ÖZETAmaç: Monitörize anestezi bakımında deksmedetomidin ile midazolam/remifentanil kombinasyonunun nazal septum cerrahisinde karşılaştırılması amaçlandı.Gereç ve Yöntem: Lokal anestezi altında nazal septum cerrahisi planlanan 50 hasta rasgele iki gruba ayrıldı. Grup D'ye 10 dk. Sonuç: Monitorize anestezi bakımında hızlı sedasyon istendiğinde, akciğer hastalığı yoksa desaturasyon açısından uygun önlemler alınarak midazolam/remifentanil kombinasyonu; semptomatik akciğer hastalığı olanlarda maliyeti göz önünde bulundurarak ve bradikardi açısından dikkatli olunarak deksmedetomidin tercih edilebilir.Anahtar kelimeler: Monitörize anestezi bakımı, deksmedetomidin, midazolam, remifentanil SUMMARY Comparison of Dexmedetomidine versus Midazolam/Remifentanil Combination for Monitorized Anaesthesia CareObjective: The aim of this study was to compare dexmedetomidine versus midazolam/remifentanil combination for monitorized anaesthesia care during nasal septal surgery.Material and Methods: 50 patients undergoing nasal septal surgery under local anaesthesia were randomly assigned into two groups. Group D received 0,3 µg kg -1 hr -1 dexmedetomidine infusion after the loading dose of 1 µg kg -1 /10 min. Group M/R received 0,05 mg kg -1 bolus dose of midazolam over 30 seconds followed by 0,05 mg kg -1 min -1 remifentanil infusion. The infusion rates were adjusted to target level of sedation and analgesia scores. Hemodynamic and respiratory parameters, analgesia and sedation scores were recorded before (0 min.) and 1, 5 and 10 minutes after sedation, and every 5 minutes thereafter. Total amount of drugs used, patient and surgeon satisfaction scores, hemodynamic and respiratory parameters, postanaesthetic Aldrete scores, amnesia and postoperative recovery scores and side effects were recorded at 1., 5., 15., 30. minutes, and 1., 2., and 4. hours, postoperatively.Results: Sedation scores were higher in group M/R at 5 and 15 minutes, postoperatively (p<0.05). Heart rates were lower in Group D at 10 and 35 minutes (p<0.05). Respiratory rates were lower in Group M/R throughout the operation (p<0.05) and also SpO 2 values were lower at 5., 10. and 15. minutes (p<0.05). Cost of anesthesia in Group D was higher (p<0.05).Conclusion: During monitorized anaesthesia care midazolam/remifentanil can be used for rapid onset of sedation in the absence of pulmonary disease while taking measures for desaturation. Dexmedetomidine may be preferred not disregarding bradycardic complications in symptomatic pulmonary disease, and its higher cost.

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ÖZETİnterskalen brakiyal pleksus bloğu omuz ve üst ekstremite cerrahisinin tüm tiplerinde anestezi ve analjezi sağlaması amaçlı kullanılmıştır. İnterskalen brakial pleksus bloğu uygulaması sonucu spinal, epidural ve subdural anestezi gibi ciddi komplikasyonlar tanımlanmıştır. Bu olgu sunumu, genel anestezi ile segmental mastektomi ve aksiller lenf nodu diseksiyonu uygulanan hastada omuz, üst kol ve aksiller bölge analjezisi amaçlı posterior yaklaşımla brakiyal pleksus uygulaması sonrası gelişen subdural blok komplikasyonudur.Anahtar kelimeler: Brakiyal pleksus, komplikasyon, subdural blok SUMMARY Complication of Posterior Interscalene Brachial Plexus Block: A Case of Subdural BlockBlockade of interscalene brachial plexus has been used to provide anesthesia and analgesia for all types of surgery of the upper extremity and shoulder. Several serious complications such as spinal, epidural and subdural anesthesia have been described as a result of interscalene brachial plexus block. This case report describes a subdural block complication, developed after attempted posterior approach brachial plexus blockade for analgesia of the shoulder, upper arm and axillary region in a patient undergoing segmental mastectomy and axillary lymph node dissection with general anesthesia.