Dexmedetomidine is an effective adjuvant to subtenon block in phacoemulsification cataract surgery

BackgroundResearches to find a better adjuvant in regional anesthesia are still continued until now.Dexmedetomidine prolongs anesthesia and analgesia of local anesthetics in various neural blocks as well as the onset of sensory and motor block. The objective of the present study was to evaluate the effect of adding dexmedetomidine to local anesthetics on the sensory and motor block of the subtenon block in patients undergoing phacoemulsification cataract surgery.MethodsSixty patients of American Society of Anaesthesiologists (ASA) grade I–III, aged between 18 and 70 years, scheduled for phacoemulsification cataract surgery were randomly assigned to two equal groups. Group C (control group) received 2 ml of a mixture of 2% lidocaine and 0.5% bupivacaine and Group D (dexmedetomidine group) received 2 ml of a mixture of 2% lidocaine and 0.5% bupivacaine plus dexmedetomidine (0.5 μg/kg). Onset and duration of sensory and motor block was recorded. Pain during administration of anesthesia and during surgery was graded using the verbal analogue scale and recorded. Intraocular pressure, hemodynamic, and sedation parameters were recorded before and after surgery.ResultsOnset of both sensory and motor block was significantly decreased in group D (P < 0.001, P = 0.004 respectively), and duration of sensory and motor block was more prolonged in group D than in group C (P < 0.001, P = 0.961). Pain during administration of anesthesia was significantly lower in group I compared with group II, and more patients in group I compared with group II were pain free, without a significant difference between the two groups. Intraocular pressure was significantly decreased in group D (P < 0.001). More sedation score was observed in group D (P = 0.022). Heart rate and mean arterial blood pressure were insignificantly decreased in group D more than in group C.ConclusionDexmedetomidine is a safe and effective adjuvant to subtenon block in phacoemulsification cataract surgery.     

Comparison of the efficacy of dexmedetomidine,ketamine, and a mixture of both for pediatric MRI sedation

AimTo compare the efficacy of intramuscular ketamine, dexmedetomidine, and a mixture of both for pediatric MRI sedation.Subjects and methodsOne-hundred and sixty-two children with ASA physical I–II were enrolled in a double-blind comparative study and assigned into three equal groups for sedation. Group D, patients received IM dexmedetomidine 3 μg/kg. Group K, patients received IM ketamine 4 mg/kg. Group DK, patients received a combination of IM dexmedetomidine 1.5 μg/kg and ketamine 2 mg/kg. Primary outcomes included incidence of failed sedation and the requirement of midazolam supplementation. Secondary outcomes were time to sedation, duration of sedation, and discharge time.ResultsThe onset of satisfactory sedation was significantly shorter in the DK group in comparison with the D group (4.8 ± 1.6 vs. 16.8 ± 4.5 min), while no significant difference between the DK group and K group. The duration of sedation was significantly less in the DK group in comparison with the K group, and the discharge time was significantly less in the DK group in comparison with the D and K groups. The sedation failure rate was significantly lower in the DK group (5.6%) in comparison with the K group (22.2%) and the D group (27.8%). The use of rescue midazolam was significantly less in the DK group (0.03 ± 0.12 mg) in comparison with the K and D groups (0.21 ± 0.41 mg, 0.24 ± 0.41 mg, respectively). None of the patients experienced episodes of hypotension or bradycardia in the DK and K groups while four patients (7.4%) experienced episodes of hypotension and five patients (9.3%) experienced episodes of bradycardia in the D group.ConclusionIn pediatric MRI sedation, the combination of IM dexmedetomidine and ketamine was superior to either IM dexmedetomidine or ketamine given individually with regard to the onset of sedation, the sedation failure rate, and hemodynamic stability.     

