Single-injection percutaneous peribulbar anesthesia with a short needle versus sub-Tenon's anesthesia for cataract extraction

This study compared the efficacy of single-injection percutaneous peribulbar anesthesia [PBA] with a short needle with sub-Tenon's anesthesia [STA] to produce optimal operating conditions for cataract extraction in patients with complicated cataract. Two hundred patients with complicated cataract were enrolled in this prospective, double-blinded, randomized study. Adequate akinesia was a surgical requisite for all cases included in the study because of the expected difficult surgery. The patients were divided into two equal groups to receive either peribulbar anesthesia [PBA] with a 16-mm needle or sub-Tenon's anesthesia. Surgical akinesia [as a primary end point], analgesia, incidence of complications, as well as patient and surgeon satisfaction [as secondary end points] were assessed. Both techniques provided similar analgesia during the operation and similar rates of incidence of chemosis with no serious complications; while the PBA group provided higher degree of akinesia 10 minutes after injection of the local anesthetic, a lower incidence of subconjunctival hemorrhage [SCH] and higher patient and surgeon satisfaction compared to the STA group. We concluded that when globe akinesia is necessary during surgery, the single-injection technique for percutaneous peribulbar anesthesia with a short needle proved to be more suitable than the STA in providing akinesia for cataract surgery. Also, this PBA technique demonstrated a lower incidence of SCH and was preferred to STA by the patients and surgeon

Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia. Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine [group D] or propofol [group P]. Sedation level was titrated to a Ramsay sedation scale [RSS] of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO[2] was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients' sedation was similar for both groups. The patients' satisfaction was higher in the dexmedetomidine group. Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon's satisfaction, and higher patient's satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

Preanesthetic medication in children: a comparison of intranasal dexmedetomidine versus oral midazolam

Relieving preoperative anxiety is an important concern for the pediatric anesthesiologist. Midazolam has become the most frequently used premedication in children. However, new drugs such as the alpha2 -agonists have emerged as alternatives for premedication in pediatric anesthesia. One hundred and twenty children scheduled for adenotonsillectomy were enrolled in this prospective, double-blind, randomized study. The children were divided into two equal groups to receive either intranasal dexmedetomidine 1 microg/kg [group D], or oral midazolam 0.5 mg/kg [group M] at approximately 60 and 30 mins, respectively, before induction of anesthesia. Preoperative sedative effects, anxiety level changes, and the ease of child-parent separation were assessed. Also, the recovery profile and postoperative analgesic properties were assessed. Children premedicated with intranasal dexmedetomidine achieved significantly lower sedation levels [P=0.042], lower anxiety levels [P=0.036], and easier child-parent separation [P=0.029] than children who received oral midazolam at the time of transferring the patients to the operating room. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both the groups [P=0.067]. Also, the number of children who required fentanyl as rescue analgesia medication was significantly less [P=0.027] in the dexmedetomidine group. Intranasal dexmedetomidine appears to be a better choice for preanesthetic medication than oral midazolam in our study. Dexmedetomidine was associated with lower sedation levels, lower anxiety levels, and easier child-parent separation at the time of transferring patients to the operating room than children who received oral midazolam. Moreover, intranasal dexmedetomidine has better analgesic property than oral midazolam with discharge time from postanesthetic care unit similar to oral midazolam

Epidural ropivacaine alone versus ropivacaine and sufentanil for postoperative analgesia after major orthopaedic surgery

In this randomized, double-blinded study, we evaluated the efficacy of patient controlled epidural postoperative analgesia after major orthopaedic surgery using ropivacaine alone versus ropivacaine and sufentanil in different doses. Sixty patients' ASA physical status I-III, scheduled for elective major knee or total hip replacement surgery were enrolled into the study. Patients were block randomized on admission to the hospital for their surgery to receive one of three patient controlled epidural postoperative infusion solutions: ropivacaine 2 mg.ml[-1] [Group R], ropivacaine 2 mg.ml[-1] and sufentanil 1 micro g.ml[-1] [Group RS]. or ropivacaine 1 mg.ml[-1] and sufentanil 0.75 micro g.ml[-1] [Group RSL]. The three groups were comparable as regards age, weight, height, gender and type of surgery. There were insignificant changes between the three groups as regards heart rate and MABP at any time of measurements. There was significant decrease in the total volume of analgesic solution infused in-group RS compared with other two groups and the total volume infused in-group R was also significantly less compared with group RSL. The number of PCEA demands and the number of PCEA demands delivered and the total dose of ketorolac given as a rescue analgesia were significantly less in-group RS compared with the other two groups. The incidences of respiratory depression, nausea and pruritus were significantly higher in-group RS compared with the other two groups. Although there was less sensation of pain whether during rest or passive mobilization as determined by VAS in-group RS compared with the other two groups but this was not statistically significant. The quality of analgesia was significantly better in-group RSL with most of the patients [90%] were comfortable compared with group R [75%] and group RS [65%]. It could be concluded that the use of patient controlled epidural analgesia with low concentrations of ropivacaine [1 mg.mr[-1]] and sufentanil [0.75 micro g.ml[-1]] was an effective method for postoperative analgesia after major orthopaedic surgery with less side effects and this may be closer to provide the best analgesia postoperatively