effect of dexmedetomidine on electrophysiological properties of normal conduction system and accessory pathways in Wolff-Parkinson-White syndrome during tanscatheter cryoablation

The effects of dexmedetomidine sedation upon the electrophysiologic [EP] properties of normal atrioventricular [A-V] and accessory pathway [AP] conduction were studied in twenty five patients with Wolff-Parkinson-White [WPW] syndrome during accessory pathway cryoablation in cardiac catheterization laboratories [CCL]. The presence of an AP was confirmed by baseline EP studies. Sedation was induced in 25 patients using dexmedetomidine [Imcg/kg] over 10 minutes and maintained with dexmedetomidine infusion [0.2 to 0.7 mcg/kg/hr]. A baseline EP study was performed which consisted of effective refractory period [ERP] and shortest cycle length [SCC] measurement during antegrade conduction in the normal A-V pathway and AP, as well as during retrograde conduction in the AP. Comparison with baseline EP studies indicated that the administration of sedation had no effect upon conduction or ERP in either patlway. Haemodynamic, blood gases showed no significant changes throughout the ablation procedure with no development of dysrrhythmia. We conclude that dexmedetomidine sedation is suitable for patients undergoing ablative procedures for accessory pathways in cardiac catheterization laboratories [CCL]

Combined general anesthesia and peribulbar block with ropivacaine and colonidine in patients undergoing retinal detachment surgery

The aim of this study was to evaluate the effects of peribulbar injection of 1% ropivacaine and hyaluronidase with 0.5 microg/kg clonidine combined with GA on the occurrence of oculocardiac reflex, IOP, surgical bleeding, postoperative pain, and occurrence of postoperative nausea and vomiting [PONV]. We enrolled 60 patients scheduled for primary retinal detachment surgery. They randomly allocated to one of two groups to receive either GA plus PB block by 1% ropivacaine and hyaluronidase 16 lU/mL with clonidine in a dose of 0.5 micro g/kg [PB group, n= 30] or GA alone [control group, n = 30]. In the PB group, the incidence of oculocardiac reflex was decreased; intraocular pressure and surgical bleeding were reduced. Immediate postoperative pain scores were lower, and the time of administration of the first postoperative analgesic was longer. Both the number of patients who required an analgesic supplement and the total amount of additional analgesic requested were smaller in the PB group. The two groups were similar with respect to the incidence of postoperative nausea and vomiting. PB block combined with GA was superior to GA alone for retinal detachment surgery with scleral buckling, resulting in less intraoperative bleeding and less incidence of intraoperative occurrence of oculocardiac reflex and also improving postoperative analgesia

influence of general anesthesia when combined with epidural anesthesia in postoperative delirium in elderly patients undergoing hip replacement surgery

Cognitive impairment [e.g., delirium confusion] is a significant problem in elderly patients during the early postoperative period. Postoperative delirium, a transient mental dysfunction, can result in Increased morbidity, delayed functional recovery and prolonged hospital stay in the elderly. The aim of this study is to determine the effect of epidural anesthesia when combined with general anesthesia on the incidence as well as the recovery of delirium in elderly patients undergoing hip replacement surgery. The present study was carried out on sixty adult patients [ASA I-I1I] of both sex scheduled for hip replacement surgery. Patients were randomly allocated to one of two groups to receive either general anesthesia [GA group, n =30] or GA plus epidural anesthesia with 0.75% ropivacaine [GA-EDA group, n = 30]. All patients were tested for cognitive dysfunction [Delirium] using the Confusion Assessment Method [CAM] score preoperatively and for 24 hr postoperatively. This study showed a significant incidence of +ve CAM score [36.7% and 26.7%] in the GA group and GA- EDA groups respectively at 1hr postoperatively when compared with the preoperative baseline values. From the 2[nd] hr postoperatively, there were continuous reduction in the +ve CAM score patients throughout the study period. When comparing the two studied groups, there were no significant difference in the incidence of +ve CAM score throughout the study period. Epidural anesthesia in combination with general anesthesia does not affect the incidence as well as the recovery pattern of delirium in elderly patients undergoing hip replacement surgery

effect of remifentanil-midazolam on electrophysiological properties of normal conduction system and accessory pathways in wolff-parkinson-white syndrome in cardiac catheterization laboratories

The effects of remifentanil midazolam sedation upon the electrophysiologic [EP] properties of normal atrioventricular [A-V] and accessory pathway [AP] conduction were studied in twenty patients with Wolff-Parkinson-White [WPW] syndrome during accessory pathway ablation in cardiac catheterization laboratories [CCL] The presence of an AP was confirmed by baseline EP studies. Sedation was induced with remifentanil [0.5mcg/kg] over 30-60 second and midazolam [0.1 mg /kg] and maintained with remifentanil infusion [0.025-0.05mcg/kg/min]. A baseline EP study was performed which consisted of effective refractory period [ERP] and shortest cycle length [SCC] measurement during antegrade conduction in the normal A-V pathway arid AP, as well as during retrograde conduction in the AP. Comparison with baseline EP studies indicated that the administration of remifentanil-midazolam sedation had no effect upon conduction or ERP in either pathways. Haemodynamic stability and no significant blood gases changes oct urred throughout the ablation procedure with no development of dysrrhythmia. We conclude that a combination of remifentanil-midazolarn is suitable for sedation in patients undergoing ablative procedures for accessory pathways in cardiac catheterization laboratories [CCL]

Anesthetic challenge for ventricular septal defect closure in cardiac catheterization laboratories

Transcatheter device closure has been used to close ventricular septal defects with satisfactory results. We report our initial experience with ventricular septal defect [VSD] device closure from January 2003 to April 2006 using the new Amplatzer perimembranous and muscular ventricular septal occluders in Cardiac Catheterization Laboratories [CCL]. During this period, we closed 42 VSD's percutaneously, 25 perimembranous and 15 muscular under general anesthesia. Two patients were excluded for technical causes. The mean age was [10.00 +/- 09.10] years [range 2-33 years], mean weight of [28.19 +/- 19.86] kg [range from 10-84 kg], 18 males and 22 females. Duration of procedures ranged from 46-310 minutes with the mean time of [147.80 +/- 72.67 minutes], 18 patients developed significant hypotension, two of them needed blood transfusion, 8 patients developed significant arrhythmia which needed intervention, 7 patients developed hypothermia and active warming was needed, one patient developed brachial plexus injury post procedure, pediatric intensive care [PICU] admission was needed in 13 patients, No deaths occurred, no air embolism, no haemothorax, and no cardiac tamponade or there were no late morbidity due to catheterization-related events. Hemodynamic instability and hypothermia were common during device closure of VSDs, and were likely to be inescapable features of these procedures in many patients because of the technique necessary for device placement