Investigation of the effects of propofol/ketamine versus propofol/fentanyl on nausea-vomiting administered for sedation in children undergoing magnetic resonance imaging: a prospective randomized double-blinded study

Background/aim In this study, we aimed to compare the effects of propofol-ketamine and propofol-fentanyl sedations on post-procedure nausea-vomiting in children undergoing magnetic resonance imaging (MRI).Materials and methodsThis study included 100 pediatric patients (2–10 years old) who had propofol-ketamine and propofol-fentanyl for sedation to undergo MRI. The patients were divided into two groups, and sedation was performed through propofol-ketamine (Group K; n = 50) or propofol-fentanyl (Group F; n = 50). For sedation induction, intravenous (IV) bolus of 1.2 mg/kg propofol and 1 mg/kg ketamine were administered in Group K, IV bolus of 1.2 mg/kg propofol, and 1 µg/kg fentanyl in Group F. All patients received 0.5 mg/kg IV bolus propofol in additional doses when the Ramsay Sedation Score (RSS) was below 4 for maintenance. Perioperative heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate, and nausea-vomiting scores were recorded for each patient.Results There was no difference between the groups in terms of nausea incidences at the 1st hour. However, the rate of vomiting was significantly higher in Group K.ConclusionIn our study, we showed that the vomiting rate was higher in the 1st hour in Group K compared to Group F.     

靶控输注丙泊酚及咪唑安定镇静对记忆的影响

目的 观察靶控输注丙泊酚、咪唑安定镇静对记忆的影响.方法 选择40例男性志愿者,年龄20～40岁,随机均分为4组,采用血浆靶控输注的方式,1组、3组输注丙泊酚,2组、4组输注咪唑安定,将镇静深度控制在OAA/S1级或3级,分别在清醒及达到预期镇静深度时听词汇,苏醒后使用词干补笔法和加工分离程序计算外显记忆及内隐记忆得分.结果 四组外显记忆与0比较无差异,3、4组内隐记忆大于0(P＜0.05),而1、2组内隐记忆与0比较无差异.结论 在靶控输注药物镇静时,随着镇静的加深,记忆逐渐消失,两种药物在相同镇静深度下对于记忆的影响相同.     

Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Purpose

Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications.

Materials and Methods

A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer''s Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded.

Results

The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications.

Conclusion

BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.     

Pharmacodynamic Estimate of Propofol-Induced Sedation and Airway Obstruction Effects in Obstructive Sleep Apnea-Hypopnea Syndrome

Purpose

Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS.

Materials and Methods

In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer''s Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software.

Results

Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce_50(m) (Ce associated with 50% probability of an effect≥m) for sedation scores (m≥2, 3, 4, and 5) and airway-obstruction scores (m≥2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 µg/mL and 1.53, 1.64, and 2.09 µg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce₅₀₍₄₎ for airway obstruction significantly improved the performance of the basic model (p<0.05).

Conclusion

The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.     

A comparison of different proportions of a ketamine-propofol mixture administered in a single injection for patients undergoing colonoscopy

Introduction

In this study, we aimed to determine the appropriate proportion of ketamine-propofol (ketofol), which was prepared in two different proportions for colonoscopy procedures.

Material and methods

This is a prospective and randomized trial. Group 1 was administered a mixture of 100 mg ketamine and 200 mg propofol. Group 2 was administered 50 mg ketamine and 200 mg propofol. Additional doses of 0.5 mg/kg bolus propofol without ketamine were administered to both groups to stabilize the bispectral index at 70–80 and with a Ramsey sedation score of 3–4. The pulse rate, mean arterial pressure (MAP), peripheral oxygen saturation values, colonoscopy period, adverse events, recovery time, discharge time, additional propofol doses, total propofol doses, colonoscopist and patient satisfaction were recorded.

Results

In group 2, the 1 min MAP mean was significantly lower than the initial, 10, 15 and 20 min MAP means (p = 0.014, p = 0.002). The 20 min PR mean of group 2 was statistically significantly higher than group 1 (p = 0.045). The 15 min PR mean of group 2 was significantly lower than the initial and the 1 min PR means (p = 0.023, p = 0.006). The total propofol dose mean of group 2 was significantly higher than group 1 (p = 0.0001). The presence of adverse events in group 2 was significantly lower than that in group 1 (p = 0.0001). The mean colonoscopist satisfaction in group 2 was significantly lower than that in group 1 (p = 0.047).

