Estudio prospectivo, comparativo de APACHE-IV y SAPS-II y el cálculo del rango estandarizado de mortalidad en pacientes con sepsis severa y shock séptico

Estudio prospectivo, comparativo de APACHE-IV y SAPS-II y el cálculo del rango estandarizado de mortalidad en pacientes con sepsis severa y shock séptico A Prospective Study of Comparison of APACHE-IV & SAPS-II Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients. Dabhi AS, Khedekar SS, Mehalingam V. J Clin Diagn Res. 2014 Oct;8(10):MC09-13. doi: 10.7860/JCDR/2014/9925.5052. Epub 2014 Oct 20 Abstract CONTEXT: Severe sepsis and septic shock are major causes of mortality in the Intensive Care Unit (ICU) Illness Scoring Systems can help in the prediction of outcome of these patients. AIM: To calculate and compare APACHE-IV and SAPS-II Scoring Systems along with calculation of Standardised Mortality Rate (SMR) in patients of severe sepsis and septic shock in the ICU. STUDY DESIGN: Observational-analytical prospective study. MATERIALS AND METHODS: The study was conducted on 84 patients with severe sepsis and septic shock admitted to the Medical ICU of a tertiary care teaching hospital. RESULTS: Mean of Predicted Mortality Rate (PMR) for APACHE-IV was 37.85% and for SAPS-II, it was 72.36% which shows that APACHE-IV had under-predicted overall mortality while SAPS-II had over-predicted overall mortality of patients with severe sepsis and septic shock. Standardised Mortality Rate for APACHE-IV was 1.60 and for SAPS-II, it was 0.83. CONCLUSION: Predicted Mortality of APACHE-IV and SAPS-II Scoring Systems did not correlate with the observed mortality for patients with severe sepsis and septic shock. KEYWORDS: APACHE-IV; SAPS-II; Septic shock; Severe sepsis; Standardised mortality rate PDF

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Tablets

El uso nocturno de eReaders emisores de luz afecta negativamente el sueño, el tiempo circadiano, y el estado de alerta de la siguiente mañana. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness Chang AM, Aeschbach D, Duffy JF, Czeisler CA Proc Natl Acad Sci U S A 2014; doi: 10.1073/pnas.1418490112 La luz emitida por una tableta electrónica puede alterar el sueño si el dispositivo se usa en las horas previas a acostarse, según un nuevo estudio. También las personas que en esos momentos leían en un dispositivo electrónico se sentían menos somnolientas y necesitaron más tiempo para dormirse que las que leían en un libro impreso normal. En el estudio, 12 adultos jóvenes leyeron unas cuatro horas antes de acostarse durante cinco noches consecutivas, con una luz muy tenue en la habitación. La mitad leyeron libros electrónicos y el resto, libros impresos. Luego pasaron otras cinco noches leyendo, pero intercambiando los papeles. Los participantes que leyeron un libro electrónico necesitaron más tiempo (unos 10 minutos) para dormirse que los que leyeron los libros impresos. Evaluaron que sentían menos sueño. Cuando se durmieron, pasaron menos tiempo durmiendo en la fase REM, caracterizada por un sueño profundo y restaurador. La sangre extraída a los participantes reveló que usar un dispositivo electrónico retrasó el aumento natural nocturno de los niveles de melatonina en más de una hora y media, en comparación con los que leyeron un libro impreso. Con las medidas se llegó a la conclusión que las pantallas electrónicas emiten dosis altas de luz con una longitud de onda azul que, según investigaciones previas, suprime la melatonina y aumenta el nivel de alerta. Sucede lo mismo con aparatos similares: ordenadores portátiles, teléfonos móviles, monitores LED y otros dispositivos electrónicos. Abstract In the past 50 y, there has been a decline in average sleep duration and quality, with adverse consequences on general health. A representative survey of 1,508 American adults recently revealed that 90% of Americans used some type of electronics at least a few nights per week within 1 h before bedtime. Mounting evidence from countries around the world shows the negative impact of such technology use on sleep. This negative impact on sleep may be due to the short-wavelength-enriched light emitted by these electronic devices, given that artificial-light exposure has been shown experimentally to produce alerting effects, suppress melatonin, and phase-shift the biological clock. A few reports have shown that these devices suppress melatonin levels, but little is known about the effects on circadian phase or the following sleep episode, exposing a substantial gap in our knowledge of how this increasingly popular technology affects sleep. Here we compare the biological effects of reading an electronic book on alight-emitting device (LE-eBook) with reading a printed book in the hours before bedtime. Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness than when reading a printed book. These results demonstrate that evening exposure to an LE-eBook phase-delays the circadian clock, acutely suppresses melatonin, and has important implications for understanding the impact of such technologies on sleep, performance, health, and safety. KEYWORDS: chronobiology; digital media; electronics; phase-shifting; sleep PDF

