Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery

AbstractBackground and objectivesIt is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site.Methods60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M), patients were administered 40mg/kg magnesium sulfate in 100mL saline solution over 10min as the intravenous loading dose 10min before induction, with a subsequent 10–15μg/kg/h infusion during surgery. In the dexmedetomidine group (Group D), patients were administered 1μg/kg dexmedetomidine in 100mL saline solution as the loading dose 10min before surgery and 0.5–1μg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60–70mmHg.ResultsBleeding score was significantly decreased in Group D (p=0.002). Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5min after intubation (p<0.05). The number of patients who required nitroglycerine was significantly lower in Group D (p=0.01) and surgeon satisfaction was significantly increased in the same group (p=0.001). Aldrete recovery score ≥9 duration was significantly shorter in Group D (p=0.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale.ConclusionsDexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site

Kardiyak ilaçlarla zehirlenmelerde yoğunbakım yönetimi

Kalsiyum kanal blokerleri ( KKB) ile zehirlenme potansiyek olarak öldürücü bir durumdur. KBB’ler hipertansiyon, anjina pektoris, hipertrofik kardiyomyopati, supraventriküler aritmiler, migren gibi hastalıkların tedavisinde kullanılan ilaçlardır. L tipi kalsiyum kanalları üzerinden etkisini gösterir. Üç alt gruba ayrılırlar; Fenilalkilaminler (verapamil) Benzodiazepinler (diltizem) Dihidropiridinler (amlodipin, nifedipin, nikardipin) Dihidropiridin grubundakiler myokard kasından ziyade vasküler düz kasları etkilerler. KKB zehirlenmelerinde kardiyak toksisite belirtileri hipotansiyon, bradikardi, 2. Veya 3. Derece AV blok ve kardiyak arresttir. Non kardiyak belirtiler arasında konfüzyon, ajitasyon, bilinç bozukluğu ve nöbet aktivitesi görülebilir. Kalsiyum kanallarının pankreas ada hücrelerinde blokajına bağlı olarak insülin salınımında azalma ve hiperglisemi görülebilir. Periferik vazodilatasyona sekonder olarak pulmoner ödem görülebilir. Bağırsak iskemisi, ileus laktik asidoz da KKB zehirlenmelerinde görülebilecek durumlardır