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Background: The aim of the present study was to compare the effects of a combination of gabapentin and paracetamol with gabapentin alone and placebo on post-operative pain and morphine consumption., Methods: Seventy-five ASA I-II patients undergoing abdominal hysterectomy were included in the study and randomly divided into three groups. Placebo capsules (Group I, n = 25), 1200 mg of gabapentin (Group II, n = 25), or 1200 mg of gabapentin and 20 mg/kg paracetamol in combination (Group III, n = 25) were administered 1 h prior to surgery. Anaesthesia was standardized for all patients. Non-invasive arterial pressure, heart rate, respiratory rate, peripheral oxygen saturation, morphine consumption, nausea and vomiting, visual analogue scale-pain intensity scores (VAS-PI) and sedation scores were recorded at 1, 2, 4, 6 and 24 h following the operation., Results: Morphine consumption at 24 h was 66.60 +/- 11.49 mg, 42.74 +/- 12.33 mg and 30.50 +/- 11.55 mg, respectively, in groups I, II and III (P < 0.05). Post-operative VAS-PI scores at movement and at rest were decreased with gabapentin and even more with a combination of gabapentin and paracetamol. Post-operative sedation scores were higher in groups II and III during the initial 4 h while these scores were higher in group I at 24 h., Conclusions: The single dose of gabapentin as well as a combination of gabapentin and paracetamol decreased the opioid requirement and increased the patients' satisfaction post-operatively.

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: Pain on injection is still a major problem with propofol. In this study, we compared the efficacy of single-dose premedication of dexmedetomidine for pain on injection of propofol and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 100 patients scheduled to undergo surgery. Patients were randomly assigned to one of two groups, either receiving dexmedetomidine (Group D) or saline (Group C) before the injection of propofol. Patients in Group D (n = 50) were given dexmedetomidine infusion 0.6 μg/kg for 10 min. Patients in Group C (n = 50) were given saline infusion in an identical manner. Pain perception was assessed during injection of propofol in all patients. Results: The median pain score on injection of propofol was significantly lower in Group D than in Group C (median pain score 2 [1–3] vs 1 [0–2]; P < 0.006). The number of patients with pain in Group D decreased (48/50 [96%] in Group C vs 42/50 [84%] in Group D; P = 0.046). Conclusions: Intravenous administration of a single dose of dexmedetomidine as a premedication reduced the incidence and severity of pain on propofol injection without significant adverse haemodynamic effects. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia during coronary artery bypass surgery. Design: Prospective study. Setting: University hospital. Participants: Sixty patients undergoing elective coronary artery bypass grafting surgery with ejection fraction more than 45%. Interventions: Anesthesia was induced with etomidate, 0.2 mg/kg, and fentanyl, 5 μg/kg, in group D (n = 30) and with midazolam, 0.1 to 0.3 mg/kg, and fentanyl, 5 μg/kg, in group M (n = 30). Anesthesia was maintained with desflurane, 2% to 6%, and fentanyl, 15 to 25 μg/kg, in group D and midazolam infusion, 0.1 to 0.5 mg/kg/h, and fentanyl, 15 to 25 μg/kg, in group M. Measurements and Main Results: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Data were obtained before induction of anesthesia (t0), after induction of anesthesia (t1), after intubation (t2), after surgical incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine infusion (t6), and at the end of the surgery (t7). Blood samples were obtained to measure total bilirubin, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, creatinine, and blood urea nitrogen just before induction of anesthesia and at the first, fourth, and 14th days postoperatively. Conclusions: Intraoperative hemodynamic responses were similar in both groups, and transient hepatic and renal dysfunctions were observed in the postoperative period in both groups. The extubation and intensive care unit discharge times were found to be shorter in the desflurane-fentanyl group. [Copyright &y& Elsevier]

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]