New volatile anesthetic, desflurane, reduces vitamin E level in blood of operative patients via oxidative stress.

It has been well known that some volatile anesthetic agents produce oxidative stress. Desflurane as a new volatile agent might have limited oxidative toxic effect because it is relatively a new short-acting anesthetic characterized by a short duration of action and a quick postanesthetic recovery. We investigated effect of desflurane on serum glutathione peroxidase (GSH-Px), lipid peroxidation (LP), vitamin E, and erythrocyte superoxide dismutase (SOD) values in patients. Fifteen adult patients are scheduled for elective surgery, ASA I or II physical status. Tidal volume and ventilation frequency were kept unchanged during the operation. Baseline values in venous blood samples were preoperatively taken and blood was also taken postoperatively at the 1st and the 12th hours of desflurane exposure. LP levels were significantly (p < 0.05) higher postoperatively at 1st hour than in preoperative values while alpha-tocopherol concentration was significantly (p < 0.001) lower in postoperative period at 1st hour than in preoperative period. Erythrocyte SOD and serum GSH-Px activities did not differ between pre- and postoperative periods. In conclusion, we observed that desflurane produced oxidative stress by decreasing alpha-tocopherol levels. Use of vitamin E may be possible to reduce the oxidative effect of desflurane.

Lemierre syndrome: a case of a rarely isolated microorganism, Staphylococcus auerus.

BACKGROUND: Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections that causes septic embolization to the lungs and other distant sites. One-third of cases present a polymicrobial bacteremia, although the most isolated microorganism is Fusobacterium necrophorum. A case of postanginal sepsis caused by a rarely isolated microorganism, Staphylococcus auerus, in a geriatric patient is reported. CASE REPORT: An 80-year-old man was admitted to hospital with fever and sore throat. Doppler ultrasonography imaging of the neck veins demonstrated an occlusive thrombus in the right internal jugular vein. Clinical deterioration occurred in spite of all ICU therapy. The revealed right internal jugular vein filled with thrombus. Staphylococcus aureus was cultivated on blood and urine samples. CONCLUSIONS: The responsible microorganism and the advanced age of the patient may make clinicians aware of the variants of this syndrome.

Oxidant and antioxidant activities of different anesthetic techniques. Propofol versus desflurane.

OBJECTIVE: To investigate the correlation between propofol and desflurane in terms of lipid peroxidation and antioxidant activity and to search the possible antioxidant anesthesia technique. METHODS: The study was performed in the Department of Anesthesia and Reanimation, Medical Faculty, Suleyman Demirel University, Isparta, Turkey, between January 2006 and July 2006. Thirty, ASA I-II patients, with an age range of 19-55 years, undergoing elective surgery under general anesthesia were randomized to receive either propofol infusion (Group P) or desflurane inhalation (Group D) following standard induction. Malondialdehyde (MDA), glutathione peroxidase (GSH), super oxide dismutase (SOD) and alpha-tocopherol (Vitamin E) were measured preoperatively, at peroperatively first hour and postoperatively 12-hour. RESULTS: Malondialdehyde was found lower peroperatively in Group P compared to Group D (p<0.05). In Group D, Vitamin E levels were decreased significantly peroperatively compared to preoperative period (p=0.001). CONCLUSION: We observed a systemic oxidative stress increment with desflurane by terms of MDA; a lipid peroxidation product and endogenous antioxidant activity suppression by terms of Vitamin E at only peroperative period. This study may be defined to support the fact that free oxygen radicals were released more by desflurane than propofol.

[The effect of three different lornoxicam administrations on postoperative analgesia]. / Preoperatif üç farkli yolla uygulanan lornoksikamin postoperatif analjezi üzerine etkisi.

In this study we evaluated the postoperative analgesic efficacy of lornoxicam PO, IM and IV administration preoperatively. Fourty patients, aged between 18-65 years, ASA I-II class, were randomized to four groups. Lornoxicam 8 mg was administired PO, IM, IV (Group PO, Group IM, Group IV) 1 hour before the operation. Analgesia was not performed in control group (Group C). First analgesic requirement time, analgesic consumption and the VAS and VRS pain scores were recorded postoperatively. When VAS 3 patient controlled analgesia with lornoxicam was begun. We found that first analgesic requirement time was shorter, postoperative 2nd hour VAS and VRS scores and drug consumptions were higher in Grup C cases according to the other groups. There was no significant difference in first analgesic requirement time and analgesic consumption. Preoperative administration of 8 mg lornoxicam delayed the first analgesic requirement time and decreased total analgesic requirement. There was no difference on analgesic effect between PO, IM, and IV administrations.

