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ABSTRACT: The aim of this study was to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for deep sedation and analgesia during pediatric burn wound dressing changes. After obtaining approval from the University Ethics Committee, burn wound care or wound dressing changes were performed on 60 ASA physical status I and II inpatients aged between 8 and 60 months with second-degree burns ranging from 5 to 25% TBSA. After recording the demographic data, the heart rate, systolic arterial pressure, diastolic arterial pressure, peripheral oxygen saturation, respiratory rate, and Ramsey sedation scores were recorded for all patients before and during the procedure. Group KP (n = 30) received 1 mg kg-1 ketamine + 1 mg kg propofol and group KD (n = 30) received 1 mg kg ketamine + 0.5 μg kg-1 dexmedetomidine for induction. Additional propofol (1 mg kg) for group KP and additional dexmedetomidine (0.5 μg kg) for group KD were administered when required. No statistically significant differences in sedation scores and peripheral oxygen saturation and diastolic arterial pressure (P > .05) were found between the two groups. However, systolic blood pressure values in group KD showed a significant increase after induction (P < .05). The recovery time was longer in group KD than in group KP (P > .05). The respiratory rate was higher in group KD than in group KP beginning from the fifth minute of the procedure. A significant amount of respiratory depression and hypoxia was observed in group KP but not in KD (P < .05). Both the KP and KD combinations were effective for sedation and analgesia during dressing changes in the pediatric burn patients. The KD combination can be considered as an excellent alternative for pediatric wound dressing changes which does not result in respiratory depression.
Journal of burn care & research: official publication of the American Burn Association 08/2012; · 1.37 Impact Factor
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ABSTRACT: Pediatric patients undergoing cardiac catheterization usually need deep sedation. In this study, 60 children were randomly allocated to receive sedation with either a ketamine-propofol combination (KP group, n = 30) or a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction of sedation, and the KPD group received an additional 1 μg/kg of dexmedetomidine infusion during 5 min for induction of sedation and a maintenance infusion of 0.5 μg/kg/h. In both groups, 0.2 mg/kg of propofol was administered as a bolus to maintain a Ramsey sedation score (RSS) greater than 4 throughout the procedure. None of the patients in either group required intubation. In the KP group, one patient required mask ventilation. The chin-lift maneuver needed to be performed for eight patients in the KP group and one patient in the KPD group (p < 0.05). Adding dexmedetomidine to the ketamine-propofol combination decreased movement during the procedures. The heart rate in the KPD group was significantly lower after induction of sedation and throughout the procedure (p < 0.05). No significant differences in systolic blood pressure, diastolic blood pressure, or respiration rates were found between the two groups (p > 0.05). The mean recovery time was longer in the KP group (5.86 vs 3.13 min; p < 0.05). Adding dexmedetomidine to a ketamine-propofol combination led to a reduced need for airway intervention and to decreased movement during local anesthetic infiltration and throughout the procedure. The recovery time was shorter and hemodynamic stability good in the KPD group.
Pediatric Cardiology 02/2012; 33(5):770-4. · 1.30 Impact Factor
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ABSTRACT: Dexmedetomidine, an α(2)-receptor agonist, provides sedation, analgesia, and anxiolytic effects, and these properties make it a potentially useful anesthetic premedication. In this study, we compared the effects of intranasal dexmedetomidine and midazolam on mask induction and preoperative sedation in pediatric patients.
Ninety children classified as ASA physical status I, aged between 2 and 9, who were scheduled to undergo an elective adenotonsillectomy, were enrolled for a prospective, randomized, and double-blind controlled trial. All of the children received intranasal medication approximately 45-60 min before the induction of anesthesia. Group M (n = 45) received 0.2 mg·kg(-1) of intranasal midazolam, and Group D (n = 45) received 1 μg·kg(-1) of intranasal dexmedetomidine. All of the patients were anesthetized with nitrous oxide, oxygen, and sevoflurane, administered via a face mask. The primary end point was satisfactory mask induction, and the secondary end points included satisfactory sedation upon separation from parents, hemodynamic change, postoperative analgesia, and agitation score at emergence.
