Comparison of In Vitro Effects of Opioid Analgesics on Spontaneous Proximal and Distal Colon Contractions in Healthy Rats and Rats with Peritonitis.

OBJECTIVE: The goal of this study was to investigate and compare the effects of opioids on proximal and distal colon contractions in normal rats and rats with peritonitis, with and without the presence of naloxone in the environment. METHODS: The study was approved by Cumhuriyet University Ethics committee. In this study, 16 Wistar Albino male rats were used. Rats were divided into two groups. Peritonitis was induced using a cecum ligation and perforation method, 24 h before the tissues of rats in the peritonitis group were collected, and sham surgery was performed 24 h before the tissues of rats in the control group were collected. Twenty-four hours after the surgery, rats' organs were harvested and hung in organ baths. Concentration-dependent inhibitory effects of morphine and meperidine on spontaneous intestinal movements were observed. Any differences between the groups were tested using the Kruskal-Wallis test, and any differences between the groups were tested using the Tukey test. RESULTS: No significant difference was observed between the proximal and distal colon smooth muscle contraction responses in both groups after 80 mM Potassium Chloride (KCl) injection (p>0.005). In the peritonitis group, amplitudes and frequencies of spontaneous contractions in proximal and distal colon significantly increased (p<0.05). Drugs decreased the amplitude and frequency responses in the control group (p<0.05). In the peritonitis group, whereas morphine decreased the amplitude and frequency responses in comparison with the control group (p<0.05), meperidine did not cause any significant changes (p>0.05). In both groups, adding naloxone to the organ baths before adding opioids completely blocked the morphine's inhibitory effect on the amplitude and frequency (p<0.05), but it could not completely block the inhibition caused by meperidine. CONCLUSION: Morphine and meperidine exhibit an inhibitory effect on the intestinal motility in both groups. This effect can be blocked by naloxone completely in morphine, and partially in meperidine.

Bloqueio dos nervos ilioinguinal e ílio-hipogástrico com dexcetoprofeno intravenoso melhora a analgesia após histerectomia abdominal / Ilioinguinal-iliohypogastric nerve block with intravenous dexketoprofen improves postoperative analgesia in abdominal hysterectomies / Bloqueo de los nervios ilioinguinal e ilio-hipogástrico con dexketoprofeno intravenoso mejora la analgesia después de la histerectomía abdominal

JUSTIFICATIVA E OBJETIVO: O objetivo deste estudo foi avaliar os efeitos da aplicação intravenosa(IV) de dexcetoprofeno trometamol em bloqueio dos nervos ilioinguinal e ílio-hipogástrico na qualidade analgésica e no consumo de morfina após histerectomia abdominal total. MÉTODO: Estudo clínico controlado e randomizado conduzido com 61 pacientes. O estudo foi feito em sala de operação, sala de recuperação pós-anestésica e ambulatório. Os 61 pacientes foram randomicamente alocados em três grupos: grupo controle (Grupo C), grupo bloqueio (Grupo B) e grupo bloqueio com dexcetoprofeno (Grupo BD). Antes da incisão cirúrgica feita após a indução da anestesia, fizemos o bloqueio dos nervos ilioinguinal e ilio-hipogástrico (Grupo C recebeu solução salina e grupos B e BD receberam levobupivacaína). Em contraste com os grupos C e B, o Grupo BD recebeu dexcetoprofeno. Administramos morfina a todos os pacientes para analgesia, com o uso do método de analgesia controlada pelo paciente (ACP) durante o pós-operatório de 24 horas. Registramos os escores para dor pela escala visual analógica (EVA), os índices de satisfação, o consumo de morfina e os efeitos colaterais durante o pós-operatório de 24 horas. RESULTADOS: Os escores EVA do Grupo BD foram menores do que os dos grupos C e B no pós-operatório (p < 0,05) nos intervalos de 1, 2, 6 e 12 horas. Os escores EVA do Grupo C foram maiores do que os do Grupo B nas primeiras 2 horas de pós-operatório. O tempo até a primeira demanda de ACP foi mais longo, os valores de consumo de morfina mais baixos e os índices de satisfação maiores no Grupo BD do que nos outros dois grupos (p < 0,05). CONCLUSÃO: O bloqueio dos nervos ilioinguinal e ílio-hipogástrico com dexcetoprofeno IV aumenta a satisfação do paciente e diminui o consumo de opioides e sugere que dexcetoprofeno trometamol é um analgésico anti-inflamatório não esteroide eficaz em analgesia pós-operatória.