Effect of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats.

AIM: To evaluate the effects of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats. METHODS: Five groups were allocated (n = 8) in the study. Group I was taken as the control group, group II as the hemorrhagic shock group, group III as hemorrhagic shock + laparotomy, group IV as hemorrhagic shock + splenectomy and group V as splenectomy + omentectomy + hemorrhagic shock group. Hemorrhagic shock was induced by drawing blood and reducing mean arterial pressure (MAP) to 40 mmHg within 10 min. After a hypotensive period of 1 h, animals were resuscitated. Bronchoalveolar lavage (BAL) was performed to recover cells from the alveolar space with 40 mL of BAL fluid after resuscitation malondialdehyde (MDA) and L-gamma-glutamyl-L-cysteinyl-glycine (GSH) levels were measured in serum, erythrocytes and lung tissue. RESULTS: Serum, erythrocyte, lung tissue MDA and GSH levels were significantly increased in hemorrhagic shock groups II-V (P < 0.05). Lymphocyte, neutrophil and alveolar macrophage counts in BAL fluid indicated a significant difference between control and shock groups (P < 0.05). CONCLUSION: The degree of trauma increases hemorrhagic shock-induced acute lung injury.

Protective effects of N-acetylcysteine and erdosteine on hemorrhagic shock-induced acute lung injury.

BACKGROUND: The drugs N-acetylcysteine and erdosteine were used to evaluate their protective effects in hemorrhagic shock-induced acute lung injury in an animal model. METHODS: Forty rats were used and randomly allocated into four groups (n=10). Animals in group III were fed with water containing 1 mg/dl erdosteine, and those in group IV were given 0.5 mg/dl N-acetylcysteine 3 days before the experiment. Group I was taken as the control and group II was taken as the hemorrhagic shock group. Hemorrhagic shock was initiated by blood withdrawal and reduction of the mean arterial pressure to 40 mmHg within 10 min via the right carotid artery. After a hypotensive period of 2 h, animals were resuscitated by transfusion of the shed blood and Ringer lactate in a volume equal to the shed blood. After a period of 1 h, blood samples were taken via the carotid artery. Bronchoalveolar lavage was performed to recover cells from the alveolar space with 40 ml of bronchoalveolar lavage fluid. Lung tissues were also resected to measure tissue malondialdehyde and L-gamma-glutamyl-L-cysteinyl-glycine levels with high performance liquid chromatography. The numbers of neutrophils and alveolar macrophages in bronchoalveolar lavage fluid were counted. RESULTS: Serum malondialdehyde levels were significantly higher in the shock groups (P<0.05), but there was no significant difference (P>0.05). Lung malondialdehyde levels were also significantly increased in the shock groups (P<0.05). In the erdosteine-applied group, tissue malondialdehyde levels were lower than in group II and the NAC-applied group (P<0.05). In the analyses of serum and lung tissue L-gamma-glutamyl-L-cysteinyl-glycine, the values of groups I, II and IV were found to be below the calibration graphics. The alveolar macrophage count was found to be the highest and the neutrophil count the lowest in group III when compared with the other groups in bronchoalveolar lavage fluid analyses (P<0.05). CONCLUSION: We may say that in the model of hemorrhagic shock-induced acute lung injury, it was found that erdosteine has a protective effect on lung tissue.

N-butanoyl-L-homoserine lactone (BHL) deficient Pseudomonas aeruginosa isolates from an intensive care unit.

Acylated homoserine lactones (AHLs) are self-generated diffusible signal molecules that mediate population density dependent gene expression (quorum sensing) in a variety of Gram-negative bacteria, and several virulence genes of human pathogens are known to be controlled by AHLs. In this study, strains of Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae, isolated from intensive care patients, were screened for AHL production by using AHL responsive indicator strains of Chromobacterium violaceum CV026 and Agrobacterium tumefaciens NT1. Positive reactions were recorded for all 50 isolates of P. aeruginosa and 10 isolates of Acinetobacter baumannii with Agrobacterium tumefaciens NT1. Surprisingly, most P. aeruginosa isolates gave negative results with C. violaceum CV026 in contrast to previous reports. This suggests that the new isolates of P. aeruginosa either failed to make short chain AHLs or the level of the signal molecule is very low.

