Effect of dexmedetomidine or epidural blockade combined with general anesthesia on perioperative inflammatory cytokines in lung cancer patients undergoing video-assisted thoracoscopic surgery

To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Quasi experimental study. The Combined Military Hospital, Skardu, from February 2009 to July 2010. American Society of Anaesthesiology (ASA) physical status (PS) I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 (n=51) received general anaesthesia (GA) and group 2 (n=49) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients (29.4%) for pain relief in the postoperative period. Two patients (4.1%) in the EA group required additional analgesic during that period. Eleven patients (21.5%) in the GA group had postoperative vomiting. In the EA group only 1 patient (2%) had postoperative vomiting. Patients in EA group had better postoperative pain relief (p = 0.001) and remained free from vomiting than the GA group (p = 0.003). Thirty six patients (70.5%) of the GA group and 34 patients (69.4%) in the EA group were discharged within 36 hours postoperatively (p = 0.896). The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy.

Background Postoperative nausea and vomiting (PONV) are the most common annoying events and complications following general anesthesia and surgery. Emetic incidents can lead to aspiration of gastric contents, wound unsealing, psychological distress, and delayed recovery from anesthesia and discharge times. Aim This study was designed to compare the effects of a single dose of dexmedetomidine or dexamethasone as an adjuvant to ondansetron for reducing PONV after functional endoscopic sinus surgery operation and to assess if there is any advantage of one drug over the other. Patients and methods This study is a prospective randomized single-blind study. The study involved 60 patients with American Society of Anesthesiologists physical status I and II, of both sexes, between 18 and 50 years of age, undergoing elective functional endoscopic sinus surgery operation. At the end of surgery, patients were randomly allocated to receive an intravenous single dose of either 0.1 mg/kg of ondansetron as a control group, or 8 mg of dexamethasone following 0.1 mg/kg of ondansetron, or dexmedetomidine 0.1 μ/kg following 0.1 mg/kg ondansetron. Postoperatively, all the incidents of nausea, retching and/or vomiting were recorded and patients were asked if vomiting had occurred or if the patients felt nauseated with only two possible answers (yes or no). Results There was no significant differences among the three groups regarding the incidence of PONV during the first 24 h postoperatively, with a slight difference in the ondansetron–dexmedetomidine (ondan–dexmed) group, which was less in frequency in relation to the other groups (P Regarding the PONV incidence in relation to intraoperative and postoperative medications, there was a highly significant difference among the three groups regarding the severity of PONV. The PONV severity was lower in the ondan–dexmed group in relation to the other groups (P Conclusion A single dose of dexmedetomidine combined with ondansetron is superior to ondansetron alone or ondansetron combined with dexamethazone for preventing PONV in patients undergoing functional endoscopic sinus surgery under general anesthesia.