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Sobrevida postoperatoria/Postoperative survival

Sobrevida después morbilidad postoperatoria: Estudio longitudinal, observacional de cohortes Survival after postoperative morbidity: a longitudinal observational cohort study. Moonesinghe SR, Harris S, Mythen MG, Rowan KM, Haddad FS, Emberton M, Grocott MP. Br J Anaesth. 2014 Dec;113(6):977-84. doi: 10.1093/bja/aeu224. Epub 2014 Jul 10. Abstract BACKGROUND: Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. METHODS: We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbiditywas recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. RESULTS: Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32-3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62-3.65), returning to baseline thereafter. CONCLUSIONS: Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications. KEYWORDS: complications; complications, morbidity; complications, neurological; surgery, non-cardiac PDF

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Neurocirugía/Neurosurgery

Resultados tempranos después stent de la arteria carótida en comparación con endarterectomía para estenosis carotídea asintomática Early Outcomes After Carotid Artery Stenting Compared With Endarterectomy for Asymptomatic Carotid Stenosis Jay Chol Choi, MD; S. Claiborne Johnston, MD, PhD; Anthony S. Kim, MD, MAS Stroke. 2015;46:120-125. DOI: 10.1161/STROKEAHA.114.006209.) http://stroke.ahajournals.org/content/46/1/120.full.pdf Costo-efectividad de las transferencias a los centros con unidades de cuidados intensivos neurológicos después de una hemorragia intracerebral  Cost-Effectiveness of Transfers to Centers With Neurological Intensive Care Units After Intracerebral Hemorrhage Jeffrey J. Fletcher, MD, MSc; Vikas Kotagal, MD, MSc; Aaron Mammoser, MD, MSc; Mark Peterson, PhD, MSc; Lewis B. Morgenstern, MD; James F. Burke, MD, MS Stroke. 2015;46:58-64. DOI: 10.1161/STROKEAHA.114.006653. http://stroke.ahajournals.org/content/46/1/58.full.pdf Mejora de la preservación de la función durante la cirugía neuroma acústico Improved preservation of function during acoustic neuroma surgery Hirofumi Nakatomi, MD, PhD, Hidemi Miyazaki, MD, Minoru Tanaka, MD, PhD et al. J Neurosurg 122:24-33, 2015 http://thejns.org/doi/pdf/10.3171/2014.8.JNS132525

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E-Books. Alerta

E-Books
Notificaciones semanales ⋅ 28 de enero de 2015
NOTICIAS


El Universal

Dona OCDE 10 mil #39;ebooks#39; a San Lázaro
El Universal
Los textos en formato electrónico representan estudios de los 34 países miembros de la Organización y de 60 naciones colaboradoras.




Cinco Días

Conoce cinco lectores de eBooks gratuitos y de buena calidad para Android
Cinco Días
Los tablets (e incluso algunos phablets) con sistema operativo Android ofrecen la posibilidad de ser utilizados como si fueran un libro electrónico.




levante.emv.com

El préstamo de ´ebooks´ se estrena en la C.Valenciana
levante.emv.com
Efe/Levante-emv.com La Comunitat Valenciana dispone desde estos días de una plataforma de préstamo gratuito de libros electrónicos, a través de ...




Bolsamania.com

eBooks: siete alternativas para descargar libros electrónicos gratis
Bolsamania.com
BATS Chi-X Europe, que se convirtió en un Recognised Investment Exchange (RIE) en mayo de 2013, es la mayor operadora de renta variable ...




WWWhat's new? (blog)

Amazon lanza un Creador de eBooks para educadores
WWWhat's new? (blog)
Los profesores trabajan frecuentemente con documentos en PDF, libros y artículos de todo tipo que envían a sus alumnos y compañeros de trabajo ...




Diario 26

E-book vs. libro de papel: duelo de lectura en la playa
Diario 26
Sin embargo, este último verano, apareció un nuevo competidor que suma cada vez más adeptos: los e-books. Cada vez hay más títulos y la ...




