A challenging issue in COVID-19 infection: The relationship between PA1-1 and TAFI levels in patients with coagulation disorder: A retrospective and observational study.

COVID-19 disrupts the balance between coagulation and fibrinolysis. Especially in the clinical course of serious disease, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), and tissue plasminogen activator levels increase in association with hypercoagulable state and hypofibrinolysis. This explains the increased incidence of thrombosis seen in COVID-19 infection. In this study, we aimed to examine the changes in PAI-1 and TAFI levels of COVID-19 patients. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital-Ankara Turkey, between April 1 and May 7, 2021. Patients who were diagnosed with COVID-19 were included in this retrospective study. TAFI and PAI-1 levels were analyzed from the samples that had been stored at -80 °C formerly. One hundred thirty-five patients diagnosed with COVID-19 and followed up in the service or intensive care unit were included in the study. Thirty-four (25.2%) patients required follow-up in the intensive care unit. Mortality rate was 10.4%, the coagulation tests of these patients were also compared. PA1-1 levels were found to be statistically significantly higher in intensive care unit patients (median: 133 pg/mL vs 31 pg/mL; P < .001), and there was no significant difference in TAFI levels (median:7.31 ng/mL vs 9.80 ng/mL; P = .171) between the 2 groups. TAFI levels were found to be higher in patients who died. In COVID-19 infection, as the severity of the disease increases, the coagulation balance deteriorates and eventually a hypercoagulable state occurs with an increase in PAI-1 and TAFI levels. Markers such as PAI and TAFI can be illuminating in further studies in determining prognosis and mortality and developing new treatment options.

Effects of Preoperative Pregabalin On Postoperative Pain Control in Total Knee Arthroplasty Surgery.

OBJECTIVE: Pain management is a major component of postoperative patient care. Pain management following total knee arthroplasty (TKA) provides patient comfort and early mobilization and prevents serious complications. The present study aimed to evaluate the effects of preoperative administration of oral pregabalin on postoperative pain control in patients undergoing TKA. METHODS: One hundred and twenty-six patients undergoing TKA were retrospectively included, of whom 65 (51.6%) received 150 mg pregabalin 2 hours before the operation and 61 (48.4%) did not. All patients received the same postoperative pain management protocol. Resting pain was recorded using a visual analog scale (VAS) at the postoperative 4th, 12th, and 48th hours. Findings including headache, dizziness, nausea-vomiting, constipation, dry mouth, pruritus, urinary retention, and sleepiness were recorded. RESULTS: The mean age of 126 patients (84.1% female) was 65.5 ± 4.5 years (range, 55-72 years). No significant differences were found in age, sex, ASA score, and operation duration between the groups. VAS scores at the postoperative 4th, 12th, and 48th hours, frequency of pushing the button of PCA system, and the total tramadol dose were significantly lower in the pregabalin group. The percent decrease in the postoperative VAS scores from the 4th hour to the 48th hour was significant in the pregabalin group. Nausea was the most frequent side effect followed by urinary retention, constipation, and pruritus. CONCLUSION: Preoperative pregabalin administration provided a favorable contribution to the postoperative pain management in the patients undergoing TKA. Preoperative pregabalin administration could reduce opioid drug usage and opioid related side effects.

The effects of topical chlorhexidine-benzydamine spray on laryngeal mask airway application.