Objective To investigate the effect of anesthesia factor on lung injury in patients undergoing thoracoscopic radical lung cancer surgery and to evaluate efficacy of combination of thoracic paravertebral block(TPVB) with dexmedetomidine mixed with ropivacaine and general anesthesia. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical statusⅡor Ⅲ, scheduled for elective thoracoscopic radical lung cancer surgery, were divided into 5 groups(n=20 each) using a random number table: general anesthesia group(group G), TPVB with ropivacaine combined with general anesthesia group(group R), intravenously infused dexmedetomidine combined with general anesthesia group(group Div), intravenously infused dexmedetomidine plus TPVB with ropivacaine combined with general anesthesia group(group Div+ R), and TPVB with dexmedetomidine mixed with ropivacaine combined with general anesthesia group(group Dtp+ R). In group R, TPVB was performed under ultrasound guidance, two-point method was selected according to the position of intercostal space at surgical incision, and 0.5% ropivacaine 10 ml was injected into each puncture site.Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min in group Div.Dexmedetomidine was intravenously infused for TPVB in group Div+ R.TPVB solution contained dexmedetomidine 0.5 μg/kg and ropivacaine in group Dtp+ R.Anesthesia was then induced and maintained by IV infusion of propofol and remifentanil.The intraoperative consumption of propofol and remifentanil and development of adverse reactions such as hypoxemia, hypotension and bradycardia were recorded.Normal lung tissues around the tumor margin were obtained immediately after tumor resection for determination of the expression of hypoxia-inducible factor 1 alpha(HIF-1α), BCL2/adenovirus E1B 19kDa interacting protein 3(BNIP3) and microtubule-associated protein 1 light chain 3 Ⅱ(LC3 Ⅱ)(by Western blot), contents of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) in lung tissues(by enzyme-linked immunosorbent assay) and cell apoptosis(by TUNEL) and for examination of the pathological changes(with a light microscope) which were scored.Apoptosis index was calculated. Results The amount of propofol consumed was significantly lower in Div+ R and Dtp+ R groups than in the other three groups, and the amount of remifentanil consumed was significantly higher in G and Div groups than in the other three groups(P<0.05). The incidence of hypertension and tachycardia was significantly lower in R and Div groups than in group G(P<0.05). The incidence of hypotension was significantly lower in R, Div and Dtp+ R groups than in group Div+ R(P<0.05). The incidence of bradycardia was significantly higher in Div and Div+ R groups than in group R(P<0.05). Compared with G and R groups, apoptosis index, contents of TNF-α and IL-6 and lung injury scores were significantly decreased, and the expression of HIF-1α, BNIP3 and LC3Ⅱ was up-regulated in Div, Div+ R and Dtp+ R groups(P<0.05). Compared with group Div, the TNF-α content and lung injury scores were significantly decreased, and the expression of HIF-1α and LC3Ⅱ was up-regulated in Div+ R and Dtp+ R groups, and the IL-6 content was significantly decreased in group Dtp+ R(P<0.05). Conclusion Combination of TPVB with dexmedetomidine mixed with ropivacaine and general anesthesia produces better efficacy in reducing lung injury in patients undergoing thoracoscopic radical lung cancer surgery. Key words: Dexmedetomidine; Amides; Nerve block; Anesthesia, general; Lung neoplasms

[Objective]To observe the preventive and curative effect of ondansetron combined with dexamethasone,and a small amount of droperidol on nausea and vomiting in patients with controlled epidural analgesia after gynecological hysterectomy.[Methods]Totally 100 patients underwent abdominal hysterectomy in combined spinal epidural anesthesia,were randomly divided into three groups:20 cases in control group ( Group C) were not given any antiemetics; 40 cases in ondansetron group (Group O)were given 8 mg ondansetron intraoperatively by intravenous injection; 40 cases in ondansetron,dexamethasone and droperidol group ( Group O + D + F) were given 10 mg dexamethasone intraoperatively by intravenous injection,8 mg ondansetron was injected at the end of operation,and patient controlled epidural analgesia ( PCEA )wasused postoperatively.In Group C and Group O,the analgesia formula were ropivacaine mesylate (0.238％) and fentanyl solution(0.004％) 100ml in all; In Group O + D + F,2.5mg droperidol was added to analgesic solution.In 48 hours after the operation,the effects of analgesia and incidences of nausea and vomiting were observed.[Results]There were no significant difference in the analgesic effect VAS scores between the three groups.The incidence of nausea and vomiting in Group O was significantly lower than that in Group C (P＜0.05) within 24 hours postoperatively.The incidence of nausea and vomiting in Group O + D + F was significantly lower than that in Group C (P＜0.01) within 48 hours postoperatively.And the incidence of nausea and vomiting in Group O + D + F was significantly lower than that in Group O (P＜0.01) within 48 hours postoperatively.[Conclusions]Ondansetron alone can reduce the of postoperative nausea and vomiting within 24 hours postoperatively.Combination of ondansetron,dexamethasone and droperidol can effectively reduce the incidence of postoperative nausea and vomiting within 48 hours postoperatively. Key words: Postoperative nausea and vomiting ; Hysterectomy ; Ondansetron ; Dexamrethasone ; Droperidol ;