Librópatas

BookBub, el Groupon de los ebooks en oferta
Librópatas
Se llama BookBub y como bien apuntan en un artículo en The Guardian es una especie de Groupon para los ebooks. Cualquiera puede darse de alta ...




El Diario Montanes

El libro vence al 'e-book'
La Verdad
Las tapas, las hojas y la tinta parecían caminar a paso ligero hacia su apocalipsis, empujadas por unos nuevos dispositivos, los 'e-books', capaces ...




Todo eReaders (blog)

La web Tom Kabinet no podrá vender eBooks de segunda mano si no son legales
Todo eReaders (blog)
Hace ya tiempo que conocimos la página web Tom Kabinet que se dedica a la venta de eBooks de segunda mano, pero hoy vuelve a ser noticia a ...



Las ventas de eBooks crecen en China gracias a las smartphones
Todo eReaders (blog)
Las ventas de eBooks en muchos países de medio mundo, entre los que se encuentran Estados Unidos o el Reino Unido, están sufriendo un ...

Librerias. Alerta

librerias
Notificaciones semanales ⋅ 26 de enero de 2015
NOTICIAS

ICUB destina 400.000 euros a ayudas a librerías, galerías y salas de música
ABC.es
Diversas librerías, galerías de arte, espacios de creación y salas de música de Barcelona recibirán este año subvenciones del Instituto de Cultura de ...
El ICUB subvenciona con 400.000 euros a librerías, galerías y salas musicales - La Vanguardia
Cobertura total de la noticia



Ficción, historia y best sellers copan ventas del verano en librerías locales
ÚltimaHora.com
Algunos eligen los viajes, otros se quedan en casa, pero eso sí: entre ambos grupos hay quienes buscan las libreríaspara comprar aquel texto que ...




El Nacional.com

Librerías esperan reedición de clásicos de Monte Ávila
El Nacional.com
El problema son las reediciones. Esa es una de las quejas constantes entre encargados de libreríasprivadas con respecto a los títulos de Monte ...




La Gaceta Tucumán

Arranca la peregrinación por las librerías
La Gaceta Tucumán
Arranca la peregrinación por las librerías. Mirar, recorrer, comparar, decidir... el centro se ha poblado de padres buscadores de oportunidades.




El Mundo

La principal cadena de librerías israelí anula la venta del número especial de Charlie Hebdo ante ...
El Mundo
Ante la presión de varios grupos y diputados árabes en Israel, la principal cadena de librerías israelí, Steimatzky, ha suspendido la venta prevista en ...




Nuevo Diario de Santiago del Estero

En plenas vacaciones, los santiagueños se anticipan a los aumentos en los útiles de los niños.
Nuevo Diario de Santiago del Estero
Aunque el ciclo lectivo recién inicia el 2 de marzo, en algunas librerías de la ciudad ya ofrecen las “canastas escolares” con descuentos, para ...




eldiario.es

La Caníbal y buc de llibres, librerías cooperativas que hacen guerrilla cultural
eldiario.es
La crisis ha castigado duramente las librerías. La gente lee cada vez menos. La cultura es vista como prescindible. En estas circunstancias poner en ...




La Voz de Almería

La última obra de Bruno Nievas llega hoy a las librerías
La Voz de Almería
Hoy miércoles 21 de enero llega a las librerías españolas 'Lo que el hielo atrapa', la tercera novela de Bruno Nievas (Almería, 1973), publicada por ...




Europa Press

Catorce librerías de toda España se dan cita en la feria del libro antiguo de Badajoz
20minutos.es
Un total de 14 librerías de toda España se da cita en la Feria del libro antiguo, de ocasión o de saldo de Badajoz, que recoge obras del siglo XVI o ...

