Study objective The correct performance of the shoulder arthroscopic technique requires appropriate visualization through a video camera which raises the need for providing satisfactory bloodless surgical field. The current study was conducted to evaluate the clinical efficacy of dexmedetomidine infusion compared to that of remifentanil for controlled hypotension in patients undergoing shoulder arthroscopy. Patients and methods Forty patients undergoing elective arthroscopic shoulder surgery under general anesthesia were enrolled in the current study. Patients were randomly distributed into one of two equal groups: dexmedetomidine group (D group) and remifentanil group (R group) according to the agent used for controlled hypotension. In group D, IV dexmedetomidine l μg/kg was infused over 10 min before anesthesia induction, followed by a continuous infusion of 0.3-0.6 μg/kg/h during the operation. In group R, 1 μg/kg remifentanil IV bolus was administered before induction of anesthesia and continued 0.25-0.50 μg/kg/min during the operation. In both groups, the drug infusion was titrated to achieve a mean arterial pressure (MAP) of 60-70 mmHg. Hemodynamic parameters, surgical field condition, recovery profile, and the incidence of perioperative adverse events were assessed. Results Controlled hypotension was achieved successfully in both study groups. There was no intergroup significant difference as regards the intraoperative MAP and heart rate (HR) recordings (P > 0.05) except for the significantly lower HR recorded after extubation,30 min and 1 h postoperative in group D when compared with group R (P < 0.05). The surgical field condition was satisfactory on surgeon assessment in both groups (P > 0.05). Extubation time, time to reach modified Aldrete score ≥ 9 and time to 1st postoperative analgesic requirement were significantly longer in the group D when compared with group R (P < 0.05). Postoperative Ramsay sedation score recordings were significantly higher in the group D when compared with group R (P < 0.05) except at 2 h postoperative recordings and all the VAS score recordings were significantly lower in group D when compared with group R (P < 0.05). There was no intergroup significant difference as regards the incidence of perioperative adverse events. Conclusion Both remifentanil and dexmedetomidine can induce adequate levels of hypotensive anesthesia and satisfactory surgical field visibility in patients undergoing shoulder arthroscopy under general anesthesia. Patients treated with dexmedetomidine had better quality and more extended postoperative analgesia but longer postoperative anesthesia recovery and higher postoperative sedation scores when compared with remifentanil.

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Background: The aim of the current study was to compare the effects of midazolam-ketamine versus dexmedetomidine-ketamine combinations on hemodynamics, sedation level, and recovery period in pediatric patients undergoing cardiac catheterization for hemodynamic study. Patients and methods: Fifty pediatric patients undergoing cardiac catheterization for hemodynamic study were enrolled in the current study. Patients were randomly distributed to one of two equal groups: midazolamketamine group (group M) and dexmedetomidine-ketamine group (group D). The patients in group M received intravenous midazolam 0.1 mg/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous midazolam infusion of 0.1 mg/kg/h and ketamine infusion of 1 mg/kg/h for maintenance whereas patients in group D received intravenous dexmedetomidine1μg/kg and ketamine 1 mg/kg as a bolus for induction, then received an intravenous dexmedetomidine infusion of 0.5 μg/kg/h and ketamine infusion of 1 mg/kg/h for maintenance. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO 2), and sedation scores were recorded. Recovery time, perioperative adverse events, and total ketamine consumption required for anesthesia maintenance were also recorded. Results: The HR was significantly lower in group D when compared with group M at 10, 20, and 30 min of the procedure with no significant difference as regards the MAP between the two study groups. There were no statistically significant differences between the two study groups in terms of Ramsay sedation scores. Ketamine consumption in group D was significantly lower than in group M. The recovery time was significantly shorter in group D when compared with group M. Conclusion: The dexmedetomidine-ketamine combination was superior to midazolam-ketamine combination because of less intraoperative ketamine consumption required for adequate intraoperative sedation and the shorter recovery time.

Study objective The aim of this study was to compare the effect of dexmedetomidine versus ketamine when added to caudal bupivacaine on the incidence of emergence delerium (ED), postoperative sedation, and analgesia in pediatric patients undergoing inguinal hernia repair under sevoflurane anesthesia. Methods Eighty seven pediatric patients who underwent elective inguinal hernia repair under sevoflurane anesthesia were randomly distributed into one of three equal groups. Group B (bupivacaine, n = 29), group BK (bupivacaine ketamine, n = 29), and group BD (bupivacaine dexmedetomidine, n = 29). Patients of group B received caudal injectate of 1 ml/kg bupivacaine 0.25%, while group BK patients received caudal injectate of 1 ml/kg bupivacaine 0.25% mixed with ketamine 0.5 mg/kg, and group BD patients received caudal injectate of 1 ml/kg bupivacaine 0.25% mixed with dexmedetomidine 1 μg/kg. Primary outcome measure was the assessment of the incidence of postoperative ED. Secondary outcomes included the postoperative sedation scores and postoperative Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores, time to 1st postoperative analgesic, and total postoperative analgesic consumption. Also, the incidence of perioperative complications were assessed. Results The incidence of ED was significantly lower in group BD and BK compared with group B (P < 0.05) with no significant difference between group BD and BK (P > 0.05). Postoperative sedation scores were significantly higher in group BK and BD compared with group B (P < 0.05) at the 1st 30 min and 1st 2 h postoperative respectively; they were also significantly higher in group BD compared with group BK at (10 min–2 h) postoperative (P < 0.05). The duration of analgesia was significantly longer, and the total postoperative paracetamol consumption was significantly lower in group BD and BK compared with group B (P < 0.05); they were also significantly lower in group BD compared with group BK (P < 0.05). There was no intergroup significant difference as regards the incidence of perioperative complications. Conclusions Both dexmedetomidine (1 μg/kg) and ketamine (0.5 mg/kg) added to pediatric caudal block were effective to control pediatric ED after sevoflurane anesthesia. Patients received caudal dexmedetomidine had longer time to 1st postoperative analgesia and less postoperative analgesic consumption but longer postoperative sedation when compared with ketamine with no significant difference between both drugs as regards the incidence of perioperative adverse events.

Background The purpose of this study was the assessment of the analgesic and hemodynamic implications of dexmedetomidine used as an additive to bupivacaine in ultrasound-guided serratus anterior plane (SAP) block for patients undergoing video-assisted thoracoscopic surgeries (VATS ) under general anesthesia. Results The hemodynamic stability was maintained perioperatively with no significant difference of MBP and HR recordings between the two study groups (P > 0.05). The time to 1st postoperative analgesic demand was significantly longer in group BD than in group B (P < 0.05). The postoperative total nalbuphine and rescue ketorolac requirements were significantly lower in group BD than in group B (P < 0.05). The VAS scores were significantly lower in group BD at 8th and 12th h postoperatively than in group B, with no significant difference at 0–6 h and 18–24 h postoperatively (P > 0.05). Ramsay sedation scores were significantly higher in the group BD than in group B in the initial 1st h after surgery (P < 0.05) with no significant difference at the subsequent postoperative recordings (P > 0.05). Conclusion Using dexmedetomidine (0.5 μg/kg) as an additive to bupivacaine for SAP block prolongs the duration of postoperative analgesia and reduces the postoperative analgesic requirements in the 1st 24 h after VATS without any significant side effects.