This study was designed to evaluate the effect of dexmedetomidine when added to lidocaine for IV regional anesthesia. This is the first clinical study demonstrating that the addition of 0.5 microg/kg dexmedetomidine to lidocaine for IV regional anesthesia improves quality of anesthesia and intraoperative-postoperative analgesia without causing side effects.

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Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.

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BACKGROUNDThyroid hormone dysfunction could affect outcome and increase mortality in critical illness. Therefore, in a prospective, observational study we analyzed and compared the prognostic accuracy of free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), along with the APACHE II and SOFA scoring systems in predicting intensive care unit (ICU) mortality in critically ill patients.PATIENTS AND METHODSPhysiology scores were calculated for the first 24 hours after ICU admission in 206 patients with acute respiratory distress syndrome. APACHE II and SOFA scores were employed to determine the initial severity of illness. Thyroid hormones were measured within the first 24 hours. Logistic regression models were created for APACHE II scores, SOFA scores, and thyroid hormone levels. The models predicted high- and low-risk subgroups. Models that showed a good fit were stratified by Kaplan-Meier survival curves.RESULTSThere were 98 (47.6%) survivors and 108 (52.4%) non-survivors. The survivors had a lower APACHE II score (11.50 vs 15.82, P<0.0005), a lower SOFA score (6.06 vs 9.42, P<0.0005), a younger age (57 vs 70 years, P=0.008), a shorter ICU stay (13 vs 16 days, P=0.012), and a higher fT3 level (2.18 vs 1.72 pg/mL, P=0.002) than non-survivors. ICU survival was most closely predicted by a model that included age and fT3 and a model that included APACHE II and APACHE II*sex.CONCLUSIONIn critically ill patients, serum fT3 concentrations markedly decreased after ICU admission among non-survivors. According to our findings, fT3 levels might have additive discriminatory power to age, SOFA and APACHE II scores in predicting short-term mortality in ARDS patients admitted to ICU.