BackgroundPerioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.MethodsOne-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg−1, and midazolam was administered at a concentration of 0.025 μg.kg−1 via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (Tbeginning, Tpreop5 min, Tpreop 10 min, Tinduction, Tintubation, Tintubation5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation, Textubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.ResultsSBP was significantly different between normotensive and hypertensive groups at the following time points: Tpreop 5 min, Tpreop 10 min, Tinduction, Tintubation, Tintubation 5 min and Tinitial surgery. MBP was significantly different in the hypertensive groups at Tinduction, Tintubation, Tintubation 5 min, Tinitial surgery, Tsurgery 15 min, Tsurgery 30 min, Textubation and Textubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.ConclusionIn the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.Trial registrationTrial registration: Clinicaltrials.gov identifier: NCT02058485.

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EA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In our study we aimed to compare the time of antagonism and effect of sugammadex which is used for antagonism of rocuronium on diabetic and nondiabetic patients. Sugammadex is a new generation antagonist of neuromuscular blockade which effects by encapsulating rocuronium molecules in the neuromuscular junction through acting like a synthetic receptor of rocuronium. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Included patients were divided into two groups: diabetic (n=21) and non-diabetic (n=20). After loss of eyelid reflex and automatically identification of supramaximal stimulating current by the neuromuscular monitoring system, rocuronium 0.6 mg/kg IV was administered. Train-of-four (TOF) stimulation with the supramaximal current was applied and by recording of second TOF value the patient was intubated. TOF stimulation was performed and recorded every 20 seconds. Intraoperatively by return of T2, rocuronium 0.15 mg/kg IV was administered. T2i time was recorded as intubation time whereas T2d time was recorded as clinical effect time. At the end of the operation sugammadex 2 mg/kg IV was administered. When TOF ratio reached 0.9, patients were extubated and the time interval was recorded. R Re es su ul lt ts s: : There was no differences between two groups of intubation time ( 19±239,21 [228 (20-945)] seconds in diabetics and 228, 20±115,22 [238.5 (54-446)] seconds in non-diabetics (p=0.611). There were no statistical significant difference between the two groups in intubation time, clinical effect time, extubation time and recovery time. C Co on nc cl lu us si io on n: : Contrary to expected delay of clinical effect and recovery times with conventional reversal agents in diabetic patients resulting from diabetic complications has not occurred with sugammadex. In conclusion, sugammadex seems to be like a good alternative for diabetic patients because of its role in reversing the effects of neuromuscular blocking agents as well as alleviating problems in recovery period.K Ke ey y W Wo or rd ds s: : Diabetes mellitus; neuromuscular blockade; sugammadex Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, rokuronyumun antagonizması için kullanılan sugammadeksin antagonizma ve etki sü-relerinin diyabetik ve diyabetik olmayan hastalarda karşılaştırılması amaçlanmıştır. Sugammadeks, etkisini nöro-musküler kavşaktaki rokuronyum moleküllerini enkapsüle ederek gösteren, rokuronyum için sentetik bir reseptör gibi davranan yeni nesil nöromusküler blok antagonistidir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Hastalar diyabetik (n=21) ve diyabetik olmayan (n=20) olmak üzere iki gruba ayrıldı. Kirpik refleksi kaybından sonra supramaksimal uyarı nöro-musküler monitörizasyon sistemi tarafından otomatik olarak belirlendi ve rokuronyum 0,6 mg/kg intravenöz olarak uygulandı. Supramaksimal uyarı ile "train-of-four (TOF)" stimülasyonu yapıldı ve TOF2 değeri elde edilince hasta entübe edildi. Yirmi saniyede bir TOF stimülasyonu yapılarak, değerler kaydedildi...

Background: Our paper aimed to investigate whether there was a correlation among the pulse oximetry, cerebral oximetry (CO) and MetHb (methemoglobin) values of a patient with congenital methemoglobinemia who underwent a laparoscopic cholecystectomy operation. Case: The 35year-old male patient with a weight of 70 kg, body massindex (BMI) of 21, American Society of Anesthesia status-2(ASA-2) category who was planned for laparoscopic cholecystectomy operation was identified to have been diagnosed with congenital methemoglobinemia as per his medical history was methemoglobin levels ranged between 12% and 20% according to the periodical measurements taken for the past 3 years. The patient received standard monitoring during anesthesia and device monitoring with a cerebral oximeter (Invos 5100C somatic/cerebral oximeter, Covidien) and a CO-oximetry (Rad −87 "Rainbow", Masimo Inc., Irvine, CA) device to continuously follow up his MetHb values was also added. During the intra-operative follow-up, the patient's methemoglobin level rose to 16%, his peripheral oxygen saturation levels decreased to 86% and his cerebral oximetry values were identified to have also decreased; therefore, methylene blue (MB) was intravenously administered to the patient. The patient continued to be followed up in the post-operative period and he did not develop any complications. Discussion: Appropriate treatment and monitoring enabled the prevention of potential complications. We believe that monitoring with NIRS and MASIMO CO-oximetry device will enable physicians to perform a safe follow-up and treatment in the intraoperative and postoperative follow-up of methemoglobinemia patients.