This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. Children in Group F received fentanyl 2.5 µg.kg-1 , children in Group D received dexmedetomidine 0.5 µg.kg-1 and children in Group C received saline solution. Anaesthesia was induced with 50% N 2 O and 8% sevoflurane in O 2 by mask and atracurium 0.6 mg.kg-1 was administered for tracheal intubation. All children received paracetamol 40 mg/kg rectally one hour preoperatively and dexamethasone 0.5 mg.kg-1 intravenously. The time to extubation was shorter in Group D than Group F. The eye-opening time was longer in Group F (16.1±5.3 minutes) than in Groups C (12.0±4.2 minutes) and D (12.7±3.2 minutes). The proportion of painfree children in early recovery was significantly higher in Groups D (47%) and F (43%) than Group C (13%) (P <0.05). The proportion of children with agitation scores >3 was lower in Groups D 17% (5/30) and F 13% (4/30) than in Group C 47% (14/30) (P <0.05). Fentanyl 2.5 µg.kg-1 and dexmedetomidine 0.5 µg.kg-1 had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children.

Summary The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 μg) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side‐effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients.

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A dexmedetomidine dose of 1 mug/kg IV administered over 10 min before the induction of anaesthesia with propofol may be useful in preventing the acute hyperdynamic responses to ECT without altering the duration of seizure activity and recovery time.

The pre-operative administration of the alpha(2)-agonist dexmedetomidine decreases the fentanyl requirement and attenuates the increase in SVRI and PVRI at the post-sternotomy period relative to the baseline levels, and decreases effectively MAP, MPAP and PCWP in comparison with the values in the placebo group, in patients with pulmonary hypertension undergoing mitral valve replacement surgery.