Comparison of the perfusion index as an index of noxious stimulation in monitored anesthesia care of propofol/remifentanil and propofol/dexmedetomidine: a prospective, randomized, case-control, observational study

Pain Management in Burn Patients: Pharmacologic Management of Acute and Chronic Pain

Burn-related pain can contribute to decreased quality of life and long-term morbidity, limiting functional recovery. Burn-related pain should be assessed first by chronicity (acute or chronic), followed by type (nociceptive, neuropathic, nociplastic), to guide multimodal pharmacologic management in a stepwise algorithm approach. Combination therapies increase the efficacy and reduce toxicity by offering a multimodal approach that targets different receptors in the peripheral nervous system and central nervous system. When multimodal pharmacologic management is ineffective, etiologies of burn-related pain amenable to surgical interventions must be considered. It is important to know when to refer a patient to pain management.

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

Background One-lung ventilation (OLV) is a common ventilation technique used during thoracic surgery. It can cause serious complications in children, and hypoxic pulmonary vasoconstriction (HPV) is a protective mechanism against the resulting hypoxia. Dexmedetomidine does not affect HPV, so we will investigate its impact on the partial pressure of oxygen in arterial blood (PaO2) and pulmonary shunt fraction (Qs/Qt). Methods Children who underwent OLV were divided into two equal groups. The Dex group received 0.4 μg/kg/h of dexmedetomidine intravenously. The placebo group received normal saline. Two blood samples were taken to analyze arterial and central venous blood gasses during four time periods: T1, 10 minutes after anesthesia; T2, 10 minutes after OLV; T3, 60 minutes after OLV; and T4, 20 minutes after the end of OLV. Heart rate, mean arterial pressure (MAP), PaO2, Qs/Qt, and peak inspiratory pressure (PIP) values were recorded at these time points. Results Regarding heart rate, the Dex group remained relatively stable, whereas the placebo group showed a slight increase in T3 and T4. Concerning MAP, the Dex group had a reduction at T1 compared with the placebo group and remained similar for other points. PaO2 decreased with OLV. However, the Dex group consistently maintained higher PaO2 values than the placebo, especially in T3 and T4. Concerning Qs/Qt, the Dex group maintained lower time values than the placebo group at OLV. Regarding PIP, the Dex group had significantly lower T2 and T3 than the placebo group. Conclusion Administration of dexmedetomidine in children with OLV improves PaO2 and reduces pulmonary shunt fraction (Qs/Qt), thereby improving oxygen transport. It reduces the maximum PIP values, thereby reducing pressure-related complications.