The Effects of Secondhand Smoke Exposure on Postoperative Pain and Ventilation Values During One-Lung Ventilation: A Prospective Clinical Trial.

OBJECTIVES: To investigate the relationships between secondhand smoke (SHS) exposure and oxygenation during one-lung ventilation (OLV) in lobectomy surgery and between SHS exposure and postoperative analgesic consumption. DESIGN: Prospective study. SETTING: University, Faculty of Medicine, operating room. PARTICIPANTS: Sixty adult patients with American Society of Anesthesiologists score II to III, aged 18 to 65 years, with a body mass index (BMI) <35 kg/m2 scheduled for lobectomy surgery by open thoracotomy. INTERVENTIONS: Patients were divided into 2 groups: the SHS group (n = 30) (urine cotinine level ≥6.0 ng/mL) and the NS (nonsmoker) group (n = 30) (urine cotinine level <6.0 ng/mL and no smoking history). SHS exposure was defined according to a previously published algorithm. MEASUREMENTS AND MAIN RESULTS: Noninvasive blood pressure, electrocardiography, capnography, and peripheral oxygen saturation were monitored, and intra- and postoperative arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), and intraoperative peak airway pressure were compared between the 2 groups. Postoperative analgesic consumption was calculated. No significant differences in demographics or preoperative data were noted between the 2 groups. PaO2 values 10 minutes after OLV onset and 10 minutes after the end of OLV were increased significantly in the NS group compared with those in the SHS group (p < 0.05). PaO2 values after 10 minutes of OLV in the NS and SHS groups were 285.5 ± 90 mmHg and 186.7 ± 66 mmHg, respectively. PaO2 values after OLV termination in the NS and SHS groups were 365.8 ± 58 mmHg and 283.6 ± 64 mmHg (p < 0.05), respectively. PaCO2 values 10 minutes after OLV onset, 10 minutes after the end of OLV, at the end of surgery, and upon arrival in the intermediate care unit were significantly different between the 2 groups (p < 0.05). CONCLUSION: The present study demonstrated that during OLV, patients exposed to SHS exhibited significantly lower arterial oxygen pressure compared with nonsmokers. Arterial carbon dioxide values were increased significantly in SHS-exposed patients. Morphine consumption for postoperative analgesia also was increased in patients exposed to SHS compared with that in nonsmokers.

Vanadium release in whole blood, serum and urine of patients implanted with a titanium alloy hip prosthesis.

INTRODUCTION: Vanadium (V) is a minor constituent of the Titanium-Aluminum-Vanadium (TiAlV) alloy currently used in cementless hip prostheses. Present study aimed at verifying the correlation of vanadium levels among different matrices and assessing reference levels of the ion in a population of patients wearing a well-functioning hip prosthesis. METHODS: Vanadium was measured using Inductive Coupled Plasma Mass Spectrometry (ICP-MS) in whole blood, serum and urine of 129 patients implanted with a TiAlV-alloy hip prosthesis. RESULTS: The values in the serum were above the upper limit of the reference values in 42% of patients (29% in urine and 13% in whole blood). A good correlation among matrices was observed (p < 0.001). The cohort of patients (N = 32) complaining of pain or in which a loosening or damage to the prosthesis was assessed showed a significantly higher excretion of vanadium in urine as compared with the remaining asymptomatic patients (p = 0.001). The 95th percentile distribution of vanadium in the cohort of patients with a well-functioning prosthesis was 0.3 µg/L in whole blood, 0.5 µg/L in serum and 2.8 µg/L in urine, higher that in the unexposed population, especially for urine. CONCLUSIONS: The presence of a prosthesis, even though well-functioning, may cause a possible release of vanadium into the blood and a significant urinary excretion. The reference values of vanadium of the asymptomatic patients with titanium alloy hip prostheses supplied information regarding the background exposure level of the ions and their lower and upper limits.

Effects of the extradural administration of local anaesthetic agents and morphine on the urinary excretion of cortisol, catecholamines and nitrogen following abdominal surgery.

Twenty patients undergoing major abdominal surgery were allocated randomly to receive either general anaesthesia with low-dose fentanyl plus intermittent systemic morphine for postoperative pain or the same general anaesthetic plus extradural analgesia during and following surgery (local anaesthetics from before skin incision until 24 h after skin incision plus extradural morphine 4 mg every 12 h from 3 h to 72 h after skin incision). Postoperative pain scores were lower (P less than 0.05) in the group receiving extradural analgesia, but this regimen failed to prevent the increase in the urinary excretion of cortisol, adrenaline, noradrenaline and nitrogen both on separate days and on cumulative measurements over 4 days. Pain scores did not correlate to urinary excretion of the various endocrine-metabolic indices either on separate days or over the cumulative 4-day period. It is concluded that the relief of pain per se has no major influence on the catabolic response to abdominal surgery.