Satisfactory mask induction was achieved by 82.2% of Group M and 60% of Group D (P = 0.01). There was no evidence of a difference between the groups in either sedation score (P = 0.36) or anxiety score (P = 0.56) upon separation from parents. The number of patients who required postoperative analgesia was higher in the midazolam group (P = 0.045).
Intranasal dexmedetomidine and midazolam are equally effective in decreasing anxiety upon separation from parents; however, midazolam is superior in providing satisfactory conditions during mask induction.
Pediatric Anesthesia 01/2012; 22(9):871-6. · 2.10 Impact Factor
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ABSTRACT: Intraoperative penile erections following the initiation of either regional or general anaesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel the planned surgery. The aetiology is unclear. Various treatments proposed for producing detumescence are not always effective. Use of intracavernous alpha-adrenergic agonists is an efficient and rapid but short-lasting treatment. Furthermore, repeated intracavernous injections of vasoactive drugs may be harmful. Dexmedetomidine is a potent, selective α(2)-adrenoreceptor agonist. In our study, we evaluated the effect of dexmedetomidine on intraoperative penile erection.
Penile erection developed during an endoscopic procedure in 12 more than 7,800 patients. Anaesthesia used was general in 3 patients, epidural in 1 patient and spinal in 8 patients. The erection rigidity was evaluated by the operating urologist. Dexmedetomidine was diluted in normal saline to a concentration of 4 μg/ml. In all of the cases, 0.5 μg/kg dexmedetomidine was injected intravenously.
The incidence of intraoperative penile erection was 0.34% for general anaesthesia, 0.11% spinal anaesthesia and 1.72% epidural anaesthesia at our institution. Detumescence was achieved in 9 patients during the first 5 min and in one patient at the 9th minute after a single intravenous dexmedetomidine (83%). There was no detumescence in two patients after 15 min (17%).
This study demonstrated that 0.5 μg/kg intravenous injection of dexmedetomidine is a simple, effective and safe method for immediate relief of intraoperative penile erection with high success rate.
International Urology and Nephrology 06/2011; 44(2):353-7. · 1.47 Impact Factor
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ABSTRACT: When electroencephalogram (EEG) activity is recorded for diagnostic purposes, the effects of sedative drugs on EEG activity should be minimal. This study compares the sedative efficacy and EEG effects of dexmedetomidine and midazolam.
EEG recordings of 60 pediatric subjects with a history of simple febrile convulsions were performed during physiologic sleep. All of these patients required sedation to obtain follow-up (control) EEGs. Subjects in Group D received 0.5 μg·kg(-1) of dexmedetomidine, and those in Group M received 0.1 mg·kg(-1) of midazolam. For rescue sedation, the same doses were repeated to maintain a Ramsey sedation score level of between 4 and 6.
The mean doses that were required for sedation were 0.76 μg·kg(-1) of dexmedetomidine and 0.38 mg·kg(-1) of midazolam. Diastolic blood pressure and HR were lower in Group D than in Group M (P < 0.05). Hypoxia was observed in 11 (36.7%) subjects in Group M and none in Group D; this was statistically significant (P < 0.001). Frontal and parieto-occipital (PO) EEG frequencies were similar during physiologic sleep and dexmedetomidine sedation. However, EEG frequencies in these areas (P < 0.001) and PO EEG amplitude (P = 0.030) were greater during midazolam sedation than during physiologic sleep.
Dexmedetomidine is a suitable agent to provide sedation for EEG recording in children. There is less change in EEG peak frequency and amplitude after dexmedetomidine than after midazolam sedation.
Pediatric Anesthesia 04/2011; 21(4):373-8. · 2.10 Impact Factor
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ABSTRACT: Postoperative vomiting is a common complication after strabismus surgery in children. The serotonin 5-HT(3) receptor antagonists have proven to be a particularly valuable addition to the armamentarium against postoperative nausea and vomiting (PONV). Palonosetron is a second-generation 5-HT(3) receptor antagonist that has recently been approved for prophylaxis against PONV.
The aim of this study was to evaluate the efficacy of different doses of palonosetron for the prevention of PONV in children undergoing strabismus surgery.
