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    Comparison of Dexmedetomidine and Alfentanil during Middle Ear Surgery
    (Mediterranean Soc Otology & Audiology, 2011) Sahin, Fazilet; Deren, Serpil; Erdogan, Gulay; Ornek, Dilsen; Dikmen, Bayazit
    Background: We aimed to compare the effects of controlled hypotension with dexmedetomidine or alfentanil on hemodynamic parameters, surgeon satisfaction and bleeding in surgical field under N2O-free low-flow sevoflurane anesthesia in patients undergoing middle ear surgery. Materials and Methods: Forty patients, classified as ASA physical status I-II and candidates for middle ear surgery were randomly allocated into two groups by sealed-envelope method. Before induction Group D (n=20) received 0.1 mu g/kg/min dexmedetomidine for 10 minutes and Group A (n=20) received 20 mu g/kg alfentanil. Group D received 0.7 mu g/kg/hour maintenance dose of dexmedetomidine and Group A 1 mu g/kg/min alfentanil up until 30 minutes from the end of the surgery. All patients were had an induction with 6 mg/kg thiopental + 0.1mg/kg vecuronium bromide. Following intubation 3% sevoflurane was administered in a mixture of 2.0 L/min O-2 + 2.0 L/min air and this was followed by low-flow anesthesia to deliver 0.5 L/min O-2 + 0.5 L/min air. During the operation, controlled hypotension level was adjusted to have a systolic blood pressure of 80-90 mmHg and mean arterial pressure of 50-65 mmHg. Hemodynamic parameters were recorded with five minutes intervals. The surgeon, blinded to the study drugs, assessed amounts of bleeding in the operative field and surgeon satisfaction. Results: Achieving the desired hypotension levels happened later in Group D. At the stage of membrane placement, targeted mean arterial pressures were achieved in both groups. Three patients in Group D required short-term nitroglycerine infusion to reach the desired hypotension levels. The amounts of bleeding and surgeon satisfaction were equal in both groups. The return of hypotensive effect of dexmedetomidine was slower once it was stopped. In Group A, postoperative nausea and vomiting were frequently observed and 0.1 mg doses of naloxone were administered to four patients for two times after extubation. Conclusion: Although additional hypotensive agent required in dexmedetomidine group and desired hypotension levels were happened lately, there was no difference in the amount of bleeding, surgical view and surgeon satisfaction between dexmedetomidine and alfentanil.
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    Median ulnar nerve selective blockage versus brachial plexus blockage in carpal tunnel release surgery
    (2019) Baskan, Semih; Camgoz, Suleyman; Demirelli, Gokhan; Aytac, Ismail; Ornek, Dilsen
    Aim: This study aimed to evaluate the feasibility of median ulnar nerve selective blockage vs. brachial plexus blockage in day procedures such as carpal tunnel release surgery. We hypothesized that selective median and ulnar blockage is a feasible classic axillary approach.Material and Methods: This randomized, controlled, double-blind, single-center study included 60 patients. Patients were randomly allocated to two groups; namely, the plexus blockage group (control) and selective group. Patients in the plexus blockage group were administered with 15 ml of local anesthetic for axillary plexus, and in the selective group, 2.5 ml of local anesthetic was applied under USG guidance. We evaluated of full sensory and motor block.Results: The onset of motor block time was observed to be longer and recovery time was shorter in the selective group than in the plexus blockage group (P0.05). Conclusion: Selective nerve block has been shown to be more advantageous than the classic axillary approach of brachial plexus block for day procedures such as carpal tunnel release surgery.Keywords: Carpal tunnel syndrome; brachial plexus blockage; ultrasonography; ulnar nerve block; median nerve block