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Background/aim: To examine the effects of active and passive smoking on perioperative anesthetic and analgesic consumption. Materials and methods: Patients were divided into three groups: group S, smokers; group PS, passive smokers; and group NS, individuals who did not have a history of smoking and were not exposed to smoke. All patients underwent the standard total intravenous anesthesia method. The primary endpoint of this study was determination of the total amount of propofol and remifentanil consumed. Results: The amount of propofol used in induction of anesthesia was significantly higher in group S compared to groups PS and NS. Moreover, the total consumption of propofol was significantly higher in group S compared to groups PS and NS. The total propofol consumption of group PS was significantly higher than that of group NS (P = 0.00). Analysis of total remifentanil consumption showed that remifentanil use was significantly higher in group S compared to group NS (P = 0.00). Conclusion: The amount of the anesthetic required to ensure equal anesthetic depth in similar surgeries was higher in active smokers and passive smokers compared to nonsmokers.
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Anestesia Local , Fumar/efectos adversos , Adulto , Anestesia Local/métodos , Anestésicos Combinados/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Persona de Mediana Edad , Propofol/administración & dosificación , Remifentanilo/administración & dosificación , Contaminación por Humo de Tabaco/efectos adversosRESUMEN
Avian haemosporidians are common vector-borne blood parasites that have been reported in birds all over the world. Investigations of avian haemosporidian parasites are conducted mainly on passerine birds. However, studies that focus on non-passerine avian hosts are important for our understanding of the true diversity, host specificity and genetic variability among these widespread parasites. In the present study, blood samples from a total of 22 raptor birds belonging to two orders, two families and six species from the Central Anatolia Region of Turkey were investigated for three genera of avian haemosporidians (Plasmodium Marchiafava et Celli, 1885, Haemoproteus Kruse, 1890 and Leucocytozoon Sambon, 1908) using a combination of microscopic examination of blood films and nested PCR targeting the parasite mitochondrial cytochrome b gene (cyt-b). In total, six individual raptor birds identified positive for species of Plasmodium or Leucocytozoon and one individual was found co-infected with all three haemosporidian genera. We identified five parasite cyt-b haplotypes, three of which were reported for the first time. Among these, one Plasmodium haplotype is linked to a corresponding morphospecies (P-TURDUS1, Plasmodium circumflexum Kikuth, 1931). All haplotypes were clearly distinguishable in phylogenetic analyses. As one of the first studies to investigate blood parasites from non-passerine birds in the Central Anatolia Region of Turkey, this study provides important new information on the phylogenetic relationships and genetic diversity of avian haemosporidian parasites from raptor birds. We discuss these findings in the context of avian haemosporidian host-parasite relationships and we draw attention to the need for microscopy to detect parasite sexual development stages in surveys of avian haemosporidians.
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Haemosporida/clasificación , Filogenia , Rapaces/parasitología , Animales , ADN Protozoario/genética , Variación Genética , Haemosporida/citología , Haemosporida/genética , Reacción en Cadena de la Polimerasa , TurquíaRESUMEN
BACKGROUND: The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaras, Türkiye, and to investigate parameters affecting mortality. METHODS: The demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. RESULTS: Twenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. CONCLUSION: Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.
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BACKGROUND: The aim of this study was to evaluate the place of angiotensin II and its receptors in the prognosis of septic patients. METHODS: Patients with sepsis and septic shock were included in the study group. The control group consisted of patients who were followed up in the ICU and had no sepsis/septic shock. Plasma angiotensin II, angiotensin receptor-1 and 2 (AT-1, AT-2) levels were evaluated first and third days. RESULTS: Angiotensin II levels were significantly lower in the septic shock and non-survivor. AT-1 levels were lower in all septic patients on the first day compared to the control. While AT-1 levels on the third day decreased in the septic shock group, it increased in the sepsis group. AT-2 levels were significantly higher in sepsis, and lower in septic shock compared to controls on the first day. Angiotensin II (95%, 82%) and AT-2 levels (100%, 87%) were observed to have high sensitivity and specificity in demonstrating the presence of shock in septic patients. Angiotensin II and AT-1/AT-2 ratios were observed to have high sensitivity and low specificity in the development of mortality. CONCLUSIONS: In septic patients, angiotensin II, AT-2 and AT-1/AT-2 levels can predict the probability of shock development and mortality.
