Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section.

BACKGROUND: Dexmedetomidine has arousal sedation and analgesic effects. We hypothesize that epidural dexmedetomidine in single-dose combined with ropivacaine improves the experience of parturient undergoing cesarean section under epidural anesthesia. This study is to investigate the effect of 0.5 µg/kg epidural dexmedetomidine combined with epidural anesthesia (EA) in parturients undergoing cesarean section. METHODS: A total of 92 parturients were randomly divided into Group R (receiveing epidural ropivacaine alone) Group RD (receiveing epidural ropivacaine with 0.5 µg/kg dexmedetomidine). The primary outcome and second outcome will be intraoperative NRS pain scores and Ramsay Sedation Scale. RESULTS: All 92 parturients were included in the analysis. The NRS were significantly lower in Group RD compared to Group R at all observation timepoint (P > 0.05). Higher Ramsay Sedation Scale was found in Group RD compared to Group R (P < 0.001). No parturient has experienced sedation score of 4 and above. No significant difference regarding the incidence of hypotension, bradycardia and nausea or vomiting, Apgar scores and the overall satisfaction with anesthesia was found between Group R and Group RD (P > 0.05). CONCLUSION: Epidural dexmedetomidine of 0.5 µg/kg added slightly extra analgesic effect to ropivacaine in EA for cesarean section. The sedation of 0.5 µg/kg epidural dexmedetomidine did not cause mother-baby bonding deficit. Satisfaction with anesthesia wasn't significantly improved by epidural dexmedetomidine of 0.5 µg/kg. No additional side effect allows larger dose of epidural dexmedetomidine attempt. TRIAL REGISTRATION: This study was registered at www.chictr.org.cn (ChiCTR2000038853).

Effect of different doses of epidural dexmedetomidine on reducing visceral traction reaction for cesarean section: a double-blind randomized controlled trial.

PURPOSE: This study aimed to evaluate the effect of different doses of epidural dexmedetomidine on reducing visceral traction reaction for cesarean section under epidural anesthesia. METHODS: Nulliparas were randomly allocated to receive epidural ropivacaine alone (group R) or in combination with dexmedetomidine 0.5 µg/kg (group RD0.5), 0.75 µg/kg (group RD0.75), and 1 µg/kg (group RD1) with 46 nulliparas in each group. The primary outcome was intraoperative visceral traction reaction (graded from 0 to 3, with 0 and 3, respectively, regarded as 'no discomfort in stomach or perineum; no nausea, vomiting or intestinal tympanites' and 'serious visceral pain, nausea and vomiting, intestinal tympanites'). RESULTS: Visceral traction reaction was significantly alleviated in group RD0.5, RD0.75, and RD1, respectively, compared to group R while it was comparable among RD groups. Increased Ramsay Sedation Scale and lower incidence of shivering were found in RD groups compared to group R (p < 0.001). None of the primipara has experienced Ramsay Sedation Scale above 4. Higher incidence of thirst was found in group RD0.75 and RD1 compared to group R and RD0.5 (p < 0.001). The Apgar scores at 1 and 5 min of the neonates, onset time to T6 sensory block, maximum sensory block level, the incidence of hypotension, bradycardia and nausea or vomiting were comparable among groups. CONCLUSION: It is suggested that 0.5 µg/kg epidural dexmedetomidine can be used as adjuvant to epidural ropivacaine during cesarean section, because of its alleviating visceral traction reaction, moderate sedating, and reducing shivering without thirst increase.

Evidence for a Novel Phylotype of Pseudomonas syringae Causing Bacterial Leaf Blight of Cantaloupe in China.

Bacterial leaf blight (BLB) has caused severe yield losses in cantaloupe (Cucumis melo L.) in the major melon-growing regions of China since the beginning of the twentieth century. Historically, Pseudomonas syringae pv. lachrymans was considered to be the causal agent of BLB of cantaloupe and angular leaf spot of cucumber. In the process of characterizing bacteria isolated from cantaloupe, we observed that putative P. syringae pv. lachrymans yielded negative results in P. syringae pv. lachrymans-specific PCR assays. This suggested that the P. syringae pv. lachrymans-like strains from cantaloupe were distinct from those recovered from cucumber. To investigate the differences between P. syringae pv. lachrymans-like strains isolated from cantaloupe and cucumber, 13 P. syringae strains isolated from cantaloupe [12 from China and 1 from Zimbabwe (NCPPB2916)] and 7 additional P. syringae reference strains were analyzed by catabolic profiling, phylogenetic analysis by multilocus sequence analysis (MLSA) and pathogenicity tests on cantaloupe leaflets. Catabolic profiling and MLSA based on 10 housekeeping genes and 2 hypersensitive response and pathogenicity (hrp) genes allowed us to differentiate strains isolated from cantaloupe and cucumber. Pseudomonas syringae pv. lachrymans strains isolated from cucumber clustered with genomospecies 2, and 13 P. syringae strains isolated from cantaloupe belonged to genomospecies 1. While all cantaloupe strains were closely related to P. syringae pv. aptata, they could be differentiated from this pathovar based on metabolic tests and MLSA. Pathogenicity tests showed that all strains isolated from cantaloupe and cucumber were only pathogenic on their original hosts. Based on these observations we conclude that P. syringae pv. lachrymans strains recovered from cantaloupe in China represent a novel phylotype.