Objective To explore the application of general anesthesia combined with epidural anesthesia in laparoscopic radical resection of rectal cancer. Methods From February 2015 to July 2016, 95 rectal cancer patients undergoing laparoscopic radical resection in the Fifth People's Hospital of Datong were randomly divided into general anesthesia(GA) group(48 cases) and GA combined with epidural anesthesia(CEGA) group(47 cases) according to the digital table.The effect of anesthesia, hemodynamic index, recovery time, extubation time, general anesthesia dosage, adverse reaction were assessed. Results In the CEGA group, 89.36% reached the level Ⅰ~Ⅱ anesthesia, GA group was 72.92%, the difference between the two groups was statistically significant (U=5.034, P<0.05). The anesthesia dosage of the GA group was higher than that of the CEGA group[(780.26±152.01)mg vs.(499.31±153.01)mg, the difference between the two groups was statistically significant(t=4.561, P<0.05). The recovery time, operation time in the CEGA group were (10.26±2.81)min, (139.26±34.16)min, respectively, which in the group GA were (23.46±3.64)min, (109.23±35.03)min, respectively, the difference between the two groups was statistically significant (t=6.235, 9.490, all P<0.05). The incidence rate of adverse reaction of the CEGA group was 10.64%, which of the GA group was 27.08%, the difference between the two groups was statistically significant (χ2=10.342, P<0.05). At pneumoperitoneum and extubation, HR, MVP in the GA group were (105.26±15.07)times/min, (109.18±16.27)times/min, (13.26±2.65)kPa, (14.91±2.57)kPa, respectively, which were significantly higher than those in the CEGA group (t=6.575, 6.154, 5.842, 6.544, all P<0.05). The Steward awakening scores of each base point before and after extubation in the CEGA group were significantly higher than those in the GA group (t=6.354, 3.268, 3.869, 3.992, 3.564, 4.065, 4.031, 4.689, all P<0.05). Conclusion CEGA has good anesthetic effect, less dosage in general anesthesia, little influence on hemodynamics and easy to wake up.It is an ideal anesthesia method for laparoscopic radical resection of rectal cancer. Key words: Anesthesia, general; Anesthesia, epidural; Laparoscopy; Colorectal surgery

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve (GAN) block combined with general anesthesia for middle ear microsurgery in adult patients. Methods Sixty-four adult patients of both sexes, aged 18-60 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective middle ear microsurgery, were assigned into 2 groups (n=32 each) using a random number table: GAN block combined with general anesthesia group (group GANB+ G) and general anesthesia group (group G). Patients received GAN block with 0.25% ropivacaine 2 ml using ultrasound-guided in-plane technique before anesthesia induction in group GANB+ G.Anesthesia induction and maintenance protocols (IV infusion of propofol and target-controlled infusion of remifentanil) were similar in two groups.Analgesia was performed with sufentanil, flurbiprofen axetil or parecoxib sodium after operation to maintain visual analog scale score <4 within 48 h after operation.The infusion duration and consumption of propofol and remifentanil, requirement for postoperative analgesia and occurrence of postoperative nausea and vomiting were recorded. Results Compared with group G, the consumption of remifentanil was significantly reduced, and the requirement for postoperative analgesia and incidence of postoperative nausea and vomiting were decreased in group GANB+ G (P<0.05 or 0.01). Conclusion Ultrasound-guided GAN block combined with general anesthesia provides better analgesic efficacy in the the perioperative period in adult patients undergoing middle ear microsurgery. Key words: Ear, middle; Ultrasonography; Nerve block