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Sepsis , Choque Séptico , Humanos , Angiotensina II , Pronóstico , Receptores de AngiotensinaRESUMEN
UNLABELLED: The aim of this study is to investigate effect of enflurane that is a pro-convulsive anesthetic agent and propofol on seizure durations and recovery times during electroconvulsive therapy. METHODS: The subjects were divided into two groups according to the induction anesthetics. Anesthesia was induced with enflurane 5% in group E or propofol 1.2 mg x kg(-1) in group P. After the loss of consciousness, 0.5 mg x kg(-1) of succinylcholine was given. The patients maintained normocapnia. RESULTS: There were no significant differences between groups regarding seizure times. Recovery times were shorter in group E, but postictal agitation was significantly lower in propofol group. DISCUSSION: High incidence of spike activity on EEG and grand mal seizure patterns could be induced by enflurane. But motor and EEG seizure times were not prolonged by enflurane in the presence normocapnia. In conclusion, propofol is more suitable anesthetic agent for ECT, but enflurane might be preferred in patients because of rapid recovery.
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Terapia Electroconvulsiva , Enflurano/farmacología , Propofol/farmacología , Convulsiones/inducido químicamente , Adulto , Dióxido de Carbono/sangre , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
UNLABELLED: Ischemia/reperfusion (I/R) occurs in a number of pathological conditions, including myocardial infarction, stroke, aortic surgery, cardiopulmonary bypass surgery, organ transplantation, resuscitation, and critical care. Massive and abrupt release of oxygen-free radicals after reperfusion triggers oxidative damage. Before critical operations or after resuscitation, it would be wise to find a suitable prophylactic treatment to avoid I/R damage. We aimed to determine whether several commonly used intravenous anesthetics protect against renal I/R injury. METHODS: Animals were randomly divided into seven groups, each consisting of six animals: sham group, control group, thiopental group, propofol group, intralipid group, etomidate group, and ketamine group. At the end of the 60-min ischemic period, 60 min reperfusion was established and the materials administered 15 min before the reperfusion. At the end of the reperfusion period, the samples of blood and tissue were reaped for biochemical and serological evaluation. RESULTS: I/R procedure significantly increased malondialdehyde (MDA) levels, decreased catalase (CAT) activities, and superoxide dismutase (SOD) levels. The lowest MDA mean level was in the thiopental group and the highest MDA mean level was in control group. The lowest CAT mean level was in the intralipid group and the highest CAT mean level was in the etomidate group. The lowest SOD mean level was in the control group and the highest SOD mean level was in the propofol group. CONCLUSION: Thiopental and propofol, especially thiopental, are more effective to protect renal I/R injury.
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Anestésicos Intravenosos/farmacología , Antioxidantes/farmacología , Riñón/irrigación sanguínea , Riñón/metabolismo , Daño por Reperfusión/metabolismo , Tiopental/farmacología , Anestésicos Disociativos/farmacología , Animales , Antioxidantes/metabolismo , Catalasa/metabolismo , Etomidato/farmacología , Emulsiones Grasas Intravenosas/farmacología , Ketamina/farmacología , Peroxidación de Lípido/efectos de los fármacos , Malondialdehído/metabolismo , Propofol/farmacología , Ratas , Ratas Wistar , Daño por Reperfusión/prevención & control , Superóxido Dismutasa/metabolismoRESUMEN
BACKGROUND: Effective noninvasive mechanical ventilation (NIV) requires a patient to be comfortable and in synch with the ventilator, for which sedation is usually needed. Choice of the proper drug for sedation can lead to improved clinical outcomes. OBJECTIVE: The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam on sedation and their effects on hemodynamics and gas exchange. METHODS: In this randomized, double-blind study, intensive care unit patients with acute respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease undergoing NIV were equally randomized to receive a loading dose of 1 µg/kg IV dexmedetomidine or 0.05 µg/kg midazolam over 10 minutes followed by a maintenance infusion of 0.5 µg/kg/h dexmedetomidine (group D) or 0.1 mg/kg/h midazolam (group M). The following parameters were measured by a blinded clinician at baseline and 1, 2, 4, 6, 8, 12, and 24 hours after the loading dose was administered: Ramsay Sedation Score (RSS), Riker Sedation-Agitation Scale (RSAS), Bispectral Index (BIS), arterial blood gases, and vital signs. A second blinded investigator determined dosing changes according to the outcome of maintaining a target sedation level of RSS 2 to 3, RSAS 3 to 4, and BIS >85. RESULTS: A total of 45 patients were assessed for enrollment in the study; 4 did not meet the inclusion criteria and 1 refused to participate (men/women 19/21; mean age 58/60; all patients were receiving bronchodilators, steroids, antibiotics, and mucolytics). In both groups (n = 20), RSS significantly increased and RSAS levels and BIS values significantly decreased after the loading dose, compared with baseline (P < 0.05). RSS levels were significantly lower beginning at 4 hours in group D compared with group M (P < 0.05). RSAS levels were not significantly different between the 2 groups in the first 8 hours. However, RSAS levels were significantly higher at 8 hours after the loading dose was administered in group D compared with group M (P < 0.01). BIS was significantly higher in group D throughout the study period (P < 0.05). Respiratory rates and gas exchange values were not significantly different between the Accepted for publication April 7, 2010. 2 groups. The number of times a change in infusion dose was needed was significantly lower in group D (2 patients with 1 change each) than in group M (3 patients with 1 change, 1 patient with 2 changes, and 3 patients with 3 changes each) (P < 0.01). CONCLUSIONS: Dexmedetomidine and midazolam are both effective sedatives for patients with NIV. Dexmedetomidine required fewer adjustments in dosing compared with midazolam to maintain adequate sedation.
