Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 µg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

Objectives: The current study aimed to evaluate low dosage of mivacurium added to lidocaine for intravenous regional anesthesia [IVRA].Methods: The present study used a double-blind methodology. The study group comprised 60 patients with the American Society of Anesthesiologists physical status I and II, who were scheduled to undergo carpal tunnel release as an outpatient procedure. Patients were randomly divided into two groups. In the mivacurium group [Group M; N = 30], intravenous regional anesthesia was achieved using 6 mg of mivacurium with lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml; in the control group [Group C; N = 30] 3 mg/kg lidocaine was diluted with saline to a total volume of 40 ml. The onset and recovery time of sensory and motor blocks, intraoperative-postoperative visual analog scale, and verbal rating scale, tourniquet pain, satisfaction score, analgesic requirement, hemodynamic variables, and side effects were noted.Results: Group M showed significantly shorter sensory block and motor block onset time, longer motor block recovery time, and decreased analgesic requirement during the 24-hour postoperative period.Conclusions: Despite the longer motor block recovery, the addition of a low dose of mivacurium to lidocaine for IVRA accelerated the sensory and motor blocks onset and improved the postoperative analgesia without important perioperative adverse effects. We demonstrated that the addition of a low dose of mivacurium to lidocaine for IVRA provided a significant clinical benefit by shortening the sensory and motor blocks onset, providing sufficient muscle relaxation, and also reducing postoperative analgesic consumption without any serious adverse effects.

Background:Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively.Aims:This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia (SA).Methods:A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- (n = 30) and 0.5 μg/kg dexmedetomidine in 100 ml saline was applied in group D- (n = 30) and 100 ml saline was administered in group P- (n = 30) in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period.Results:In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20th min (P = 0.01). Sedation scores in group D were significantly higher than the baseline values (P = 0.03) and values in group T and P (P = 0.04).Conclusions:Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.

We performed this study to compare the effects of intravenous dexmedetomidine and fentanyl on propofol injection pain. We conducted a prospective, randomized and double blind study of 120 adult unpremedicated patients (18-65 years of age) scheduled to undergo elective surgery under general anesthesia. The patients were allocated randomly into three groups (n= 40): fentanyl (F), dexmedetomidine (D), and Control (C). Ten ml of the study solution was injected over 10 seconds. One minute after the administration of fentanyl (1 µg/ kg) or dexmedetomidine (0,15 µg/ kg) or placebo, propofol 2,5 mg/ kg was infused at a rate of 20 ml/ min. Injection pain was assessed using a four - point verbal rating scale. The incidence of propofol- associated injection pain were 65% (26) for group C, 27% (16) for group F, and 25% (10) for group D. The incidence of pain were less in the fentanyl, and especially in the dexmedetomidine groups than control group (p< 0.05). Severe pain in groups were D<F<C (p< 0.05). Heart rate and the mean arterial blood pressure of the groups F and D were lower than control groups at baseline, 0, 5, 10, 15, 30 minutes (p< 0.05). HR of the group D was lower than that group F at baseline period (p< 0.05). In addition, MAP of the group D was lower than that group F at 10, 15, 30 min (p< 0.05). Premedication of subclinical doses of dexmedetomidine and fentanyl effectively reduced propofol-induced pain and its intensity.