The α 2-agonist dexmedetomidine (Dex), a sedative and analgesic, reduces heart rate (HR) and blood pressure, and has been used in the practice of anesthesia. In this study, we aimed to evaluate the effects of Dex on hemodynamic variables, anesthetic sparing effects, and recovery profiles in patients who underwent surgery in prone position. The prone position itself can cause a decrease in the systemic blood pressure. Forty patients who undergo lumbar discectomy were randomly assigned to receive either Dex (a loading dose 1 μ g/ kg in 10 minutes followed by an infusion rate of 0.2 μ g/ kg/ hr) or saline. In both groups, the anesthesia was induced with fentanyl, thiopental and rocuronium, and maintained with desflurane in 50% N 2 O. Mean arterial blood pressure (MAP), HR, cardiac output (CO), and level of anesthesia were monitored. Recovery times and analgesic requirements were also recorded. As a response to endotracheal intubation, a significant increase in MAP and HR was observed in the control group compared to the Dex group, but no difference in CO. The recovery times were significantly shorter in the Dex group compared to the control group. Anesthetic and analgesic requirements of the Dex group were lower than controls. Thus, the use of Dex caused no detrimental effects on the hemodynamic variables in prone position. In addition, Dex decreased pressure response to intubation, and anesthetic and analgesic requirements, shortened recovery times, and decreased postoperative pain level. Dex may be an alternative to currently used adjunctive anesthetic agents in lumbar discectomy operations.anesthesia; dexmedetomidine; NICO; cardiac output; lumbar discectomy
Rationale:Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration.Patient concerns:A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil. At the end of the operation, sugammadex was administered and resulted in initially hypotension and bradycardia then the situation worsened by premature ventricular contraction and bigeminy with tachycardia, bronchospasm, and hypoxia.Diagnosis:The Ring and Messmer clinical severity scale grade 3 anaphylactic reaction occurred just after sugammadex injection and the patient developed prolonged hypotension with recurrent cardiac arrhythmias in postoperative 12 hours.Interventions:Treatment was initiated bolus injections of ephedrine, epinephrine, lidocaine, steroids and antihistaminic and continued with lidocaine bolus dosages and norepinephrine infusion for the postoperative period.Outcomes:The general condition of the patient improved to normal 3 hours after the sugammadex injection, and she was moved to the intensive care unit. At 2nd and 8th hours of intensive care unit follow-up, she developed premature ventricular contraction and bigeminy with the heart rate of 130 to 135 beats/min, which returned to sinus rhythm with 50 mg lidocaine. After that, no symptoms were observed and the patient was discharged to plastic surgery clinic at the following day.Lessons:Sugammadex may result in life-treating anaphylactic reaction even in a patient who did not previously expose to drug. Moreover, prolonged cardiovascular collapse and cardiac arrhythmias may occur.
Abstract:Purpose: In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats Materials and methods: Twenty-eight Wistar Albino rats were included in the study after streptozocin (60 mg/ kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg -1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon ® 1000 mg/5 mL -Roche) were applied one hour before administrating 150 mg.kg -1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer. Results: Erythrocyte deformability was signifi cantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model. Conclusions: Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2
different surgical procedures. We could find only two cases of colonic interposition for esophageal stricture with EBD [2,3]. The anesthetic methods were different, and the procedures were shorter than those used in our case. There was only one patient with EBD who underwent a reconstructive operation of 12 h duration [4]. Because of the paucity of the literature on anesthesia of long duration in patients with EBD, we report the anesthetic technique employed in a 12-year-old girl with EBD who underwent a colonic interposition operation of more than 10 h duration. Case reportThe patient was a 12-year-old-girl, 125 cm tall and weighing 24 kg. She had a history of EBD since birth, and she was admitted for investigation of vomiting. A mid-esophageal stricture was shown by barium esophagogram. On physical examination, her body surface was covered with numerous blisters and with fresh and scattered bullae, particularly involving the face, the extensor sides of the extremities, and around the mouth and nose. There was evidence of microstomia, poor dentition, and limited temporomandibular joint mobility. There were also flexion contractures of the fingers of both hands (Fig. 1). The preoperative hemoglobin level was 10.3 g·dl Ϫ1 . Serum electrolytes, protein, and blood urea nitrogen were within normal limits. She had been treated with corticosteroids in the past, but at the time of admission she was taking phenytoin and was applying hydrocortisone ointment 0.5% to her lesions.The patient was taken to the operating room without premedication, and she placed herself on the operating table, which was fitted with cotton rolls. Anesthesia was induced with vital capacity inhalation of sevoflurane in combination with nitrous oxide and oxygen by a disposable face mask. A 25 G intravenous cannula was inserted in the right forearm, and an
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