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High-throughput, cost-effective, and portable devices can enhance the performance of point-of-care tests. Such devices are able to acquire images from samples at a high rate in combination with microfluidic chips in point-of-care applications. However, interpreting and analyzing the large amount of acquired data is not only a labor-intensive and time-consuming process, but also prone to the bias of the user and low accuracy. Integrating machine learning (ML) with the image acquisition capability of smartphones as well as increasing computing power could address the need for high-throughput, accurate, and automatized detection, data processing, and quantification of results. Here, ML-supported diagnostic technologies are presented. These technologies include quantification of colorimetric tests, classification of biological samples (cells and sperms), soft sensors, assay type detection, and recognition of the fluid properties. Challenges regarding the implementation of ML methods, including the required number of data points, image acquisition prerequisites, and execution of data-limited experiments are also discussed.
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BACKGROUND: Pneumoperitoneum (P) created to facilitate laparoscopy (L) is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. AIM: This study investigated the effects of pre- and post-laparoscopic conditioning, zinc, pentoxifylline (PTX), and N-acetylcysteine (NAC) on markers of I/R injury in an animal model. METHODS: Sprague-Dawley male rats (n = 56, weight range 300-350 g) were randomly placed in one of seven treatment groups. Except for group C (control group who underwent a sham operation without pneumoperitoneum), pneumoperitoneum was created in all using CO(2) insufflation under a pressure of 15 mmHg. Group L (laparoscopy) was subjected to 60 min of pneumoperitoneum. Group Lpre (laparoscopic preconditioning plus laparoscopy) was subjected to 5 min of insufflation and 5 min of desufflation followed by 60 min of pneumoperitoneum. Group Lpost (laparoscopy plus laparoscopic post-conditioning) was subjected to 60 min of pneumoperitoneum and 60 min of desufflation followed by 5 min of insufflation and 5 min of desufflation. The laparoscopy plus zinc (LZ), PTX (LP), and NAC (LNAC) groups received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg) 5 min before the desufflation period. Animals were sacrificed at the end of the experiments, and kidney samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD). RESULTS: MDA levels, as an indicator of oxidative stress in kidney tissue samples, were significantly higher in all pneumoperitoneum groups compared to Group C, except for Group Lpre. The pattern of change in tissue levels of SOD, GPX, and catalase was variable in the different treatment groups. CONCLUSIONS: In this animal model of renal ischemia/reperfusion injury, laparoscopy caused renal ischemia as evidenced by elevated markers of tissue ischemia-reperfusion injury. This effect was significantly attenuated by post-laparoscopy conditioning, zinc, pentoxifylline, and N-acetylcysteine, but not by pre-laparoscopy conditioning.