BACKGROUND AND OBJECTIVE: In this study, our aim was to evaluate the effects of intravenous dexketoprofen trometamol with ilioinguinal and iliohypogastric nerve block on analgesic quality and morphine consumption after total abdominal hysterectomy operations. METHODS: We conducted this randomized controlled clinical study on 61 patients. The study was conducted in the operation room, post-anesthesia care unit, and inpatient clinic. We randomly grouped the 61 patients into control group (group C), block group (group B) and dexketoprofen-block group (group DB). Before the skin incision performed after anesthesia induction, we performed ilioinguinal iliohypogastric block (group C given saline and group P and DB given levobupivacaine). In contrast to group C and B, group DB was given dexketoprofen. We administered morphine analgesia to all patients by patient-controlled analgesia (PCA) during the postoperative 24 hours. We recorded Visual Analogue Scale (VAS), satisfaction scores, morphine consumption and side effects during postoperative 24 hours. RESULTS: We found the DB group's VAS scores to be lower than the control group and block group's (p < 0.05) values at postoperative 1st, 2nd, 6th and 12th hours. VAS scores of group C were higher than of group B at postoperative first 2 hours. Time to first PCA demand was longer, morphine consumption values were lower and satisfaction scores were higher in group DB than in the other two groups (p < 0.05). CONCLUSIONS: Ilioinguinal-iliohypogastric nerve block with IV dexketoprofen increases patient satisfaction by decreasing opioid consumption, increasing patient satisfaction, which suggests that dexketoprofen trometamol is an effective non-steroidal anti-inflammatory analgesic in postoperative analgesia.

JUSTIFICATIVA Y OBJETIVO: El objetivo de este estudio fue evaluar los efectos de la aplicación intravenosa (IV) del dexketoprofeno trometamol en el bloqueo de los nervios ilioinguinal e Ilio-hipogástrico en la calidad analgésica y en el consumo de morfina después de la histerectomía abdominal total. MÉTODO: Estudio clínico controlado y aleatorio llevado a cabo con 61 pacientes. El estudio se hizo en un quirófano, en la sala de recuperación postanestésica y en el ambulatorio. Los 61 pacientes fueron aleatoriamente divididos en tres grupos: grupo control (Grupo C), grupo bloqueo (Grupo B) y grupo bloqueo con dexketoprofeno (Grupo BD). Antes de la incisión quirúrgica hecha después de la inducción de la anestesia, hicimos el bloqueo de los nervios ilioinguinal e ilio-hipogástrico (Grupo C recibió solución salina y grupos B y BD recibieron levobupivacaína). En contraste con los grupos C y B, el Grupo BD recibió dexketoprofeno. Administramos morfina a todos los pacientes para la analgesia con el uso del método ACP durante el postoperatorio de 24 horas. Registramos las puntuaciones EVA, los índices de satisfacción, el consumo de morfina y los efectos colaterales durante el postoperatorio de 24 horas. RESULTADOS: Los puntuaciones EVA del Grupo BD fueron menores que las de los grupos C y B en el postoperatorio (p < 0,05) en los intervalos de 1, 2, 6 y 12 horas. Las puntuaciones EVA del Grupo C fueron mayores que las del Grupo B en las primeras 2 horas del postoperatorio. El tiempo hasta la primera demanda de ACP fue más largo, los valores de consumo de morfina más bajos y los índices de satisfacción mayores en el Grupo BD que en los otros dos grupos (p < 0,05). CONCLUSIONES: El bloqueo de los nervios ilioinguinal e Ilio-hipogástrico con dexketoprofeno IV, aumenta la satisfacción del paciente y reduce el consumo de opioides, sugiriendo que el dexketoprofeno trometamol es un analgésico antiinflamatorio no esteroide eficaz en analgesia postoperatoria.