A total of 150 children who were classified with an American Society of Anesthesiologists physical status of I, were aged between 2 and 12 years, and were undergoing strabismus surgery under general anesthesia were enrolled in the study. A random numbers table was used to assign each child to receive palonosetron 0.5, 1.0, or 1.5 μg/kg (n = 50 in each group). All episodes of PONV at the intervals of 0-2, 2-6, 6-24, and 24-48 hours were evaluated using a numeric scoring system for PONV. A p-value of <0.05 was considered statistically significant.
The percentage of children with PONV during 0-48 hours after anesthesia was 24% with palonosetron 0.5 or 1.0 μg/kg, and 20% with palonosetron 1.5 μg/kg. There was no statistically significant difference between the study groups with respect to the number of children with PONV scores of 1, 2, or 3 during 0-48 hours after anesthesia. There was no statistically significant difference between the study groups with respect to the number of children with postoperative vomiting during all time periods after anesthesia. The percentage of children aged >6 years with postoperative nausea during 0-48 hours after anesthesia was 8.6%, 18.2%, and 15.4% with palonosetron 0.5, 1.0, or 1.5 μg/kg, respectively, but there was no statistically significant difference between the study groups.
Palonosetron doses of 0.5, 1.0, and 1.5 μg/kg are recommended for further evaluation, as they appear to be the effective doses for the prevention of PONV following strabismus surgery in children.
Drugs in R&D. 01/2011; 11(1):29-36.
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ABSTRACT: Clonidine is used increasingly in pediatric anesthesia practice to prolong the duration of action of caudal block with a local anesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine.
Sixty ASA I and II children, aged 2-8 undergoing inguinal hernia repair or orchidopexy surgery received standardized premedication with midazolam and general anesthesia. The children were randomized in a double-blind fashion to three groups. Group L (n = 20) patients received 0.75 ml x kg(-1) of caudal 0.25% levobupivacaine and i.v. 5 ml saline, Group L-Ccau (n = 20) patients received 0.75 ml x kg(-1) of caudal 0.25% levobupivacaine + 2 microg x kg(-1) clonidine and i.v. 5 ml saline, Group L-Civ (n = 20) patients received 0.75 ml x kg(-1) of caudal 0.25% levobupivacaine and i.v. 2 microg x kg(-1) clonidine in 5 ml of saline. Mean arterial blood pressure, heart rate, peripheral oxygen saturation, and end-tidal carbon dioxide values were recorded. Postoperative pain [Children and Infants Postoperative Pain Scale (CHIPPS) score], sedation (Ramsay Sedation Scale) and motor blockade (Modified Bromage Scale) were assessed at predetermined time points during the first 24 h after surgery.
Caudal clonidine significantly delayed the time to first rescue analgesic and fewer patients required rescue analgesia in the 24 h after surgery. No motor block was observed in any of the three groups on awakening or during the study period. In Group L-Ccau, the CHIPPS score was lower than in Group L at all times through 240 min (P < 0.05), while the pain scores were lower in Group L-Civ only at extubation and at 240 min (P < 0.05).
Caudal clonidine prolongs the duration of analgesia produced by caudal levobupivacaine without causing significant side effects and this is because of a spinal mode of action.
Pediatric Anesthesia 02/2010; 20(4):350-5. · 2.10 Impact Factor
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ABSTRACT: BACKGROUND: Fentanyl-induced cough is common but has nor been viewed as a serious anesthetic problem. However, the cough may be explosive at times, may require immediate intervention, and may be associated with undesirable increases in intracranial, intraocular, and intra-abdominal pressures. Prevention of fentanyl-induced cough in such situations is of paramount importance. Ketamine, at concen-trations achieved with standard clinical doses, has a direct relaxant effect on airway smooth muscle. OBJECTIVE: This study was designed to assess the effects of ketarnine or lido-caine on fentanyl-induced cough. METHODS: This double-blind, randomized, placebo-controlled study was con-ducted at the Erciyes University Medical School, Kayseri, Turkey. Consecutive adult patients aged 18 to 65 years and classified as American Society of Anesthesiologists physical status I or II who were undergoing elective surgery with general anesthesia were enrolled. Patients were randomly allocated equally into 3 groups to receive lidocaine 1 mg/kg, ketamine 0.5 mg/kg, or placebo intravenously 1 minute before fentanyl administration. Following intravenous fentanyl (1.5 pg/kg over 2 seconds) injection, an observer, unaware of the type of medication given to the patients, recorded the number of episodes of coughing, if any. Any episode of cough was classified as cough-ing and graded by investigators blinded to treatment as mild (1-2 coughs), moderate (3-4), or severe (;~5). Blood pressure, heart rate, pulse oximetry oxygen saturation (SpOz)' and adverse effects (AEs) were recorded. RESULTS: A total of 368 patients were approached for inclusion; 300 patients met the inclusion criteria and were enrolled in the study. No patients in the ketamine group had cough. The frequency of cough was significantly lower in the lidocaine (11/100 [11 %}; P = 0.024) and ketamine (0/100; P = 0.001) groups compared with
Current Therapeutic Research Clin Exp. 01/2010; 71(5):289-297.
