA, cation, gynecologic surgeries, magnesium, magnesium level, photometric method, standardized anesthesia, surgerie

The Effect of Low‑Dose Ketamine (Preemptive Dose) on Postcesarean Section Pain Relief

Background: Postsurgical pain is the main cause of anxiety in patients; therefore, analgesics (adjuvants) such as preemptive doses of ketamine with minimal adverse effects would be beneficial. However, studies are needed regarding their efficacy. Aim: To determine the preemptive effect of intravenous ketamine on pain intensity and need to opioids in cesarean section which performed under spinal anesthesia. Subjects and Methods: The study was a randomized, double‑blinded, clinical trial involving 60 term parturients for cesarean, using random block method, they were divided into two groups of each. The case group received ketamine with dose of 0.2 mg/kg and the control one normal saline with the same volume. Pain intensity was compared in 0,30,60,90,120,150, and 180 min and 6,12,18, and 24 h after surgeries with visual analog scale (VAS) index. The average opioid usage was compared during 24 h after those too. Final analyses were done with Mann‑Whitney, Chi‑square, and Spss.v. 16 (P < 0.05 was meaningful level). Results: There was not significant statistical difference on average VAS during interrupted times (F = 0.15, P = 0.70). Average dosage of diclofenac suppository and mean time for taking the first dosage of opioids have not statistical difference too (respectively; P = 0.76, P = 0.87). Average dose of pethidine was lesser than placebo statistically. It means, the case group did not take pethidine but this amount was 6 (20%) in the control one (P = 0.02). Conclusion: Taking the preemptive dosage of ketamine (0.2 mg/kg) before cesarean could act as a probably model for decreasing opioid consumption. Keywords: Ketamine, low dose, pain relief, preemptiv

Case Report: Management of Anesthesia in a Pregnant Patient with an Unmodified Congenital Heart Disease

Congenital heart diseases (CHDs) affect approximately 0.8% of all the newborns with malformed structured heart or large vessels. Nowadays, due to the progress in medical methods and management, most women with CHD are expected to reach childbearing age. Noticeable improvement in anesthesia management is important for successful outcome and survival in pregnant patients with CHDs, even with the most complex disease. A multiparous patient, who had two components of cyanotic CHDs, which includes transposition of the great arteries (TGA) and single ventricle (atrioventricular connection) in childhood, got pregnant at the age of 39 years. She had a normal pregnancy course without any specific symptoms. She did not experience functional deterioration during her pregnancy. Termination of pregnancy was decided when intrauterine growth restriction (IUGR), was diagnosed by ultrasonography at 37 weeks, and a normal 1250‑g baby was delivered by cesarean section. This case report, records the anesthetic care of the 39‑year‑old female who underwent cesarean section due to IUGR. General anesthesia was successfully administered, with precise attention to maintenance of systemic vascular resistance (to minimize shunting), better oxygenation, administration of pre procedural antibiotics, and judicious replacement of intravenous fluids via air‑filtered tubing.Keywords: Africa, anesthesia, cesarean, congenital heart disease, pregnancy, transposition of the great arterie