The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy.

BACKGROUND: Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively. AIMS: This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia (SA). METHODS: A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- (n = 30) and 0.5 µg/kg dexmedetomidine in 100 ml saline was applied in group D- (n = 30) and 100 ml saline was administered in group P- (n = 30) in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period. RESULTS: In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20(th) min (P = 0.01). Sedation scores in group D were significantly higher than the baseline values (P = 0.03) and values in group T and P (P = 0.04). CONCLUSIONS: Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.

Cardiovasular changes after placement of a classic endotracheal tube, double-lumen tube, and Laryngeal Mask Airway.

STUDY OBJECTIVE: To compare hemodynamic responses, P wave dispersion (Pd), and QT dispersion (QTd) after placement of a classic endotracheal tube (ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA). DESIGN: Prospective study. SETTING: Outpatient surgery center. PATIENTS: 75 adult, ASA physical status 1 and 2 patients undergoing cystoscopy and thoracoscopic surgery. INTERVENTIONS: Patients were randomized to undergo placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA (Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and fentanyl 1.0 µg/kg, and maintained with nitrous oxide, oxygen, 2% to 3% sevoflurane, and rocuronium 0.5 mg/kg. MEASUREMENTS: Mean arterial pressure (MAP) and heart rate (HR) were recorded immediately before intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30 minutes after intubation/airway insertion. RESULTS: QT dispersion after tube placement was significantly higher than before tube placement in Group D (P = 0.0001) and Group L (P = 0.03). Mean arterial pressure and HR in Group T were significantly higher than in Group L at the first minute after tube placement (P = 0.02). Heart rate and MAP at baseline were significantly higher than the other measurement times in Groups T and D (P < 0.01). CONCLUSIONS: The LMA caused no change in Pd, HR, or MAP values during or after airway placement, but caused QTd after airway insertion. The ETT caused a sudden increase at the first minute after tube placement, without any Pd or QTd. In addition, DLT caused QTd without any serious change in hemodynamics.

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.