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ABSTRACT: Background: Injury of a peripheral nerve may lead to neuropathic pain, a form of chronic pain that does not respond to traditional pain therapies. The aim of this study was to investigate the effect of pulsed radiofrequency (PRF) applied to the L5 and L6 dorsal roots on the neuropathic pain that develops after sciatic nerve injury in rabbits.
Methods: In this study, 18 New Zealand rabbits were used. These were divided into 3 groups. In groups 1 and 2, the left sciatic nerve was tightly ligated as a partial ligation model with 4-0 silk sutures. Group 3 was a sham group. Pulsed radiofrequency was applied to group 1 rabbits on both dorsal roots at 42°C for 8 mins. The responses of all the groups to thermal and mechanical stimuli were measured for a period of 4 weeks after this process.
Results: Ten days after ligation of the left sciatic nerve and before PRF application, neuropathic pain occurred; the responses of groups 1 and 2 to the hot plate test and to the mechanical stimulus were lower (P < 0.005) when compared with the baseline values. There were no statistically significant differences between baseline values and group 1 rabbits' responses to the hot plate test 2 weeks after the application of PRF or to the mechanical stimulus 3 weeks after RF application. The decrease seen in group 2 persisted after 4 weeks (P < 0.001).
Conclusions: The hyperalgesia that develops as a result of neuropathic pain in rabbits was observed to be reduced by PRF application.
Regional Anesthesia and Pain Medicine 12/2009; 35(1):11-15. · 4.08 Impact Factor
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ABSTRACT: This study compares the effectiveness of midazolam and dexmedetomidine for the sedation of eclampsia patients admitted to our intensive care unit (ICU).
Forty women with eclampsia requiring termination of pregnancy by caesarean delivery were randomized in to 2 groups of 20 to receive either midazolam or dexmedetomidine. The midazolam group received a loading dose of 0.05 mg/kg followed by an infusion of 0.1 mg kg(-1) h(-1). The dexmedetomidine group loading dose was 1 microg/kg per 20 minutes, followed by continuous infusion at 0.7 microg kg(-1) h(-1). Heart rate, blood pressure, Ramsey sedation score, antihypertensive need, convulsion fits, and duration in ICU were monitored and recorded all through the ICU stay.
Dexmedetomidine markedly reduced heart rates for the first 24 hours (P < .05) compared with midazolam, but there were no differences at 48 and 72 hours. Mean arterial blood pressures were similar in the 2 groups (P > .05), although in the dexmedetomidine group, it was lower at 5, 6, 12, and 24 hours compared with the first 4 hours (P < .05). Moreover, fewer patients given dexmedetomidine required nitroglycerine and nitroprusside (P < .05). The duration of ICU stay was less in the dexmedetomidine group, 45.5 hours (range, 15-118 hours), than in the midazolam group, 83 hours (minimum-maximum, 15-312 hours).
Dexmedetomidine sedation in eclampsia patients is effective in reducing the demand for antihypertensive medicine and duration of ICU stay.
Journal of critical care 04/2009; 24(4):551-5. · 2.13 Impact Factor
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ABSTRACT: To investigate the use of 3 different doses of ropivacaine on the quality of anesthesia and hemodynamics in epidural anesthesia for transurethral surgery.
