Hatice Evren Eker

Children on phenobarbital monotherapy requires more sedatives during MRI.

Background:  Phenobarbital induces specific hepatic cytochrome P‐450 enzyme pathways causing increased clearance of hepatically metabolized drugs. In this study, we investigated the duration and additional anesthetic requirement during Magnetic resonance imaging (MRI) in epileptic children with or without phenobarbital monotherapy.

Ultrasound-Guided Supraclavicular Brachial Plexus Block for Analgesia during Endovascular Treatment of Dysfunctional Hemodialysis Fistulas

PURPOSE To evaluate prospectively the efficacy and safety of ultrasound (US)-guided supraclavicular brachial plexus block (BPB) for analgesia during endovascular treatment of dysfunctional hemodialysis fistulas. MATERIALS AND METHODS US-guided supraclavicular BPB was performed before endovascular treatment of dysfunctional hemodialysis fistulas in 40 consecutive patients. After BPB, standard interventional procedures were performed for treatment of dysfunctional hemodialysis fistulas. A visual analog scale (0-10) was used to assess pain related to performance of BPB immediately after the endovascular procedure. Patient satisfaction and operator satisfaction during the procedure were also assessed after the procedure. RESULTS Satisfactory regional anesthesia and analgesia were achieved in all patients without a need for supplemental intravenous analgesia. The mean onset time for complete block was 5.4 minutes ± 2.6. Pain scores were 0 (no pain) in 26 patients and 1-3 (mild, annoying pain) in 14 patients. The patients satisfaction with pain control was recorded as satisfied (very well) in all cases. The operators satisfaction with this anesthetic technique was also recorded as satisfied (very well) in all cases. Complications related to the block procedure did not occur in any patient. CONCLUSIONS US-guided supraclavicular BPB can be used safely to provide analgesia during endovascular treatment of dysfunctional hemodialysis fistulas in adult patients.

Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients

BACKGROUND AND OBJECTIVE Sedation in dialysis dependent end-stage renal disease patients requires caution as a result of performing high doses of sedatives and its complications. Multidrug sedation regimens might be superior and advantage on lesser drug consumption and by the way adverse events which occur easily in end-stage renal disease patients. We evaluated the effects of dexmedetomidine premedication on propofol consumption, sedation levels with Observers Assessment of Alertness and Sedation scores and the bispectral index and the hemodynamic changes, potential side effects in geriatric patients with end-stage renal disease who underwent hip fracture surgery under spinal anesthesia. METHOD In this randomized, controlled, double-blind study 60 elderly patients (age≥65 years) with end-stage renal disease and hip fracture scheduled for anterograde femoral intramedullary nailing were assigned to groups that received either intravenous saline infusion (Group C) or dexmedetomidine 0.5μg/kg/10min infusion for premedication (Group D). All the patients received propofol infusion after the induction of the spinal anesthesia. RESULTS Total propofol consumption, propofol dose required for targeted sedation levels according to Observers Assessment of Alertness and Sedation scores and bispectral index levels, recovery times were significantly lower in Group D (p<0.001). The time to reach to Observers Assessment of Alertness and Sedation score 4 and to achieve bispectral index≤80 was significantly lower in Group C compared with Group D (p<0.001). Adverse events were similar in both groups. CONCLUSION Dexmedetomidine premedication lowers intraoperative propofol consumption to maintain targeted level of sedation. Therefore low dose dexmedetomidine premedication in addition to propofol infusion might be an alternative in geriatric patients with end-stage renal disease for sedation.

Meperidine Induced Seizure in a Patient With Lyme Borreliosis

A 15 years old child with Lyme borreliosis was treated with meperidine via a patient controlled analgesia (PCA) pump for pain management. He had no history of seizure and had normal hepatic and renal functions. At the 7th hour of meperidine PCA delivery, generalized tonic-clonic seizure was developed and successfully suppressed with antiepileptics and no neurologic sequel was occurred. The total meperidine consumption in the patient was quite lower than the recommended doses with PCA. Although Lyme disease might also cause seizure activities, the timing of the seizures was related with the accumulation of normeperidine which is the main metabolite of meperidine with central nervous system stimulant effect. The meperidine pain management on patients with Lyme syndrome should be reconsidered to avoid undesired effects. Keywords

