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    Comparison between the effects of rocuronium, vecuronium, and cisatracurium using train-of-four and clinical tests in elderly patients
    (Brieflands, 2013) Sagir O.; Yucesoy Noyan F.; Koroglu A.; Cicek M.; Ilksen Toprak H.
    Background: Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients. Objectives: We aimed to investigate the safety of train-of-four ratio and clinical tests in the assessment of patient recovery, and to determine the effects of the rocuronium, vecuronium, and cisatracurium on intubation, extubation and recovery times in elderly patients undergoing abdominal surgery. Patients and Methods: After obtaining institutional approval and informed consent, 60 patients over 60 years old and undergoing elective abdominal operations were included in this double-blind, randomized clinical trial. Following a standard anesthesia induction, 0.6mg kg-1 rocuronium, 0.1mg kg-1 vecuronium, and 0.1mg kg-1 cisatracurium were administered to the patients in Group R, Group V, and Group C, respectively. Train-of-four (TOF) ratios were recorded at 10-minute intervals during and after the operation. Modified Aldrete Score (MAS) and clinical tests were recorded in the recovery room at 10-minute intervals. In addition, intubation and extubation times, duration of recovery room stay, and any complications were recorded. Results: Intubation time was found to be shorter in Group R than that in Groups V and C (P < 0.001). Times to positive visual disturbances and grip strength tests were shorter in Group C than that in Group V (P = 0.016 and P = 0.011, respectively). In Group R and group C, time to TOF ? 0.9 was significantly longer than all positive clinical test times except grip strength (P < 0.05). Conclusions: We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients. © 2013 Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM); Published by Kowsar Corp.
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    The effects of intra-operative low-dose dexmedetomidine infusion on postoperative pain in patients undergoing septorhinoplasty
    (Maney Publishing, 2006) Cicek M.; Yucel A.; Gedik E.; Sagir O.; But A.K.; Ersoy M.O.
    Study objective: To determine the effects of intra-operative low-dose dexmedetomidine infusion on postoperative morphine consumption, pain, sedation and patient satisfaction in patients undergoing septorhinoplasty. Method: Fifty adult patients were randomised to receive either dexmedetomidine (a loading dose of 1 ?g kg-1 for the first ten minutes and a maintenance dose of 0.2 ?g kg-1 h-1 afterwards, Group D) or 0.9% saline in the same manner (Group C) after induction of anaesthesia. At the end of the operation, the infusions were discontinued. After extubation, patient controlled analgesia was started intravenously. Results: Patients in Group D consumed 47% less morphine than patients in Group C during the first 24 h and had a lower cumulative morphine consumption at all times after starting patient controlled analgesia (7.08 mg vs. 8.56 mg at 2 h (p < 0.05), 10.84 mg vs. 14.0 mg at 4 h (p < 0.05), 13.56 mg vs. 18.28 mg at 6 h (p < 0.05) and 17.96 mg vs. 33.72 mg at 24 h (p < 0.05), respectively in Group D and Group C). Visual analogue scale scores for pain were higher at all times in Group C than in Group D (p < 0.05). Sedation scores were higher in Group D than in Group C at 30 min after starting patient controlled analgesia (p < 0.05). Patient satisfaction scores were higher at all times in Group D than in Group C (p < 0.05). Conclusions: Intra-operative low-dose dexmedetomidine infusion during septorhinoplasty decreases postoperative morphine consumption, provides effective postoperative pain relief and achieves better patient satisfaction without increased adverse effects. © 2006 VSP.