Quality of MRI pediatric sedation: Comparison between intramuscular and intravenous dexmedetomidine

ObjectiveThe study was designed to compare the efficacy of dexmedetomidine whether given intramuscular or intravenous for pediatric MRI sedation.Subjects and methodsNinety children between the ages of 2 and 8 years with ASA physical status I–II, scheduled for elective MRI, were enrolled in a double blind, comparative randomized study. Patients assigned into two equal groups. Group DV, sedation was performed using IV dexmedetomidine hydrochloride; a loading dose of 1 μg/kg administered over 10 min followed by a continuous infusion at 1 μg/kg/h. Group DM where the patient received IM dexmedetomidine 3 μg/kg. Primary endpoints included incidence of failed sedation and the requirement of midazolam supplementation. Secondary endpoints were time to sedation, duration of sedation, discharge time, and hemodynamic status.ResultsThe sedation failure rate was significantly higher in the DV group (40%) in comparison with the DM group (20%) (P = 0.04). Also, the use of rescue midazolam was significantly higher in the VD group (0.37 ± 0.47 mg) in comparison to the DM group (0.17 ± 0.35 mg) (P = 0.025). The onset of satisfactory sedation was significantly shorter in DV group in comparison to DM group (7.93 ± 0.884 vs. 16.87 ± 4.49). Also, the discharge time was significantly less in the DV group (32.27 ± 3.04 min) in comparison to DM group (41.87 ± 5.80 min). Patients in DV group had significantly lower MBP compared to patients in DM group after receiving dexmedetomidine (p < 0.05). Although the HR decreased in both groups during the MRI study, the decrease was statistically significant in the DV group compared to the DM group in the period extended from the 2nd to 35th min (p < 0.05).ConclusionIn pediatric MRI sedation, although IM dexmedetomidine does have a late sedation onset; it reduces the sedation failure rate, the need for supplement sedation and the incidence of hemodynamic instability associated with IV dexmedetomidine.     

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Background and objectivesEven a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short‐term sedation in the intensive care unit but also is an alpha 2 agonist sedative.Method60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre‐induction loading dose of 50 mg kg⁻¹ over 10 min and maintained at 15 mg kg⁻¹ h⁻¹; in Group D, dexmedetomidine was given at 1 mcg kg⁻¹ 10 min before induction and maintained at 0.6 mcg kg⁻¹ h⁻¹. Intraoperatively, the haemodynamic and respiratory parameters and 6‐point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11‐point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted.ResultsGroup D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters.ConclusionsDue to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.     

A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation

ObjectiveThe type of sedative drugs could play a major role in providing hemodynamic stability which is crucial during transcatheter aortic valve implantation (TAVI) procedure. The aim of this study is to compare propofol with dexmedetomidine for conscious sedation during TAVI.DesignA prospective randomized pilot study.PatientsFifty patients with a mean age of 74 years, American Society of Anesthesiologists 3-4, complaining from severe aortic stenosis were enrolled in this study to undergo TAVI.InterventionsThe propofol group (group P; n = 25) received a bolus dose of 0.5 mg/kg propofol followed by a continuous intravenous infusion of propofol at a rate of 30 to 50 μg kg^− 1 min^− 1, and the dexmedetomidine group (group D; n = 25) received dexmedetomidine at a loading dose of 1 μg/kg and then a continuous intravenous infusion of dexmedetomidine at a rate of 0.5 μg kg^− 1 h^− 1.MeasurementsHeart rate, mean arterial blood pressure, number of phenylephrine boluses, oxygen saturation, sedation, and satisfaction scores were measured just after the start of infusion of the sedation drugs and at the end of the procedure. Postoperative complications were also recorded.ResultsThere was a statistically significant reduction in the heart rate in group D in comparison to group P where it was 67.28 ± 6.9 beats/min in the first group in comparison to 78 ± 6.9 beats/min in the last one (P < .001). The mean arterial blood pressure was statistically significant lower in group D in comparison to group P (58.12 ± 5.4 mm Hg in group D vs 68.24 ± 11.4 mm Hg in group P; P < .001). Also, the number of phenylephrine boluses was higher in group D than in group P (36.5 ± 7.17 in group D vs 20.6 ± 2.07 in group p; P < .001). No difference between the 2 groups regarding oxygen saturation, sedation, pain, satisfaction scores, and postoperative complications.ConclusionDuring TAVI, dexmedetomidine may be associated with significant hypotension and bradycardia rather than propofol.     

