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Background and Objective: Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability.Methods: We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5mgkg(-1), remifentanil 3microgkg(-1) and propofol 3mgkg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SpO(2) were recorded.Results: The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05).Conclusion: The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses. [ABSTRACT FROM AUTHOR]

Background and objective: The aim of this study was to evaluate the efficacy of dexmedetomidine, an α2-adrenoceptor agonist, on intraoperative bleeding, anaesthetic drug requirement and postoperative pain. Methods: Forty patients scheduled for elective tympanoplasty and septorhinoplasty operations under general anaesthesia were included in the study. The patients were randomly assigned to receive either a dexmedetomidine 1 μg kg-1 bolus 10mm before induction of anaesthesia plus 0.5 μg kg-1 h-1 infusions during maintenance or placebo. Mean arterial pressure was maintained between 60 and 80 mmHg. Perioperative mean arterial pressure, heart rate, time to extubation and time to awakening were recorded. Bleeding during surgery was assessed by the surgeon, blinded to the study drugs, both intraoperatively and postoperatively as a final personal opinion about the whole surgical process. Results: The heart rate and mean arterial pressure were significantly lower during induction, operation and extubation in the dexmedetomidine group (P < 0.05). Blood losses were lower in the dexmedetomidine group (P < 0.05). Propofol dose required for induction, and fentanyl and isoflurane consumption were significantly reduced in the dexmedetomidine group (P < 0.05). The total amounts of nitroglycerin and meperidine used were higher in the control group (P < 0.05). Conclusions: Dexmedetomidine decreased bleeding, postoperative analgesic requirements and intraoperative anaesthetic requirements and was associated with more stable haemodynamic responses to anaesthesia. We conclude that dexmedetomidine is a useful adjuvant to decrease bleeding when a bloodless surgical field is requested. [ABSTRACT FROM AUTHOR]

Background and objective: Magnesium administered before anaesthesia induction results in a significant reduction in intravenous anaesthetic consumption. The purpose of this study was to evaluate whether the dose of intravenous magnesium sulphate reduces the minimum alveolar anaesthetic concentration of sevoflurane for endotracheal intubation (MACEI) and skin incision (MAC), and attenuates haemodynamic responses. Methods: We studied 60 patients who were scheduled for elective surgery. Patients were not premedicated before induction of anaesthesia and were randomly assigned to receive intravenous saline 0.9% (Group I, n = 20) or magnesium sulphate 30 mg kg-1 bolus + 10 mg kg-1 h-1 continuous infusion (Group II, n = 20) or 50 mg kg-1 bolus + 10 mg kg-1h-1 continuous infusion (Group III, n = 20). Results: Median and 95% confidence limits for sevoflurane MACEI were 2.68 (2.48–2.85), 2.88 (2.70–3.06) and 2.96 (2.70–3.16), and for sevoflurane MAC were 2.08 (1.76–2.40), 2.26 (2.08–2.47) and 2.40 (2.19–2.68) in Groups I, II and III, respectively. The differences in MACEI and MAC among groups were not statistically significant, except Group III in MAC study (P < 0.05). Mean arterial pressures and heart rate did not increase in Groups II and III after endotracheal intubation and skin incision. Conclusions: Magnesium sulphate administered before induction of anaesthesia increases MAC of sevoflurane and reduces cardiovascular responses to intubation. [ABSTRACT FROM AUTHOR]

Background and objective: Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy. Methods: Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60s (alfentanil 10μg kg-1 or remifentanil 1 μg kg-1) followed by a continuous infusion (alfentanil 15 μg kg-1 h-1 or remifentanil 0.15 μg kg-1 min-1). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 μg kg-1 min-1 in both groups. Atracurium was given for endotracheal intubation at a dose of 0.5 mg kg-1 and maintained with a continuous infusion of 0.4 mg kg-1 h -1. Mean arterial pressure heart rate, the tota amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded. Results: In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05). Conclusions: Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation. [ABSTRACT FROM AUTHOR]

Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 μg kg 1 was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. Methods: One hundred anti twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg-1. Alter intravenous induction with thiopental and atracurium to facilitate endorracheal incubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 μgkg during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. Alter discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 ± 1.7 mm) and 4 (6.4 ± 2.1 mm) than in Groups 1 (8. 1 ± 2.1 mm) (P = 0.0001 and 0.006, respectively) and 2 (8.8 ± 1 .9 mm) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 ± 3.9mm) than in Groups 1 (1 3.8 ± 4.9 mm) (P = 0.01 7) and 2 (14.9 ± 4.1 mm) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10%. in Groups 2 and 4, respectively (P> 0.05). Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 μg kg did nor provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia. [ABSTRACT FROM AUTHOR]