Infusión de isoproterenol y microcirculación en shock séptico

Infusión de isoproterenol y microcirculación en shock séptico  Isoproterenol infusion and microcirculation in septic shock. Wiramus S, Textoris J, Bardin R, Vigne C, Kelway C, Martin C, Leone M. Heart Lung Vessel. 2014;6(4):274-9. Abstract INTRODUCTION: Our study primarily aimed at investigating the effect of isoproterenol infusion on tissue oxygen saturation in patients with septic shock. The secondary aim was to assess the relation between cardiac index, central venous oxygen saturation and tissue oxygen saturation. METHODS: This retrospective study was conducted from December 2010 to March 2012. We included 14 consecutive patients with septic shocktreated with isoproterenol. All patients were monitored by cardiac index and tissue oxygen saturation. From medical charts, routine hemodynamic data were extracted one hour before and six hours after the onset of isoproterenol infusion. RESULTS: From baseline to H6, tissue oxygen saturation levels rise from 78 [72-82]% to 85 [78-88]% (p = 0.03). Isoproterenol infusion was associated with an increase of central venous oxygen saturation (from 67 [65-74]% to 84 [77-86]%, p = 0.02) and cardiac index (from 2.9 [2.7-3.1] L/min/m² to 3.9 [3.0-4.4] L/min/m², p = 0.006). Tissue oxygen saturation was correlated neither to cardiac index (p = 0.14, R(2) = 0.08) nor to central venous oxygen saturation (p = 0.19, R(2) = 0.10). CONCLUSIONS: Use of isoproterenol was associated with an increase of tissue oxygen saturation. This increase was not correlated to cardiac index, suggesting a decoupling between macrocirculation and microcirculation. KEYWORDS: isoproterenol; microcirculation; oxygen saturation; septic shock Artí­culo/Article

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Líquidos perioperatorios/Perioperative fluids

Fluidoterapia perioperatoria: Declaración del grupo internacional de optimización de fluidos Perioperative fluid therapy: a statement from the international Fluid Optimization Group. Navarro LH, Bloomstone JA, Auler JO Jr, Cannesson M, Rocca GD, Gan TJ, Kinsky M7, Magder S, Miller TE, Mythen M, Perel A, Reuter DA,Pinsky MR, Kramer GC. Perioper Med (Lond). 2015 Apr 10;4:3. doi: 10.1186/s13741-015-0014-z. eCollection 2015. Abstract BACKGROUND:Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key components of assuring adequate organ perfusion while avoiding the risks associated with either organ hypo- or hyperperfusion. Relative to perioperative fluid therapy, three inescapable conclusions exist: overhydration is bad, underhydration is bad, and what we assume about the fluid status of our patients may be incorrect. There is wide variability of practice, both between individuals and institutions. The aims of this paper are to clearly define the risks and benefits of fluid choices within the perioperative space, to describe current evidence-based methodologies for their administration, and ultimately to reduce the variability with which perioperative fluids are administered.METHODS: Based on the abovementioned acknowledgements, a group of 72 researchers, well known within the field of fluid resuscitation, were invited, via email, to attend a meeting that was held in Chicago in 2011 to discuss perioperative fluid therapy. From the 72 invitees, 14 researchers representing 7 countries attended, and thus, the international Fluid Optimization Group (FOG) came into existence. These researches, working collaboratively, have reviewed the data from 162 different fluid resuscitation papers including both operative and intensive care unit populations. This manuscript is the result of 3 years of evidence-based, discussions, analysis, and synthesis of the currently known risks and benefits of individual fluids and the best methods for administering them. RESULTS: The results of this review paper provide an overview of the components of an effective perioperative fluid administration plan and address both the physiologic principles and outcomes of fluid administration. CONCLUSIONS: We recommend that both perioperative fluid choice and therapy be individualized. Patients should receive fluid therapy guided by predefined physiologic targets. Specifically, fluids should be administered when patients require augmentation of their perfusion and are also volume responsive. This paper provides a general approach to fluid therapy and practical recommendations. KEYWORDS: Fluid responsiveness; Fluid resuscitation; Goal-directed fluid therapy; Perioperative fluids PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Apnea obstructiva del sueño/Obstructive sleep apnea

