Evaluation of the Effectiveness of Sugammadex for Digoxin Intoxication: An Experimental Study.

Previous studies have shown that cyclodextrin group medicines bind to various drugs. The hypothesis of our study is to determine whether sugammadex could bind to digoxin and delay the cardiovascular toxicity of that drug. Twenty-eight sedated Wistar rats were infused with digoxin at 3 mg/h (0.25 mg/ml). Five minutes after the start of infusion, animals were treated with a bolus of either 16 mg/kg (Sgdx16), 100 mg/kg (Sgdx100), or 1000 mg/kg (Sgdx1000) sugammadex. The control group infusion did not contain sugammadex. Heart rate, electrocardiography, and respiratory rate were monitored. The primary endpoint was time to asystole. Digoxin infusion continued until the animals arrested. The time to asystole for the Sgdx1000 group was significantly longer compared to that for the control group (p < 0.05). The mean lethal dose of digoxin was 5.35 ± 2.06 mg/kg in the saline-treated rats. On the other hand, the mean lethal dose of digoxin was 8.54 ± 1.51 mg/kg in the sugammadex 1000 group (p < 0.05). The mean lethal dose of digoxin was significantly higher than control group (p < 0.05). We found that the 1000 mg/kg dose of sugammadex delayed digoxin cardiotoxicity in a rat model of digoxin toxicity. We conclude that further research must be conducted on the interaction between digoxin and sugammadex.

Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study / Avaliação dos efeitos de sugamadex e dexmedetomidina intra-arterial: estudo experimental

Abstract Background: Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. Methods: Rabbits were randomly divided into 4 groups. Group Control (n = 7); no intervention performed. Group Catheter (n = 7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n = 7); rabbits were given 4 mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n = 7); rabbits were given 1 µg/kg dexmedetomidine into the central artery of the ear. After 72 h, the ears were amputated and histologically investigated. Results: There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p < 0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. Conclusion: Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.

Resumo Justificativa: A injeção intra-arterial de medicamentos pode causar isquemia aguda e grave e resultar em morbidade e mortalidade. Não há informações na literatura que avaliem os efeitos endoteliais arteriais de sugamadex e dexmedetomidina. A hipótese de nosso estudo foi que dexmedetomidina e sugamadex causariam alterações histológicas na estrutura endotelial arterial quando administrados por via intra-arterial. Método: Os coelhos foram randomicamente divididos em quatro grupos: grupo controle (n = 7), sem intervenção; grupo cateter (n = 7), uma cânula foi inserida na artéria central da orelha e medicamentos não foram administrados; grupo sugamadex (n = 7), receberam 4 mg/kg de sugamadex na artéria central da orelha; grupo dexmedetomidina (n = 7), receberam 1 µg/kg de dexmedetomidina na artéria central da orelha. Após 72 horas, as orelhas foram amputadas e histologicamente examinadas. Resultados: Não houve diferença significativa entre os grupos controle e cateter referente aos escores histológicos. Os escores do dano causado ao endotélio e à membrana e fibra elásticas, da hipertrofia do músculo liso e do aumento do tecido conjuntivo foram significativamente maiores nos grupos dexmedetomidina e sugamadex do que nos grupos controle e cateter (p < 0,05). Não houve diferença significativa entre os grupos dexmedetomidina e sugamadex nos escores histológicos. Conclusão: A administração de sugamadex e dexmedetomidina a coelhos por via intra-arterial causou danos arteriais histológicos. Para entender as alterações histológicas causadas por sugamadex e dexmedetomidina com mais clareza, estudos experimentais adicionais são necessários.

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy / Ventilação mecânica não invasiva e anestesia peridural em colecistectomia aberta de emergência

Abstract Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

Resumo Ventilação não invasiva é uma modalidade de tratamento aceita tanto em exacerbações agudas de doenças respiratórias quanto em doença pulmonar obstrutiva crônica. É comumente usada em unidades de terapia intensiva ou para suporte respiratório pós-cirúrgico em salas de recuperação pós-anestesia. Este relato descreve o suporte intraoperatório em ventilação não invasiva para bloqueio do neuroeixo em cirurgia abdominal alta de emergência.

Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study.

BACKGROUND: Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. METHODS: Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1µg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated. RESULTS: There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. CONCLUSION: Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy.

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

[Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study]. / Avaliação dos efeitos de sugamadex e dexmedetomidina intra-arterial: estudo experimental.

BACKGROUND: Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. METHODS: Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1µg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated. RESULTS: There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. CONCLUSION: Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.

Effects of peroperative intravenous paracetamol and lornoxicam for lumbar disc surgery on postoperative pain and opioid consumption: A randomized, prospective, placebo-controlled study.

OBJECTIVES: The aim of the present randomized, placebo-controlled study was to compare postoperative analgesic effects of peroperative paracetamol and lornoxicam administration. METHODS: Sixty adult patients with American Society of Anesthesiologists (ASA) risk classification I-II, who would undergo single-level lumbar discectomy under general anesthesia, were enrolled. Patients were administered either 1000 mg paracetamol (Group P), 8 mg lornoxicam (Group L), or saline (Group C) prior to induction of anesthesia (n=20 for all groups). All patients were administered the same anesthesia induction and maintainance. Postoperative analgesia was maintained with the same analgesic drug in each group. Rescue analgesia was supplied with intravenous meperidine delivered by a patient-controlled analgesia device. Numeric rating score (NRS) results, first analgesic demand time, and cumulative meperidine consumption were recorded postoperatively. Primary outcome was NRS at first postoperative hour. Secondary outcome was measure of opioid consumption during first 24 postoperative hours. RESULTS: At first postoperative hour, NRS of Group L [4 (0-8)] was lower than NRSs of Groups P and C [6(0-7); 6(0-9), respectively; p<0.016]. Time to first analgesic demand of Group L was longer, compared with those of the other groups (p<0.016). Cumulative postoperative meperidine consumption in Group L was less than those of Groups P and C at 2-, 12-, and 24-hour time intervals (p<0.016), while Groups P and C had similar findings for the same time intervals. CONCLUSION: Preoperative lornoxicam administration decreased early postoperative pain scores more effectively than paracetamol.

Intravenous lipid emulsion prolongs survival in rats intoxicated with digoxin.

BACKGROUND: Intravenous lipid emulsion eliminates the toxicity-related symptoms of several drugs. We hypothesized that intravenous lipid emulsion prolongs the survival time in digoxin-intoxicated rats. METHODS: Electrocardiograms of 14 anesthesized Wistar rats were monitored. All of the rats received digoxin infusion at a rate of 12 mL/h (0.25 mg/mL). Five minutes after the start of digoxin infusion, animals were treated either with 12.4 mL/kg intravenous lipid emulsion (group L) or saline (group C). The primary outcome variable was time elapsed until asystole development. Cumulative dose of digoxin required to induce asystole was also recorded. RESULTS: Mean time until asystole development in groups C and L were 21.28 ± 8.61 and 32.00 ± 5.41 minutes, respectively (P< .05). The mean lethal doses of digoxin in the groups C and L were 3.97 ± 1.54 and 6.09 ± 0.96 mg/kg, respectively (P< .05). CONCLUSION: Intravenous lipid emulsion prolonged the time until asystole development and increased cumulative lethal dose in rats intoxicated with digoxin.

[Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy]. / Ventilação mecânica não invasiva e anestesia peridural em colecistectomia aberta de emergência.

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction.