Conclusions

In colonoscopy, a ketofol mixture prepared in the proportion 1 : 2 provides appropriate hemodynamic conditions and sufficient sedation.     

Effect of mother's voice on neonatal respiratory activity and EEG delta amplitude

While the influence of the mother's voice on neonatal heart‐rate response and its relevant activity on cerebral cortex and the autonomic nervous system (ANS) are well known, few studies have assessed its influence on respiratory activity. We investigated the relationship among the respiration rate, the delta wave amplitudes through electroencephalography, and the basal state of ANS through the respiratory variability index while 22 full‐term neonates hear their mother's voice and an unknown voice. It was found that when respiratory variability was large, a transient (<5 s) change in respiration rates was observed in response to an unknown voice, while a greater increase in the delta wave amplitude was observed in the frontal lobe than the parietal one in response to the mother's voice. Conversely, when respiratory variability was small, a sustained increase (>10 s) in respiration rates was observed in response to the mother's voice, while a greater increase in the delta wave amplitude was found in both the frontal and parietal lobes. These results suggest that the basal state of ANS influences the latency of increases in respiration rates. Furthermore, induced by the mother's voice, transient increases in respiration rates are reduced in association with frontal lobe activity, and sustained increases in respiration rates are promoted in association with frontal and parietal lobe activities.     

Procedural Sedation for Pediatric Upper Gastrointestinal Endoscopy in Korea

BackgroundSedative upper endoscopy is similar in pediatrics and adults, but it is characteristically more likely to lead to respiratory failure. Although recommended guidelines for pediatric procedural sedation are available within South Korea and internationally, Korean pediatric endoscopists use different drugs, either alone or in combination, in practice. Efforts are being made to minimize the risk of sedation while avoiding procedural challenges. The purpose of this study was to collect and analyze data on the sedation methods used by Korean pediatric endoscopists to help physicians perform pediatric sedative upper endoscopy (PSUE).MethodsThe PSUE procedures performed in 15 Korean pediatric gastrointestinal endoscopic units within a year were analyzed. Drugs used for sedation were grouped according to the method of use, and the depth of sedation was evaluated based on the Ramsay scores. The procedures and their complications were also assessed.ResultsIn total, 734 patients who underwent PSUE were included. Sedation and monitoring were performed by an anesthesiologist at one of the institutions. The sedative procedures were performed by a pediatric endoscopist at the other 14 institutions. Regarding the number of assistants present during the procedures, 36.6% of procedures had one assistant, 38.8% had 2 assistants, and 24.5% had 3 assistants. The average age of the patients was 11.6 years old. Of the patients, 19.8% had underlying diseases, 10.0% were taking medications such as epilepsy drugs, and 1.0% had snoring or sleep apnea history. The average duration of the procedures was 5.2 minutes. The subjects were divided into 5 groups as follows: 1) midazolam + propofol + ketamine (M + P + K): n = 18, average dose of 0.03 + 2.4 + 0.5 mg/kg; 2) M + P: n = 206, average dose of 0.06 + 2.1 mg/kg; 3) M + K: n = 267, average dose of 0.09 + 0.69 mg/kg; 4) continuous P infusion for 20 minutes: n = 15, average dose of 6.6 mg/kg; 5) M: n = 228, average dose of 0.11 mg/kg. The average Ramsay score for the five groups was 3.7, with significant differences between the groups (P < 0.001). Regarding the adverse effects, desaturation and increased oxygen supply were most prevalent in the M + K group. Decreases and increases in blood pressure were most prevalent in the M + P + K group, and bag-mask ventilation was most used in the M + K group. There were no reported incidents of intubation or cardiopulmonary resuscitation. A decrease in oxygen saturation was observed in 37 of 734 patients, and it significantly increased in young patients (P = 0.001) and when ketamine was used (P = 0.014). Oxygen saturation was also correlated with dosage (P = 0.037). The use of ketamine (P < 0.001) and propofol (P < 0.001) were identified as factors affecting the Ramsay score in the logistic regression analysis.ConclusionAlthough the drug use by Korean pediatric endoscopists followed the recommended guidelines to an extent, it was apparent that they combined the drugs or reduced the doses depending on the patient characteristics to reduce the likelihood of respiratory failure. Inducing deep sedation facilitates comfort during the procedure, but it also leads to a higher risk of complications.     

