ABSTRACT
Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It induces analgesia in patients and decreases anesthetic requirements by up to 90%. The current study aimed to evaluate the effects of dexmedetomidine premedication on tourniquet pain, intraoperative-postoperative analgesic requirements, sedation levels, quality of anesthesia, and the hemodynamic parameters when used as a single dose before intravenous regional anesthesia [IVRA]. Fifty-four patients undergoing hand surgery [carpal tunnel and tendon release] were randomly divided into 2 groups for IVRA. IVRA was performed with 40 mL of 0. 5% lidocaine in both groups. A single dose of dexmedetomidine 0. 5 microg/kg in 20 mL saline was administered to group D [n=27] and placebo solution 20 mL to group C [n=27] through the non-IVRA catheter 15 minutes before IVRA. Sensory and motor block onset and recovery time, hemodynamic variables, tourniquet pain, analgesic requirements according to verbal rating scale [VRS] and visual analog scale[VAS], sedation score, and anesthesia quality were recorded in the intraoperative and postoperative period. Improved quality of anesthesia, reduced postoperative pain scores, and total analgesic requirements were found in group D during postoperative period. Additionally, the patients experienced a higher degree of sedation during intraoperative and postoperative period. The premedication of 0. 5 microg/kg low dose dexmedetomidine before IVRA improves the quality of anesthesia and decreases the postoperative analgesic requirement of outpatients undergoing hand surgery without any serious side effects
ABSTRACT
We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 mg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. [n=30]. Patients were intubated after receiving fentanyl 1 mg/kg and rocuronium bromide 0.5 mg/kg. 21 [70%] patients in group D did not show the oculocardiac reflex [OCR] versus 7 [23%] in group P [p=0.0006]. The preoperative and postoperative agitation scores [p=0.0001 and p=0.03, respectively], the score on the Faces Pain Scale during awakening [3.0 [interquartile range, IQR 2.0-4.0] in group D and 0.0 [IQR 1.0-2.25] in group P] [p=0.001] and at the 60th postoperative minute [IQR 2.0 [1.5-3.0] in group D and 2.0 [IQR 1.5-3.0] in group P] [p=0.004], sore throat [26.6% in group D and 60% in group P] [p=0.01] and analgesic requirement [20% in group D and 53% in group P] [p=0.01] in group P were significantly higher than in group D. The Ramsay Sedation Score [RSS] in group D was significantly higher than in group P during awakening [2.0 [2.0-2.0] in group D and 4.5 [4.0-5.0] in group P] [p=0.0001]. Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery
ABSTRACT
The aim of this prospective study was to analyze the rate and characteristics of acute poisoning cases admitted to adult intensive care unit [ICU]. All cases of acute poisoning admitted to ICU of the Harran University Hospital, Turkey, between July 2002 and May 2005, were included in this study. Clinical, laboratory, and demographic characteristics, type of poison and patient's outcomes were recorded. There were 86 poisoning cases among 844 patients admitted to the ICU. The mean age was 26 +/- 9 years and the majority of the patients [56.9%] were 15-24 years of ages. Eighty percent of acute poisonings were self-inflicted and 65.2% of these patients were singles. Medical drugs overdose were the major cause [51.2%] of intoxication followed by agricultural chemicals [37.2%] The most frequently involved medicinal drugs were benzodiazepines, antidepressants and analgesics. Eleven patients in pesticides-rodenticides and 9 patients in other medical drugs poisoning have required mechanical ventilation between 1-12 days. The duration of the intensive care stay was 6.4 +/- 4.3 days. Five cases [5.8%] with acute poisonings were fatal. There was a high rate of suicides attempt in young singles, predominantly female population. These data were the highest agricultural activity of the country that provide important information about the characteristics of poisoning at the city