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Acetilcisteína/uso terapéutico , Riñón/irrigación sanguínea , Laparoscopía , Pentoxifilina/uso terapéutico , Neumoperitoneo Artificial/efectos adversos , Cuidados Posoperatorios , Cuidados Preoperatorios , Daño por Reperfusión/etiología , Daño por Reperfusión/prevención & control , Zinc/uso terapéutico , Animales , Modelos Animales de Enfermedad , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
INTRODUCTION: Clinical doses of anaesthetic agents were administered to rabbits and effects on the brain, heart, and liver were investigated biochemically and histopathologically. MATERIAL AND METHODS: The rabbits were randomly divided into three main groups (16 rabbits each) and each group into study (n = 8) and control (n = 8) groups. All study group rabbits received 3 mg/kg of midazolam (M) intramuscularly. Group 1.1 (M) received nothing further, group 2.1 (MK) also received 25 mg/kg of ketamine, and group 3.1 (MKI) besides ketamine was also given 2% isoflurane to induce anaesthesia for 30 min. NaCl solution in the same volume as midazolam and ketamine was injected into the controls. RESULTS: In clinical evaluation significant differences were detected in respiratory and heart rates. In blood gas analysis the PO2 and PCO2 values showed statistical differences in anaesthesia intervals. Significant biochemical value changes were recorded in creatine kinase-Mb, glucose, and total protein. Histopathological liver examinations revealed higher total apoptotic and normal cell numbers in the MK than in the M and MKI groups. Apoptotic cell numbers were statistically significant in M and MK groups. CONCLUSION: Anaesthetic agents may increase programmed apoptosis. The MKI anaesthetics combination was found to cause less cell destruction in general than the other study groups. It was indicated that MKI was the safer anaesthetic combination in rabbits.
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The Monte Carlo (MC) method is widely recognized as the gold standard for modeling light propagation inside turbid media. Due to the stochastic nature of this method, MC simulations suffer from inherent stochastic noise. Launching large numbers of photons can reduce noise but results in significantly greater computation times, even with graphics processing units (GPU)-based acceleration. We develop a GPU-accelerated adaptive nonlocal means (ANLM) filter to denoise MC simulation outputs. This filter can effectively suppress the spatially varying stochastic noise present in low-photon MC simulations and improve the image signal-to-noise ratio (SNR) by over 5 dB. This is equivalent to the SNR improvement of running nearly 3.5 × more photons. We validate this denoising approach using both homogeneous and heterogeneous domains at various photon counts. The ability to preserve rapid optical fluence changes is also demonstrated using domains with inclusions. We demonstrate that this GPU-ANLM filter can shorten simulation runtimes in most photon counts and domain settings even combined with our highly accelerated GPU MC simulations. We also compare this GPU-ANLM filter with the CPU version and report a threefold to fourfold speedup. The developed GPU-ANLM filter not only can enhance three-dimensional MC photon simulation results but also be a valuable tool for noise reduction in other volumetric images such as MRI and CT scans.
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Gráficos por Computador , Diagnóstico por Imagen , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional , Algoritmos , Simulación por Computador , Humanos , Luz , Imagen por Resonancia Magnética , Modelos Teóricos , Método de Montecarlo , Distribución Normal , Fantasmas de Imagen , Fotones , Dispersión de Radiación , Relación Señal-Ruido , Programas Informáticos , Procesos Estocásticos , Tomografía Computarizada por Rayos XAsunto(s)
Complicaciones del Embarazo/cirugía , Cálculos Ureterales/cirugía , Ureteroscopía , Femenino , Humanos , EmbarazoAsunto(s)
Anestésicos Intravenosos , Piperidinas , Anestesia General , Anestesia Intravenosa , Niño , Humanos , Bombas de Infusión , RemifentaniloRESUMEN
Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively.
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Anestesia Caudal/métodos , Anemia de Fanconi/cirugía , Luxación Congénita de la Cadera/cirugía , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Preescolar , Anemia de Fanconi/fisiopatología , Femenino , Luxación Congénita de la Cadera/etiología , Humanos , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
Lumbar plexus block (LPB) is a suitable method for elder patients for lower extremity surgery. Many complications could be seen during LPB, but not as many as central block. In this case report, we aimed to report a total spinal block, an unusual complication. LPB with sciatic block was planned for a male patient, 76 years old, scheduled for total knee replacement due to gonarthrosis. The patient became unconscious after psoas compartment block with Chayen technique for LPB. The operation ended at 145th minute. The patient was admitted to intensive care unit until postoperative second day and discharged to home on fifth day of surgery. Main concern of patient monitorization should be an anesthesiologist. In this manner, we conclude that contacting to the patient should be ensured during these procedures.