Background and objective: Patients having spinal anaesthesia with hyperbaric bupivacaine may become sensitive to sedative drugs but no data exists about any dose-related effect of the local anaesthetic on the sedative requirement. We aimed to investigate whether hyperbaric bupivacaine dose in spinal anaesthesia has any effect on midazolam requirements. Methods: Sixty unpremedicated patients were allocated to three equal groups. Patients in Groups I and II received hyperbaric bupivacaine 0.5% 10 and 17.5 mg respectively for spinal anaesthesia and Group III was a control group without spinal anaesthesia. In Groups I and II, after the evaluation of sensory block, patients received intravenous midazolam 1 mg per 30 s until the Ramsay sedation score reached 3 (drowsy but responsive to command). In Group III, general anaesthesia was induced after sedation score had reached 3 using midazolam. The total dose of midazolam (mg kg-1) given to each patient, the level of sensory block and complications were recorded. Results: The level of sensory block was higher in Group II (T7) than Group I (T9)(P < 0.01). The doses of midazolam were 0.063 mg kg-1 in Group I, 0.065 mg kg-1 in Group II and 0.101 mg kg-1 in Group III (P < 0.001). There was no correlation between level of sensory block and dose of midazolam in Group I (r = -0.293, P = 0.21) and Group II (r 0.204, P = 0.39). Conclusions: Different doses of hyperbaric bupivacaine for spinal anaesthesia do not affect the midazolam requirements for sedation. However, spinal anaesthesia with hyperbaric bupivacaine with a maximum spread in the middle thoracic dermatomes may be associated with sedative effects and thus a reduced need for further sedation with midazolam. [ABSTRACT FROM AUTHOR]

We investigated the influence of small- and large-dose capsaicin in modulating systemic inflammatory responses during different stages of sepsis in rats. Rats were divided into six groups: group C, control; group S, sepsis; group CLC, small dose of capsaicin (1 mg/kg subcutaneously); group SLC, small dose of capsaicin plus sepsis; group CHC, large dose of capsaicin (150 mg/kg subcutaneously); group SHC, large dose of capsaicin plus sepsis. Rats were made septic by cecal ligation and puncture (CLP). Each group was subdivided into two subgroups. The animals were killed at 9 or 18 h after CLP. Plasma concentrations of calcitonin gene-related peptide (CGRP), tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, and total nitrite/nitrate (NOx) were measured. Superoxide dismutase and malondialdehyde (MDA) were determined in liver, lung, and heart tissues. CGRP was increased in groups S, CLC, and SLC when compared with the other groups. In the SLC group, plasma concentrations of TNF-alpha, IL-6, NOx, and tissue MDA levels were reduced and IL-10 level was increased when compared with groups S and SHC 18 h after CLP (P < 0.05). Small-dose capsaicin treatment increased antiinflammatory IL-10 levels and attenuated the increases in proinflammatory cytokines, NOx, and tissue MDA in septic rats.

Unlabelled: Dexamethasone effectively decreases the incidence of nausea and vomiting among pediatric and adult patients. In this study, we evaluated the effects of single-dose dexamethasone on wound healing in a prospective, randomized, experimental animal model. Anesthesia was induced with thiopental 100 mg/kg intraperitoneally. Dexamethasone 1 mg/kg was administered intraperitoneally in a dexamethasone group, and physiological saline was administered in a control group. Collagenization, epithelization, and fibroblast content were significantly less in the dexamethasone group compared with the control group (P values of 0.002, 0.041, and 0.023, respectively). The vascularity and the degree of inflammatory cells were more intense in the dexamethasone group compared with the control group (P values of 0.023 and 0.002, respectively). The white blood cell count was similar in the control (7.84 +/- 2.09) and dexamethasone (6.98 +/- 2.12) groups. The mean hydroxyproline level was 0.72 +/- 0.13 mg/g in the dexamethasone and 1.03 +/- 0.19 mg/g in the control group. Hydroxyproline levels were significantly less in the dexamethasone group (P = 0.001). We conclude that dexamethasone at 1 mg/kg may have negative effects on wound healing., Implications: We evaluated the effects of dexamethasone on wound healing in a prospective, randomized, experimental animal model. Our results show that dexamethasone at 1 mg/kg may have negative effects on wound healing.

Unlabelled: Tracheal intubation may be accomplished with remifentanil and a non-opioid IV anesthetic without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized manner the dose requirements for remifentanil with thiopental without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. After premedication with midazolam 0.03 mg/kg IV, 105 patients were randomized equally to one of three study groups, each receiving the following: remifentanil 2 micro g/kg (Group I), 3 micro g/kg (Group II), and 4 micro g/kg (Group III). Remifentanil was administered over 30 s, and anesthesia was induced with thiopental 5 mg/kg. Tracheal intubation conditions were assessed by the anesthesiologist performing the intubation as: (a) excellent, (b) satisfactory, (c) fair, and (d) unsatisfactory. There were no statistically significant differences among groups regarding to demographic data. Blood pressure and heart rate did not increase in any group after accomplishing intubation. There was a significant improvement in intubation conditions between Groups I and II, I and III, and II and III (P < 0.001). We conclude that remifentanil 4 micro g/kg administered before thiopental 5 mg/kg provided excellent or satisfactory intubation conditions in 94% of patients and prevented cardiovascular responses to intubation., Implications: We evaluated in a double-blinded manner the dose requirements for remifentanil with thiopental without muscle relaxants for obtaining acceptable intubation condition. Our results show that remifentanil 4 micro g/kg administered before thiopental provided excellent or satisfactory intubation condition in 94% of patients.