Comparative study between novel sedative drug (dexmedetomidine) versus midazolam–propofol for conscious sedation in pediatric patients undergoing oro-dental procedures

ObjectiveA comparative study to evaluate the effect of dexmedetomidine as a sedative in pediatric dental patients in comparison to the currently used combination of midazolam and propofol.MethodsSixty ASA I children (4–10 years old) referred from the outpatient clinic of the pediatric dentistry department for sedation for dental procedures. They were randomly classified into two groups, group I (dexmedetomidine group) was given as 2 μg/kg loading dose over 5 min followed by 0.4 μg/kg/h continuous infusion. Group II (midazolam–propofol group) midazolam was given as 0.05 mg/kg and propofol was given loading dose as 1 mg/kg over 5 min followed by 5 mg/kg/h continuous infusion. Heart rate, mean arterial blood pressure, oxygen saturation, respiratory rate were recorded every 5 min till discharge. The onset of sedation, procedure time, recovery time, discharge time and the need of analgesia were recorded. The incidence of occurrence of adverse effects was observed.ResultsIn group I, the mean onset of sedation was significantly longer than in group II, but recovery time was significantly shorter in group I than group II, there are significantly hemodynamics effects in the first 15 min and more incidence of occurrence of side effects in group II than group I. There are more analgesic effects of dexmedetomidine in group I than group II postoperatively.ConclusionDexmedetomidine is safe and effective when used for sedation in pediatric patients undergoing dental procedures.     

Maternal and preterm fetal sheep responses to dexmedetomidine

BackgroundThe α₂ adrenergic receptor agonist dexmedetomidine has some unique pharmacologic properties that could benefit pregnant patients (and their fetuses) when they require sedation, analgesia, and/or anesthesia during pregnancy. The purpose of the present study was to delineate maternal and fetal responses to an intravenous infusion of dexmedetomidine.MethodsThis study was conducted on surgically-recovered preterm sheep instrumented for physiologic recording and blood sampling. Maternal and fetal cardiovascular and blood gas parameters and fetal cerebral oxygenation levels were recorded before, during, and after 3 h of dexmedetomidine infusion to the ewe at a rate of 1 μg/kg/h.ResultsDrug infusion produced overt sedation but no apparent respiratory depression as evidenced by stable maternal arterial blood gases; fetal blood gases were also stable. The one blood parameter to change was serum glucose, By the end of the 3-h infusion, glucose increased from 49 ± 10 to 104 ± 33 mg/dL in the ewe and from 22 ± 3 to 48 ± 16 mg/dL in the fetus; it declined post-drug exposure but remained elevated compared to the starting levels (maternal, 63 ± 12 mg/dL, P = 0.0497; and fetal, 24 ± 4 mg/dL, P = 0.012). With respect to cardiovascular status, dexmedetomidine produced a decrease in maternal blood pressure and heart rate with fluctuations in uterine blood flow but had no discernable effect on fetal heart rate or mean arterial pressure. Likewise, maternal drug infusion had no effect on fetal cerebral oxygenation, as measured by in utero near-infrared spectroscopy.ConclusionsUsing a clinically-relevant dosing regimen, intravenous infusion of dexmedetomidine produced significant maternal sedation without altering fetal physiologic status. Results from this initial acute assessment support the conduct of further studies to determine if dexmedetomidine has clinical utility for sedation and pain control during pregnancy.     

Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in pediatric patients

ObjectiveTo compare the sedative, hemodynamic, respiratory and adverse effects of dexmedetomidine versus propofol during gastrointestinal endoscopy (GIE) in pediatrics.MethodsAfter obtaining approval of the research and ethics committee and informed consent of the parents of the patients, eighty pediatric patients ASA I/II aged 1–14 years, scheduled for gastrointestinal endoscopy were randomized into dexmedetomidine group or propofol group. Sedation was achieved with propofol 2 mg/kg bolus then infused at 100 μg/kg/min or dexmedetomidine 2.5 μg/kg over 10 min then infused at 2 μg/kg/h to achieve a Ramsay sedation scale (RSS) ⩾5. HR, MAP, RR and SPO2 were continuously monitored and analyzed at (T0) baseline, (T1) after induction, (T2) after insertion of endoscope, (T3) during procedure, (T4) recovery period. Times of induction, procedure, and recovery were reported together with any adverse effects.ResultsThere were no significant differences in demographic data between the two groups. HR values were significantly lower in dexmedetomidine group at T1, T2 and T3 (83.95 ± 13.79 versus 92.95 ± 12.38, 103.35 ± 15.34 versus 112.75 ± 12.79 and 90.80 ± 13.99 versus 104.05 ± 10.73) beats/min respectively, (p-value < 0.05). No significant differences were found in MAP, RR and SPO2 values between groups at all time points. Induction and recovery times were significantly longer in dexmedetomidine group 10.51 ± 1.75 versus 3.17 ± 0.72 min and 28.55 ± 7.95 versus 13.68 ± 3.35 min (p-value < 0.001). Seven patients in dexmedetomidine group (17.5%) versus one patient in propofol group (2.5%) showed unwanted movement (p-value 0.057), and no cases in dexmedetomidine group demonstrated oxygen desaturation versus 6 patients (15%) within propofol group (p-value 0.026).ConclusionDexmedetomidine sedation during GIE provides more respiratory safety and HR stability presenting itself as a suitable alternative agent especially for the relatively longer procedures.     

Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico

Background and objectivesThe primary aim of this study is to assess the effect of ultrasoung‐guided erector spinae block on postoperative opioid consumption after laparoscopic cholecystectomy. The secondary aims are to assess the effects of erector spinae plane block on intraoperative fentanyl need and postoperative pain scores.MethodsPatients between 18‐70 years old, ASA I‐II were included in the study and randomly allocated into two groups. In Group ESP, patients received bilateral US‐ESP with 40 ml of 0.25% bupivacaine at the level of T7, while in Group Control, they received bilateral US‐ESP with 40 ml of saline before the induction of anesthesia. Then a standard general anesthesia procedure was conducted in both groups. NRS scores at the postoperative 15th, 30th, 60th minutes, 12th and 24th hours, intraoperative fentanyl need and total postoperative tramadol consumption were recorded.ResultsThere were 21 patients in Group ESP and 20 patients in Group Control. Mean postoperative tramadol consumption was 100 ± 19.2 mg in Group ESP, while it was 143 ± 18.6 mg in Group Control (p < 0.001). The mean intraoperative fentanyl need was significantly lower in Group ESP (p = 0.022). NRS scores at the postoperative 15th, 30th min, 12th hour and 24th hour were significantly lower in ESP group (p < 0.05). According to repeated measures analysis, NRS score variation over time was significantly varied between two groups (F[1,39] = 24.061, p < 0.0005).ConclusionsBilateral US‐ESP block provided significant reduction in postoperative opioid consumption, intraoperative fentanyl need and postoperative pain scores of patients undergoing laparoscopic cholecystectomy.     

Premedication with intranasal dexmedetomidine,midazolam and ketamine for children undergoing bone marrow biopsy and aspirate

BackgroundPreanesthetic medication in pediatrics is very helpful in relieving anxiety, fear, and psychological trauma due to maternal deprivation. Many drugs used in different routes aiming to alleviate stress and prevent psychological trauma. Of these drugs midazolam and ketamine are commonly used. We aimed in this work to compare both of them with dexmedetomidine which is α 2-agonist when used intranasally in children undergoing bone marrow biopsy and aspirate in sedation and premedication.Methods96 children aged 2–8 years with ASA physical status II scheduled for bone marrow biopsy and aspirate were divided into three groups 32 child in each one: (M group) who were premedicated with intranasal midazolam 0.2 mg/kg, (D group) who were premedicated with intranasal dexmedetomidine 1 μg/kg, and (K group) who were premedicated with intranasal ketamine 5 mg/kg. The degree of sedation was assessed every 5 min for 30 min by using a 4 point sedation scale. Also, child–parent separation was assessed and graded according to a 4 point scale at 30 min.ResultsWe found that dexmedetomidine group achieved a faster sedation score less than 3 at the point of 10 min, then all groups achieved a comparable sedation score till point of 25 min, both dexmedetomidine and midazolam groups had better sedation score than ketamine group at 30 min. Children achieved child–parents separation score grade 1 was significantly higher in dexmedetomidine group than midazolam and ketamine groups.ConclusionsMidazolam, ketamine and dexmedetomidine produced adequate sedation with little side effects. So, we prefer to use midazolam due its efficacy and safety as well as availability and its low price in comparison to ketamine and dexmedetomidine.     

Estudo prospectivo randômico,duplo‐cego e controlado comparando tramadol,clonidina e dexmedetomidina para tremores pós‐raquianestesia

Introduction

Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects.