Objective To evaluate the efficacy of erector spinae plane block(ESPB)combined with general anesthesia when used for thoracoscopic radical resection of lung cancer. Methods Forty patients of both sexes, aged 30-64 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic radical resection of lung cancer, were divided into 2 groups(n=20 each)using a random number table method: ESPB combined with general anesthesia group(group EG)and general anesthesia group(group G). ESPB was performed before anesthesia induction, and 20 min later the effect was evaluated by testing the area of block in group EG.Anesthesia was induced with midazolam, propofol, sufentanil and cisatracurium and maintained with sevoflurane and remifentanil to maintain the bispectral index value between 40 and 60.Patient-controlled intravenous analgesia was applied in both groups at the end of operation, flurbiprofen axetil 100 mg was intravenously injected as a remedy for analgesia when necessary, and the visual analog scale score was maintained less than or equal to 3.The intraoperative consumption of sulfentanil and remifentanil, emergence time from anesthesia and time of tracheal extubation were recorded.The development of adverse effects within 48 h after operation, postoperative length of hospital stay, requirement for rescue analgesia and patients′ overall satisfaction with postoperative analgesia were also recorded. Results Compared with group G, the intraoperative consumption of sulfentanil and remifentanil was significantly decreased, the emergence time from anesthesia and time of tracheal extubation were shortened, the incidence of nausea and vomiting within 48 h after operation was decreased, the first occurrence time was prolonged, the requirement for rescue analgesia was decreased, postoperative length of hospital stay was shortened, and patients′ satisfaction scores were increased in group EG(P<0.05). Conclusion ESPB combined with general anesthesia can reduce the perioperative consumption of opioids and is helpful in improving prognosis when used for thoracoscopic radical resection of lung cancer. Key words: Erector spinae; Nerve block; Anesthesia, general; Thoracoscopy; Lung neoplasms

Objective To compare the effects of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia and epidural block combined with general anesthesia on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer. Methods Eighty-four patients of both sexes, aged 35-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer, were divided into 3 groups (n=28 each) using a random number table method: general anesthesia group (group G), TEAS combined with general anesthesia group (group TG), and epidural block combined with general anesthesia group (group EG). In group TG, patients received continuous TEAS of bilateral Neiguan, Hegu, Zusanli, Shangjuxu and Xiajuxu acupoints starting from 30 min before anesthesia induction until the end of surgery at a frequency of 2/100 HZ and intensity of 3-8 mA with disperse-dense waves.In group EG, an epidural catheter was placed at L1, 2 and advanced for 3 cm in the epidural space in cephalad direction, 2% lidocaine 3 ml was given as a test dose, 0.375% ropivacaine 6-10 ml was injected into the epidural space, the level of anesthesia was adjusted to T6, and then 0.375% ropivacaine 5 ml/h was infused to the epidural space until the end of operation.Patients were endotracheally intubated after routine induction of general anesthesia and mechanically ventilated, and combined intravenous-inhalational anesthesia was used to maintain anesthesia.The Quality of Recovery (QoR-15) score was recorded on 1 day before surgery and 1-3 days after surgery.The development of nausea and vomiting, cognitive decline and requirement for rescue analgesics was recorded within 3 days postoperatively.The intraoperative consumption of remifentanil and propofol, vasoactive drugs, extubation time, time of PACU stay, time of passing flatus and length of postoperative hospital stay were recorded. Results Compared with group G, the consumption of remifentanil was significantly decreased, the QoR-15 scores were increased at 1-3 days after surgery, the incidence of nausea and vomiting and cognitive decline was decreased, and the extubation time, time of passing flatus and length of postoperative hospital stay were shortened in group TG and group EG (P<0.05). Compared with group TG, the intraoperative requirement for vasoactive drugs was significantly increased in group EG (P<0.05). Conclusion TEAS combined with general anesthesia and epidural block combined with general anesthesia have the comparable effect on the recovery of patients undergoing laparoscopic radical resection of colorectal cancer, however, the former one provides more stable hemodynamics during surgery. Key words: Electric stimulation therapy; Anesthesia, epidural; Laparoscopy; Colorectal surgery; Prognosis