Ketamine dosing for sedation during repeated radiotherapy sessions in children

Background/aim We report the analysis of ketamine doses needed and the recovery times in pediatric oncology patients undergoing repeated radiotherapy sessions. Materials and methods In a single-blind prospective study design, thirty-three pediatric patients undergoing radiotherapy due to oncologic disorders received 2 mg/kg ketamine and 10 μg/kg atropine intravenously and the rescue drug to be administered was ketamine at 0.5 mg/kg when the sedation level was inadequate. Total ketamine consumption, additional doses, and recovery time were recorded. Results Data of 635 consecutive radiotherapy sessions were evaluated. There was no significant alteration in total ketamine consumption required to complete the radiotherapy periods during consecutive procedures (P > 0.05). However, the recovery times started to decrease by the fourth session (P = 0.02) and continued to decrease onwards during the whole study period (P = 0.001). The mean of the first recovery time was 13.68 ± 3.99 min, whereas the mean of the last recovery time was 7.66 ± 6.35 min. Conclusion A requirement for an incremental increase in ketamine dose after subsequent administrations was not detected, despite a significant decrease in recovery times being anticipated when ketamine is used repeatedly for sedative purposes in consecutive radiotherapy sessions.

Is atropine premedication during ketamine–dexmedetomidine sedation is necessary?

SIR—In his editorial ‘Let them drink’ (1), Philip Ragg mentions that review articles have been advocating to allow clear fluids closer to the scheduled anesthesia times for over 20 years. He could have gone back further. Dr Digby Leigh in his first text on pediatric anesthesia published in 1947 (2) stated ‘All patients are given clear fluids freely up to one hour before their journey to the operating room’. Uptake of these suggestions certainly has been slow.

634 COMPARISON OF INTERSCALENE BLOCK WITH 0.25% BUPIVACAINE AND 0.25% LEVOBUPIVACAINE FOR SHOULDER SURGERY: A RANDOMIZED, DOUBLE‐BLIND STUDY

Results: 35 patients were included with mean age of 70.2 years. The time between admission and surgery was mean 26 hours, 9 patients has more than one episode of nausea-vomiting, 3 patients developed postoperative delirium (9%) and all patients had postoperative VAS pain score less then 5. The supplemental analgesia was mean 20.5 hours. Conclusion: Our study shows that intratecal injection of 0.1mg Morphine in elderly patients with hip fracture is associated with a good quality of analgesia and low incidence of postoperative delirium.

553 THE EVALUATION OF PERIPHERAL NERVE BLOCKS WITH STEROIDS IN THE MANAGEMENT OF ACUTE AND CHRONIC NEUROPATHIC PAIN DUE TO TRAUMA

Methods: In a pan-European study, the per protocol set comprised 88 patients with PHN and 193 patients with painful DPN, randomized to lidocaine plaster or oral pregabalin (titrated to effect: 300 or 600mg/day). Primary efficacy endpoint was a ≥ 2 point reduction from baseline in NRS-3 or an overall score of ≤ 4 after 4 weeks’ treatment. Results: For PHN, higher response rates were observed for lidocaine plaster (61.2%;28/45) than for pregabalin (46.5%;20/43). For DPN, response rates were comparable for both treatment groups (lidocaine plaster: 66.7%;66/99; pregabalin: 69.1%;65/94). As expected, painful allodynia was more frequent with PHN compared to DPN at Baseline. Improvement in patients with PHN was statistically significant for lidocaine plaster, but not for pregabalin. Patients with DPN showed comparable improvement for both treatments. Significantly fewer patients in the lidocaine plaster group experienced drug-related adverse events: 5.8% (9/155) versus 41.2% (63/153; p < 0.0001). Overall, 36 pregabalin patients experienced drug-related adverse events leading to discontinuation, compared with 4 for lidocaine plaster. Conclusions: 5% lidocaine medicated plaster showed higher efficacy than pregabalin in patients with PHN. For DPN, efficacy was comparable for both treatments. 5% lidocaine medicated plaster showed a favourable efficacy/safety profile compared to pregabalin in patients with PHN or painful DPN supporting its first line position in the treatment of focal neuropathic pain. Funded by Grünenthal