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Artroplastia de Reemplazo de Rodilla , Plexo Lumbosacro , Bloqueo Nervioso , Anciano , Humanos , MasculinoRESUMEN
The aim of this study was to describe whether or not spinal anaesthesia with bupivacaine versus levobupivacaine has any effects on the QTc interval during caesarean section. Sixty healthy pregnant women scheduled for elective caesarean section were randomized to spinal anaesthesia with either bupivacaine (the bupivacaine group) or levobupivacaine (the levobupivacaine group). ECG recordings were performed prior to spinal anaesthesia at baseline (T1), 5 min. after spinal anaesthesia, but before uterine incision (T2), and after skin closure (T3). QT intervals were calculated and corrected with the patients' heart rate according to the Bazett formula. Compared with baseline values, mean maximum QTc intervals at T2 and T3 were significantly longer in the levobupivacaine group, but only at T2 in the bupivacaine group. In addition, compared with the bupivacaine group, the QTc maximum interval at T3 was significantly longer in the levobupivacaine group. At T2, the QTc maximum intervals were longer than baseline in both groups. By the end of the surgery, the prolongation of the QTc interval had disappeared in the bupivacaine group but not in the levobupivacaine group.
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Anestésicos Locales/efectos adversos , Bupivacaína/análogos & derivados , Cesárea/métodos , Síndrome de QT Prolongado/inducido químicamente , Adulto , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Bupivacaína/efectos adversos , Método Doble Ciego , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Levobupivacaína , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
Scar formation due to acne is a common problem among the young population and significantly affects their quality of life. The aim of this study was to evaluate the efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser resurfacing for acne scars and to objectively demonstrate the altering of collagen density in the dermis by 22-MHz digital ultrasonography. Twenty-one patients, aged 19-55 years, with facial acne scars were treated with Er:YAG laser. The results of the laser resurfacing were evaluated for the degree of clinical improvement, alteration of the collagen density by 22-MHz digital ultrasonography and any adverse effects at 3 months. At 3 months after the treatment, good (in 12 patients) and near total (in four patients) clinical improvement was noted in most of the patients compared to baseline. Overall treatment results were 76% (both near total and good) in 16 patients. By ultrasonographic evaluation, the average density of dermal collagen (total density/number of patients) of 21 patients was 32.714 (right cheek) and 32.142 (left cheek) before laser facial resurfacing. At the third month after treatment, the average density of dermal collagen of 21 patients was 36.380 (right cheek) and 38.809 (left cheek). In conclusion, Er:YAG laser skin resurfacing was found to be a safe and effective treatment modality for treatment of atrophic facial acne scars. As public demand grows for less invasive modalities to approach clinical diagnosis and evaluation, digital ultrasonography seems to provide an easy and confidential method for collagen density evaluation.
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Cicatriz/diagnóstico por imagen , Cicatriz/cirugía , Técnicas Cosméticas , Láseres de Estado Sólido/uso terapéutico , Acné Vulgar/complicaciones , Adulto , Cicatriz/etiología , Colágeno , Cara , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Turquía , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Electroconvulsive therapy (ECT) is commonly used for treatment of depression, mania and affective disorders. Anaesthetics for general anaesthesia during ECT should have rapid onset, rapid emerge, not interfere with seizure activity and not shorten seizure duration. The aim of this study is to compare effects of enflurane, a pro-convulsive anaesthetic agent, and propofol on seizure durations, postictal suppression index and recovery times during electroconvulsive therapy. METHODS: Unpremedicated subjects were divided into two groups according to induction of anaesthesia. Patients were induced for ECT with 5% enflurane in group E and 1.2mg.kg(-1) propofol in group P until loss of consciousness. The durations of electroencephalogram (EEG) and motor seizures, postictal suppression index, time to spontaneous breathing, duration of eye opening, and obeying commands were recorded. RESULTS: There was no statistically significant difference between the groups regarding motor and EEG seizure times and postictal suppression index on the EEG records. Recovery times (times of starting spontaneous breathing, eye opening, and obeying command) were significantly shorter in group E compared to group P. No nausea or vomiting were observed and no ECG abnormality was noted except transient sinus bradycardia and sinus tachycardia. CONCLUSIONS: Although sufficient seizure for the treatment was provided during enflurane anaesthesia, any additional benefit was not revealed regarding seizure times or postictal suppression index when compared to propofol anaesthesia. On the other hand, recovery times after enflurane anaesthesia were shorter than propofol anaesthesia. However, there is still a need for further study in different ETCO(2) levels.