Objective To explore the two different anesthesia methods on hemodynamics and inflammatory cytokines in elderly patients during peroperative period.Methods Fifty elderly patients with Knee Replacement( ASA Ⅰ,Ⅱ )were randomly divided into general anesthesia group( group A,n =25 ) and combined general and epidural anesthesia group( group B,n =25 ).The changes of mean arterial pressure(MAP) and heart rate ( HR ) were monitored before induction of anesthesia ( T1 ),at intubation ( T2 ),during skin incision ( T3 ) and at the time of extubation ( T4 ),at 30 min after extubation ( T5 ).Blood samples were taken from artery for determination of plasma TNF-α,IL-6,IL-10 concentrations before tourniquet inflation ( T5 ),10 min after tourniquet deflation(T6),30 min after tourniquet deflation (T7)and 30 min after operation (T8)by enzymelinked immunosorbent assay(ELISA).Results The MAP and HR of patients in two groups at T2,T3,T4 were all increased when compared with T1 [ group A:HR:( 94.3 ± 10.4 ) bpm,( 96.4 ± 12.7 ) bpm,(93.3 ± 11.1 )bpm vs(62.6 ±7.3)bpm;MAP:( 18.8 ±3.4)kPa,( 19.6 ±3.4)kPa,( 17.8 ±2.0)kPa vs ( 14.5 ± 1.5)kPa,P＜0.05;group B:HR(76.2 ±6.5)bpm,(70.1 ± 9.7) bpm,(71.5 ± 8.3) bpm vs(64.6 ± 8.4) bpm;MAP:( 16.3 ± 2.5 ) kPa,( 15.3 ± 1.2) kPa,( 14.8 ± 1.4) kPa vs ( 14.1 ± 1.3 ) kPa,P ＜ 0.05 ].There was significant difference on MAP and H R between group A and group B( F =11.957,9.745;P ＜ 0.05 ).The level of plasma TNF-α,IL-6 and IL-10 were significantly increased at T6 to T8 compared with T5 in both groups[ groupA:TNF-α:(4.36 ±0.18) ng/L,(7.54 ± 1.23) ng/L,(10.35 ±2.21 )ng/L vs (2.26 ±0.16) ng/L; groupA:IL-6:(4.32 ±0.21 ) ng/L,( 8.35 ± 1.26 ) ng/L,( 10.23 ± 2.23 ) ng/L vs ( 1.36 ± 0.08 ) ng/L; groupA:IL-10:(5.32±1.10) ng/L,(7.56 ± 1.36) ng/L,(8.63 ± 2.21) ng/L vs (1.25 ± 0.03) ng/L; groupB:TNF-α:(3.43 ±0.06)ng/L,(5.24 ±2.10) ng/L,(7.68 ± 1.43) ng/L vs(2.22 ±0.15) ng/L;groupB:IL-6:(3.41 ±0.08 ) ng/L,(5.34 ± 1.34 ) ng/L,( 8.54 ± 2.03 ) ng/L vs ( 1.28 ± 0.04 ) ng/L; groupB:IL-10:( 7.28 ± 1.22 )ng/L,( 10.53 ± 2.14)ng/L,( 12.45 ± 2.03 )ng/L vs( 1.31 ± 0.04)ng/L,P ＜ 0.05 ].And there was significant difference on TNF-α,IL-6 and IL-10 between group A and group B( F =7.889,3.554,5.443,respectively,P ＜0.05).Conclusion Compared with general anesthesia group,combined general and epidural anesthesia group can ensure hemodynamic stability of elderly patients during peroperative period very well and can reduce the releasing of inflammatory cytokins,it is a viable and an ideal method. Key words: General anesthesia; Epidural blockade; Hemodynamic; Inflammatory cytokines

