clinical comparison of etomidate-lipuro, propofol and admixture at induction

The purpose of this study was to compare etomidate-lipuro and propofol and 50%, [1:1] admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus. Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro-propofol admixture. After monitorization with bispectral index [BIS] all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 [BIS 40 time] and total amounts of induction doses were measured. BIS 40 time measurements were P > E > PE [199.4 +/- 40.9, 176.9 +/- 31.6, 163.5 +/- 20.6 s]. The hemodynamic [systolic, diastolic and mean blood pressures, heart rate] changes were minimal in group PE than other two groups [P = 0.017]. The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E [76.3%]. Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were [83.8%] in group P and in [63.2%] group E. Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction

Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery

To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need. Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group group R, and dexmedetomidine group group D received a bolus of 1 ug/kg over 10 minutes, followed by 0.2 ug/kg/minute peroperative infusion of remifentanil, and 0.4 ug/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded. Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D. This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia