Comparison of the effects of general and spinal anesthesia for cesarean delivery on maternal and fetal outcomes: A retrospective analysis of data.

OBJECTIVE: General or single-shut spinal anesthesia (SA) is applied for cesarean section and both methods of anesthesia have different effects on the mother and newborn. This retrospective study, in which 1-year data were analyzed, was aimed to examine the effects of general or SA on maternal and neonatal outcomes. METHODS: Anesthesia technique, mother's age, gestational age, number of pregnancies, previous cesarean delivery number, maternal complications, and indications for cesarean delivery were analyzed in 883 cesarean deliveries. In addition, weight and Apgar scores of newborn and umbilical cord blood gas values were examined. RESULTS: Neonatal intensive care need was higher in the general anesthesia (GA) group, Apgar scores were higher in the SA group, but neonatal mortality was similar. The umbilical cord Ph and lactate were lower; PCO2 values were higher in the GA group. Neonatal weight, mother's age, gestational age, and Apgar scores were predictive for neonatal mortality, but anesthesia technique was not. CONCLUSION: While umbilical cord blood gas values were less affected and the need for neonatal intensive care was lower with SA, we believe that both anesthesia methods can be used safely for mother and neonatal in cesarean anesthesia considering maternal and neonatal morbidity and mortality.

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

INTRODUCTION: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. AIM: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. MATERIAL AND METHODS: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 µg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. RESULTS: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. CONCLUSIONS: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

Comparison of General Anesthesia with Spinal Anesthesia in Laparoscopic Cholecystectomy Operations.

OBJECTIVE: Laparoscopic cholecystectomy (LC) operations are being performed under general anesthesia (GA). Further studies are needed on the issue whether these operations can be performed under spinal anesthesia (SA). In this study we aimed to compare SA with (GA) in terms of efficacy and complications in patients who will undergo LC operations, and to investigate the effects of preemptive analgesia on the development of shoulder pain, transition to general anesthesia, and postoperative analgesia. METHOD: Sixty patients in ASA I-II risk group between 18-65 years of age undergoing laparoscopic cholecystectomy were randomly divided into general anesthesia (GA, n=30) and spinal anesthesia (SA, n=30) groups. Patients were premedicated with i.v. midazolam and fentanyl preoperatively. Anesthesia was induced with propofol in the GA group, and maintained with Desflurane and remifentanil. In the SA group, spinal anesthesia was provided with intratechal administration of 15 mg bupivacaine at L2-3 level, and block level was increased to T4 by keeping the patient in Trendelenburg position for 7-10 minutes. Demographic data, hemodynamic parameters, operation time, visual analog scale (VAS) scores at postoperative 0th,1st, 4th, 8th,12th and 24th hours, patient-surgeon satisfaction, side effects, and occurrence of right shoulder pain in SA group were inquired and recorded. RESULTS: Effective anesthesia was produced in both groups. Hypotension was observed in 5, bradycardia requiring atropin administration in 4, and perioperative shoulder pain in 9 patients in Group SA, but none of them required general anesthesia. Hypotension developed in one patient in Group GA. The postoperative VAS scores were significantly lower in Group SA at 0th,1st, 4th hours. Patient satisfection scores were higher in Group SA. CONCLUSION: We concluded that spinal anesthesia may be an alternative method to general anesthesia in patients who will undergo laparoscopic cholecystectomy operations especially when the risk of general anesthesia is too high.

Follow-up of P dispersion after transcatheter closure of an atrial septal defect in children.

OBJECTIVES: To determine in paediatric patients with atrial septal defects whether differences in P wave dispersion occurred with transcatheter closures using the Amplatzer septal occluder. METHOD: A total of 31 children who had undergone transcatheter closures were evaluated. P maximum, P minimum, and P dispersion were measured with 12-lead surface electrocardiography, before the procedure and one week, one month, three months, six months and one year following the procedure. SPSS 10 was used for statistical analysis. RESULTS: There were 23 (74.2%) females and 8 (25.8%) males with an overall mean age of 7.5 +/- 4.1 years and mean weight of 26.2 +/- 16.9 kg. The P maximum and P minimum measurements differed between patients during the follow-up period. Both measurements decreased with time. However, P dispersion was not significantly different throughout the follow-up period (before the procedure P maximum 95.4 +/- 15.6 ms, P minimum 64.5 +/- 15.4 ms, and P dispersion 30.8 +/- 11.4 ms; one year later, P maximum 76.1 +/- 14.6 ms, P minimum 47.1 +/- 12.1 ms, and P dispersion 29.1 +/- 9.1 ms). CONCLUSION: Over time, there are no P dispersion differences in transcatheter closures using the Amplatzer septal occluder.

Comparison of proseal laryngeal mask and endotracheal tube for airway safety in pediatric strabismus surgery.

OBJECTIVE: To compare proseal laryngeal mask airway (PLMA) with an endotracheal tube (ET) for airway safety, maintained ease of insertion, and hemodynamic stability in pediatric strabismus surgery (PSS). METHODS: This prospective-randomized clinical study was carried out in the Department of Anesthesiology, Faculty of Medicine, Gaziantep University, Turkey between April 2008 and July 2009. Eighty American Society of Anesthesiology (ASA) I-II children, weight 10-30 kg, aged between 1-12 years undergoing PSS were selected. The anesthesia was induced with 8% sevoflurane, 50% nitrous oxide/oxygen mixture, and a neuromuscular blockade with 0.5 mg/kg atracurium in both groups. After a sufficient dosage of anesthesia, the patients were randomized into 2 groups (Group P: PLMA, n= 40, Group T: ET, n=40) and an airway management device; either a PLMA or ET was inserted. The number of placement attempts, placement success or failure, success or failure of a gastric suction tube placement during the procedures and perioperative complications were assessed. RESULTS: Thirty-eight patients (95%) in the PLMA group, 39 (97.5%) patients in the ET group were successfully placed with a PLMA and ET on the first attempt (p>0.05). There were no statistically significant differences in the hemodynamic parameters, end-tidal carbon dioxide, and complications. CONCLUSION: This study revealed that PLMA may offer an alternative airway to ET wherein positive pressure ventilation was the preferred choice for children undergoing PSS.

Leiomyosarcoma protruding into the left ventricle during diastole: report of a case.

Cardiac leiomyosarcoma is a rare tumor with poor survival prospects. Surgery prolongs survival, but the tumor often recurs early after surgery. The diagnosis is often made by transthoracic echocardiography. Magnetic resonance imaging and computed tomography are required to characterize the location and extent of cardiac masses. In this report, we present a patient with a leiomyosarcoma that was resected completely. The tumor was located in the left atrium, mimicked a myxoma, and protruded into the left ventricle during diastole.

Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas.

OBJECTIVE: Brachial plexus block offers several advantages when creating vascular access for hemodialysis. However, no controlled studies have directly evaluated arteriovenous fistula (AVF) blood flow in patients anesthetized by this method. We compared the effects of ultrasound-guided, infraclavicular brachial plexus block and local infiltration anesthesia on blood flow in the radial artery and AVF during the early and late postoperative periods. METHODS: Sixty patients were randomly assigned to an experimental group, which received infraclavicular brachial plexus block (IB), or to a control (C) group that received local infiltration anesthesia. Blood flow in the distal radial artery was measured before and after IB or infiltration anesthesia. AVF flow during the early and late postoperative period was evaluated using duplex ultrasound imaging. The rates of primary fistula failure were also compared. RESULTS: After anesthesia, preoperative radial arterial flow was 56 ± 8.6 mL/min in group IB vs 40.7 ± 6.11 mL/min in group C (P < .0001). Blood flow in the fistula, measured in mL/min at 3 hours, 7 days, and 8 weeks postoperatively, was also greater in group 1B vs group C, respectively, at 69.6 ± 7.9 vs 44.8 ± 13.8 (P < .001), 210.6 ± 30.9 vs 129 ± 36.1 (P < .001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001). CONCLUSION: When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia.

Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effects of inhalational anaesthesia using low and high gas flow rates of nitrous oxide and desflurane on mucociliary clearance and pulmonary function. METHODS: Fifty adult patients of the American Society of Anesthesiologists physical status I-II, aged between 18 and 70 years, were recruited to the study. Patients were assigned randomly to one of two study groups. The fresh gas flow rate was 1 l min(-1) (0.5 l min(-1) O2 + 0.5 l min(-1) N2O + desflurane) in group 1 and 3 l min(-1) (1.5 l min(-1) O2 + 1.5 l min(-1) N2O + desflurane) in group 2. Patients' haemodynamic parameters and changes in the humidity and temperature of the inspired gases were recorded and the saccharin clearance time was measured before and after anaesthesia. Respiratory parameters, body temperature, end-tidal CO2 concentration and inspired and expired oxygen and nitrous oxide concentrations were also recorded. RESULTS: The forced vital capacity and forced expiratory volume in 1 s were significantly lower and the saccharin clearance time was significantly longer in group 2 compared to group 1 (P < 0.05). There were statistically significant differences between the groups regarding the humidity and temperature of the inspired gases (P < 0.05). CONCLUSION: Respiratory function and mucociliary clearance are better preserved in a low-flow anaesthesia technique than in high-flow anaesthesia with nitrous oxide and desflurane. Therefore, a low-flow anaesthesia technique with nitrous oxide and desflurane may provide an important clinical advantage because it provides appropriately heated and humidified gases to the tracheobronchial tree.

P-wave dispersion between transcatheter and surgical closure of secundum-type atrial septal defect in childhood.

Patients with atrial septal defect have an increased risk for atrial fibrillation. Increased P-wave dispersion predicts the development of atrial fibrillation. The aim of this study was to determine difference in P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure in childhood. A total of 68 children (the mean age was 7.2 plus or minus 3.3 years; the mean secundum atrial septal defects diameter was 17.3 plus or minus 5.4 millimetres) were evaluated in this study. Transcatheter closure was attempted in 41 children with secundum atrial septal defects, and the defect in 27 patients was closed by surgical techniques. P maximum, P minimum and P dispersion were measured by the 12-lead surface electrocardiography. P maximum, P minimum and P dispersion were found to be similar in patients with pre- and post-procedure (98.0 plus or minus 19.3 versus 95.1 plus or minus 23.0 milliseconds; 68.0 plus or minus 20.8 versus 67.6 plus or minus 24.3 milliseconds, 29.9 plus or minus 11.0 versus 27.1 plus or minus 12.1 milliseconds, respectively). There was no statistical significance in the comparison of P dispersion between the two groups. But in the surgical group, P-wave dispersion was decreased more significantly compared with baseline values (p-value equal to 0.03). In conclusion, there is no P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure of secundum atrial septal defect.

Comparison of the coaxial circle circuit with the conventional circle circuit.

OBJECTIVE: The coaxial circle system helps prevent heat loss during surgery, and it also acts as a humidifier. This study aimed to compare the coaxial breathing system and the conventional system in their ability to warm and moisturize inhaled gases, and we also analyzed lung function protection and saccharin clearance time in patients who underwent tympanomastoidectomy (TMT) with the aid of these two systems. MATERIALS AND METHODS: Forty adult patients of ASA physical status I-II were scheduled for elective TMT. A standard volume-dependent ventilator setting was used to establish normocapnia. The coaxial circle system was used in the treated group (n=20), whereas the conventional circuit system was used in the control group (n=20). Saccharin clearance, VC (vital capacity), FRC (functional residual capacity), FEV1 (forced expiratory volume in 1 second), airway pressure, relative humidity and temperature of inspired gas, body temperature and adverse and hemodynamic effects were measured at different perioperative periods. RESULTS: The relative humidity (mg H2O Lt -1) of inspired gas in the treated group was higher than in the control group at 5, 15, 30, 45, 60 and 90 minutes after anesthesia induction. The temperature of inspired gas (Centigrade) in the treated group was higher than in the control group (p<0.05) after 5, 10, 15, 30, 45, and 90 minutes of anesthesia. Postoperative saccharin clearance time was lower than before the operation in the treated group (p<0.05). Postoperative FRC was lower than preoperative FRC in the study and control groups (p<0.05). CONCLUSION: The coaxial circle system decreased postoperative saccharin clearance time and increased postoperative FRC, relative humidity and the temperature of inspired fresh gas, without any adverse perioperative effects in patients who underwent TMT.

Dexmedetomidine-ketamine and midazolam-ketamine combinations for sedation in pediatric patients undergoing extracorporeal shock wave lithotripsy: a randomized prospective study.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) requires sedation in pediatric patients. Dexmedetomidine is a relatively new agent used for sedation. The aim of this randomized prospective study was to compare the effects of dexmedetomidine-ketamine and midazolam-ketamine combinations on the recovery time, hemodynamic and respiratory variables, and side effects in pediatric patients undergoing ESWL. METHODS: Fifty pediatric patients aged between 2 and 15 years who were scheduled for elective ESWL were randomized into two groups. In Group D we applied dexmedetomidine at1 µg/kg, given over 10 min, and a bolus of 1 mg/kg ketamine for sedation. In Group M we applied midazolam at a 0.05 mg/kg bolus dose 10 min before the procedure and a 1 mg/kg bolus of ketamine. We measured and monitored the hemodynamic variables, oxygen saturation, and recovery time, and we also monitored the side effects. RESULTS: Four patients in group D refused to complete the study; 21 patients in group D and 25 patients in group M completed the study. We found the recovery time [eye-opening time (9.3 ± 4.5 vs. 16.2 ± 6.5 min; p < 0.001), verbal response time (12.8 ± 4.9 vs. 19.2 ± 7.2 min; p < 0.001), and the cooperation time (17.1 ± 5.0 vs. 23.3 ± 7.7 min; p < 0.001)] to be shorter in the dexmedetomidine group. Also, the heart rate values were lower in the dexmedetomidine group at the 20th minute of the procedure (99.1 ± 19.0 vs. 118.7 ± 7.3 beats/min; p = 0.016). CONCLUSION: In this study we found the recovery time to be shorter, with hemodynamic stability, in the dexmedetomidine group, compared with the midazolam group. So we can conclude that dexmedetomidine may be a good and safe alternative agent for sedation, with a shorter recovery period than midazolam, in the pediatric population.

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.

Dexmedetomidine in the supratentorial craniotomy.

OBJECTIVE: In this double-blind prospective clinical study, we investigated the effects of fentanyl and dexmedetomidine as adjuvant agents in supratentorial craniotomies on the following: hemodynamic changes during perioperative and recovery periods, brain edema perioperatively, recovery times and side effects, such as hypertension, shivering, nausea and vomiting. MATERIALS AND METHODS: Thirty consenting ASA physical status I-II patients undergoing intracranial tumor surgery were randomly divided in two groups. In group D (n=15), dexmedetomidine was infused as a 1 µg/kg bolus dose 10 minutes before induction of anesthesia and maintained with 0.4-0.5 µg/kg/min during the operation. In group F (n=15), animals were given fentanyl 0.02 µg/kg/min as an infusion for anesthesia maintenance. At induction, fentanyl was given as a 2 µg/kg dose in group D and as a 4 µg/kg dose in group F. Hemodynamic changes, recovery times and postoperative side effects were recorded before induction, during the perioperative period and 24 hours postoperatively. RESULTS: In group D; MAP and HR values after intubation, after skull clamp insertion and after extubation were lower than in group F (p<0.05). In group D, cerebral relaxation scores were also significantly lower. Recovery times were found to be shorter in group D as compared to group F; the same trend was observed for the supplemental opioid requirement. During the postoperative period, there was no shivering, nausea or vomiting in group D, but in group F, 3 patients complained of shivering, and 2 patients experienced nausea and vomiting. CONCLUSION: In our study, we found that dexmedetomidine controlled the hemodynamic changes better than fentanyl perioperatively, after extubation and during the early postoperative period. Our results suggest that that dexmedetomidine is safer and more effective in controlling hemodynamic changes during surgical stimulation than the standard agents used in neuroanesthesia.

The effects of dexmedetomidine on ischemia reperfusion injury in patients undergoing arthroscopy under spinal anesthesia.

