Aliye Esmaoglu

Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy.

Background : Dexmedetomidine has shown sedative, analgesic, and anxiolytic effects after intravenous (IV) administration. Sevoflurane is associated with a high incidence of emergence agitation in preschool children. In this placebo‐controlled study, we examined the effect of single dose dexmedetomidine on emergence agitation in children undergoing adenotonsillectomy.

Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block.

BACKGROUND AND OBJECTIVES: We evaluated the effect of adding dexmedetomidine to levobupivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. METHODS: Sixty patients scheduled for elective forearm and hand surgery were divided into 2 equal groups in a randomized, double-blind fashion. The 4 main nerves in the axilla (musculocutaneus, radial, median, ulnar) were identified using neural stimulation. Patients were assigned randomly to 1 of the 2 groups. In group L (n = 30), 40 mL (200 mg) of 0.5% levobupivacaine + 1 mL saline and in group LD (n = 30), 40 mL (200 mg) of 0.5% levobupivacaine + 1 mL dexmedetomidine were given. Motor and sensory block onset times, block durations, and duration of analgesia were recorded. RESULTS: Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group LD than in group L (P < 0.05). Sensory and motor blockade durations were longer in group LD than in group L (P < 0.01). Duration of analgesia was longer in group LD than in group L (P < 0.05). Systolic arterial blood pressure levels in group LD at 10, 15, 30, 45, 60, 90, and 120 minutes were significantly lower than those in group L (P < 0.05). Diastolic arterial blood pressure levels in group LD at 60, 90, and 120 minutes were significantly lower than those in group L (P < 0.05). Heart rate levels in group LD, except basal measurements, were significantly lower than those in group L (P < 0.05). In group LD bradycardia was observed in 7 patients, although there was no bradycardia in group L (P < 0.05). CONCLUSIONS: Dexmedetomidine added to levobupivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradycardia.

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes

Background:  The aim of this study was to compare propofol–ketamine (PK) and propofol–fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes.

Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy

Background:  The aim of this study was to compare the clinical efficacy and safety of propofol‐ketamine with propofol‐fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy (UGIE).

Dexmedetomidine vs midazolam for premedication of pediatric patients undergoing anesthesia

Background:  Dexmedetomidine, an α2‐receptor agonist, provides sedation, analgesia, and anxiolytic effects, and these properties make it a potentially useful anesthetic premedication. In this study, we compared the effects of intranasal dexmedetomidine and midazolam on mask induction and preoperative sedation in pediatric patients.

Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia

Background and objective: The aim of this study was to determine the duration of onset and regression time of sensory and motor blocks, the quality of anaesthesia and postoperative analgesia by the addition of dexmedetomidine to local anaesthetic solution in intravenous regional anaesthesia (IVRA). Methods: Forty patients scheduled for elective hand surgery participated in this prospective randomized double‐blind study. The IVRA was achieved using 3 mg kg−1 lidocaine diluted with saline to a total volume of 40 mL in the control group or 1 μg kg−1 of dexmedetomidine +3 mg kg−1 lidocaine diluted with saline to a total volume of 40 mL in the dexmedetomidine group. The onset and regression times for sensory and motor blocks were recorded. Qualities of anaesthesia, intraoperative and postoperative analgesic requirements were noted. Results: There was no difference between the groups with respect to sensory and motor blocks onset and regression time. The quality of anaesthesia was better in the dexmedetomidine group than the control group and the difference was statistically significant. Intraoperative and postoperative analgesic requirements were greater in the control group than in the dexmedetomidine group. Conclusions: Addition of dexmedetomidine to local anaesthetic solution in IVRA improved the quality of anaesthesia and decreased analgesic requirements, but had no effect on the sensory and motor blocks onset and regression times.

Dexmedetomidine and meperidine prevent postanaesthetic shivering

Background and objective: This placebo‐controlled study was performed to evaluate the efficacy of dexmedetomidine compared with meperidine and placebo in preventing postanaesthetic shivering. Methods: We studied 120 patients (ASA I‐II) scheduled for elective abdominal or orthopaedic surgery of about 1‐3 h duration. Forty patients in each group randomly received 1 μg kg−1 of dexmedetomidine, 0.5 mg kg−1 of meperidine or saline 0.9% as placebo, intravenously (i.v.). Mean arterial pressure, heart rate, oxygen saturation and central body temperature were measured. Extubation, awakening and orientation times, shivering, pain, recovery and sedation scores were recorded. Results: Postanaesthetic shivering was seen in 22 patients in the placebo group, four patients in the meperidine group and six patients in the dexmedetomidine group. Sedation scores were significantly higher in the dexmedetomidine group compared with meperidine and placebo groups. Both dexmedetomidine and meperidine caused a significantly prolonged extubation and awakening time compared with placebo. Also, dexmedetomidine caused a significantly prolonged orientation time compared with other two groups. Conclusion: Intraoperative intravenously administration of dexmedetomidine 1 μg kg−1 reduces postanaesthetic shivering as does meperidine 0.5 mg kg−1 in patients after major surgery.

Comparison between dexmedetomidine and midazolam for sedation of eclampsia patients in the intensive care unit.

PURPOSE This study compares the effectiveness of midazolam and dexmedetomidine for the sedation of eclampsia patients admitted to our intensive care unit (ICU). PATIENTS AND METHODS Forty women with eclampsia requiring termination of pregnancy by caesarean delivery were randomized in to 2 groups of 20 to receive either midazolam or dexmedetomidine. The midazolam group received a loading dose of 0.05 mg/kg followed by an infusion of 0.1 mg kg(-1) h(-1). The dexmedetomidine group loading dose was 1 microg/kg per 20 minutes, followed by continuous infusion at 0.7 microg kg(-1) h(-1). Heart rate, blood pressure, Ramsey sedation score, antihypertensive need, convulsion fits, and duration in ICU were monitored and recorded all through the ICU stay. RESULTS Dexmedetomidine markedly reduced heart rates for the first 24 hours (P < .05) compared with midazolam, but there were no differences at 48 and 72 hours. Mean arterial blood pressures were similar in the 2 groups (P > .05), although in the dexmedetomidine group, it was lower at 5, 6, 12, and 24 hours compared with the first 4 hours (P < .05). Moreover, fewer patients given dexmedetomidine required nitroglycerine and nitroprusside (P < .05). The duration of ICU stay was less in the dexmedetomidine group, 45.5 hours (range, 15-118 hours), than in the midazolam group, 83 hours (minimum-maximum, 15-312 hours). CONCLUSION Dexmedetomidine sedation in eclampsia patients is effective in reducing the demand for antihypertensive medicine and duration of ICU stay.

The effects of caudal or intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine in children

Background:  Clonidine is used increasingly in pediatric anesthesia practice to prolong the duration of action of caudal block with a local anesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine.

Desflurane anaesthesia increases sister chromatid exchanges in human lymphocytes

Background:  We investigated genotoxic effects of desflurane on the frequency of sister chromatid exchange (SCE) in peripheral blood lymphocytes of patients during and after anaesthesia.