Dexmedetomidine and remifentanil as adjuncts to total intravenous anesthesia with propofol

Aim: The aim was to compare the effects of dexmedetomidine and remifentanyl in total intraveous anesthesia [TIVA] in laparoscopic cholecystectomy operations

Methodology: Forty, 18-60 years old, elective laparoscopic cholecystectomy patients were included in the study. In Group D, TIVA was performed by 150 microg/kg/min propofol and 0.5 microg/kg/h dexmedetomidine infusions. In Group R patients, TIVA was performed with 150 microg/kg/min propofol and 0.5 microg/kg/min remifentanil infusions. Systolic blood pressure, heart rate, SpO[2], end tidal CO[2] were recorded. All infusions were terminated at the end of surgery. Adequate spontaneous respiration, extubation, and response to verbal commands; and Aldrete score >/= 9 times, postoperative pain scores and vital parameters in the postoperative period were recorded. Patient-controlled analgesia pump was used in all postoperative patients. Total analgesic consumption, patients' first analgesic needs were recorded

Results: Intraoperative Systolic blood pressure, diastolic blood pressure and heart rate values remained significantly lower in remifentanyl group compared to those in dexmedetomidine group [p < 0.05]. First postoperative analgesia time was shorter and hemodynamic parameters were significantly higher in this group [p < 0.05]. Postoperative recovery of dexmedetomidine group remained more stable in terms of VAS values [p < 0.05]

Conclusions: Remifentanil provides a potent intraoperative anesthesia compared with dexmedetomidine; however, dexmedetomidine may be considered in TIVA as an option for a stable postoperative recovery

Ineffective Doses of Dexmedetomidine Potentiates the Antinociception Induced by Morphine and Fentanyl in Acute Pain Model

The aim of this study was to evaluate the synergistic potentiation effect of ineffective doses of dexmedetomidine on antinociception induced by morphine and fentanyl in acute pain model in rats. Seventy albino Wistar rats were separated into 7 groups. Data for the control and sham groups were recorded. The ineffective dose of dexmedetomidine was investigated and found to be 3 micro g/kg. Each group was administered the following medications: 3 mg/kg morphine (intraperitoneal) to Group 3, 5 microg/kg fentanyl (intraperitoneal) to Group 4, dexmedetomidine 3 micro g/kg (subcutaneously) to Group 5, dexmedetomidine 3 microg/kg (subcutaneous)+3 mg/kg morphine (intraperitoneal) to Group 6 and finally 3 microg/kg dexmedetomidine (subcutaneous)+5 microg/kg fentanyl (intraperitoneal) to Group 7. Just before the application and 15, 30, 60, 90 and 120 min after the administration of medication, two measurements of tail flick (TF) and hot plate (HP) tests were performed. The averages of the measurements were recorded. TF and HP latencies were the main outcomes. The analgesic effect of the combinations with dexmedetomidine+morphine (Group 6) and dexmedetomidine+fentanyl (Group 7), compared to the analgesic effect of morphine alone and fentanyl alone was significantly higher at 15, 30, 60 and 90 minutes after administration. In this study, dexmedetomidine in ineffective doses, when combined with morphine and fentanyl, potentiates the effects of both morphine and fentanyl.

Persistent status epilepticus due to bupropion intoxication

Bupropion is a generally well-tolerated drug and has adverse effects such as headache, dizziness, dry mouth, nausea, constipation, tremor, drowsiness, agitation, insomnia, hallucinations, allergic reactions and seizures. Although seizures have been reported with therapeutic doses of bupropion, there are few reports presenting development of status epilepticus due to bupropion intoxication with different doses. This rare case of persistent status epilepticus due to intoxication with 9 gm bupropion describes a surviving patient after one of the highest ingested dose cited in literature. We indicate that early management is crucial for patients with intoxication with massive doses of bupropion

perioperative anaphylactic reaction caused by latex in a patient with no history of allergy

Latex is one of the most common causes of intraoperative anaphylactic reactions

Latex anaphylaxis may lead to signi" cant morbidity and even may sometimes be fatal. During a surgical operation of a 19 year old male, for removal of a seminal vesicular cyst under general anesthesia, sudden appearance of classic signs of an anaphylactic reaction, e.g. skin eruptions, hypoxemia, hypotension, ! ushing, edema and bronchospasm alerted us. Antihistaminics, steroids and adrenaline were administered

It was assumed that the most possible cause of this anaphylactic reaction could have been latex

Therefore, all latex gloves in use were changed to latex free ones. The boy recovered and after 24 hours of observation in intensive care unit [ICU], he was shifted to urology clinic

Perioperative anaphylactic shock in a patient with unruptured hepatic hydatid cyst: a case report

Hydatid cyst disease is an infection most frequently caused by the larval form of a parasite named Echinococcus granulosus. Spillage of hydatid fluid during open surgery has been shown to result in serious anaphylactic reaction. We report a case of 46 years old male with hydatid cyst of liver, who had a sudden onset of intra-operative hypotension, tachycardia, flushing, edema and bronchospasm. He was managed with adrenaline, antihistaminics, steroids, supplementary fluids and vasopressors, and after successful resuscitation, was shifted to ICU for further management. Four days later, he was weaned off from vasopressors and ventilatory support and shifted to the surgical ward. Early diagnosis and intervention are crucial for successful management of the anaphylactic reactions

The Effects of Intravenous Ephedrine During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial

We designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Patients were randomly allocated into two groups: ephedrine group (n=21) and control group (n=21). Intravenous preload of 15 mL/kg lactated Ringer's solution was given. Shortly after the spinal injection, ephedrine 0.5 mg/kg or saline was injected intravenous for 60 sec. The mean of highest and lowest heart rate in the ephedrine group was higher than those of control group (P<0.05). There were significant lower incidences of hypotension and nausea and vomiting in the ephedrine group compared with the control group (8 [38.1%] vs. 18 [85.7%]); (4 [19%] vs. 12 [57.1%], respectively) (P<0.05). The first rescue ephedrine time in the ephedrine group was significantly longer (14.9+/-7.1 min vs. 7.9+/-5.4 min) than that of the control group (P<0.05). Neonatal outcome were similar between the study groups. These findings suggest, the prophylactic bolus dose of 0.5 mg/kg intravenous ephedrine given at the time of intrathecal block after a crystalloid fluid preload, plus rescue boluses reduce the incidence of hypotension.