BACKGROUND: Laryngeal mask airway (LMA) use is very common during anesthesia practice. Sore throat, earache, hoarseness and swallowing difficulties may occur on LMA insertion. The primary aim of this study was to describe the effects of topical application of a spray formula of chlorhexidine gluconate and benzydamine hydrochloride (Kloroben® oral spray, 30 mL) on postoperative sore throat due to LMA use. The secondary aims were to evaluate earache, swallowing difficulty, nausea and vomiting and the hemodynamic responses due to LMA insertion and the incidence of coughing, tooth clenching, desaturation and laryngeal spasms during LMA removal. METHODS: After obtaining Institutional Ethics Committee approval and written informed consent (Ref no 29/15), a total of 100 adult patients were included. In Group C, four puffs of a spray formula of chlorhexidine gluconate and benzydamine hydrochloride were applied to the nasopharyngeal area 15 min before surgery. In Group S, 0.9% saline was applied, using the same protocol. RESULTS: When both groups were compared, more patients in Group S had cough, sore throat and swallowing difficulties one hour after surgery (P<0.05), but there was no statistically significant difference at 6, 12, and 24 h between the two groups (P>0.05). The incidence of nausea, vomiting, and earaches was similar in both groups at all measurement times (P>0.05). CONCLUSIONS: Preemptive topical benzydamine hydrochloride and chlorhexidine gluconate in a spray formula may decrease the incidence of sore throat, cough and swallowing difficulties associated with LMA use.

Oral mask ventilation is more effective than face mask ventilation after nasal surgery.

OBJECTIVE: To evaluate and compare the face mask (FM) and oral mask (OM) ventilation techniques during anesthesia emergence regarding tidal volume, leak volume, and difficult mask ventilation (DMV) incidence. DESIGN: Prospective, randomized, crossover study. SETTING: Operating room, training and research hospital. SUBJECTS: American Society of Anesthesiologists physical status I and II adult patients scheduled for nasal surgery. INTERVENTIONS: Patients in group FM-OM received FM ventilation first, followed by OM ventilation, and patients in group OM-FM received OM ventilation first, followed by FM ventilation, with spontaneous ventilation after deep extubation. The FM ventilation was applied with the 1-handed EC-clamp technique. The OM was placed only over the mouth, and the 1-handed EC-clamp technique was used again. A child's size FM was used for the OM ventilation technique, the mask was rotated, and the inferior part of the mask was placed toward the nose. MEASUREMENTS: The leak volume (MVleak), mean airway pressure (Pmean), and expired tidal volume (TVe) were assessed with each mask technique for 3 consecutive breaths. A mask ventilation grade ≥3 was considered DMV. MAIN RESULTS: DMV occurred more frequently during FM ventilation (75% with FM vs 8% with OM). In the FM-first sequence, the mean TVe was 249±61mL with the FM and 455±35mL with the OM (P=.0001), whereas in the OM-first sequence, it was 276±81mL with the FM and 409±37mL with the OM (P=.0001). Regardless of the order used, the OM technique significantly decreased the MVleak and increased the TVe when compared to the FM technique. CONCLUSION: During anesthesia emergence after nasal surgery the OM may offer an effective ventilation method as it decreases the incidence of DMV and the gas leak around the mask and provides higher tidal volume delivery compared with FM ventilation.

[Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia techniques for single sided inguinal herniorrhaphy]. / Tek tarafli inguinal hernilerde ilioinguinal iliohipogastrik sinir blogu ile spinal anestezi yöntemlerinin karsilastirilmasi

OBJECTIVES: The aim of the study is to compare the hemodynamic effects, postoperative analgesia, time to achieve discharge criteria, and patient-surgeon satisfaction of patients who are assigned for single sided inguinal hernia repair operated under iliohypogastric ilioingiinal nerve block (IHNB) or spinal anesthesia. METHODS: Twenty-five ASA I-III patients in Group S received 15 mg 0.5% hyperbaric bupivacaine intrathecally, and 25 ASA I-III patients in Group I received IHNB with 20 mL 0.5% plain bupivacaine. RESULTS: Mean block application duration (16.4±3 vs 6.5±2.1 min), mean sensory block rise time (25.2±5.1 vs 6.9±3.4 min), and time to sensory block termination (262.4±65.2 vs 116.6±102.5 min) was found to longer in Group I with respect to Group S (p<0.001). Mean time to first mobilization (307.1±146.9 vs 456.9±131.7 min), and mean time to meet discharge criteria (4.6±0.8 vs 8.1±2.7 hr) was shorter in group I. Mean VAS scores in postoperative 1, 2, 4 and 6 th and mean tramadole consumption in 24 hr (375.6±113.1 vs 180.5±17.9 mg) were higher in Group S (p<0.001). Hemodynamic parameters, patient and surgeon satisfaction were comparable (p>0.05). CONCLUSION: IHNB provides longer postoperative analgesia and earliar discharge, although takes more time to perform and to produce maximum effect, for single sided inguinal henia repair.

