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
Glanzmann thirombastenia [GT] is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27 year old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia [IVRA]. The use of platelet transfusion and the recombinant factor VIIa, are stressed