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

OBJECTIVE:

Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy.

MATERIALS AND METHODS:

Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated.

RESULTS:

The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K.

CONCLUSION:

Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period.     

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

AimTo evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery.MethodsPatients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis.ResultsThe level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon''s, anesthesiologist''s, and patients'' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range.ConclusionsFor patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone.Clinical trial number{"type":"clinical-trial","attrs":{"text":"NCT 03251222","term_id":"NCT03251222"}}NCT 03251222

Conscious sedation is an established anesthetic method of choice in patients undergoing short ophthalmic procedures and has been used successfully for many years. In Slovenia, there is also a published protocol in use for such cases (1).Intravenous (i.v.) remifentanil is used for analgesic and sedative purposes. It is a short-acting opioid analgesic with partial anxiolytic action that has been thoroughly studied in obstetric analgesia (2).The fine intra-ocular endoscopic technique is implemented in vitrectomies. Surgical instruments are inserted into the vitreous humor through the sclera by a surgeon. Patient cooperation is crucial during the procedure, meaning the level of sedation should not be too deep. Otherwise, sudden eye movements could potentially result in eye injury (3). For many ophthalmic surgeons, local anesthesia (LA) has become preferred over general anesthesia (GA) because of quicker patient rehabilitation and avoidance of possible complications from GA (4). Several methods of LA have been described for vitreoretinal cases, including retrobulbar, peribulbar, sub-Tenon’s, and even topical anesthesia (5). Many drugs have been used for sedation during eye surgery, such as propofol, benzodiazepines, and opioids, and there is a relative risk of oversedation, disorientation, and confusion, in addition to an increased risk of respiratory depression and oxygen desaturation (5,6). All of these adverse effects can hamper patient cooperation during surgery and make these agents less than ideal for intraoperative management of sedation. As a result, sedatives and anxiolytics with unpredictable dose requirements, such as propofol and midazolam, are not optimal for such procedures.In contrast, dexmedetomidine is a highly selective alpha-2-adrenoreceptor agonist with both sedative and analgesic properties and is not associated with respiratory depressant effects. Dexmedetomidine has been studied for its sedation- and analgesia-sparing properties in intensive care and surgical settings (eg, neurosurgery, maxillofacial surgery, ENT surgery) but not in vitreoretinal surgery (7-9).Dexmedetomidine is mainly administered intravenously. Although intranasal (i.n.) dexmedetomidine is still used off-label, recently an increasing consensus has emerged for its different uses, namely, in non-painful diagnostic procedures, in painful procedures, and in surgical premedication. Some studies have been published regarding this form of use in the pediatric population (10-12). However, at present, there is no consensus regarding indications, dosage, and timing for administration. Available pediatric evidence confirms the efficacy and safety of dexmedetomidine for i.n. administration. The reported dose for pediatric procedures performed under sedation ranges from 2.5 to 4 μg/kg i.n. Onset of action is expected to be slower (25-30-minute) with low doses (1-2 μg/kg) and faster (16.7-28-minute) with higher doses (2.5-3 μg/kg), while offset time is similar in both – 85-minute in average; range 55-100 minutes (13).The aim of our study was to evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon''s and patients'' satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery. We conducted an applied research study that produced objective indicators, showing which type of sedation was more comfortable for patients and more effective in terms of achieving the desired sedation and reducing pain during vitreoretinal procedures with fewer side effects.     

Comparison of the effects of dexmedetomidine and propofol on hypothermia in patients under spinal anesthesia: a prospective,randomized, and controlled trial

Background: Redistribution hypothermia caused by vasodilation during anesthesia is the primary cause of perioperative hypothermia. Propofol exerts a dose-dependent vasodilatory effect, whereas dexmedetomidine induces peripheral vasoconstriction at high plasma concentrations. This study compared the effects of dexmedetomidine and propofol on core temperature in patients undergoing surgery under spinal anesthesia.Methods: This prospective study included 40 patients (aged 19-70 years) with American Society of Anesthesiologists Physical Status class I-III who underwent elective orthopedic lower-limb surgery under spinal anesthesia. Patients were randomly allocated to a dexmedetomidine or propofol group (n = 20 per group). After induction of spinal anesthesia, patients received dexmedetomidine (loading dose: 1 μg/kg over 10 min; maintenance dose: 0.2-0.7 μg/kg/h) or propofol (loading dose: 75 μg/kg over 10 min; maintenance dose: 12.5-75 μg/kg/min). The doses of sedatives were titrated to maintain moderate sedation. During the perioperative period, tympanic temperatures, thermal comfort score, and shivering grade were recorded.Results: Core temperature at the end of surgery did not differ significantly between the groups (36.4 ± 0.4 and 36.1 ± 0.7°C in the dexmedetomidine and propofol groups, respectively; P = 0.118). The lowest perioperative temperature, incidence and severity of perioperative hypothermia, thermal comfort score, and shivering grade did not differ significantly between the groups (all P > 0.05).Conclusions: In patients undergoing spinal anesthesia with moderate sedation, the effect of dexmedetomidine on patients'' core temperature was similar to that of propofol.     

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes

BackgroundSedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.MethodsA retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.ResultsThe cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.ConclusionSedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.     

Obesity risk factors in a representative group of Polish prepubertal children

Introduction

The study aim was to evaluate risk factors of obesity in Polish children aged 7 to 9 years.

Material and methods

A representative group of 2571 children (1268 girls and 1303 boys) was randomly selected according to the European Childhood Obesity Group protocol. Weight and height were measured and body mass index (BMI) was calculated. A questionnaire was completed by the children''s parents with respect to behavioural and family-related risk factors of obesity. International Obesity Task Force criteria were used for classification of children''s obesity.

Results

Obesity was found in 3.7% of girls and 3.6% of boys. There was a statistically significant association between the prevalence of obesity in girls and their mother''s obesity: OR = 5.06 (1.96–13.05), p < 0.001, father''s obesity: OR = 5.19 (1.96–13.69), p < 0.001, and both parents’ obesity: OR = 5.43 (1.39–21.29), p = 0.01. Obesity in boys was significantly associated with mother''s obesity: OR = 5.6 (2.6–12.02), p < 0.001, father''s obesity: OR = 6.21 (2.89–13.37), p < 0.001, and both parents’ obesity: OR = 7.22 (2.44–31.33), p < 0.001. Skipping or irregular eating of breakfast was a risk factor for obesity in girls with OR = 2.71 (1.33–5.51), p = 0.005. Neither family income nor parents’ education level was related to their offspring''s obesity. TV watching, physical activity level and eating in fast food places were not significant risk factors for obesity.

Conclusions

Eating breakfast regularly seems to protect girls from obesity development while low physical activity is not a significant obesity risk factor in this age group for either boys or girls. This finding stresses the more important role of healthy diet than physical activity promotion in obesity prevention in prepubertal children.     

MR-compatible pumps versus manual titration of propofol for pediatric sedation

This study aimed to review the use of two methods of propofol infusion: a metred burette system where propofol is diluted in Lactated Ringer using the rule of six [] or an infusion pump: Medrad Continuum Magnetic resonance (MR) compatible Infusion System (Medrad Inc. Indianola, PA) and to determine the difference, if any, between the total amount of drug delivered, the impact on vital signs, sedation status and discharge time of the patients. With Institutional Review Board (IRB) approval, 140 children aged 0 to 18 years, American Society of Anesthesiologists (ASA) physical status I or II requiring sedation for elective outpatient brain Magnetic Resonance Imaging (MRI) examination were included in the study. A total of 70 patients in each group were studied. The (Mean?±?S.D.) total amount of propofol infused was significantly less in the infusion pump group (12.47?±?7.67 mg/kg) than the metred burette system (15.84?±?16.13 mg/kg, p?=?0.003). There were also significant mean differences in awakening times (26.63?±?16.35 vs. 37.06?±?20.98?min, p?=?0.006), and discharge times (53.46?±?21.12 vs. 67.89?±?26.84?min, p?=?0.008) in the infusion pump group versus the buretrol infusion group. This study demonstrates that both infusion techniques preserve haemodynamic stability and are associated with minimal complications. The use of an infusion pump, which consistently maintains accurate dosing, reduces the amount of propofol judged adequate by the anaesthesiologist to achieve sedation in MRI. This leads to a more consistently faster emergence and early discharge after sedation in children undergoing MRI studies.     