Efeitos da musicoterapia sobre dor e estresse oxidativo na aspiração folicular: estudo clínico randomizado

Background and objectiveThe aim was to investigate the effects of Turkish classical music on pain and oxidative stress in patients undergoing oocyte pick‐up.MethodsThe study was a randomized, controlled trial. The groups included were Group NM (Non‐Music), control group; Group PM, which comprised patients who listened to music before the operation; and Group CM, which comprised patients who listened to music both before and during the operation. Blood was drawn prior to the operation to measure the oxidative stress values. Pain, hemodynamic parameters, oxidative stress values were assessed postoperatively.ResultsThe number of patients requiring additional propofol was higher in Group PM than in Groups NM and CM (p = 0.003). The postoperative Visual Analog Scale (VAS) score were lower in Groups PM and CM than in Group NM (p = 0.001, p = 0.007) in the 1^st and 60^th minutes. The postoperative VAS score was lower in Group CM than in Group NM (p = 0.045) in the 5^th minute. The postoperative additional analgesic requirements were lower in Groups PM and CM than in Group NM (p = 0.045). The postoperative blood glutathione peroxidase values were significantly higher in Groups PM and CM than in Group NM (p = 0.001). The postoperative catalase values were significantly higher in Groups PM and CM than in Group NM (p = 0.008 and p ≤ 0.001). The preoperative malondialdehyde values were significantly lower in Groups PM and CM than in Group NM. The preoperative nitric oxide values were higher in Groups PM and CM than in Group NM (p ≤ 0.001), whereas the postoperative nitric oxide values were lower in Groups PM and CM than in Group NM (p ≤ 0.001).ConclusionTurkish classical music has beneficial effects on pain and oxidative stress in oocyte pick‐up patients.     

The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis

Study objectiveAdministration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine.DesignWe identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries.SettingPediatrics who underwent interventional procedures and surgeries.PatientsChildren under the age of 18.InterventionsStudies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally.MeasurementsWe pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.Main resultsThis meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was − 2.45 (random, 95% CI; − 3.33, − 1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95% CI; 0.26, 0.68 I² = 45%) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was − 0.41 (random, 95% CI; − 1.09, 0.27 I² = 69%) for continuous outcomes and RR was 0.43 (M-H, random 95% CI; 0.32, 0.58 I² = 0%) for dichotomous outcomes compared to that of per os benzodiazepines.ConclusionsThis review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.     

The effects of caudal or intravenous dexmedetomidine on postoperative analgesia produced by caudal bupivacaine in children: a randomized controlled double-blinded study

Study ObjectivesThe aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 μg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries.DesignA randomized controlled double-blind study.SettingUniversity-affiliated teaching hospital.PatientsSeventy-five American Society of Anesthesiologists I children, aged 1 to 6 years.InterventionPatients were randomly allocated to 3 groups. All patients received 1 mL/kg caudal 0.25% bupivacaine. In addition, those in group B (n = 25) received 10-mL IV saline, those in group B-D_cau (n = 25) received 1 μg/kg caudal dexmedetomidine and 10-mL IV saline, and those in group B-D_IV (n = 25) received 1 μg/kg IV dexmedetomidine in 10-mL saline.MeasurementsIntraoperative mean blood pressure, heart rate, peripheral oxygen saturation, end-tidal sevoflurane, and bispectral index as well as postoperative pain and behavior scores and time to first analgesia were assessed.Main resultsGroup B-D_cau had a significantly longer time to first rescue analgesia than groups B-D_IV and B, with mean (SD) values of 14.4 (7.5), 9.18 (2.7), and 6.6 (2.5) hours, respectively (P < .05). Fewer patients in group B-D_cau (n = 16) required rescue analgesia during the first 24 hours postoperatively compared to group B (n = 24) and group B-D_IV (n = 20) (P < .05).Groups B-D_cau and B-D_IV had lower pain and behavior scores than Group B. Eight patients Group B had agitation compared to 2 in Group B-D_IV and 0 in Group B-D_cau. Four patients in Group B-D_IV developed bradycardia and hypotension during surgery.ConclusionsCompared to IV administration, caudal administration of dexmedetomidine during caudal bupivacaine anesthesia provided prolonged postoperative analgesia and a greater analgesic sparing effect without significant side effects. This suggests a greater role of neuraxial compared to that of peripheral α-2 adrenoceptors in pain processing.     

