Dexmedetomidine As A Substitute For Remifentanil In Ambulatory Gynecologic Laparoscopic Surgery

Objectives: To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need. Methods: Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group (group R), and dexmedetomidine group (group D) received a bolus of 1 mu g/kg over 10 minutes, followed by 0.2 mu g/kg/minute peroperative infusion of remifentanil, and 0.4 mu g/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, Place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded. Results: Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D. Conclusion: This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia.Wo

Spinal Anesthesia In Kartagener'S Syndrome

Kartagener's syndrome, an autosomal recessive disorder is a combination of dextrocardia (situs inversus), bronchiectasis and sinusitis. We report a 22-year-old woman with this syndrome scheduled for appendectomy. Spinal anesthesia was preferred for the patient with this rare disorder due to the relative advantages of the regional technique over general anesthesia.Wo

Comparison between intravenous and thoracic epidural analgesia in single coronary artery bypass graft surgery

WOS: 000306195600005Aim: To compare thoracic epidural analgesia with intravenous analgesia in patients who underwent coronary artery bypass grafting surgery. Materials and methods: This retrospective study included 40 patients who had received elective single artery bypass surgery. After general anesthesia, one group was given patient-controlled thoracic epidural analgesia and the other group was given patient-controlled intravenous meperidine analgesia. Patient assessments were performed during the postoperative period and included the duration of hospital stay, pain and sedation scores, ambulation score, atrial fibrillation incidence, and organ morbidities. Results: No differences were detected between the groups in the demographic or intraoperative data. However, a statistically significant difference was detected in favor of thoracic epidural analgesia for the duration of extubation and hospital stay, pain control, sedation grade, mobilization, and quality of recovery scores. Conclusion: After single coronary artery surgery, thoracic epidural analgesia was more effective than intravenous analgesia; it also enabled earlier tracheal extubation and a shorter hospitalization period

Effects of intraarticular tramadol, magnesium and ketamine on postoperative pain in arthroscopic meniscectomy

Objective: Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy. Methods: Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients’ postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics. Results: The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K. Conclusion: Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium. Resumo: Objetivo: O controle da dor pós-operatória é importante para recuperação e reabilitação precoces em meniscectomia artroscópica. Portanto, nosso objetivo foi comparar os efeitos de tramadol, magnésio e cetamina administrados por via intra-articular em associação com bupivacaína pericapsular sobre a dor e a recuperação após meniscectomia artroscópica. Métodos: Noventa pacientes submetidos à meniscectomia artroscópica foram incluídos no estudo. O Grupo T recebeu tramadol, o Grupo K recebeu cetamina e o Grupo M recebeu magnésio em doses reconstituídas por via intra-articular e todos os grupos receberam bupivacaína por via periarticular. As avaliações foram feitas mediante comparação dos escores em escala visual analógica no pós-operatório dos pacientes em movimento e em repouso, necessidade de analgésicos adicionais, tempo até a primeira necessidade de analgésico, tempo de mobilização, efeitos adversos e satisfação com os analgésicos. Resultados: Os escores da escala visual analógica foram menores no minuto zero e maiores nos minutos 15 e 30 e nas horas 1, 2 e 6 no Grupo T. Os escores da escala visual analógica em movimento foram maiores nos minutos zero e 15 no Grupo M e maiores no minuto 30 e nas horas 1, 2 e 6 no Grupo T. Os escores dos grupos foram semelhantes em relação à necessidade de analgésico adicional no pós-operatório, ao consumo de analgésico e à satisfação com os analgésicos, mas os tempos até a primeira necessidade de analgesia e até a primeira mobilização foram mais curtos nos grupos M e K, respectivamente. Conclusão: A administração intra-articular de cetamina permite mobilização precoce e diminui a necessidade de analgésicos adicionais, além de proporcionar um melhor efeito analgésico em comparação com tramadol e magnésio por via intra-articular. Keywords: Intraarticular analgesia, Ketamine, Tramadol, Magnesium, Knee arthroscopy, Palavras-chave: Analgesia intra-articular, Cetamina, Tramadol, Magnésio, Artroscopia de joelh

Surgical Treatment of Amplatzer Embolus in a Secundum Atrial Septal Defect Patient

A secundum atrial septal defect is the most common congenital heart defect. Transcatheter treatment of secundum atrial septal defects is a popular and less invasive alternative to surgery. Procedural complications may occur in a wide spectrum, particularly device embolus as the most emergent one, but luckily they do not commonly occur in the clinical setting. Mortality from adverse events related to transcatheter treatment strategies is twentyfold higher than that of primary elective surgical closure. Here, we report an Amplatzer device embolus in a secundum atrial septal defect patient. The device was successfully removed with surgery, postoperative course was uneventful, and the patient was discharged from the hospital on the 5th postoperative day

The Effects of Esmolol on Erythrocyte Deformability in Rat Liver Ischemia-Reperfusion Injury

Background: Esmolol has protective effects in ischemia reperfusion (IR) injury. The purpose of our study was to look into the effects of this which esmolol on erythrocyte deformability in rat liver IR injury model

Hyaluronan Based Heparin Free Coated Open and Closed Extracorporeal Circuits for High Risk Coronary Revascularization

This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were pro spectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF™, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC™, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n = 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n = 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n = 12); and Group 4: Control-open, uncoated ECC (n = 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p < .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p < .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed+coated group at T4 (p < .05). Postoperative hemorrhage (mL) was 510 ± 40 in closed+coated and 536 ± 40 in open+coated groups (control: 784 ± 48, p ≤ .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 ± .01 in closed+coated, 2.01 ± .01 in open+coated, and 3.3 ± .015 in control groups (p ≤ .05). Use of a closed and completely heparin free coated ECC may reduce neutrophil degradation, cytokine release characterized by improved clinical outcomes including reduced blood loss, reduced requirement for inotropes, and reduced atrial fibrillation