Unsal Oner

Characteristics of Acute Adult Poisoning in Gaziantep, Turkey

Background:The objective of this prospective hospital-based study was to evaluate the rate and characteristics of acute human poisoning in our province (Gaziantep City, Turkey). Methods: All cases of acute human poisonings admitted to the emergency department of the Gaziantep University Hospital, Gaziantep, Turkey, between January 2000 and December 2001, were included in the study. The rate and causes of mortality from poisoning as well as demographic data of the patients were investigated. Results: There were 179 (0.7%) poisoning cases among 25,605 patients who admitted to the emergency department. Of the poisoning cases, 64.3% were female and 35.6% were male patients. The poisoning made a peak between the ages of 16 and 25. The majority of poisonings resulted from oral ingestion with deliberate intake accounting for 78.7% of the cases. Most of the suicide attempt cases were also females. Analgesics were the most common agents (42.4%) among the drugs incriminated in poisoning. Twenty-four patients (13.7%) were admitted to intensive care unit, of whom 42% were female and 58% were male patients. Drugs for suicide attempts were the main cause of poisoning in the patients who admitted to intensive care unit. Five patients (2.8% of all cases) died in the intensive care unit. Conclusions: These data provide important preliminary information on the pattern of symptomatic poisonings in this south-east part of our country.

Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia

Background and objectives: Functional endoscopic sinus surgery can be performed under either local or general anaesthesia. The objective of this study was to investigate the haemodynamic effects of perioperatively administered dexmedetomidine, a new generation &agr;‐2‐agonist, in patients for functional endoscopic sinus surgery. Methods: Sixty‐two patients who were planned to undergo functional endoscopic sinus surgery under local anaesthesia were included in the study. Following meperidine premedication, both groups were monitored in a standard manner with electrocardiogram, non‐invasive blood pressure and percentages of peripheral saturation of oxygen. Saline intravenous infusion was started in the placebo group, and dexmedetomidine bolus intravenous infusion (an initial loading dose of 1 &mgr;g kg−1 given for a 10‐min period followed by 0.7 &mgr;g kg−1 h−1) was administered to the treatment group. Maintenance dose infusion was stopped 15 min before the end of the surgical procedure. Results: Systolic, diastolic and mean arterial pressures, and heart rate markedly decreased in the dexmedetomidine group. However, dexmedetomidine had no effect on serum nitric oxide levels, measured by a nitric oxide/ozone chemiluminescence method. No significant difference was found in oxygen saturation levels of the two groups. Postoperative nausea and vomiting rates were significantly lower in the dexmedetomidine group. No adverse effects were observed with this &agr;‐2‐agonist. Dexmedetomidine provided appropriate levels of sedation. Conclusion: These results suggest that dexmedetomidine provides analgesia, adequate sedation and surgical comfort without adverse effects for patients undergoing functional endoscopic sinus surgery under local anaesthesia.

Epidural corticosteroid injection and amitriptyline for the treatment of chronic low back pain associated with radiculopathy

AbstractThe therapeutic role of epidural steroids has not been established for patients whose chances for improvement are poor, e.g. patients with chronic symptoms. In such cases, supplementary treatment with some medications are proposed, but no randomised prospective study is available regarding the results of these combinations. In this study, we evaluated the outcome of a protocol consisting of amitriptyline and epidural corticosteroid. Ninety-two patients suffering from chronic low back pain together with unilateral radicular involvement were introduced into the study. The patients were randomly assigned to two groups. All patients received benzylprednisolone (14 mg) + bupivacaine (0.25%) combination via epidural route. In addition, amitriptyline (10–50 mg p.o.) was administered to group 2 for 9 months. The results were assessed by a visual analogue scale and Oswestry Low back Pain Disability Questionnaire. At 2 weeks, both groups showed statistically significant improvement. At 6 weeks, recovery was...

Propofol/Dexmedetomidine and Propofol/Ketamine Combinations for Anesthesia in Pediatric Patients Undergoing Transcatheter Atrial Septal Defect Closure: A Prospective Randomized Study

