Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy.

BACKGROUND: The present study was designed to show the effects of dexmedetomidine infusion with loading dosage on perioperative hemodynamics, propofol consumption, and postoperative recovery when used for general anesthesia in patients undergoing spinal laminectomy. METHODS: Fifty American Society of Anesthesiologists (ASA) I-II patients were randomised into two groups. Group D received dexmedetomidine 0.6 microg kg(-1) as bolus before induction and 0.2 microg kg(-1) h(-1) by infusion. Group F received fentanyl 1 microg kg(-1) as bolus before induction and 0.5 microg kg(-1) h(-1) by infusion. Signs of inadequate analgesia, defined as an increase in heart rate and mean arterial pressure (MAP) 20% above the baseline, were managed by increasing or decreasing the dosage of dexmedetomidine and fentanyl. Statistical analysis was performed with student t, chi-squared and Fisher's exact tests. RESULTS: The maintenance dosage was 0.64+/-0.06 microg kg(-1) h(-1) for fentanyl in Group F and 0.31+/-0.08 microg kg(-1) h(-1) for dexmedetomidine in Group D. MAP values in Group D were significantly higher than in Group F only after intubation. Before and after extubation, MAP values in Group F were significantly higher than those in Group D. There was no statistical difference in heart rate between the groups. Propofol dosages for induction (1.40+/-0.48 mgkg(-1)) and maintenance of anesthesia (2.03+/-0.41 mg kg(-1)) were lower with dexmedetomidine. Extubation time and postanesthesia care unit discharge time were similar in both groups. The fentanyl group patients required supplemental analgesia earlier than the dexmedetomidine group (34.8+/-1.35 min vs 60.4+/-1.04 min). Postoperative nausea and vomiting were significantly higher in Group F. CONCLUSION: In conclusion, propofol-dexmedetomidine is suitable for patients undergoing elective spinal laminectomy and provides stable perioperative hemodynamic responses. Propofol-fentanyl medication requires a higher dosage of postoperative analgesics and causes frequent postoperative nausea and vomiting compared with propofol-dexmedetomidine.

The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation.

BACKGROUND AND OBJECTIVES: The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. METHODS: This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17-82 (50.09 +/- 17.76; mean +/- SD) yr, 3 males and 8 females, APACHE II score 12.63 +/- 3.90, SOFA score 3.27 +/- 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 microg kg-1 over 10 min followed by a maintenance infusion of 0.5 microg kg-1 h-1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The variation of Richmond agitation sedation scale score was between 0.9 and -1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001) CONCLUSIONS: Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.

Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study.

In the present study we aimed to demonstrate the efficacy of short-term pretreatment with finasteride in patients undergoing transurethral resection of the prostate (TUR-P). For this purpose 40 patients with BPH, who were candidates for TUR-P, were randomized into two groups. The first group (n=20) received 5 mg finasteride/day for 4 weeks prior to surgery and the second group (n=20) remained as the control. Patients who underwent prior prostate or urethral surgery and had a diagnosis of prostate cancer or chronic renal failure, patients who received finasteride, aspirin, coumadin or similar anticoagulant drugs prior to surgery and patients who had capsule perforations or open sinuses during the surgery were excluded from the study. All patients had a normal digital rectal examination and PSA values less than 4 ng/ml. As we look at the results there was no statistically significant difference between the finasteride group and control group regarding age, IPSS, PSA, prostate volumes, preoperative serum hemoglobin, hematocrit values and mean operating times and used irrigating fluids. The total amount of bleeding and bleeding per gram resected tissue were significantly lower in the finasteride group regardless of prostate volume. Furthermore the decrease in the hemoglobin and hematocrit values was higher in the control group. As a conclusion four weeks of finasteride pretreatment provided a significant decrease in peroperative bleeding regardless of prostate volume without any major side effects.

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES: Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS: Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS: Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS: Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.