Dexmedetomidine acts as an oxidative damage prophylactic in rats exposed to ionizing radiation

Study objectiveTo investigate the effects of dexmedetomidine on oxidative injury caused by ionizing radiation.DesignRandomized controlled experimental study.SettingDepartment of radiation oncology and research laboratory of an academic hospital.InterventionsTwenty-eight rats were randomized to 4 groups (n = 7 per group). Group S rats were administered physiologic serum; group SR rats were administered physiologic serum and 10 Gy external ionizing radiation. Groups D100 and D200 were administered 100 and 200 μg/kg dexmedetomidine intraperitoneally, respectively, 45 minutes before ionizing radiation.MeasurementsLiver, kidney, lung, and thyroid tissue and serum levels of antioxidant enzymes (glutathione peroxidase [GPX], superoxide dismutase, and catalase) and oxidative metabolites (advanced oxidation protein products, malondialdehyde, and nitrate/nitrite, and serum ischemia-modified albumin) were measured 6 hours postprocedure.Main resultsIn group SR, IR decreased antioxidant enzyme levels and increased oxidative metabolite levels (P < .05). In plasma, antioxidant enzyme levels were higher and oxidative metabolite levels were lower in groups D100 and D200 than in group SR (P < .01). In tissues, hepatic and lung GPX levels were higher in groups D100 and D200 than in group SR (P < .001). Renal and thyroid GPX levels were higher in D200 than in group SR (P < .01). Thyroid superoxide dismutase levels were higher in groups D100 and D200 than in group SR (P < .01). Renal, lung, and thyroid catalase levels were higher in group D200 than in group SR (P < .01). Hepatic, renal, and lung advanced oxidation protein products and malondialdehyde levels were lower in groups D100 and D200 than in group SR (P < .01). Hepatic, renal, and lung nitrate/nitrite levels were lower in group D200 than in group SR (P < .05).ConclusionsDexmedetomidine preserves the antioxidant enzyme levels and reduces toxic oxidant metabolites. Therefore, it can provide protection from oxidative injury caused by ionizing radiation.     

Efeitos de dexmedetomidina em conjunto com o pré‐condicionamento isquêmico remoto em lesão de isquemia‐reperfusão renal em ratos

Background and objectivesThe aim of this study was to evaluate the effects of remote ischemic preconditioning by brief ischemia of unilateral hind limb when combined with dexmedetomidine on renal ischemia–reperfusion injury by histopathology and active caspase‐3 immunoreactivity in rats.Methods28 Wistar albino male rats were divided into 4 groups. Group I (Sham, n = 7): Laparotomy and renal pedicle dissection were performed at 65th minute of anesthesia and the rats were observed under anesthesia for 130 min. Group II (ischemia–reperfusion, n = 7): At 65th minute of anesthesia bilateral renal pedicles were clamped. After 60 min ischemia 24 h of reperfusion was performed. Group III (ischemia–reperfusion + dexmedetomidine, n = 7): At the fifth minute of reperfusion (100 μg/kg intra‐peritoneal) dexmedetomidine was administered with ischemia–reperfusion group. Reperfusion lasted 24 h. Group IV (ischemia–reperfusion + remote ischemic preconditioning + dexmedetomidine, n = 7): After laparotomy, three cycles of ischemic preconditioning (10 min ischemia and 10 min reperfusion) were applied to the left hind limb and after 5 min with group III.ResultsHistopathological injury scores and active caspase‐3 immunoreactivity were significantly lower in the Sham group compared to the other groups. Histopathological injury scores in groups III and IV were significantly lower than group II (p = 0.03 and p = 0.05). Active caspase‐3 immunoreactivity was significantly lower in the group IV than group II (p = 0.01) and there was no significant difference between group II and group III (p = 0.06).ConclusionsPharmacologic conditioning with dexmedetomidine and remote ischemic preconditioning when combined with dexmedetomidine significantly decreases renal ischemia–reperfusion injury histomorphologically. Combined use of two methods prevents apoptosis via active caspase‐3.     

Feasibility and outcome of emergency ureteroscopic removal of lower ureteral stone under intravenous sedation: A prospective study

