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    Hyperbaric bupivacaine affects the doses of midazolam required for sedation after spinal anaesthesia
    (Lippincott Williams & Wilkins, 2005) Toprak, HI; Ozpolat, Z; Ozturk, E; Ulger, MH; Sagir, O; Ersoy, MO
    Background and objective: Patients having spinal anaesthesia with hyperbaric bupivacaine may become sensitive to sedative drugs but no data exists about any dose-related effect of the local anaesthetic on the sedative requirement. We aimed to investigate whether hyperbaric bupivacaine dose in spinal anaesthesia has any effect on midazolam requirements. Methods: Sixty unpremedicated patients were allocated to three equal groups. Patients in Groups I and II received hyperbaric bupivacaine 0.5% 10 and 17.5 mg respectively for spinal anaesthesia and Group III was a control group without spinal anaesthesia. In Groups I and II, after the evaluation of sensory block, patients received intravenous midazolam I mg per 30 s until the Ramsay sedation score reached 3 (drowsy but responsive to command). In Group III, general anaesthesia was induced after sedation score had reached 3 using midazolam. The total dose of midazolam (mg kg(-1)) given to each patient, the level of sensory block and complications were recorded. Results: The level of sensory block was higher in Group II (T7) than Group I (T9) (P < 0.01). The doses of midazolam were 0.063 mg kg(-1) in Group I, 0.065 mg kg(-1) in Group II and 0.101 mg kg(-1) in Group III (P < 0.001). There was no correlation between level of sensory block and dose of midazolam in Group I (r = -0.293, P = 0.21) and Group II (r = 0.204, P = 0.39). Conclusions: Different doses of hyperbaric bupivacaine for spinal anaesthesia do not affect the midazolam requirements for sedation. However, spinal anaesthesia with hyperbaric bupivacaine with a maximum spread in the middle thoracic dermatomes may be associated with sedative effects and thus a reduced need for further sedation with midazolam.
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    Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results
    (Elsevier Sci Ltd, 2005) Koroglu, A; Demirbilek, S; Teksan, H; Sagir, O; But, AK; Ersoy, MO
    Background. We evaluated the sedative, haemodynamic and respiratory effects of dexmedetomidine and compared them with those of midazolam in children undergoing magnetic resonance imaging (MRI) procedures. Methods. Eighty children aged between 1 and 7 yr were randomly allocated to receive sedation with either dexmedetomidine (group D, n=40) or midazolam (group M, n=40). The loading dose of the study drugs was administered for 10 min (dexmedetomidine 1 mu g kg(-1) or midazolam 0.2 mg kg(-1)) followed by continuous infusion (dexmedetomidine 0.5 mu g kg(-1) h(-1) or midazolam 6 mu g kg(-1) min(-1)). Inadequate sedation was defined as difficulty in completing the procedure because of the child's movement during MRI. The children who were inadequately sedated were given a single dose of rescue midazolam and/or propofol intravenously. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp(o2)) and ventilatory frequency (VF) were monitored and recorded during the study. Results. The quality of MRI was significantly better and the rate of adequate sedation was higher in group D than in group M (P < 0.001). In group D, the requirement for rescue drugs was lower and the onset of sedation time was shorter than in group M (P < 0.001). MAP, HR and VF decreased from baseline during sedation in both groups (P < 0.001). Conclusions. Dexmedetomidine provided adequate sedation in most of the children aged 1-7 yr without haemodynamic or respiratory effects during MRI procedures.