The current study was conducted in the Department of Anesthesiology, Medical Faculty of Erciyes University, Turkey, between May 2004 and June 2006. The study recruited 81 males of ASA I- II group, ages 60-80 years, undergoing transurethral resection of prostate or bladder tumors. Patients were randomly assigned to 3 groups receiving epidural ropivacaine in different doses and concentrations. Group I (n=27) received 15 ml (102.5mg) of 0.75% solution, group II (n=27) received 10 ml (75 mg) of 0.75% solution, and group III (n=27) received 10 ml (50mg) 0.5% ropivacaine. The quality of the blocks and the hemodynamic changes were compared.
Motor block was significantly less in group III than in groups I and II. The sensory block level was T6 or more in 55% of patients in group I, 35% in group II, and 21% in group III. The duration of sensory block was less, and the time to achieve the T10 level was greater in group III. Hypotension and bradycardia were more frequent in group I.
Effective anesthesia with few side effects was obtained with low dose ropivacaine.
Saudi medical journal 02/2009; 30(1):67-71. · 0.52 Impact Factor
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ABSTRACT: Oral ketamine has been found to be effective during invasive procedures in children with malignancy. To the best of our knowledge, analgesic effects of oral ketamine have not been reported in pediatric cancer pain management. We described a patient with end-stage cancer pain that was resistant to opioids and was relieved by oral ketamine.
Pain Medicine 04/2008; 10(1):120-1. · 2.35 Impact Factor
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ABSTRACT: The aim of this study was to compare the clinical efficacy and safety of propofol-ketamine with propofol-fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy (UGIE).
This was a prospective, randomized, double blinded comparison of propofol-ketamine with propofol-fentanyl for sedation in patients undergoing elective UGIE. Ninety ASA I-II, aged 1 to 16-year-old patients were included in the study. Heart rate (HR), systolic arterial pressure, peripheral oxygen saturation, respiratory rate (RR) and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either propofol-ketamine (PK; n = 46) or propofol-fentanyl (PF; n = 44). PK group received 1 mg x kg(-1) ketamine + 1.2 mg x kg(-1) propofol, and PF group received 1 microg x kg(-1) fentanyl + 1.2 mg x kg(-1) propofol for sedation induction. Additional propofol (0.5-1 mg x kg(-1)) was administered when a patient showed discomfort in either group.
The number of patients who needed additional propofol in the first minute after sedation induction was eight in Group PK (17%), and 22 in Group PF (50%) (P < 0.01) and those who did not need additional propofol throughout the endoscopy were 14 in Group PK (30%) and three in Group PF (7%) (P < 0.01). HR and RR values after induction in Group PF were significantly lower than Group PK (P < 0.01).
Both PK and PF combinations provided effective sedation in pediatric patients undergoing UGIE, but the PK combination resulted in stable hemodynamics and deeper sedation though more side effects.
Pediatric Anesthesia 11/2007; 17(10):983-8. · 2.10 Impact Factor
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ABSTRACT: The aim of this retrospective study is to evaluate the upper and the lower extremity amputations with regard to phantom pain, phantom sensation and stump pain. A questionnaire consisting of 23 questions was send to the patients who underwent upper or lower extremity amputation surgery between 1996- 2005. The patients were questioned for the presence of phantom pain and sensations and if they existed for the frequency, intensity, cause of amputation, pre-amputation pain, stump pain, usage of artificial limb. Totally 147 patients were included and the response rate was 70 %. The incidence of phantom pain in Upper Extremity Group was 60 % and 65.8% in Lower Extremity Group. The incidence of phantom sensations was 70.7% in Upper Extremity Group and 75.6% in Lower Extremity Group. There was no significant difference between two groups considering in phantom pain and phantom sensations. The phantom pain was significantly higher in patients who lost dominant hand, experienced pre amputation pain and suffered stump pain. There were no significant differences in regard to phantom pain and sensation between upper and lower extremity amputations. However the presence of preamputation pain, stump pain and amputation of dominant hand were found as risk factors for the development of phantom pain.
Agri: Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology 02/2007; 19(1):50-6.