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Periodo de Recuperación de la Anestesia , Anestésicos por Inhalación/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Terapia Electroconvulsiva , Enflurano/uso terapéutico , Propofol/uso terapéutico , Convulsiones/epidemiología , Adulto , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Pneumoperitoneum induced to facilitate laparoscopy is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. AIM: This study investigated the effects of pre- and postlaparoscopic conditioning, zinc, pentoxifylline, and N-acetylcysteine on markers of I/R injury of the small intestine in an animal model. METHODS: Male Sprague-Dawley rats (n=56) were randomized to 1 of 7 treatment groups. Except for group 7 (control group that underwent sham surgery without pneumoperitoneum), pneumoperitoneum was induced in all by use of carbondioxide insufflation under a pressure of 15 mmHg. Group 1 (laparoscopic I/R) was subjected to 60 minutes of pneumoperitoneum. Group 2 (laparoscopic preconditioning plus laparoscopy) was subjected to 5 minutes of insufflation and 5 minutes of desufflation followed by 60 minutes of pneumoperitoneum. Group 3 (laparoscopy plus laparoscopic postconditioning) was subjected to 60 minutes of pneumoperitoneum and 60 minutes of desufflation followed by 5 minutes of insufflation and 5 minutes of desufflation. Group 4 (zinc), group 5 (pentoxifylline), and group 6 (N-acetylcysteine) received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg), respectively, 5 minutes before the desufflation period. Animals were killed at the end of the experiments, and small intestine samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD). RESULTS: There was no significant difference for MDA levels between each other in the groups 1, 2, and 3. But MDA levels were higher significantly in groups 1, 2, and 3 than those of groups 4, 5, 6, and 7. SOD and GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. According to the SOD levels, there was no significant difference between each other in those of groups 1, 2, 4 through 7. GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. GPX levels of group 1 were significantly lower than those of groups 5 and 7. The mean CAT level of groups 1 and 2 was significantly lower than that of groups 3, 6, and 7. The mean CAT level of group 3 was significantly higher than that of groups 1, 2, 4 through 7. CONCLUSIONS: In this animal model of small intestine I/R injury, laparoscopy caused small intestine ischemia as evidenced by elevated markers of tissue I/R injury. This effect was significantly attenuated by zinc, pentoxifylline, and N-acetylcysteine, but not by prelaparoscopy conditioning and postlaparoscopy conditioning.
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Acetilcisteína/uso terapéutico , Depuradores de Radicales Libres/uso terapéutico , Intestino Delgado/irrigación sanguínea , Laparoscopía/efectos adversos , Pentoxifilina/uso terapéutico , Daño por Reperfusión/etiología , Daño por Reperfusión/prevención & control , Zinc/uso terapéutico , Animales , Modelos Animales de Enfermedad , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
BACKGROUND AND OBJECTIVE: The pneumoperitoneum has been shown to decrease femoral blood flow, resulting in venous stasis. We analyzed the effects of the pneumoperitoneum and epidural analgesia on femoral vein diameter and the peak flow rate of femoral vein during laparoscopic cholecystectomy. PATIENTS AND METHODS: Forty patients were randomly allocated to receive either combined epidural analgesia (EA) and general anesthesia (GA) (group EA/GA) or GA alone (group GA). Laparoscopic cholecystectomy was the standard operation for the selected patients. Then, 10 mL of 1% lidocaine in group EA/GA or physiologic serum in group GA was injected via epidural catheter. Peak flow rates (PFRs) of femoral vein cross-sectional areas (CSAs) were measured from the right femoral vein at three different times: after induction of anesthesia, during the pneumoperitoneum, and after abdominal deflation, but prior to reversal of anesthesia. RESULTS: The two groups were similar in age, sex, body mass index, and duration of operation. The CSA slightly increased after the induction of anesthesia, compared with the previous measurements, although there was no statistical significance between them for both groups (P > 0.05). The PFR decreased, whereas the CSA increased during the pneumoperitoneum in each group. The PFR values after basal measurements were significantly higher in the EA/GA than in the GA group (P < 0.05). Group EA/GA had significantly lower heart-rate and blood-pressure levels during surgery than those in group GA (P < 0.05). CONCLUSIONS: Abdominal insufflation during laparoscopic cholecystectomy results in dilation and decreased flow in the common femoral vein. Epidural analgesia added to the GA partially compensated for the reduction in femoral PFR.