Anaesthesia for assisted conception

Objective To explore two different anesthesia methods on hemodynamics and the quality of palinesthesia in elderly patients during peroperative period.Methods Sixty elderly patients with Hip Replacement( ASA,Ⅰ,Ⅱ ) were randomly divided into general anesthesia group ( group A,n =30 ) and combined general and epidural anesthesia group( group B,n =30).The changes of mean arterial pressure(MAP)and heart rate( HR ) were monitored before induction of anesthesia( T1 ),at intubation( T2 ),during skin incision (T3) and at the time of extubation ( T4 ),at 30 min after extubation ( T5 ) and at the same time,the dosage of general anesthetics and each index's time after operation to awake were recorded of the patients in both groups.Results The MAP and HR of patients in two groups at T2,T3,T4,T5 were all increased when compared with T1.And the increasing degree of MAP and HR in group A were higher than that in group B ( MAP:within group F =17.352,interaction F =4.326,between groups F =8.652; HR:within group F =11.561,interaction F =5.241 between groups F =7.248; P ＜ 0.05 ).The dosage of general anesthetics was significantly different between two groups[ sevoflurane:(1.40 ± 0.30)MAC vs (1.00 ± 0.12 )MAC,t =0.37,P＜0.05 ; fentanyl:(0.34 ±0.08)mg vs(0.18 ±0.03) mg,t =0.21,P ＜0.05 ; vecuronium:(6.20 ±0.32) mg vs(4.10 ±0.31 ) mg,t =1.24,P ＜0.05 ; propofol:(448 ±24) mg vs(393 ±26) mg,t =3.46,P ＜0.05].There was significant difference on gag reflex time [ ( 18.00 ± 1.27 ) min vs ( 12.31 ± 2.54 ) min,t =2.74,P ＜ 0.05 ],time to extubation [ ( 24.03 ± 2.42 ) min vs ( 16.05 ± 1.20 ) min,t =3.68,P ＜ 0.05 ],fully awake time [(29.54±5.24)min vs(19.25±2.64)min,t=1.35,P＜0.05] between these two groups.Conclusion The two different anesthesia methods can ensure haemodynamic stability of elderly patients undergoing hip replacement during peroperative period.But compared with general anesthesia group,combined general and epidural anesthesia group can reduce the dosage of general anesthetics and shorten the time of extubation significantly,it is a viable and an ideal method. Key words: General anesthesia; Epidural blockade; Hemodynamic; Palinesthesia

Preventing postoperative nausea and vomiting: A comprehensive comparison of treatments

PurposePostoperative sleep disturbance is one of the most important factors affecting rapid postoperative recovery. The aim of the present study was to investigate the effects of combined epidural and general anesthesia on postoperative sleep and pain in elderly patients undergoing gastrointestinal tumor surgery.Patients and methodsNinety patients who were scheduled to undergo elective gastrointestinal tumor surgery were randomly divided into the general anesthesia (GA) and epidural combined with GA (GEA) groups. A wireless smart bracelet was used to measure objective sleep quality on the night before surgery (Preop 1), and on the first, third, and seventh night after surgery (POD1, POD3, and POD7, respectively). Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Furthermore, the total dose of general anesthetics required and postoperative pain and adverse effects were assessed.ResultsPSQI was higher on postoperative day 1 and day 3 than on preoperative day 1 in both groups. In addition, on postoperative day 1 and postoperative day 3, PSQI scores were lower in the GEA group than in the GA group. On postoperative day 1, the sleep scores, rapid eye movement sleep, and percentage of stable sleep were higher in the GEA group than in the GA group. remifentanil dosage and the incidence of postoperative nausea and vomiting were significantly lower in the GEA group than in the GA group. There was no significant difference in VAS scores at 6, 24, 48 h after operation and total PCA demand attempts within 48 h after operation between the two groups.ConclusionElderly patients usually experience considerable sleep disturbances after gastrointestinal tumor surgery. Epidural combined with GA can effectively improve postoperative short-term sleep quality and reduce the incidence of postoperative nausea and vomiting. This may be related to the reduction of intraoperative consumption of remifentanil under epidural anesthesia. However, the pain within 48 h after the operation was not improved in this study.Trial registrationThe study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date 04/04/2021 Trial ID ChiCTR2100045064).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03266-w.

