Berin Özcan

Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements.

PurposeThis prospective, randomized, double-blind study was designed to assess whether intraoperative infusion of dexmedetomidine provides effective postoperative analgesia. Postoperative pain scores and morphine consumption were compared in a treated group and a placebo group, both of which received patient-controlled morphine after total abdominal hysterectomy.MethodsFifty women were randomly assigned to two groups. Group D (n = 25) received a loading dose of dexmedetomidine 1 μg·kg-1iv during induction of anesthesia, followed by a continuous infusion at a rate of 0.5 μg·kg-1·hr-1 throughout the operation. Group P (n = 25) received a volume-matched bolus and infusion of placebo (0.9% saline). For each case, heart rate, peripheral oxygen saturation, and systolic and diastolic blood pressure were recorded intraoperatively and for 48 hr postoperatively. Patients used a patient-controlled analgesia device to receive bolus doses of morphine after surgery. Total morphine consumption, pain scores, and sedation scores were recorded for the first 48 hr (two hours in the postanesthesia care unit and 46 hr on the ward).ResultsThe groups were similar with respect to mean times to extubation of the trachea. Pain and sedation scores were also similar between groups at all corresponding times throughout the 48-hr period of observation. Group D patients consumed significantly less morphine in the postanesthesia care unit and on the ward (P < 0.05 andP < 0.01, respectively). Fewer patients in Group D experienced itching or nausea/vomiting (P < 0.05).ConclusionContinuousiv dexmedetomidine during abdominal surgery provides effective postoperative analgesia, and reduces postoperative morphine requirements without increasing the incidence of side effects.RésuméObjectifLa présente étude prospective, randomisée et à double insu a été réalisée pour déterminer si une perfusion peropératoire de dexmédétomidine fournit une analgésie postopératoire efficace. Les scores de douleur et la consommation de morphine postopératoires ont été comparés entre un groupe expérimental et un groupe témoin, les deux recevant de la morphine autocontrôlée après une hystérectomie abdominale totale.MéthodeCinquante femmes ont été réparties au hasard en deux groupes. Celles du groupe D (n = 25) ont reçu une dose initiale de dexmédétomidine iv de 1 μg·kg-1 pendant l’induction de l’anesthésie, puis une perfusion continue à 0,5 μg·kg-1·hr-1 pendant l’opération. Celles du groupe P (n = 25) ont reçu un bolus de volume apparié et une perfusion de solution saline à 0,9 %. La fréquence cardiaque, la saturation en oxygène du sang périphérique et la tension artérielle systolique et diastolique ont été enregistrées pendant l’opération et pendant 48 h après. Les patientes ont utilisé une pompe d’analgésie autocontrôlée pour recevoir des bolus de morphine postopératoire. La consommation totale de morphine, les scores de douleur et de sédation ont été notés pendant les 48 premières heures (deux heures à la salle de réveil et 46 h à la chambre).RésultatsĽextubation endotrachéale a été faite à des temps similaires dans les deux groupes. La douleur et la sédation ont aussi été semblables pour tous les enregistrements faits pendant les 48 h d’observation. Une quantité significativement plus basse de morphine a été utilisée dans le groupe D, en salle de réveil et à la chambre (respectivement P < 0,05 et P < 0,01). Moins de patientes du groupe D ont eu du prurit ou des nausées et des vomissements (P < 0,05).ConclusionLa perfusion iv continue de dexmédétomidine, administrée pendant une opération abdominale, fournit une analgésie postopératoire efficace et réduit les besoins postopératoires de morphine sans augmenter l’incidence d’effets secondaires.

Vasopressin, renin, and adrenocorticotropic hormone levels during the resuscitation of hemorrhagic shock in dogs

Hemorrhage is a potent stimulus for the release of vasopressin (VP), renin, and adrenocorticotropic hormone (ACTH). The goal of this study was to analyze changes in plasma VP, renin, and ACTH levels during hemorrhagic shock and resuscitation with two different solutions: hypertonic acetate dextran (HAD) and lactated Ringers (LR) solution. Eight randomized dogs were shocked by removing 37 +/- 9 mL/kg of blood while maintaining the mean arterial pressure (MAP) at 45 +/- 5 mmHg for 1 h. Test solutions were randomized and infused as needed with the hemorrhaged blood to restore the MAP and cardiac index to baseline. Blood samples for hormone analyses were taken in baseline, shock, and resuscitation periods. For each experiment, all hormone levels increased in the postshock period and then returned to baseline values after resuscitation with both solutions. VP and renin levels rapidly returned to baseline values after resuscitation in the LR dogs compared with the HAD dogs (p < 0.05). By contrast, there was no significant difference in ACTH levels between the two solutions. High-volume infusion with LR achieves more rapid restoration than small-volume infusion with HAD for VP and renin levels.

Combined use of axillary block and lateral femoral cutaneous nerve block in upper-extremity injuries requiring large skin grafts

An axillary block and lateral femoral cutaneous nerve block combination was used in 11 patients with upper-extremity injuries requiring large skin grafts. In our experience, this block combination was highly successful. All but one of the patients obtained excellent pain relief (mean visual analog pain scores, 0.2) that required no narcotic analgesics or sedatives. There were no systemic or neurologic side effects attributed to the local anesthetic drugs. We believe that combining an axillary block and a lateral femoral cutaneous nerve block is a clinically useful and effective technique and an excellent anesthetic alternative for procedures requiring large grafts for the upper extremity.

Esmolol reduces pain on injection of propofol

Abstract Background and objective: This randomized, double-blind, placebo-controlled study was carried out to determine the effect of esmolol on the incidence and severity of pain during propofol injection using a venous retention technique, and to compare it with lidocaine and placebo. Methods: After institutional ethical approval, 150 ASA I-II patients (ages 21–70) undergoing general anaesthesia for elective surgery were randomized to receive esmolol (0.5 mg/kg) (n = 50), lidocaine (0.5 mg/kg) (n = 50) or saline (placebo group, n = 50) diluted into a 5 ml solution after tourniquet application (70 mmHg) on the forearm. The occlusion was released after 30 seconds and 25% of the calculated induction dose of propofol was administrated at the rate of 0.5 ml/s. The patients were observed and asked immediately if they had pain in the arm, and the response was recorded. Results: Twenty-seven patients in the esmolol group, 28 in the lidocaine group, and 8 in the placebo group reported no pain (both groups vs. pl...

Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia

The most important dilemma in the diagnosis of ventilator-associated pneumonia (VAP) based on only clinical findings is overdiagnosis. The aim of the study is to prospectively evaluate the Clinical Pulmonary Infection Score (CPIS) in relation to VAP diagnosis.