BACKGROUND Children undergoing cardiac catheterization usually need general anesthesia or deep sedation. OBJECTIVE This study was performed to compare the effects of propofol/dexmedetomidine and propofol/ketamine combinations on recovery time and hemodynamic parameters in pediatric patients undergoing transcatheter atrial septal defect (ASD) closure. METHODS This was a prospective randomized study. Pediatric patients with ASD were randomly assigned into 2 groups to receive propofol/dexmedetomidine or propofol/ketamine. The dexmedetomidine group received an infusion over 10 minutes of dexmedetomidine 1 microg/kg and propofol 2.0 to 2.5 mg/kg bolus for induction, then an infusion of dexmedetomidine 0.5 microg/kg/h and propofol 4 to 6 mg/kg/h for maintenance. In the ketamine group, patients received the same dose of propofol and ketamine 1 mg/kg for induction and 0.5 mg/kg/h by infusion for maintenance. The procedure was performed using both fluoroscopy and transesophageal echocardiography. Hemodynamic data, respiratory rate, and oxygen saturation were recorded before and after induction, 1 and 5 minutes after intubation, every 10 minutes thereafter during the procedure, and after extubation by researchers blinded to the study drugs. Recovery time, the primary outcome, was evaluated by a modified Steward score; a score of >or=6 means that the patient is awake or responds to verbal stimuli, has purposeful motor activity, and coughs on command. The time to reach a modified Steward score of >or=6 was recorded. The secondary outcome was the effects on the hemodynamic variables. Creatine kinase muscle-brain subunit, myoglobin, cardiac troponin I, and brain natriuretic peptide were the biochemical variables measured. Patients were monitored for respiratory (changes in oxygen status) and hemodynamic adverse effects (heart rate changes, blood pressure changes) until the second hour in the intensive care unit after the operation was concluded. RESULTS Nine patients each were randomly assigned to propofol/dexmedetomidine and propofol/ketamine. The demographic and clinical parameters were not significantly different between groups. In the dexmedetomidine group, 5 of the patients were male, mean (SD) age was 12.5 (10.4) years, and mean weight was 40.8 (27.8) kg. In the ketamine group, 3 patients were male, mean age was 10.1 (4.5) years, and mean weight was 30.0 (15.2) kg. The recovery time was significantly longer in the ketamine group than in the dexmedetomidine group (10.5 [3.4] vs 5.7 [0.8] minutes; P = 0.01). Systolic and diastolic blood pressure values were not significantly different between groups in any study period. Heart rate values were significantly higher in the ketamine group at 5 minutes after intubation (106.6 vs 84.2 beats/min), 10 minutes (111.8 vs 87.4 beats/min) and 30 minutes (110.0 vs 89.6 beats/min) perioperatively, and after extubation (126.8 vs 92.2 beats/min) (all, P < 0.05). In the dexmedetomidine group, one patient experienced shivering and one reported nausea; in the ketamine group, one patient reported nausea. Neither respiratory depression nor severe hypotension (ie, >20% change over baseline or requiring intervention) was observed in any patient. One patient developed agitation in the ketamine group. CONCLUSIONS In this small study, both dexmedetomidine and ketamine in combination with propofol were well tolerated in these pediatric patients who required ASD closure. The recovery period was significantly shorter in the dexmedetomidine group.

Pretreatment with Dexmedetomidine or Thiopental Decreases Myoclonus after Etomidate: A Randomized, Double-Blind Controlled Trial

BACKGROUND Myoclonic movements are common problems during induction of anesthesia with etomidate. The aim of this study was to compare the effect of pretreatment with dexmedetomidine (0.5 microg/kg) and thiopental (1 mg/kg) on the incidence of etomidate-induced myoclonus and postoperative pain. MATERIALS AND METHODS A prospective double-blind study was conducted at a university hospital. Ninety patients (ASA physical status I-II) were randomly assigned to one of three groups: patients were pretreated with either dexmedetomidine (0.5 microg/kg), thiopental (1 mg/kg), or saline before induction of anesthesia with etomidate. One minute after the injection of study drugs, etomidate, 0.3 mg/kg was given. Myoclonus was assessed on a scale of 0 to 3. Recovery time, postoperative pain score, and hemodynamic variables were recorded during the intraoperative and postoperative period. Headache, nausea, vomiting, and coughing were noted during the study. RESULTS The incidence and the intensity of myoclonus was significantly lower in the dexmedetomidine and thiopental groups (34%, 36%) than in the control group (64%) (P<0.05). The postoperative pain score at 30 min in the thiopental group was significantly higher than in the dexmedetomidine and control groups (63%) (P<0.05). CONCLUSIONS We concluded that pretreatment with dexmedetomidine or thiopental is effective in reducing the incidence and severity of etomidate-induced myoclonic muscle movements and pretreatment with thiopental increases the postoperative pain.

Dexmedetomidine use during strabismus surgery in agitated children.

Objective: We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. Subjects and Methods: We enrolled 60 agitated pediatric patients, aged 4.5–11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 µg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1–3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 µg/kg and rocuronium bromide 0.5 mg/kg. Results: 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0–4.0) in group D and 0.0 (IQR 1.0–2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5–3.0) in group D and 2.0 (IQR 1.5–3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0–2.0) in group D and 4.5 (4.0–5.0) in group P] (p = 0.0001). Conclusion: Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy.

