Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

Objective: During functional endoscopic sinus surgery (FESS), sufficient control of bleeding is essential in order to increase the visibility in the operative field and reduce the risk of injury to the optic nerve or internal carotid artery. However, choosing the ideal agent is still a controversial topic. The aim of this study is to compare the effects and possible side effects of remifentanil and dexmedetomidine for controlled hypotension in FESS.Methods: Fifty ASA I-II patients, aged between 18-60 years, undergoing elective FESS, were included. Patients were randomly assigned into two groups (n=25) as Group R (remifentanil infusion, 0.25 mcg kg -1 h -1 ) and Group D (dexmedetomidine infusion, 0.2-0.7 mcg kg -1 min -1 ). The duration of anesthesia, surgery and controlled hypotension, total drug doses, dryness of the surgical area, recovery time, side effects, liver and kidney function analyses were recorded. Results:There was no statistically significant difference between the groups in operation time, duration of anesthesia and controlled hypotension time. Group R and D were similar in average SpO 2 , dryness, arterial blood pressure, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine at all measurement times. Heart rate was lower in Group D than Group R at the time of extubation and 5, 10, 15, 20, 30. min after extubation (p<0.05). Mean recovery time of Group D was longer than Group R (p<0.001).Conclusion: Based on the side effect scores, visualisation results of surgical area, liver or renal functions; both dexmedetomidine and remifentanil provided adequate, safe, controlled hypotensive anesthesia. However, dexmedetomidine was associated with significantly longer recovery time period compared with remifentanil.Amaç: Fonksiyonel endoskopik sinüs cerrahisi (FESS) sırasında kanamanın kontrol altına alınması; cerrahi alandaki görüşün artması ile birlikte, optik sinir veya internal karotis arteri gibi önemli yapıların yaralanması riskini de azaltmaktadır. Ancak, bu amaç için ideal ajan seçimi tartışmalı bir konu olmaya devam etmektedir. Bu çalışmada, FESS için kontrollü hipotansiyon uygulamalarında remifentanil ile deksmedetomidinin etkinlikleri ile gelişebilecek yan etkilerinin karşılaştırılmaası amaçlanmıştır.Yöntemler: Çalışmaya, elektif FESS cerrahisi geçirecek, ASA I-II, 18-60 yaş arasında 50 hasta dahil edildi. Hastalar randomize olarak, Grup R (remifentanil infüzyonu, 0,25 mcg kg -1 s -1 , n=25) ve Grup D (deksmedetomidin infüzyonu, 0,2-0,7 mcg kg -1 dk -1 ) olarak iki gruba ayrıldı. İlaç enjeksiyonundan, hedeflenen kan basıncının oluşmasına kadar geçen süre, anestezi ve cerrahi süreleri, verilen toplam ilaç miktarı, cerrahi sahanın kuruluğu, derlenme süresi, yan etkiler ile karaciğer ve böbrek işlevlerine ait değerler kaydedildi. Bulgular: Gruplar arasında anestezi, cerrahi işlem süresi ve kontrollü hipotansiyon süresi bakımından istatistiksel olarak anlamlı fark yoktu. Ortalama periferik oksijen satürasyonu, cerrahi sahanın kuruluğu, kan basınçları,...

SummaryObjectives: Propofol causes considerable pain upon injection, although different methods and propofol formulations have been used to decrease this pain. We aimed to investigate the effect of i.v. esmolol pretreatment on propofol injection pain.Methods: Ninety ASA I-II patients undergoing elective surgery under general anesthesia were randomly assigned into three groups of thirty each. A 20 G cannula was inserted into the dorsum of the nondependent hand. After venous occlusion for one minute, groups E, L and S were pretreated with 5 mg/ml (total 2 ml) esmolol, 40 mg lidocaine and 2 ml saline i.v. respectively. After release of venous occlusion, one fourth of the total propofol dose was administered at a rate of 0.5 ml/sec. During the injection of both pretreatment solution and propofol, patient pain was assessed by using 4 point scale. Heart rate and noninvasive arterial blood pressure values were recorded before induction, just after entubation and five minutes after entubation. Results:Demographic values were similar among groups. Incidence of pain on injection of propofol in the control, esmolol and lidocaine groups was 90%, 33.3%, 50% respectively (p<0.05). Heart rate, systolic arterial pressure, and diastolic arterial pressure values were not different between the groups.Conclusion: Pretreatment with low dose esmolol i.v. seems to be effective in attenuating pain during propofol injection.

Spinal anaesthesia (SA) is one of the oldest and most common regional anaesthesia techniques used in lower abdominal and extremity surgery. It is advantageous because it provides adequate analgesia and muscle relaxation, is easy to apply, does not affect mental functions, causes less bleeding, patients are mobilised earlier, and the incidence of deep vein thrombosis is low. However, it has

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