Background: Dexmedetomidine has sedative and sympatholytic effects. The use of dexmedetomidine in flexible fiberoptic bronchoscopy will attenuate hemodynamic response without respiratory depression. The aim of this study was to evaluate the clinical efficiency and safety of dexmedetomidine, and to compare it with the combination of propofol-fentanyl as sedation during flexible fiberoptic bronchoscopy. Patients and methods: Seventy-two patients scheduled for elective fiberoptic bronchoscopy were included and divided into two equal groups. In propofol-fentanyl group (group PF) patients received 0.5-1 mg/kg propofol and 1 lg/kg of fentanyl. Boluses of 20 mg of propofol were given to give a sedation level of 3-4 according to Ramsay sedation score. In dexmedetomidine group (group D), dexmedetomidine 1 lg/kg over 10 min was given as a loading dose, followed by a maintenance infusion of 0.2-0.7 lg/kg/h to keep the same level of sedation. Heart rate, blood pressure and oxygen saturation were recorded. Results: Heart rate and mean arterial blood pressure values were significantly lower in group D compared to group PF all over the procedure. Group D had higher oxygen saturation values than group PF. Incidence of desaturation was more frequent in PF group (16.66%) compared to 5.55% in group D. There was no significant difference in patient satisfaction between the two groups. Conclusion: Dexmedetomidine and propofol-fentanyl are effective sedatives for patients undergoing flexible fiberoptic bronchoscopy. The sympatholytic and respiratory stability effects of dexmedetomidine make it an attractive and safe alternative for sedation during FOB.

Background: Anesthesia for ESWL must provide good analgesia, rapid recovery with least side effects. Opioids are commonly used analgesics during ESWL, but are not devoid of side effects. TENS is a non-pharmacological, non-invasive analgesic technique, which has been recommended for pain control in many clinical settings. Methods: Sixty patients scheduled for ESWL were randomly assigned to group-A (30 patients): received IV fentanyl 1µg/Kg with the application of conventional TENS. Group-B (30 patients) received IV fentanyl 1µg/Kg. IV increments of 20 µg of fentanyl were given if VAS was≥3 in both groups. Fentanyl consumption, discharge time, adverse effects, and satisfaction score for patients were compared. Results: VAS was lower among group-A than group-B throughout the procedure but that was statistically non-significant. There was significantly lower fentanyl consumption in group-A compared to group-B (P-value < 0.001). Discharge time was significantly shorter among group-A (36.2 ± 0.6 min) than group-B (47.2 ± 0.8 min). Adverse effects were significantly less frequent in group-A compared to group-B. Incidences of O 2 desaturation, nausea and vomiting were higher in group-B compared to group-A. Patients' satisfaction was significantly higher among group-A than among group-B. Conclusion: TENS is an effective and safe practice in controlling pain during ESWL, it decreases fentanyl consumption and its side effects, with greater patients' satisfaction. It decreases discharged time compared to fentanyl so it is ideal for outpatient procedures. ARTICLE HISTORY

At high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.

No abstract