PurposeThis study was designed to compare the effects of premedication with dexmedetomidine and midazolam on post-electroconvulsive therapy (ECT) agitation (which patients had experienced previously and had been resistant to treatment). In addition, we aimed to evaluate the duration of convulsion, the propofol requirement, the recovery time, and patients’ satisfaction during and after ECT.MethodsFifteen patients with depressive episodes of bipolar disorder and nonbipolar recurrent depression and patients who underwent a series of three consecutive ECT treatments were studied as a crossover design. In this double-blind and placebo-controlled study, patients were randomly allocated to receive either dexmedetomidine, 0.5 μg·kg−1 (group Dex), midazolam, 0.025 mg·kg−1 (group Dor), or saline (group C) in a total volume of 20 ml given intravenously 10 min before the induction of anesthesia. Propofol was administered until the patients did not respond to a verbal command.ResultsThe mean duration of convulsive activity was longer in group Dex than in group C and group Dor (P < 0.05). The total dose of propofol requirement in group Dor and group Dex was lower than that in group C (P < 0.05). Agitation scores in both groups Dor and Dex were significantly lower than scores in group C (P < 0.05) at 10 and 15 min after ECT.ConclusionPremedication with low-dose intravenous dexmedetomidine, 0.5 μg·kg−1 or midazolam, 0.025 mg·kg−1 before ECT may be useful in managing treatment-resistant agitation after ECT, without adverse effects.

Low flow desflurane and sevoflurane anaesthesia in children

Background and objective: Low flow desflurane and sevoflurane anaesthesia were administered to children and compared for haemodynamic response, renal and hepatic function, recovery time and postoperative nausea and vomiting. Methods: Eighty ASA I‐II patients aged 5‐15 yr were included in the study. Midazolam was given for premedication. Anaesthesia induction was performed with fentanyl, propofol and atracurium. After intubation, the first group received desflurane, oxygen and nitrous oxide at 6 L min−1 and the second sevoflurane, oxygen and nitrous oxide at 6L min−1. Ten minutes after induction the flow was decreased to 1L min−1 in both groups. Haemodynamic parameters, preoperative and postoperative renal and hepatic function, the times of operation and anaesthesia, and early recovery data were recorded. Modified Aldrete scores were noted at the 10th and 30th minutes postoperatively and postoperative nausea, and vomiting were assessed. Results: There were no significant differences in haemodynamic parameters, renal and hepatic functions, postoperative recovery and postoperative nausea and vomiting between groups. The recovery time was shorter in the desflurane group compared to the sevoflurane group. Conclusion: Low flow desflurane and sevoflurane anaesthesia do not adversely affect haemodynamic parameters, hepatic and renal function in children. Desflurane may be preferred when early recovery from anaesthesia is warranted.

Premedication With Dexmedetomidine Alone or Together With 0.5% Lidocaine for IVRA

BACKGROUND This study aimed to compare the effects of low and same dose of dexmedetomidine when added to lidocaine for intravenous regional anesthesia (IVRA) and when administered for premedication before IVRA. MATERIAL AND METHODS In this double blind study, 45 patients with ASA physical status I-II were scheduled to undergo carpal tunnel release as an outpatient procedure and were randomly divided into three groups. IVRA was performed with 40 mL of 0.5% lidocaine in the operating room. A single dose of dexmedetomidine 0.5 μg/kg and placebo (saline) solution in a total volume of 20 mL were administered intravenously to group P (n=15) and group S (n=15), respectively, before IVRA. 0.5 μg/kg of dexmedetomidine was added to lidocaine in group A (n=15) during IVRA. The onset and recovery time of sensory and motor block, intraoperative-postoperative visual analog scale (VAS) and Ramsay sedation scores (RSS), analgesic requirement, hemodynamic variables, and side effects were noted. RESULTS Significantly shortened sensory block onset and recovery time in group P and A, shortened motor block onset time in group P, and decreased intra-postoperative VAS scores and analgesic requirement in groups P and A were found. Intraoperative RSS in group P and postoperative RSS in groups P and A were higher than in group S. Intraoperative and postoperative heart rate and postoperative mean arterial blood pressure (MAP) of group P was significantly lower than groups A and group S, respectively. CONCLUSION Both addition of dexmedetomidine to lidocaine and premedication with dexmedetomidine for IVRA similarly improve quality of anesthesia and perioperative analgesia without important side effects.

Ketamine versus propofol for strabismus surgery in children

Purpose: To compare the effects of intravenous infusion of ketamine and propofol anesthesia in children undergoing strabismus surgery. Methods: Sixty pediatric patients aged 4–11 years were enrolled for the study. Patients in Group K were infused ketamine 1–3 mg/kg/hr (n = 30) and patients in Group P were infused with propofol 6–9 mg/kg/hr (n = 30). After giving fentanyl 1 μg/kg and rocuronium bromide 0.5 mg/kg, patients were intubated. Results: The consumption of anesthetics (P = 0.0001) and antiemetics (P = 0.004), the incidence of oculocardiac reflex (P = 0.02) in Group K were significantly lower than in Group P. The recovery time (P = 0.008), postoperative agitation score (P = 0.005), Face Pain Scale (P = 0.001), Ramsay Sedation Score (P = 0.01) during awakening and at postoperative 30th min (P = 0.02) in Group K were significantly lower than in Group P. The postoperative agitation score during awakening was significantly lower than the preoperative values in Group K (P = 0.0001). Conclusions: The infusion of ketamine is more advantageous than the infusion of propofol in children for use in strabismus surgery.