Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: One-anastomosis gastric bypass (OAGB) with a 150 cm biliopancreatic limb is increasingly used as a bariatric surgery option, offering effective weight loss and metabolic benefits. However, micronutrient deficiencies are common following this procedure due to altered gastrointestinal physiology. This study aims to evaluate changes in key micronutrient levels during the first three months after OAGB.

Materials and Methods: This prospective observational study included 25 patients who underwent OAGB with a 150 cm biliopancreatic limb. Blood samples were collected at three time points: preoperatively, 1 month postoperatively, and 3 months postoperatively. Serum levels of iron, ferritin, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, D, E, K) were measured. Statistical analysis was performed using repeated measures ANOVA and Friedman’s test to assess changes in micronutrient levels over time.

Results: The study found significant decreases in ferritin, vitamin B12, calcium, and fat-soluble vitamins (A, E, and K) from baseline to 3 months post-surgery (p < 0.05 for all). Ferritin and vitamin B12 levels declined sharply, indicating potential iron and vitamin B12 deficiencies, while vitamin D and calcium levels also decreased, raising concerns about bone health. Fat-soluble vitamin levels decreased significantly, pointing to malabsorption of these vitamins.

Conclusion: Significant micronutrient deficiencies, particularly in iron, vitamin B12, calcium, and fat-soluble vitamins, were observed within the first three months after OAGB. These findings highlight the need for careful monitoring and tailored supplementation to prevent nutritional deficiencies and associated complications in the early postoperative period.

Abstract Introduction: Opioids such as fentanyl and remifentanil are commonly used for anesthesia induction and maintenance, each with distinct pharmacokinetic and pharmacodynamic properties. This study aimed to compare their effects on hemodynamic stability, intraoperative excitability, neuromuscular blockade requirement, postoperative nausea, and recovery characteristics.

Materials and Methods: This prospective, randomized clinical trial included 400 patients, equally divided into fentanyl (n=200) and remifentanil (n=200) groups. Baseline characteristics, intraoperative hemodynamics, anesthesia recovery parameters, and postoperative complications were recorded. Data were analyzed using appropriate statistical tests, with P < 0.05 considered statistically significant.

Results: The remifentanil group exhibited significantly lower heart rate and blood pressure at all measured time points post-induction (P < 0.05). Intraoperative excitability and neuromuscular blocker requirement were higher in the remifentanil group (P = 0.014, P = 0.009). Postoperative nausea and antiemetic use were significantly higher in the fentanyl group (P = 0.041, P = 0.038). The remifentanil group had faster induction, earlier respiratory recovery, and shorter awakening time (P < 0.05).

Conclusion: Remifentanil ensures faster recovery with reduced postoperative nausea but causes greater hemodynamic suppression and intraoperative excitability. These findings support tailored opioid selection based on surgical needs and patient-specific factors.

Abstract Introduction: Effective postoperative pain management is essential for enhanced recovery in gastric cancer surgery. Enhanced Recovery After Surgery (ERAS) protocols emphasize multimodal, opioid-sparing strategies to improve outcomes, but their impact specifically in gastric cancer patients remains underexplored.

Methods: A systematic review was conducted to evaluate pain management methods integrated within ERAS protocols for patients undergoing gastric cancer surgery. Databases including PubMed, Scopus, and Web of Science were searched for studies published between 2018 and 2024. Inclusion criteria were adult patients undergoing elective gastric cancer surgery with reported postoperative pain outcomes under ERAS protocols. Data on study characteristics, analgesic methods, pain scores, opioid consumption, and recovery outcomes were extracted and analyzed.

Results: Five studies met inclusion criteria, encompassing 529 patients. Regional analgesia (e.g., epidural, TAP block) combined with non-opioid systemic medications significantly reduced 24-hour postoperative pain scores (VAS range: 2.86–4.14) and opioid consumption (15.33–21.78 mg morphine equivalents). ERAS-compliant groups also showed faster ambulation, earlier return of bowel function, shorter hospital stays, and lower complication and readmission rates.

Conclusion: Incorporating multimodal, regional pain management within ERAS protocols improves pain control and accelerates recovery in gastric cancer surgery. Standardized implementation can enhance postoperative outcomes and reduce opioid use.

Abstract Introduction: Postoperative pain and agitation are common complications following emergency neurosurgical procedures and may adversely impact neurological recovery. Dexmedetomidine, a selective α2-adrenergic agonist, has emerged as a promising agent due to its analgesic, sedative, and opioid-sparing properties with minimal respiratory depression.

Materials and Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was performed through December 2024. Studies evaluating intravenous dexmedetomidine for postoperative pain and agitation management in adult emergency neurosurgical patients were included. Data extraction focused on analgesic efficacy, sedation quality, adverse effects, and ICU-related outcomes.

Results: Three eligible studies with sample sizes ranging from 35 to 60 patients were included. Dexmedetomidine was associated with reduced postoperative pain scores (VAS <3.10), lower incidence of agitation (12.00%–21.50%), decreased opioid use (16.89–22.34 mg morphine equivalents), and shorter mechanical ventilation durations. Hemodynamic side effects, including hypotension and bradycardia, were infrequent and manageable.

Conclusion: Intravenous dexmedetomidine appears to be a safe and effective option for managing pain and agitation following emergency neurosurgery. Larger trials are needed to confirm these findings and establish standardized protocols.