This randomised, controlled, double-blind study investigated the effects of different doses of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block in patients undergoing arthroscopic knee surgery. Ultrasound-guided femoral nerve block was performed before general anaesthesia using 25 ml of bupivacaine 0.5% combined with normal saline in the control group, and 25 μg, 50 μg or 75 μg of dexmedetomidine in three treatment groups (n = 15 for each group). All patients received a standard general anaesthetic and multimodal postoperative analgesic regimen. The use of the 50 μg and 75 μg dose levels of dexmedetomidine was associated with reduction of the onset time, extension of the duration of block, prolonged time to the first postoperative request for rescue analgesia, and reduced postoperative morphine requirements. The times to first request for postoperative analgesia were mean (SD) 10.8 (1.6) h in the control group and 11.0 (7.1), 21.8 (3.0) and 28.6 (10.0) in the 25 μg, 50 μg and 75 μg treatment groups, respectively. These times were significantly longer in the 50 μg and 75 μg treatment groups compared with the 25 μg (p < 0.0001) and control group (p < 0.0001). The total 24-h postoperative morphine consumption was 7.6 (5.1) mg in the control group, and 6.5 (3.5), 3.9 (3.4), 1.8 (2.6) in the 25 μg, 50 μg and 75 μg treatment groups, respectively. Postoperative morphine consumption was significantly higher in the control group compared with the 50 μg (p = 0.045) and the 75 μg (p = 0.001) treatment groups. The best analgesic profile was achieved at the 75 μg dose, but this was associated with increased risk of hypotension.

Background: Anesthesia for cochlear implantation in pediatrics mandates deliberate hypotension to provide a better surgical field. Dexmedetomidine is a 2 adrenoceptor agonist that provides adequate sedation with high cardiovascular stability. We aimed to compare it with fentanyl as an anesthetic adjuvant. Methods: 52 pediatric patients (ASA I or II), undergoing cochlear implantation were randomized into dexmedetomidine (D) group and fentanyl (F) group (n = 26 for each). Anesthesia was induced by I.V. dexmedetomidine in (D) group at a bolus dose of 0.4 lg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.4 lg/kg/h until the end of surgery. In (F) group; anesthesia was induced by I.V. fentanyl at a dose of 1 lg/kg over 10 min, then continuous infusion by a rate of 1 lg/kg/h. This is followed by I.V. propofol and atracurium for both groups. Maintenance was done without additional muscle relaxant to allow monitoring of the facial nerve. Both groups were compared as regards the quality of the surgical field, intraoperative hemodynamics, recovery and discharge time, postoperative pain using objective pain score and the need for rescue analgesics and anti-emetics in postanesthesia care unit (PACU). Results: Dexmedetomidine group showed a decreased heart rate and mean arterial pressure than fentanyl group. These parameters were significantly decreased compared to the baseline throughout the procedure in D group. The quality of the surgical field was significantly better in D group than in F group. Postoperative pain and complications were not different between the two groups. Recovery and discharge time was significantly shorter for the patients in D group than in F group (p < 0.05). Conclusion: Dexmedetomidine infusion in cochlear implantation in pediatric patients was better in inducing deliberate hypotension and providing better quality scale of surgical field compared to fentanyl infusion. It allowed rapid recovery from anesthesia and reduced need for pain medication in the PACU.

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Background: Life expectancy of the population may increase and cataract development may affect all the people with aging. Intraocular lens implantation surgery, a worldwide performed procedure, evolves and progresses. However, different techniques exist, which could be selected for different cases. Any ideal technique should be safe, simple, fast, and easy to learn with good clinical outcome. Objective:The aim of this work was to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification as well as surgery duration and postoperative intraocular pressure and central corneal thickness. Patients and methods:This was a prospective, randomized controlled trial conducted on 40 eyes with cataract; to compare the efficacy and safety of intraocular lens implantation with and without ophthalmic viscoelastic device after phacoemulsification of the lens as regard to surgery duration, post-operative intraocular pressure and central corneal thickness. Patients were evaluated 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups after the completion of lens cortex removal: Group A (n=20, hydro-implantation): One-piece acrylic intraocular lens implantation was performed with normal saline solution (0.9 solution) irrigation. Group B (n=20, visco-implantation): using Hydroxy-propyl-methylcellulose 2% implantation.Results: Highly significant increase in phaco operative time in visco-implantation group; compared to hydroimplantation group (p < 0.0001), Non-Significant increase in post-operative IOP, in visco-implantation group; compared to hydro-implantation group (p > 0.05 respectively). Non-significant difference as regards post-operative Central corneal thickness (CCT) (p > 0.05). Non-significant increase in post-operative CCT measurements in visco-implantation group (p > 0.05). Non-significant difference in post-operative IOP measurements in visco-implantation group (p > 0.05). Non-significant decrease in post-operative IOP and CCT measurements in hydro-implantation group (p > 0.05). Non-significant decrease in post-operative IOP in hydro-implantation group; compared to visco-implantation group; during the serial 1st and 2nd measurements. Non-significant increase in post-operative CCT in Visco-implantation group; compared to hydro-implantation group; during the serial 1st and 2nd measurements. Conclusion:The hydro-implantation had similar clinical outcome to visco-implantation with advantage of reduced surgical time and cost, and no ophthalmic viscosurgical devices (OVD) induced intraocular pressure elevation postoperatively.