Anesthesiology and pain medicine
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Opium is an addictive agent and one of the most common narcotics With great challenges of intraoperative hemodynamic instabilities. ⋯ Premedication with clonidine to decrease intraoperative blood loss can be more effective in patients with opium addiction than the ones without addiction.
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Intrathecal adjutants can be used for regional anesthesia (RA) in cesarean section to improve its quality in terms of time and complications. Some previous studies focused on the effects of adding sufentanil and/or midazolam to bupivacaine and compared each with using bupivacaine alone. However, there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine. ⋯ The findings showed that adding sufentanil or midazolam to bupivacaine shortens the onset of spinal anesthesia and increases the time duration of anesthesia; however it does not change the motor block recovery time. Adding sufentanil delays the first request for narcotic analgesics while adding midazolam leads to a decrease in nausea and hypotension. Adding sufentanil or midazolam does not have any deleterious effect on infants' Apgar scores. However, increases shivering in patients.
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Many papers have reported that TAP block provides effective postoperative analgesia, but the sole use of TAP block for surgical anesthesia has been rarely reported. ⋯ Open gastrostomy was successfully performed under subcostal TAP block with small dose fentanyl supplementation. The subcostal TAP block is considered a useful anesthetic choice in surgery for high risk patients.
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Premedication is required for reducing anxiety and child's struggling against mask acceptance on anesthesia in pediatric surgery for congenital heart disease. Midazolam has been widely used for this purpose, but because of its side effects, finding an effective replacement with less complication is necessary. ⋯ It appears reasonable to apply oral premedication with dexmedetomidine 45 minutes before transferring the patient to the operating room when he or she is more prone to resist inhalation anesthesia induction.