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ABSTRACT: The purpose of this study was to compare the effects of fentanyl and remifentanil on splanchnic perfusion during coronary artery bypass graft (CABG) surgery. Fifty patients were randomized to receive either fentanyl (10 microgxkg(-1) at induction and 5 microgxkg(-1)xh(-1) infusion for maintenance) or remifentanil (3 microgxkg(-1) at induction and 1 microgxkg(-1)xmin(-1) infusion for maintenance). Patients in both groups were comparable with regard to demographics. Intraoperative volume management and inotropic therapy were similiar in both groups. Regarding heart rate, there were no significant differences between the groups at any measurement time (P > 0.05). Compared to the fentanyl group, the remifentanil group showed a significant decrease in mean arterial pressure during induction. Also, the gastric intramucosal CO(2) pressure (Pg(CO) (2)) and the P(CO) (2)-gap, defined as the difference between Pg(CO) (2) and Pa(CO) (2), were significantly increased and the gastric mucosal pH (pHi) was significantly decreased in the remifentanil group in the postinduction period (P < 0.05). However, there were no statistically significant differences in respiratory data at any time between the two groups (P > 0.05). Both fentanyl and remifentanil seemed to be effective and well tolerated in this CABG population. Episodes of hypotension and transient reduction in splanchnic perfusion were more common in patients treated with remifentanil when compared to those receiving the fentanyl opioid regimen.
Journal of Anesthesia 01/2007; 21(1):94-8. · 0.83 Impact Factor
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ABSTRACT: This study evaluates the effect of different doses of tropisetron to prevent postoperative vomiting, which frequently occurs in children following strabismus surgery.
One hundred twenty-five American Society of Anesthesiologists' classification (ASA) I-II group patients 2-12 years of age were randomized to this prospective, single-blind, placebo-controlled clinical study. Patients were placed in groups of 5 and did not receive any premedication. The first group received placebo, and the 2nd, 3rd, 4th, and 5th groups received 0.5 mg/m(2), 1 mg/m(2), 1.5 mg/m(2), and 2 mg/m(2) of tropisetron, respectively, following anesthesia induction. The same anesthetic technique and analgesia were used for all groups. The patients were examined for the presence of vomiting and for any complaints and side effects at 2, 6, and 24 hours after surgery.
The incidence of postoperative vomiting (POV) was statistically more significant in the placebo group at 2, 6 and 24 hours, when compared to the study groups (p< 0.001), but there was no significant difference among tropisetron groups at 6-24 hours (p>0.05). There was no significant difference in terms of the incidence of POV among the study groups (16%, 16%, 24%, 20% respectively) at all periods (p>0.05). The number of patients with POV score of 3 was 10 in the placebo group, while it was 1, 2, 0 and 1 in the 2nd, 3rd, 4th, and 5th groups, respectively (p<0.01).
Tropisetron (0.5, 1.0, 1.5 and 2.0 mg/m(2)) decreased the incidence and severity of POV following strabismus surgery in children. All of the doses seemed to be equally effective. There was no difference in POV control between placebo and any of the doses of the tropisetron after six hours. So we suggest that 0.5 mg/m(2) single-dose tropisetron is enough for preventing POV following strabismus surgery in children.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 12/2006; 73(8):1106-11. · 2.00 Impact Factor
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ABSTRACT: The purpose of this study was to compare the effects of dexmedetomidine-ketamine and propofol-ketamine combinations on hemodynamics, sedation level, and the recovery period in pediatric patients undergoing cardiac catheterization.
Prospective, randomized trial.
University hospital.
Children (n = 44) undergoing cardiac catheterization.
The dexmedetomidine plus ketamine group (group 1, n = 22) received an infusion over 10 minutes of 1 microg/kg of dexmedetomidine and ketamine, 1 mg/kg, as a bolus, for induction. The patients then received an infusion of 0.7 microg/kg/h of dexmedetomidine and 1 mg/kg/h of ketamine for maintenance. The propofol plus ketamine group (group 2, n = 22) received 1 mg/kg of propofol and 1 mg/kg of ketamine for induction. The patients received 100 microg/kg/min of propofol and 1 mg/kg/h of ketamine by infusion for maintenance. Additional doses of ketamine, 1 mg/kg, were administered when a patient showed discomfort in both groups.