Comparison of post-operative ICU sedation between dexmedetomidine and propofol in Indian population

Context:

Critically ill patients requiring mechanical ventilation frequently need sedatives and analgesics to facilitate their care. Dexmedetomidine, a short-acting alpha-2-agonist, possesses anxiolytic, anesthetic, hypnotic, and analgesic properties.

Aims:

The objective of this study was to evaluate the efficacy and safety of dexmedetomidine in comparison to propofol in the management of sedation for post-operative intensive care unit (ICU) patients, as a sedative agent.

Settings and Design:

Teaching hospital, A phase III, prospective, open, randomized and comparative.

Materials and Methods:

Thirty patients who were ambulatory and who required the post-operative mechanical ventilation or post-operative sedation were enrolled, in which 15 patients received Dexmedetomidine and remaining 15 patients received propofol. All these patients were treated for the period of 8 to 24 h.

Statistical Analysis Used:

Data were analyzed using Student''s t-test and Chi-square test. The value of P < 0.05 was considered as statistically significant.

Results:

Demographic data were comparable. Pulse rate, respiratory rate and blood pressure were comparable. Depth of sedation and extubation time were similar. To maintain analgesia throughout the study period, patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine.

Conclusions:

Dexmedetomidine appears to be a safe and acceptable ICU sedative agent when both the clinician''s and patient''s perspectives are considered.     

Comparative analysis of the efficacy and safety of herbal decoction CheReCunJin alone and combined with hydroxychloroquine for treating primary Sjögren's syndrome: A randomized controlled trial

IntroductionThere is currently no established effective treatment for primary Sjögren's syndrome (pSS). Traditional Chinese Medicine (TCM) is widely used in China and is reported to improve patient symptoms. This study compare the clinical efficacy and safety of herbal decoction CheReCunJin alone and combined with hydroxychloroquine for the treatment of pSS.MethodsSeventy pSS patients without visceral involvement were randomly assigned in equal numbers to oral administration of CheReCunJin decoction only (group 1) or CheReCunJin decoction combined with hydroxychloroquine (group 2), Efficacy was evaluated after 3 months of treatment by the TCM syndrome and total effectiveness scores, European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI), and Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer's test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and immunoglobulin G (IgG) levels. Safety was assessed.ResultsThere were no differences in the baseline characteristics of the two groups. Compared with baseline values, the TCM syndrome, ESSPRI and ESSDAI scores, ESR, CRP, and Schirmer's test results improved significantly in both groups after treatment (p < 0.05). There was no significant difference in the TCM syndrome total effectiveness rate between the two groups (p = 0.31). Between-group differences in the changes in ESSPRI, ESSDAI, ESR, CRP, Schirmer's test, and IgG after treatment were not significant (all p> 0.05). Adverse reactions were reported in 5.88% of group 1 and 3.33% of group 2 participants (p = 0.83).ConclusionCheReCunJin decoction alone was effective and safe for the treatment of pSS.Trial registrationChinese Clinical Trial Registry: ChiCTR1800016471     

A cross-cultural randomized pilot trial of western-based and five elements music therapy for psychological well-being

BackgroundMusic therapy and culture are interconnected. It is unclear whether the therapeutic effects of music can be exerted in diverse cultural contexts. Both Western-based and Chinese Five elements music therapy (FEMT) have shown effectiveness in improving the perception of stress, anxiety and depression in their respective cultures. FEMT is a commonly used traditional Chinese Medicine approach; however, it has not been investigated with non-Chinese participants.PurposeTo investigate the impact of FEMT and of Western-based music therapy on stress and related outcomes and explore cross-cultural comparisons in participants from Chinese and Canadian contexts.MethodsThis pre-post randomized controlled study was conducted with 35 participants, 23 from Canada and 12 from China. Participants from the two cultural groups were randomly divided into two groups: a FEMT group (n = 20), a western art music therapy (WAMT) group (n = 15). The main outcome was self-rated stress, evaluated by a 10-point numeric rating question. Secondary outcomes included anxiety/depression (Hospital Anxiety and Depression Scale (HADS), pulse rate and qualitative comments. Cross-sectional, pre-post and longitudinal comparisons were pursued.ResultsWe observed comparable effects of FEMT and WAMT in both the Chinese and Canadian samples. There was a statistically significant decrease in self-rated stress over time, especially after the conclusion of the four-week music therapy intervention (p = 0.001), regardless of type of music therapy, and in both cultural contexts. We observed a statistically significant decrease in anxiety and depression scores in the FEMT group only (p<0.001), but no effect on pulse rate.ConclusionThis is the first study to report evidence of feasibility, acceptability and effectiveness of FEMT in non-Chinese participants. Further investigation of the observed differences is warranted.     