INTRODUCTION: The aim of this study was to measure the haemodynamic responses to a etomidate-propofol combination used for anaesthesia induction and to compare the haemodynamic responses with the separate use of each drug. METHODS: The patients were randomly divided into three groups as group P (n = 30, propofol 2.5 mg kg(-1)), group E (n = 30, etomidate 0.3 mg kg(-1)) and group PE (n = 30, propofol 1.25 mg kg(-1) + etomidate 0.15 mg kg(-1)). For each patient, the times of measurement of the heart rate (HR) and mean arterial pressure values were defined as baseline, after the induction, before the intubation, immediately after the intubation and 1, 2, 3, 4, 5 and 10 minutes after the intubation. RESULTS: In all 3 groups, a significant decrease in MAP values were seen at T2 and T3 compared to the baseline values, and this decrease was greater in group P compared to that in group E and PE (P < 0.001, P < 0.01). A significant increase was seen in all 3 groups in the mean arterial pressure (MAP) value at T4 after the intubation. When the groups were compared with each other, this increase was greater in group E than in the other two groups (with group P, P < 0.001; with group PE, P < 0.01). CONCLUSION: Etomidate-propofol combination may be a valuable alternative when extremes of hypotensive and hypertensive responses due to propofol and etomidate are best to be avoided.

[Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate]. / Impacto do anestesiologista em treinamento sobre as pressões do manguito de máscara laríngea e incidência de eventos adversos.

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2±14.0, 104.3±20.5cm H2O and 105.2±18.4cm H2O respectively (p>0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2±3.9; 3.3±1.1 and 6.6±3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate / Impacto do anestesiologista em treinamento sobre as pressões do manguito de máscara laríngea e incidência de eventos adversos

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 ± 14.0, 104.3 ± 20.5 cm H2O and 105.2 ± 18.4 cm H2O respectively (p > 0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 ± 3.9; 3.3 ± 1.1 and 6.6 ± 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

OBJETIVO: Planejamos avaliar as pressões do manguito de máscara laríngea (PMML) inflado por profissionais da área de anestesiologia com tempos de serviço variados, sem o uso de manômetro. MÉTODOS: 180 pacientes agendados para cirurgia de curta duração com máscara laríngea foram incluídos no estudo. Cinco especialistas em anestesia (Grupo E), 10 residentes (Grupo R) e seis técnicos (Grupo T) inflaram os manguitos das máscaras laríngeas; subsequentemente, as PMML foram medidas com manômetro de pressão. Os participantes repetiram essa prática em pelo menos cinco casos diferentes. As PMML superiores a 60 cm H2O na colocação inicial ou no intraoperatório foram ajustadas para valores normais. Os pacientes foram questionados sobre a presença de dor de garganta no período pós-operatório. Os grupos foram comparados quanto à média das PMML e experiência profissional. RESULTADOS: Ao inserirem a ML, as pressões do manguito dentro da faixa normal foram determinadas em 26 (14,4%) casos. As médias das PMML após a inserção da ML pelos grupos E, R e T foram 101,2 ± 14,0, 104,3 ± 20,5 cm e 105,2 ± 18,4 cm H2O, respectivamente, (p > 0,05). A média dos valores das PMML em todos os períodos de mensuração entre os grupos estava acima do limite normal (60 cm H2O). Quando os grupos foram comparados quanto às PMML, nenhuma diferença foi encontrada entre os valores das pressões. A experiência profissional era de 14,2 ± 3,9; 3,3 ± 1,1 e 6,6 ± 3,8 anos para especialistas, residentes e técnicos, respectivamente, e os valores das pressões mensuradas não foram diferentes em relação à experiência profissional. Sete pacientes (3,9%) apresentaram dor de garganta durante a entrevista realizada na 24a hora. CONCLUSÃO: Levando-se em consideração uma possibilidade menor de ajuste da pressão do manguito da máscara laríngea (PMML) e da ineficácia da experiência profissional para a obtenção de valores normais das pressões, é adequado que todos os profissionais de anestesia ajustem as PMML com manômetro.

Intraocular pressure changes associated with tracheal extubation: Comparison of sugammadex with conventional reversal of neuromuscular blockade.

