Background The combination of dexmedetomidine and ketamine is feasible for pediatric procedural sedation, particularly in radiologic imaging studies. Objective The aim of the study was to investigate the sedative effects of ketamine-dexmedetomidine (KD) and ketamine-midazolam (KM) combinations on recovery time and adverse events in pediatric patients with uncorrected tetralogy of Fallot undergoing multislice spiral computed tomography (CT). Patients and methods A total of 40 American Association of Anesthesiologists III pediatric patients aged between 2 and 3 years with surgically uncorrected tetralogy of Fallot undergoing CT were randomly allocated into two equal groups. Patients in group KD received intravenous dexmedetomidine (1 µg/kg) over 15 min, followed by 1 mg/kg of ketamine infused slowly over 15 min. Patients in the group KM received 0.1 mg/kg bolus of midazolam over 15 min, followed by 1 mg/kg initial bolus of ketamine over 15 min, followed by waiting for 2 min to evaluate the sedative effect. After a Ramsay sedation score of 4 was reached, a rescue dose of 1 mg/kg of ketamine (maximum of 2 mg/kg) was administered to maintain an Ramsay sedation score of 4 in both groups. Recovery time; sedation scores, systolic blood pressure and diastolic blood pressure, and oxygen saturation at baseline, 3, 6, and 9 min after drug administration; the number of patients requiring additional ketamine; and the incidence of complications such as apnea, hypotension, and vomiting were recorded. Results Administration of KM compared with KD was associated with significantly larger number of patients requiring additional ketamine doses (P=0.018) and a higher incidence of complications, such as tachyarrhythmia (P<0.035), vomiting (P<0.02), and agitation (P<0.04) as well. There was no significant difference between both groups regarding recovery time, sedation scores, systolic blood pressure, diastolic blood pressure, and oxygen saturation. Conclusion Sedation using KD for cardiac multislice spiral CT displayed lower rescue doses of ketamine and less occurrence of complications with insignificant effect on the recovery time compared with KM sedation.

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Purpose The aim of the study is to investigate the effect of tramadol abuse on postoperative pain control in patients undergoing paravertebral block following thoracotomy. Patients and methods Patients undergoing paravertebral block following thoracotomy were consecutively recruited and were divided into two groups: group T included patients with a history of chronic tramadol abuse and group N included patients with no history of any substance abuse (n=50 in each). Analgesic doses, vital signs, and the visual analog scale were evaluated for the first 3 days postoperatively. Complications and need for additional analgesic agents were also scrutinized. Results There were no differences in clinical or surgical details between the groups, but patients in group T needed significantly higher doses of analgesics following surgery (P<0.05). This was more so for fentanyl (P<0.01). Despite that, visual analog scale scores were higher with less pain control compared with group N (P<0.05). Conclusion Chronic tramadol abuse has a significant effect on postoperative pain control following thoracotomy. This information can be used to develop better postoperative management plans and refine expectations of both the patients and their health-care providers leading to better clinical outcomes and reduced morbidity.

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Minimally invasive mitral valve surgery (MI-MVS) has been gaining momentum since its introduction in the mid-1990s. It is a complex procedure that requires collaboration and teamwork. The anesthetists play a major role in a MI-MVS and are a cornerstone for a successful program. Their role extends from the preoperative period, all through the surgical treatment process, till discharge planning. The authors would like to highlight, in this work, the contribution of the anesthetists to the MI-MVS program and the modifications they perform to their normal setup and practice to accommodate a minimally invasive approach.

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