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery. Methods Forty-two patients of either sex with intracranial aneurysm, aged 57-78 yr, weighing 53-86 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia, were assigned into 2 groups(n=21 each)using a random number table: propofol combined with remifentanil group(group PR)and dexmedetomidine combined with propofol and remifentanil group(group DPR). In group DPR, dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5μg·kg-1 before induction of anesthesia, followed by an infusion of 0.3 μg·kg-1·h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion(TCI)after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows: propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml, respectively, in group DPR; propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml, respectively, in group PR.Bispectral index(BIS)value was maintained at 40-60.Before wake-up test, propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups, and the infusion rate of dexmedetomidine was decreased to 0.1 μg·kg-1·h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room(T0, baseline), at 10 min before wake-up test(T1), immediately after patients were wakened(T2), at 10 min after patients were wakened(T3)and at the end of wake-up test(T4), the mean blood pressure(MAP), heart rate, respiratory rate(RR), SpO2 and BIS values were recorded.The development of intraoperative awareness, emergence time, postoperative agitation, nausea and vomiting, regurgitation and aspiration and severe pain was recorded. Results MAP, heart rate, SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at T0, MAP was significantly decreased at T1, 3, 4 in group PR, and BIS value was decreased at T1-4 in DPR and PR groups(P 0.05). No cardiovascular events, respiratory depression, intraoperative awareness, postoperative nausea and vomiting, regurgitation and aspiration or severe pain was found in two groups. Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery. Key words: Dexmedetomidine; Monitoring, intraoperative; Carotid artery, internal; Embolization, therapeutic; Wake-up test

Background: Uterine Artery Embolization (UAE) has been used worldwide for the treatment of uterine fibroids. The aim of the current study is to evaluate the effects of epidural analgesia (EDA) given only intraoperatively to those of general anesthesia (does it still affect in recovery) in women undergoing uterine artery embolization (UAE) for the treatment of systematic uterine fibroids. Patients and methods: A total of 40 ASA1-III patients (ages 35-55) selected for uterine artery embolization were divided into 2 groups i.e. an epidural anesthesia group (A) and a general anesthesia group (B). Each group comprised of 20 individuals. The parameters i.e. pain scoring, incidence of nausea and vomiting, need for opioids, overall patient satisfaction score and discharge from hospital were measured. Pain intensity was measured using VAS (1–10) at 0, 1, 2, 4, 8, 12 and 24 h. Nausea lasting more than 10 min or vomiting was treated with ondansetron 4 mg. Patient satisfaction for postoperative analgesia was recorded according to a satisfaction score (poor=0, fair=1, good=2, excellent=3). All data were recorded with residents of anesthesia. Primary outcome was morphine and or pethidine, consumption in the first 24 h. Secondary outcome measures were; pain intensity, postoperative analgesic consumption, postoperative nausea and vomiting (PONV) and patient satisfaction. Results: Differences in the heart rate between the 2 groups were statistically significant at all readings where group (B) patients developed less significant tachycardia compared to group (A) patients. Differences in systolic blood pressure values between the 2 groups were statistically significant lower in group (B) compared to group (A) at 2 points: after 5 min & after 10 min from induction of anesthesia. Differences in diastolic blood pressure values between the 2 groups were statistically significant lower in group (A) compared to group (B) at all times except preoperative reading. Thus the epidural anesthesia provided more hemodynamic stability than general anesthesia, Postoperative pain severity of the patients significantly decreased in each group at recovery room (time 0) and postoperative 1st, 2nd, 4th, 12th and 24th h (repeated measured variance analysis, p<0.001. However, the reduction of postoperative VAS scores was more in epidural anesthesia group than general anesthesia (repeated measured variance analysis, test, p=0.466. Conclusion: Uterine artery embolization for fibroids is an effective and safe therapeutic modality for symptomatic fibroids especially for those patients who like to preserve their uterus. Recovery and time to return to normal activities is shorter than hysterectomy and open myomectomy. With the results of the present study it can be concluded that epidural anaesthesia was much better in pain relief, less sedating effect and overall patient satisfaction. Thus, epidural anaesthesia technique can be helpful for women undergoing UAE to recover faster providing good symptom relief for most patients.