OBJECTIVE: To compare the effects of neostigmine/atropine combination and sugammadex on intraocular pressure during tracheal extubation period. METHODS: The single-blind prospective randomised controlled study was conducted at Ordu University Research and Training Hospital from August to October 2014, and comprised patients who were randomly assigned to 2 groups according to the agent used for reversal of neuromuscular blockade. Group N received 0.05mgkg-1 neostigmine and 0.02 mgkg-1 atropine and the patients in Group S received 2mgkg-1 sugammadex intravenously. Heart rate, mean arterial pressure and intraocular pressure were measured at baseline, before the induction (T1), after the application of reversal agent (T2), and 1 (T3), 3 (T4), 5 (T5) and 10 (T6) minutes after the extubation. SPSS 16 was used for statistical analysis. RESULTS: There were 36 patients in the study; 18(50%) in each group. There was no significant difference between the groups in terms of age, gender and body mass index (p>0.05 each). Intraocular pressure was significantly higher when the baseline level was compared with all measurement intervals in Group N (p<0.05 each). In Group S, it showed no significant difference at T2 (p>0.05) whereas it was significantly higher at all other measurement intervals (p<0.05 each). Intergroup comparisons showed statistically significant difference in heart rate and mean arterial pressure levels at T2 interval which were higher in Group N (p<0.01). Intraocular pressure levels at T2 and T3 intervals were significantly higher in Group N (p<0.01). CONCLUSIONS: Lower end-extubation intraocular pressure levels were obtained when sugammadex was used as a neuromuscular block reversal agent in comparison with neostigmine-atropine combination. Sugammadex may be a better option for the reversal of neuromuscular blockade and intraocular pressure increase should be avoided in patients with glaucoma or penetrating eye injury.

Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate.

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 ± 14.0, 104.3 ± 20.5 cm H2O and 105.2 ± 18.4 cm H2O respectively (p > 0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 ± 3.9; 3.3 ± 1.1 and 6.6 ± 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery.

BACKGROUND: The aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. METHODS: Sixty years or older, ASA I-II or III, 50 patients were included in the study. 12.5mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at T10 dermatome, additional 1mL of 0.25% levobupivacaine were administered through the catheter in every 10min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. RESULTS: CSA technique provided better hemodynamic stability compared to SDSA technique particularly 90min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. CONCLUSION: CSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation.

Comparação de levobupivacaína em raquianestesia contínua ou com dose única para cirurgia de ressecção transuretral de próstata / The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery / Comparación de la levobupivacaína en raquianestesia continua ocon dosis única para cirugía de resección transuretral de próstata

Justificativa e objetivo: comparar a eficácia de levobupivacaína na indução de raquianestesia contínua (RAC) versus dose única (Radu) em pacientes programados para ressecção transuretral de próstata (RTUP). Métodos: foram incluídos no estudo 50 pacientes, ≥ 60 anos, ASA I-II ou III. Levobupivacaína a 0,5% (12,5 mg) foi administrada por via intratecal no grupo Radu. No grupo RAC, levobupivacaína a 0,25% (2 mL) foi inicialmente administrada através de cateter espinhal. Para o nível de bloqueio sensorial atingir o dermátomo T10, 1 mL adicional de levobupivacaína a 0,25% foi administrado através do cateter a cada 10 minutos. Os parâmetros hemodinâmicos e as características do bloqueio foram registrados. Amostras de sangue dos pacientes foram coletadas nos períodos pré- e pós-operatórios para determinar os níveis plasmáticos de cortisona e adrenalina. Resultados: a RAC proporcionou melhor estabilidade hemodinâmica em comparação com a Radu, particularmente aos 90 minutos após a administração intratecal. O aumento do nível de bloqueio sensorial foi rápido e o tempo para atingir a anestesia cirúrgica foi menor no grupo Radu. O desenvolvimento do bloqueio motor foi mais rápido no grupo Radu. No grupo RAC, um nível semelhante de anestesia foi obtido com o uso de uma dose mais baixa de levobupivacaína, que foi relacionada à recuperação mais rápida. Embora ambas as técnicas tenham sido eficazes na prevenção da resposta ao estresse cirúrgico, os níveis de cortisona no pós-operatório foram mais suprimidos no grupo Radu. Conclusão: a técnica RAC com levobupivacaína a 0,25% pode ser usada como um método de anestesia regional em pacientes idosos programados para RTUP. .

