الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
This study was carried out in El-Minia University Hospital in the period from January 2013 to December 2013 on sixty patients ASA physical state II & III, aged between 16 and 60 years underwent elective valvular replacement surgery using cardio-pulmonary bypass (CPB). Those patients were randomly devided into three equal groups each included 20 patiens.
Group S: received small-dose dexamethasone (0.1mg/kg) dilutd to a total volume of 5 ml saline.
Group I: received intermediate-dose dexamethasone (0.2mg/kg) dilutd to a total volume of 5 ml saline.
Group C: received placebo (normal saline) in 5 ml volume.
We aimed in this study to determine the effect of small versus intermediate dose of dexamethasone on patient-perceived quality of recovery (QoR) scores in valvular replacement cardiac surgical patients and postoperative analgesic consumption.
Patients were randomized to receive the investigated drug or placebo during the induction of anaesthesia (A second dose dexamethasone or saline-placebo was administered on the initiation of CPB to compensate for hemodilution and maintain stable post-CPB drug levels).
In the operating room all patients were cannulated with arterial cannula for invasive blood pressure monitoring and intravenous cannula for drug administration. Patients underwent a standardized cardiac anesthesia protocol that included preoxygenation for 5 minutes followed by induction with fentanyl (5µg/kg) and propofol (1-1.5mg/kg), cis- atracurium (0.15mg/kg) as muscle relaxant to facilitate tracheal intubation. Anesthesia was maintained with isoflurane with 100% oxygen and cis- atracurium (0.05mg/kg) in an intermittent bolus dose.
An initial dose of 300U/kg of heparin was administrated to achieve anticoagulation and to maintain activated coagulation times (ACT) greater than 450 seconds. CPB was conducted under mild hypothermic condition (32°C). At the end of surgical procedure, rewarming has started and the flow rate was adjusted according to the body weight and blood pressure. After optimization of temperature to 37°C, blood gases and electrolytes were estimated. After successful weaning of CPB and stabilization of hemodynamic state, anticoagulation was reversed by a calculated dose of protamine sulfate (1mg per 100 units of heparin).
After skin closure, isofluran was terminated and monitored ventilated patients were transported to the postoperative intensive care unit (ICU) for mechanical ventilation.