Hemodynamic data, respiratory rate, bispectral index, and sedation scores were recorded after induction and every 15 minutes thereafter. The time to reach a Steward recovery score of 6 was recorded. The heart rate in group 1 was significantly lower (average 10-20 beats/min) than group 2 after induction and throughout the procedure. Ketamine consumption in group 1 was significantly more than in group 2 (2.03 mg/kg/h v 1.25 mg/kg/h) for maintenance (p < 0.01). The recovery time was also longer in group 1 than in group 2 (49.54 v 23.16 minutes, respectively; p < 0.01).
The dexmedetomidine-ketamine combination was not superior to a propofol-ketamine combination because of insufficient sedation and analgesia and a longer recovery time.
Journal of Cardiothoracic and Vascular Anesthesia 08/2006; 20(4):515-9. · 1.64 Impact Factor
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ABSTRACT: To determine the onset and regression time of motor and sensory block, and the quality of anesthesia and postoperative analgesia by the addition of cisatracurium to local anesthetic solution in small doses in intravenous regional anesthesia.
Prospective, randomized, double-blind study.
University hospital.
40 ASA physical status I and II patients undergoing elective hand surgery.
Intravenous regional anesthesia was achieved using 3 mg/kg lidocaine diluted with saline to a total volume of 40 mL in the control group or 0.01 mg/kg of cisatracurium plus 3 mg/kg lidocaine diluted with saline to a total volume of 40 mL in the cisatracurium group.
The onset and the regression time for sensory and motor block were recorded. Quality of anesthesia, intraoperative, and postoperative analgesic requirements were noted. Mean arterial pressure and heart rate were recorded every 5 minutes.
The onset time of sensory and motor block in the cisatracurium group was shorter than in the control group, and the difference was statistically significant. The quality of anesthesia was better in the cisatracurium group than in the control group, and the difference was statistically significant. There was no difference between the two groups with respect to sensory block regression time. Motor block regression time was statistically longer in the cisatracurium group than in the control group. Analgesic requirement was greater in the control group than in the cisatracurium group.
The addition of cisatracurium to lidocaine in intravenous regional anesthesia shortened the sensory and motor block onset times, improved the quality of anesthesia, and decreased analgesic requirements without causing clinical side effects.
Journal of Clinical Anesthesia 06/2006; 18(3):194-7. · 1.21 Impact Factor
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ABSTRACT: The objective of this retrospective study is to evaluate the effects of anesthesia type on phantom pain or sensation. A questionnaire of ten questions on phantom pain and sensation was sent by mail to patients who underwent lower extremity amputation surgery between 1996 and 2003 at Erciyes University Hospital. A total of 40 patients (age 51.0 ? 10.7 years, 80% male) who had general anesthesia and 27 patients (age 56.3 ? 14.0 years, 78% male) who had spinal anesthesia returned the questionnaire.Phantom pain incidences were defined as 33% in the spinal anesthesia group and 65% in the general anesthesia group and the difference was statistically significant. Phantom sensation incidences were 74% in the spinal anesthesia group and 77% in the general anesthesia group and the difference was not statistically significant. In conclusion, phantom pain incidence was lower in amputees treated with spinal anesthesia.
The Pain Clinic 03/2006; 18(2):187-193.
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ABSTRACT: To evaluate the efficacies of tropisetron and tropisetron-propofol combination in the prophylaxis for postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. (This combination has apparently not been previously investigated for this particular surgery and anesthesia.)
Prospective, randomized, double-blind study. One hundred five patients aged between 19 and 68 years were included in the study. Group T received 5 mg of tropisetron (tropisetron group. n=35), group TP (tropisetron-propofol group, n=35) received 5 mg of tropisetron and 0.5 mg/kg of propofol and group P (placebo group, n=35) received saline, immediately after anesthesia induction. The anesthesia induction regimen was applied to all patients, and anesthesia was maintained with 5-7% desflurane and 66% N 2 O in O 2 .
Group TP reported a lower incidence of postoperative nausea and vomiting (17%) than those in groups T and P (42.8% and 77%, respectively). The postoperative antiemetic requirements were significantly higher in the placebo group compared to the other two groups (p<0.05).
The tropisetron-propofol combination is more effective than tropisetron alone in the prevention of postoperative nausea and vomiting after thyroidectomy.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 03/2006; 73(2):560-3. · 2.00 Impact Factor