ObjectiveTo compare the efficacy of emergency ureteroscopy (URS) with that of elective URS in the treatment of distal ureteral calculi.Patients and methodsThis prospective study included 132 patients diagnosed with a distal unilateral ureteral stone ≤5 mm and treated with either emergency or elective URS between August 2013 and July 2014. The indication for emergency URS was intractable renal pain not responding to narcotic analgesia. Children, pregnant women and patients with bilateral disease were excluded. The patients were categorized into two groups: Group I included 42 patients who underwent emergency URS under intravenous sedation, while Group II included 90 patients who underwent elective URS. The patients’ demographic data, the stone criteria, perioperative complications, procedure outcome and degree of patient satisfaction were recorded and statistically analyzed.ResultsThe mean stone size was 4.2 ± 0.5 mm in Group I and 4.1 ± 0.6 mm in Group II. The success rate was 90.5% and 97.8% in Groups I and II, respectively with a statistically insignificant difference. Complete stone retrieval without fragmentation was achieved in 83.3% in Group I and in 82.2% in Group II. The stone migrated proximally in 4 patients in Group I and in only 2 patients of Group II; these patients received ureteral stents. Mucosal injury was observed in 3 and 4 patients of Groups I and II, respectively. Thirty-seven patients of Group I (88%) reported that they were satisfied with the procedure and its outcome compared to 78 patients of Group II (87%).ConclusionEmergency URS under intravenous sedation is feasible, safe and equally effective when compared to elective URS for small lower ureteral stones.     

Continuous infusion of magnesium–lidocaine mixture for prevention of ventricular arrhythmias during on-pump coronary artery bypass grafting surgery

BackgroundDuring on-pump coronary artery bypass grafting (CABG) surgery, the incidence of reperfusion ventricular fibrillation (VF) is high and post-bypass ventricular arrhythmias are common. Both reperfusion VF and ventricular arrhythmias can cause additional myocardial injury to the already ischemic myocardium. This trial aimed to test the assumption that continuous combined magnesium and lidocaine infusion would be efficient and long lasting for the prevention of post-myocardial vascularization ventricular arrhythmias including VF.MethodsEighty ASA III patients, who were candidates for CABG surgery, were randomly assigned into two groups: Group I (control group, n = 40) and Group II (Group ML, n = 40). After endotracheal intubation, patients of control group were infused with plain normal saline in a volume equivalent to study drugs’ mixture volume. Patients of Group ML were infused with magnesium–lidocaine mixture to achieve a bolus of magnesium sulfate 2 g and lidocaine 100 mg followed by continuous infusion of Mg sulfate 500 mg/h and lidocaine 1 mg/min. The initial cardiac rhythm after aortic cross clamp (ACC) release and the occurrence of post-CPB significant ventricular arrhythmias were recorded.ResultsThe incidences of reperfusion VF and post-CPB ventricular arrhythmias in Group ML were significantly lower than that in control group (22.5% vs. 72.5%) (P < 0.001) and (7.5% vs. 25%) (P < 0.05), respectively. However, in Group ML, this beneficial effect was associated with higher incidence of sinus bradycardia (72.5% vs. 17.5%) and hence pacing needs (22.5% vs. 0.0%) when compared with control group.ConclusionOur study concluded that, during on-pump CABG surgery, the combined administration of magnesium and lidocaine as a bolus dose starting after intubation followed by continuous infusion reduced the incidence of reperfusion VF by 62% and post-CPB ventricular arrhythmias by 70% on expense of increased the incidence of sinus bradycardia and pacing.     

Levobupivacaine patient controlled analgesia: Epidural versus blind fascia iliaca compartment analgesia – A comparative study

This study was designed to compare the analgesic efficacy of levobupivacaine patient controlled analgesia epidural versus patient controlled analgesia with fascia lliaca compartment block. In patients undergoing fixation of fracture neck femur.MethodsSixty patients ASA II&III undergoing fixation of fracture neck femur were randomly allocated into two groups (n = 30).Group EEpidural group given levobupivacaine 0.25% 15 ml before induction of general anesthesia, followed by postoperative PCEA with levobupivacaine (0.125%).Group FFascia iliaca block group given levobupivacaine 0.25% 30 ml through the catheter before induction of general anesthesia, followed by postoperative patient controlled fascia illiaca analgesia with levobupivacaine (0.125%).Severity of postoperative pain at rest in 24 h using VAS, number of patients required additional analgesia (tramadol) in 24 h, doses of postoperative 24 h tramadol consumed, postoperative mean arterial blood pressure and heart rate were recorded.ResultsThe severity of postoperative pain was statistically significantly less in E group, number of patients required tramadol in 24 h were statistically significantly less in E group than F group, postoperative tramadol consumed was statistically significantly less in E group than F group.ConclusionPCEA with levobupivacaine (0.125%) was associated with satisfactory analgesia than patient controlled analgesia with fascia iliaca block in patients undergoing fixation of fracture neck femur.