A comparison of dexmedetomidine and midazolam for sedation in third molar surgery

This randomised, double-blind study compared dexmedetomidine and midazolam for intravenous sedation during third molar surgery under local anaesthesia. Sixty patients received either dexmedetomidine (up to 1 microg x kg(-1)) or midazolam (up to 5 mg), which was infused until the Ramsay Sedation Score was four or the maximum dose limit was reached. Intra-operative vital signs, postoperative pain scores and analgesic consumption, amnesia, and satisfaction scores for patients and surgeons, were recorded. Sedation was achieved by median (IQR (range)) doses of 47 microg (39-52 (25-76)) or 0.88 microg x kg(-1) (0.75-1.0 (0.6-1.0)) dexmedetomidine, and 3.6 mg (3.3-4.4 (1.9-5.0)) or 0.07 mg x kg(-1) (0.055-0.085 (0.017-0.12)) midazolam. Heart rate and blood pressure during surgery were lower in dexmedetomidine group. There was no significant difference in satisfaction or pain scores. Midazolam was associated with greater amnesia. Dexmedetomidine produces comparable sedation to midazolam.postprin

Placenta accreta spectrum surgery with the Joel Cohen incision for abdominal access: a single-center experience

Objectives: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety. Material and methods: The data on women having a hysterectomy due to PAS between 2013–2021 was collected retrospectively. Operation length, baby’s pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013–2016) or late (2017–2021) years. Results: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27–39). The mean operation length was 150 minutes (75–420), and the anesthesia–to–delivery interval was 32 minutes (5–95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups. Conclusions: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery

Fluid loading therapy to prevent spinal hypotension in women undergoing elective caesarean section Network meta-analysis, trial sequential analysis and meta-regression

BACKGROUND Fluid loading is one of the recognised measures to prevent hypotension due to spinal anaesthesia in women scheduled for a caesarean section. OBJECTIVE We aimed to evaluate the current evidence on fluid loading in the prevention of spinal anaesthesia-induced hypotension. DESIGN Systematic review and network meta-analysis with trial sequential analy

Late glacial-Holocene shelf evolution of the Sea of Marmara west of Istanbul

We present an investigation the Late Quaternary seismic stratigraphy of the shelf area of the northern the Sea of Marmara extending from its northern coast (between Silivri and Kumkapi) to approximately 100. m depth, using shallow high-resolution seismic reflection data along 73. N-S and 15 E-W lines. Seismic sequence analysis is used to identify the depositional systems, associated sedimentation conditions, and relative sea level changes. Seismic stratigraphic interpretations indicate the presence of four distinct seismic units (SU I, II, III and IV) underlying the shelf area. Seismic units are bounded by erosional unconformities overlying an acoustic basement. Seismic unit I constitutes the acoustic basement (AB), which is characterized by chaotic, subparallel, and wavy reflections that out locally off the rocky shorelines and along the crests of the positive structures where the sedimentary cover is absent. Seismic unit II is interpreted to represent the pre-Holocene deposits and exhibits subparallel reflections. Seismic unit II is interpreted to have been subjected to sub-aerial erosion during the Last Glacial Maximum. Seismic unit III-IV are interpreted to have formed during the Holocene (Flandrian) transgression and have parallel/subparallel internal reflection patterns. The top of seismic unit IV forms the present-day sea floor. As a result of the presence of fill, seismic facies within seismic unit IV reflect differences in depositional processes. The bathymetry of the study area has a close relation with sedimentation dynamics, tectonic, wave and flow dynamics and palaeotopograpy. Particularly, sudden dip changes determined at the shelf area might have been due to fault and/or fault systems that control the bottom topography. Seismic activity in the Sea of Marmara region has a key role the northern branch of the North Anatolian Fault Zone (NAFZ) affecting on the tectonic activity of the study area. The last two earthquakes in Izmit and Duzce, Turkey, in 1999 have been originated from NAFZ. The presence of several faults on various scales in the seismic profiles of the study area is identified. The active normal faults in the Holocene units that disturb the seafloor are determined. Most of these faults are intense in the eastern part of research area. The isopach map of Holocene sediment (seismic unit III and IV) indicates that the maximum sediment accumulations (up to 36. m) occur in the offshore areas of Bakirköy and Kumkapi. Young sediment thicknesses are common on the shoreline areas in the investigated area. © 2014 Elsevier Ltd.The authors acknowledge the support provided by University of Cukurova in Turkey (Grant No. FBE2002D234). The authors greatly appreciate the help of the Lieutenant Erkan Gezgin, Assoc. Prof. Dr. Mehmet Karakilcik and geophysical engineer Mehmet Şimşek for providing the seismic data. We also thank the Turkish Navy Department of Navigation, Hydrography and Oceanography

A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy

PubMedID: 18165596We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty- six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 ± 9.5 mg for morphine, 266 ± 90 mg for pethidine, and 320 ± 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl. © 2008 by International Anesthesia Research Society