The effect of colloidal fluid replacement on wound healing in an experimental sublethal hemorrhagic shock model.

OBJECTIVE: The aim of the study was to evaluate the effects of different resuscitation solutions on wound healing in an animal model of sublethal hemorrhagic shock. METHODS: Sublethal hemorrhagic shock was established by blood withdrawal until the mean arterial pressure fell to 40 mmHg within 15 min. Animals were resuscitated with four different solutions: group I (n=19) 0.9% NaCl, group II (n=20) 10% dextran 40, group III (n=20) 6% hydroxyethyl starch, group IV (n=18) 4% modified fluid gelatin. Following inhalation anesthesia, a full thickness skin incision of 2 cm in length was made on the abdominal wall and sutured primarily. The incision wound on the abdominal wall was excised on the fifth day. The breaking strength of the incision and hydroxyproline content of dry tissue were evaluated. RESULTS: Differences in breaking strength values were observed between groups I-III and I-IV (P<0.05). Hydroxyproline values were significantly lower in group IV (58.47 microg/ml) and group II (69.17 microg/ml) (P<0.05). The gelatin-resuscitated group had lower breaking strength and hydroxyproline values than the other groups. CONCLUSION: It can be concluded that resuscitation with modified fluid gelatin may have detrimental effects on wound healing in an experimental model of sublethal hemorrhagic shock.

[Combined femoral and sciatic nerve block in a cachectic progressive systemic sclerosis case with gastrointestinal and cardiac involvement]. / Gastrointestinal ve kardiyak tutulumu mevcut progresif sistemik sklerozisli kasektik olguda kombine femoral siyatik sinir blogu uygulamasi.

Scleroderma is a multisystemic disease of unknown etiology. The systemic disturbances cause difficulties in anesthesia practice. We present a successfully combined sciatic femoral block performed in a multisystemic scleroderma case who was planned for foot amputation. Combined sciatic-femoral block was planned for the patient, for whom left foot amputation was decided by the Orthopedics Department, with related physical weakness, probable difficult airway, and accompanying cardiac and pulmonary diseases. Following the required preoperative evaluation, sciatic and femoral block was performed with a total 15 ml volume consisting of 3 ml levobupivacaine 7.5% and 1 ml lidocaine 2% added to 11 ml NaCl 0.09% subsequently. Additional analgesic treatment was not required perioperatively, and the patient was hemodynamically stable. Tramadol infusion was applied with Patient Controlled Analgesia device at the 8th hour. The patient was discharged on the postoperative 10th day. We think that in high-risk severe cachectic systemic scleroderma cases, general anesthesia and central blocks are contraindicated. If gastrointestinal and cardiac involvements are present, as in our case, combined femoral-sciatic block may be considered as an alternative anesthetic technique.

Effects of granulocyte-colony stimulating factor on wound healing in a mouse model of burn trauma.

The effects of burn trauma and granulocyte-colony stimulating factor (G-CSF) treatment on wound healing in a surgical incision model were studied. Sixty adult male mice were used in this study. Under general anesthesia hot water at 97 degrees C was applied for 3 sec to the dorsum of the mice in order to achieve 20% burn wound. After burn trauma, full thickness midline skin incision 2 cm in length was performed on the abdominal wall and then were sutured primarily with 4/0 polypropylene. In Group I only skin incision was performed, group II had skin incision and burn, in group III G-CSF (0.03 BU/30 g) was applied intraperitoneally after burn and skin incision. Breaking strength and 5-hydroxyproline (5-HP) levels of the wounds were calculated 5 and 10 days after the procedure. 5-HP levels and breaking strength values showed statistical difference between groups II-III and I-II (p<0.05). 5-HP levels were lowest in incision and burn group (41.80 microg/mg). Breaking strength levels were also lowest in the same group (0.12 kg) (p<0.05). These results suggest that third degree burn causes a significant impairment on incisional wound healing and G-CSF ameliorates this impairment.

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy.

OBJECTIVE: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. MATERIAL AND METHODS: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I (n = 30) received oral ephedrine 50 mg in addition to premedication whilst those in Group II (n = 30) received only premedication 30 min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 mmHg and <20% of baseline value. Hypotension was treated with 3 mg ephedrine and bradycardia was corrected with atropine 0.5 mg, given as an i.v. bolus. RESULTS: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods (p < 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 +/- 0.97 mg in Group I and 8.86 +/- 1.24 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p = 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. CONCLUSIONS: We conclude that a prophylactic oral dose of ephedrine 50 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.