Objective:The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery.Design:A randomized prospective study.Setting:Cairo University, Egypt.Materials and Methods:The study included 150 patients undergoing aortic vascular surgery.Intervention:The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly.Measurements:The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level.Main Results:The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia reflected by troponin I level, ECG changes, and the development of new regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased the requirement for nitroglycerin and norepinephrine compared to control group (P < 0.05). The incidence of hypotension and bradycardia was significantly higher with dexmedetomidine (P < 0.05).Conclusion:The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia.

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Background: Gabapentin attenuates the haemodynamics, decreases the catecholamine release and has a neuroprotective effect. The aim of the present study was to assess the effect of gabapentin in patients with supratentorial brain tumours undergoing craniotomy under general anaesthesia. Methods: A radial arterial line, central venous line and ventriculostomy catheters were inserted before surgery. Anaesthesia was induced with thiopental, fentanyl and atracurium and maintained with sevoflurane, fentanyl and atracurium infusion. The study included 160 patients classified randomly into two groups: Group G: The patients received gabapentin capsules 1200 mg orally 2 h before surgery. Group C: The patients received placebo capsules. Results: The heart rate, mean arterial blood pressure and intracranial pressure decreased significantly with gabapentin as compared to the control group (P < 0.05). The dose of fentanyl and end-tidal sevoflurane was lower with gabapentin than the control group (P < 0.05). The urine output was higher in the gabapentin group than the control group (P < 0.05). The Glasgow coma scale score was better in the gabapentin group as compared to the control group (P < 0.05). The incidence of nausea and vomiting was lower in the gabapentin group as compared to the control group (P < 0.05). Conclusions: Pre-operative administration of gabapentin in patients undergoing craniotomy under general anaesthesia minimised the fluctuations in haemodynamics, reduced the requirements for sevoflurane and fentanyl, decreased intracranial pressure and improved the outcomes. There were some side effects associated with gabapentin such as hypotension and bradycardia.

Background: Dexmedetomidine acts on the pre and post-synaptic sympathetic nerve terminal and central nervous system. It decreases the sympathetic outflow and norepinephrine release; therefore it leads to sedation, analgesia and hemodynamic effects. The aim of the study was to compare the effect of fentanyl and dexmedetomidine as adjuvant to epidural bupivacaine in parturients undergoing normal labor. Materials and methods: The study included 170 parturients scheduled for epidural anesthesia for labor. The cases were classified randomly (by simple randomization) into two groups (n=85): Group D: The patients received 13 ml of 0.25% bupivacaine and 1μg/kg dexmedetomidine diluted in 2 ml saline. Group F: The patients received 13 ml of 0.25% bupivacaine and 1μg/kg fentanyl diluted in 2 ml saline. Results: The dexmedetomidine shortened the onset and prolonged the duration of analgesia compared to fentanyl (p<0.05). Dexmedetomidine was associated with an increased incidence of maternal hypotension, bradycardia, motor block, and dry mouth (p<0.05), while the epidural fentanyl was associated with an increased incidence of maternal pruritus, nausea and vomiting, and respiratory depression (p<0.05). The incidence of shivering was lower in the dexmedetomidine group compared to fentanyl group (p=0.003). Conclusions: The epidural dexmedetomidine has many advantages over the fentanyl, where it fastens the onset, prolongs the duration of analgesia, decreases the doses of bupivacaine and the incidence of pruritus, respiratory depression, nausea and vomiting. Also, it is associated with some disadvantages such as maternal hypotension, bradycardia and motor block.