The effect of pre-anesthetic administration of dexmedetomidine on the consumption of opioids in postoperative gynecologic patients

BACKGROUND: This study was designed to assess whether pre-anesthetic administration of dexmedetomidine reduces the postoperative consumption of opioids, in patients receiving patient-controlled fentanyl after gynecological laparotomy. METHODS: This was a prospective, randomized, double-blind, controlled study. Ten minutes before induction of anesthesia, 36 patients scheduled for elective gynecological laparotomy were assigned to receive either normal saline (group N) or dexmedetomidine 1 µg/kg (group D). A patient-controlled analgesia (PCA) device was used to administer fentanyl for the postoperative 24 h period. Cumulative fentanyl consumption and pain score were assessed at postoperative 30 min, 6 h and 24 h. Patient's satisfaction for pain control and other side effects (nausea, sedation score) were recorded for all corresponding time points. RESULTS: There was no significant difference between the groups in cumulative fentanyl consumption (Group N: 11.1 ± 3.2 µg/kg, Group D: 10.3 ± 2.9 µg/kg, P value: 0.706). The incidence of side-effects did not differ between the groups. Both groups showed similar blood pressure after anesthesia induction. However, 10 min after anesthesia induction, the heart rates in group D were significantly lower than group N (P = 0.0002). CONCLUSIONS: In patients undergoing gynecological laparotomy, the pre-anesthetic administration of single loading dose dexmedetomidine (1 µg/kg) given 10 min before anesthesia induction did not reduce the PCA consumption of postoperative fentanyl or the pain score.

A Case of Stasis Dermatitis Due to Excessive Weight Gain in a Patient with Peritoneal Dialysis / 대한신장학회잡지

Stasis dermatitis is characterized by hyperpigmented lesions occuring as a result of venous stasis of the lower half of the legs. It is often associated with venous thrombosis, varicose vein, obesity, congestive heart failure. Histopathologic findings include fibrosis, new blood vessel formation, and hemosiderin deposition in dermis layer. We here report a case of stasis dermatitis due to excessive weight gain in a patient with peritoneal dialysis. A 50-year-old man on peritoneal dialysis was admitted with edema and hyperpigmentated lesion on both lower legs. He gained weight of 8 kg for 3 months because of excessive oral intake without ultrafiltration failure. Skin biopsy of the hyperpigmented lesion revealed vascular proliferation, infiltration of inflammatory cells, fibrosis, and hemosiderin deposition in dermis. We started hemodialysis in order to correct weight gain and leg edema. After 3 months later, the skin lesions much improved.