[The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty]. / Total kalça protez operasyonlarinda lomber pleksus blogu ve epidural blogun total kan kaybi ile postoperatif analjeziye etkileri.

OBJECTIVES: In this study, the effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in patients undergoing total hip arthroplasty (THA) under general anesthesia was documented. METHODS: The study included 45 patients undergoing THA under general anesthesia. Group GA (n=15) received general anesthesia, Group GA+E (n=15) received general anesthesia + epidural catheter and Group GA+LPB (n=15) received general anesthesia + lumbar plexus catheterization. Intraoperative blood transfusion (IOBT) requirements and intraoperative bleeding (IOB) were documented. Postoperative hemoglobin, hematocrit and total blood loss through the drains were also documented. All patients received patient-controlled analgesia through the IV route. Time to first analgesic requirement (TFAR), total IV morphine consumption (MORPH 24) and 24-hour visual analogue scale (VAS) values were evaluated. RESULTS: TFAR was the lowest (8.7+/-4.0 min.) in the GA group and highest (42.7+/-14.4 min) in the GA+LPB group, and the GA+E group had lower values than the GA+LPB (32.3+/-16.0 min) group (p<0.05). IOBT, IOB, and MORPH 24 average values were the lowest in the GA+LPB group and highest in the GA group, with GA+E in between (p<0.05). Postoperative first VAS values were significantly different between the GA group and the others (p<0.001). There was also a significant difference between the GA group and the others regarding postoperative average Hb values (p<0.02). CONCLUSION: THA using either regional technique provides less blood loss and better analgesia. We will consider LPB in our future cases in view of the lower intraoperative blood loss and better analgesia.

Hepatic energy metabolism and the differential protective effects of sevoflurane and isoflurane anesthesia in a rat hepatic ischemia-reperfusion injury model.

BACKGROUND: We investigated the effects of isoflurane and sevoflurane in a warm liver ischemia-reperfusion (IR) model on cytokines, hepatic tissue blood flow (HTBF), energy content, and liver structure. METHODS: Seventy-two Wistar rats were randomly assigned into 1 of 3 groups: Control group, no volatile anesthetics; sevoflurane group, 2% sevoflurane; isoflurane group, 1.5% isoflurane. Thirty minutes after the start of volatile anesthetics, rats were subjected to 45 min hepatic ischemia and 2 and 4 h of reperfusion. Rats were killed at the end of ischemia, 2 and 4 h of reperfusion. Aspartate aminotransferase and alanine aminotransferase, HTBF, malondialdehyde, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, energy charge, and histologic examination were used to evaluate the extent of liver injury. RESULTS: Serum alanine aminotransferase and aspartate aminotransferase levels were similar in control and isoflurane groups while there was a significant decrease in the sevoflurane group in the postischemic period (P < 0.01). HTBF was remarkably better in the sevoflurane group than in the isoflurane group and worse in the control group. Tissue malondialdehyde levels were significantly low in the sevoflurane group compared with the isoflurane group at 2 h of reperfusion (P < 0.05) and reached its maximum value in the postischemic period in the control group. After ischemia, 2 and 4 h of reperfusion, tumor necrosis factor-alpha and interleukin-1beta values were lowest in the sevoflurane group and highest in the control group but it was not statistically significant (P > 0.05). In the sevoflurane group, hepatic adenosine triphosphate and energy charge were significantly high at all measurement times. At the postischemic period, energy charge was lower compared with the sevoflurane and isoflurane groups. The degree of hepatocyte injury was small in the sevoflurane group. CONCLUSIONS: Clinically relevant concentrations of sevoflurane given before, during, and after hepatic ischemia protected the liver against IR injury, whereas the effects of isoflurane on hepatic IR injury were not notable.