Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Enhanced recovery protocols employ various approaches to minimize detrimental side effects of anesthetizing agents. The authors tested the hypothesis that adding low-dose dexmedetomidine to propofol for anesthesia in ambulatory colonoscopies, compared with propofol alone, would lower the propofol requirement, improve the intra-procedure hemodynamic state, and not increase time-to-discharge. Methods In this noninferiority, double-blind, randomized controlled trial, patients having colonoscopies received total IV anesthesia either with propofol and placebo (n = 50), or propofol and a bolus dose of dexmedetomidine, 0.3 μg/kg (n = 51). Additional propofol was administered to maintain a Bispectral Index score of 60. Following the procedure, readiness for discharge was assessed regularly using the Modified Post Anesthetic Discharge Scoring System until discharge criteria were met. The primary outcome was the percentage of patients meeting discharge criteria within 30 min from procedure end-time. Results Twenty-six of 51 (51%) patients receiving propofol-dexmedetomidine were ready for discharge by 30 min from procedure end time, compared with 44 of 50 (88%) receiving propofol (P < 0.001). Propofol consumption was lower in subjects receiving propofol–dexmedetomidine (140 μg · kg-1 · min-1) compared to those receiving propofol (180 μg · kg-1 · min-1) with P = 0.011. The lowest mean arterial pressure decreased further from baseline in those receiving propofol–dexmedetomidine (−30%; mean decrease −30 ±10.5 mmHg) compared to propofol (−21%; mean decrease, −22 ± 14.2 mmHg) with P = 0.003. There was no difference in incidence of bradycardia, with sustained bradycardia occurring in 3 of 51 (6%) patients receiving propofol–dexmedetomidine compared to 1 of 50 (2%) patients receiving propofol (P = 0.62). No apnea episodes requiring positive-pressure ventilation occurred in either group. Conclusions For anesthesia in ambulatory colonoscopy, combining low-dose dexmedetomidine with propofol delayed discharge readiness and provoked hypotension compared to propofol alone.

Cardiovascular disease causes more deaths worldwide than any other medical affliction usually targeting older adults for which one of the antecedents of the disease – atherosclerosis, begins early in life thus making primary prevention efforts necessary from childhood. This study examined angiograms from a cross‐sectional random sample of patients (n=25) in order to document the cardiac vascular pattern, grading the size and dominance of the coronary arterial branching pattern to determine if one can predict which coronary artery branch may be more predisposed to disease processes. An additional mixed‐sex urban population sample from Downstate anatomy laboratory (n=61) was included to compare and contrast the angiogram data. The four branches of the coronary arteries (sinoatrial nodal; posterior interventricular [PIV]; anterior interventricular [AIV] and left circumflex) were examined and similarly graded. Results showed 79% of the cadaveric hearts to be right‐dominant, 15% co‐dominant with dual origin of the PIV artery, and 7% being left dominant. Angiogram data revealed similar results with 80% showing right dominance. While the sinoatrial nodal artery was graded normal 80% of the time, the PIV and AIV arteries were frequently identified as hypertrophied in both sample sets suggesting that these vessels are the most common sites for blockage.