Manejo perioperatorio y complicaciones en pacientes con apnea obstructiva del sueño sometidos a cirugía trans espenoidal Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: Our institutional experience. Rahimi E, Mariappan R, Tharmaradinam S, Manninen P, Venkatraghavan L. J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):351-4. doi: 10.4103/0970-9185.137266. Abstract BACKGROUND AND AIMS: Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructivesleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. MATERIALS AND METHODS: After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011. Information collected included patients' demographics, pathology of lesion, history of OSA, anesthetic and perioperative management and incidence of perioperative complications. Patients with sleep study proven OSA were compared with a control group, matched for age, sex and pathology of patients without OSA. Statistical analysis was performed using t-test and Chi-square test and the P < 0.05 was considered to be significant. RESULTS: Out of a total 469 patients undergoing transsphenoidal surgery, 105 patients were found to be at risk for OSA by a positive STOP-BANG scoring assessment. Preoperative sleep study testing was positive for OSA in 38 patients. Post-operative hypoxemia (SpO2 < 90) occurred in 10 (26%) patients with OSA and was treated with high-flow oxygen through face mask (n = 7) and by CPAP mask (n = 3). In the OSA-negative group, 2 patients had hypoxemia and were treated with low-flow oxygen using face mask. There were no differences between the groups with respect to post-operative opioid use, destination, hospital stay or other complications. CONCLUSIONS: Post-operative hypoxemia in patients with OSA following transsphenoidal surgery can be treated in most but not all patients with high flow oxygen using the face mask. We were able to safely use CPAP in a very small number of patients but caution is needed to prevent complications. Further prospective studies are needed to determine the safe use of CPAP in patients after transsphenoidal surgery. KEYWORDS: Continuous positive airway pressure; obstructive sleep apnea; transsphenoidal surgery PDF Actualización en la definición, consecuencias y manejo de la apnea obstructiva del sueño Updates on definition, consequences, and management of obstructive sleep apnea. Park JG1, Ramar K, Olson EJ. Mayo Clin Proc. 2011 Jun;86(6):549-54; quiz 554-5. doi: 10.4065/mcp.2010.0810. Abstract Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Actualización en el manejo perioperatorio y en urgencias de anticoagulantes orales no antagonistas de la vitamina K

Actualización en el manejo perioperatorio y en urgencias de anticoagulantes orales no antagonistas de la vitamina K Updates in the perioperative and emergency management of non-vitamin K antagonist oral anticoagulants. Faraoni D, Levy JH, Albaladejo P, Samama CM; Groupe d'Intérêt en Hémostase Périopératoire. Crit Care. 2015 Apr 29;19(1):203. doi: 10.1186/s13054-015-0930-9. Abstract Perioperative management of patients treated with the non-vitamin K antagonist oral anticoagulants is an ongoing challenge. Due to the lack of good clinical studies involving adequate monitoring and reversal therapies, management requires knowledge and understanding of pharmacokinetics, renal function, drug interactions, and evaluation of the surgical bleeding risk. Consideration of the benefit of reversal of anticoagulation is important and, for some low risk bleeding procedures, it may be in the patient's interest to continue anticoagulation. In case of major intra-operative bleeding in patients likely to have therapeutic or supra-therapeutic levels of anticoagulation, specific reversal agents/antidotes would be of value but are currently lacking. As a consequence, a multimodal approach should be taken which includes the administration of 25 to 50 U/kg 4-factor prothrombin complex concentrates or 30 to 50 U/kg activated prothrombin complex concentrate (FEIBA®) in some life-threatening situations. Finally, further studies are needed to clarify the ideal therapeutic intervention. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Paciente despierto/Awake patient

Endarterectomía con pacientes despiertos. Seguridad, tolerabilidad y resultados Carotid endarterectomy in awake patients: safety, tolerability and results. Mendonça CT, Fortunato JA Jr, Carvalho CA, Weingartner J, Filho OR, Rezende FF, Bertinato LP. Rev Bras Cir Cardiovasc. 2014 Oct-Dec;29(4):574-80. doi: 10.5935/1678-9741.20140053. Abstract OBJECTIVE: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. METHODS: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). RESULTS: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). CONCLUSION: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. PDF Efectos hemodinámicos de dexmedetomidina durante electrocorticografía intraoperatoria para cirugía de epilepsia Hemodynamic effects of dexmedetomidine during intra-operative electrocorticography for epilepsy surgery. Chaitanya G, Arivazhagan A, Sinha S, Madhusudan Reddy KR, Thennarasu K, Bharath RD, Rao MB2, Chandramouli BA, Satishchandra P. J Neurosci Rural Pract. 2014 Nov;5(Suppl 1):S17-21. doi: 10.4103/0976-3147.145195. Abstract BACKGROUND: Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery. MATERIALS AND METHODS: This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N2O and isoflurane were decreased to zero. Anesthesia was maintained with O2 : air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO2) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine. RESULTS: Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits. CONCLUSION: The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range. KEYWORDS: Dexmedetomidine; heart rate; hemodynamic changes; mean arterial pressure PDF

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