Background: The aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. Methods: Sixty years or older, ASA I-II or III, 50 patients were included in the study. 12.5 mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2 mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at T10 dermatome, additional 1 mL of 0.25% levobupivacaine were administered through the catheter in every 10 min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. Results: CSA technique provided better hemodynamic stability compared to SDSA technique particularly 90 min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. Conclusion: CSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation. .

Justificación y objetivo: el objetivo de este estudio fue comparar la eficacia de la levobupivacaína en la inducción de la raquianestesia continua (RAC) versus dosis única (RADU) en pacientes programados para la resección transuretral de próstata. Métodos: cincuenta pacientes, ≥ 60 años de edad, ASA I-II o III, fueron incluidos en el estudio. La levobupivacaína al 0,5% (12,5 mg) se administró vía intratecal en el grupo RADU. En el grupo RAC, la levobupivacaína al 0,25% (2 mL) fue inicialmente administrada a través de un catéter espinal. Para que el nivel de bloqueo sensorial alcanzase el dermatoma T10, se administró 1 mL adicional de levobupivacaína al 0,25% a través del catéter cada 10 min. Los parámetros hemodinámicos y las características del bloqueo fueron registrados. Las muestras de sangre de los pacientes fueron extraídas en los períodos pre y postoperatorios para determinar los niveles plasmáticos de cortisona y adrenalina. Resultados: la técnica RAC proporcionó una mejor estabilidad hemodinámica en comparación con la técnica RADU, particularmente a los 90 min después de la administración intratecal. El aumento del nivel de bloqueo sensorial fue rápido y el tiempo para alcanzar la anestesia quirúrgica fue menor en el grupo RADU. El desarrollo del bloqueo motor fue más rápido en el grupo RADU. En el grupo RAC, un nivel parecido de anestesia se obtuvo con una dosis más baja de levobupivacaína que fue relacionada con la recuperación más rápida. Aunque ambas técnicas hayan sido eficaces en la prevención de la respuesta al estrés quirúrgico, los niveles de cortisona en el postoperatorio fueron mejor suprimidos en el grupo RADU. .

Evaluation of the effectiveness of sugammadex for verapamil intoxication.

Previous studies have shown that medications from the cyclodextrin family bind to verapamil. The aim of our study was to determine whether sugammadex could bind to verapamil and prevent the cardiovascular toxicity of that drug. Twenty-eight sedated Wistar rats were infused with verapamil at 37.5 mg/kg/h. Five minutes after the start of infusion, the animals were treated with a bolus of either 16 mg/kg, 100 mg/kg or 1000 mg/kg sugammadex. The control group was treated with an infusion without sugammadex. The heart rate and respiratory rate were monitored, and an electrocardiogram was recorded. The primary end-point was the time to asystole. The verapamil infusion continued until the animals arrested. The asystole time for the S16 group was significantly longer compared to those for the control and S1000 groups (p < 0.05). The asystole time for the S1000 group was significantly shorter than those for all of the other groups (p < 0.05). Reflecting these data, there was a near doubling of the mean lethal dose of verapamil from 13.57 mg/kg (S.D. ±8.1) in the saline-treated rats to 22.42 mg/kg (S.D. ±9.9) in the sugammadex 16 group (p < 0.05). However, for the sugammadex 1000 group, the mean lethal dose was found to be 6.28 ± 1.11 mg/kg. This dose is significantly lower than those for all of the other groups (p < 0.05). We found that treatment with 16 mg/kg sugammadex delayed verapamil cardiotoxicity in rats. However, 1000 mg/kg sugammadex accelerated verapamil cardiotoxicity in rats. Further studies must be conducted to investigate the interaction between verapamil and sugammadex.