Effect of Hypericum perforatum on intraperitoneal adhesion formation in rats

Introduction

The aim of this study was to evaluate the efficacy of Hypericum perforatum for prevention of adhesion formation in rats.

Material and methods

Twenty-four female wistar rats underwent left uterine horn adhesion model. Rats were randomised into 4 groups. Group 1 (Control): Closure of abdominal incision without any agent administration. Group 2: Closure of incision after administration of intraperitoneal (i.p.) Ringer''s lactate solution. Group 3: Closure of incision after administration of i.p. olive oil (diluent of H. perforatum). Group 4: Hypericum perforatum extract (Ecodab^®) was administered i.p. before the closure of incision. Fourteen days later, relaparatomy was performed and surgical adhesion scores, inflammation and fibrosis scores were noted. Groups were compared according to these scores.

Results

There was statistical significant difference between ringer''s lactate group and olive oil group according to surgical adhesion score (p = 0.009). However, groups were not different according to inflammation and fibrosis scores (p > 0.05).

Conclusions

Despite antiinflammatory, antioxidants and antimicrobial properties of H. perforatum, our results revealed no positive effect of H. perforatum on the prevention of intraperitoneal adhesion formation.     

The effects of conventional,warm and cold acupressure on the pain perceptions and beta-endorphin plasma levels of primiparous women in labor: A randomized controlled trial

ObjectiveThis study was performed to determine the impact of different acupressure procedures, performed on women's hands during labor, on β-endorphin plasma levels and labor pain perception.DesignRandomized controlled experimental trialSetting and ParticipantsThis study was conducted with 140 pregnant women in the delivery rooms of a university research and training hospital and a state hospital in a province in the Black Sea Region of Turkey.MethodsThis study was conducted with three experimental groups (who had conventional, warm and cold acupressure on their LI4 acupressure point) and one control group (no acupressure). Each group included 35 pregnant women. The data were collected using a personal information form, the Labor Intervention Follow-up Form, the Visual Analog Scale (VAS) and the Verbal Category Scale (VCS). Its main outcomes were the women's labor pain perceptions and β-endorphin plasma levels.ResultsThe experimental and control groups had homogeneous introductory characteristics. The experimental groups had significantly higher mean VAS and VCS posttest scores than the control group (p<0.001). The experimental groups’ mean posttest β-endorphin plasma levels were also significantly higher (p<0.05).ConclusionIn this study, conventional, warm and cold acupressure reduced the women's labor pain and increased their β-endorphin plasma levels. Midwives can use acupressure to reduce labor pain.     

A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block

BackgroundCurrent literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge.PurposeThe aim of this study is to answer the research question is there a difference in clinical outcomes between the use of a femoral nerve block with spinal anesthesia versus spinal analgesia alone for people undergoing ACL reconstruction?MethodsACL reconstruction with spinal anesthesia and patient sedation (Group one); and spinal anesthesia with patient sedation and an additional femoral nerve block (Group two). Patients were re-evaluated for pain, range of motion (ROM), active contraction of the quadriceps, and a Functional Independence Measure (FIM) scoring scale.ResultsSpinal anesthesia with a femoral nerve block demonstrates pain relief 6 h after surgery (VAS 0.37; p = 0.007). From the third (VAS = 4.56; p = 0.028) to the seventh (VAS = 2.87; p = 0.05) days after surgery, this same nerve blockage delivered higher pain scores. Patients had a similar progressive improvement on knee joint range of motion with or without femoral nerve block (p < 0.002). Group one and two had 23.75 and 24.29° 6 h after surgery and 87.81 and 85.36° of knee flexion after 48 h post op.ConclusionSpinal anesthesia associated with a femoral nerve block had no additional benefits on pain control after the third postoperative day. There were no differences between groups concerning ability for knee flexion and to complete daily activities during postoperative period.Level of EvidenceRandomized Clinical Trial Level I.