OBJECTIVE: Ischemia and reperfusion injury due to tourniquet application during arthroscopy is a well known problem. This study aimed to compare the effects of dexmedetomidine and ketamine on hemodynamic and respiratory variables and on total anti-oxidant status (TAS), total oxidant status (TOS) and malondialdehyde (MDA) as markers of ischemia-reperfusion injury. MATERIALS AND METHODS: This study was approved by a local ethics committee. The study was performed on patients undergoing arthroscopic operation under spinal anesthesia. Thirty patients were randomized into two groups: Group D (dexmedetomidine; n=15) and Group K (Ketamine; n=15). Spinal anesthesia at the L2-4 level was achieved using a 25G spinal needle with hyperbaric bupivacaine at a dose of 12-15 mg in all patients. In Group D, patients were sedated with dexmedetomidine at a dose of 0.3-0.5 µg/kg/h, while Group K received ketamine at a dose of 1-1.5 mg/kg/h. Hemodynamic parameters, oxygen saturation, Ramsey sedation scale (RSS), and TAS, TOS, and MDA levels were recorded. RESULTS: Demographic parameters, TAS, TOS and MDA levels were similar between groups. In Group K, the TOS levels after tourniquet removal were significantly lower than at baseline and during the use of the tourniquet. Preoperative hemodynamic and respiratory variables were similar in both groups. Blood pressure values were decreased compared to baseline but these decreases were not statistically significant. CONCLUSION: In patients undergoing arthroscopy under spinal anesthesia, dexmedetomidine had effects similar to ketamine, led to insignificant alterations in hemodynamic and respiratory variables during surgery and had comparable effects on ischemia-reperfusion injury. Thus, we think that dexmedetomidine can be a safe alternative to ketamine as an intraoperative sedative.

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.

A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG.

The aim of this prospective, randomized, and double-blinded study was to compare the effects of desflurane, sevoflurane, propofol on both atrial and ventricular wall function by measurement of QT dispersion (QTd), corrected QT dispersion (QTcd), and P dispersion (Pd) on electrocardiogram (ECG). Forty-six patients from the American Society of Anesthesiologists class I-II undergoing noncardiac surgery, were enrolled in this study. Patients were randomly allocated to receive desflurane, sevoflurane or propofol anesthesia. ECG recordings were taken before and after 5 minutes of drug administration. Induction with desflurane significantly increased the QTd compared to baseline (38 +/- 2 ms vs. 62 +/- 6 ms, P 0.05). Sevoflurane and propofol anesthesia was not associated with any changes in QTd. QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but this decrease was only significant in the propofol group (67 +/- 5 ms vs. 45 +/- 3 ms, P 0.05). Pd was significantly increased after induction with desflurane (34 +/- 3 vs. 63 +/- 6 ms, P 0.05). There was a significant increase in QTd and Pd in desflurane group, but this increment did not cause any dangerous arrhythmias. QTcd significantly decreased in propofol group. We believe that further investigations are required for using desflurane as safe as sevoflurane and propofol in noncardiac surgery patients who have high cardiac arrhythmia and ischemia risk.

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy.

PURPOSE: This 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. METHODS: Fifteen 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 microg x kg(-1) (group Dex), midazolam, 0.025 mg x 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. RESULTS: The 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. CONCLUSION: Premedication with low-dose intravenous dexmedetomidine, 0.5 microg x kg(-1) or midazolam, 0.025 mg x kg(-1) before ECT may be useful in managing treatment-resistant agitation after ECT, without adverse effects.

Alverine citrate induced acute hepatitis.

Alverine citrate is a commonly used smooth muscle relaxant agent. A MEDLINE search on January 2004 revealed only 1 report implicating the hepatotoxicity of this agent. A 34-year-old woman was investigated because of the finding of elevated liver function tests on biochemical screening. Other etiologies of hepatitis were appropriately ruled out and elevated enzymes were ascribed to alverine citrate treatment. Although alverine citrate hepatotoxicity was related to an immune mechanism in the first case, several features such as absence of predictable dose-dependent toxicity of alverine citrate in a previous study and absence of hypersensitivity manifestations in our patient are suggestive of a metabolic type of idiosyncratic toxicity.