Epidemiology and risk factors of intensive care unit-acquired infections: a prospective multicentre cohort study in a middle-income country.

INTRODUCTION: This study aimed to determine the incidence and risk factors of infections among patients admitted to intensive care units (ICUs) in tertiary care hospitals in Turkey. METHODS: Adult patients who were admitted to the ICUs of five tertiary care hospitals for over 48 hours between June and December 2007 were monitored daily. Potential risk factors such as age, gender, comorbidities, diagnosis at admission, severity of disease (Acute Physiology and Chronic Health Evaluation II scores), exposure to antibiotics, history of invasive procedures and significant medical interventions were evaluated. A multivariate analysis of these risk factors was carried out using Cox regression. RESULTS: A total of 313 patients with a median ICU stay of 12 days were selected for the study. 236 infectious episodes (33.8/1,000 ICU-days) were diagnosed among 134 patients (42.8/100 patients) in this group. Multivariate analysis revealed that exposure to a cephalosporin antibiotic (hazard ratio [95% confidence interval] 1.55 [1.10-2.19]) was an independent risk factor, whereas having a tracheostomy cannula (0.53 [0.36-0.81]) or nasogastric tube (0.48 [0.33-0.70]) was protective. Patients admitted to the ICUs from surgical wards were significantly more exposed to cephalosporins. CONCLUSION: ICU-associated infections, which are quite high in Turkey, are largely due to inadequate infrastructure and facilities and understaffing. Abuse of antibiotics, particularly in patients who have undergone surgery, and prolonged ICU stays are significant risk factors for such infections.

Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block.

BACKGROUND: Although several studies have described effects of dexmedetomidine on peripheral nerve blocks, to date there is limited knowledge available on the impact of dexmedetomidine adjunct to levobupivacaine in axillary brachial plexus block. OBJECTIVE: In this study, we aimed to investigate the effects of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. METHODS: A total of 64 patients of American Society of Anesthesiologists physical status I/II scheduled to undergo forearm and hand surgery, in which an axillary block was used, were enrolled. The patients were randomly divided into 2 groups: in group L patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% plus 1 mL of isotonic sodium chloride. In group D patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% and 1 mL dexmedetomidine 1 µg/kg(-1) plus isotonic sodium chloride. Demographic data, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Spo2), sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, intraoperative verbal analog scale, postoperative visual analog scale (VAS) data, and side effects were recorded for each patient. RESULTS: There were no significant differences in patient and surgery characteristics between the 2 groups. Sensory block onset time was shorter in group D (P < 0.05). Sensory and motor block duration and time to first analgesic use were significantly longer in group D (P < 0.05), and the total need for analgesics was lower in group D (P < 0.05). Intraoperative 5- and 10-minute verbal analog scale values and postoperative VAS value at 12 hours were significantly lower in group D (P < 0.05). Intraoperative MAP and HR values, except at 5 minutes and postoperatively at 10 and 30 minutes and 1 and 2 hours, were significantly lower in group D (P < 0.01). Bradycardia, hypotension, hypoxemia, nausea, vomiting, and any other side effects were not seen in any patients. CONCLUSIONS: It was concluded in our study that adding dexmedetomidine to axillary brachial plexus block shortens sensory block onset time, increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects. ClinicalTrials.gov identifier ISRCTN67622282.

Investigation of the cardiac effects of pancuronium, rocuronium, vecuronium, and mivacurium on the isolated rat atrium.

BACKGROUND: Pancuronium, vecuronium, rocuronium, and mivacurium are nondepolarizing neuromuscular blocking agents that affect the cardiovascular system with different potencies. Their cardiovascular effects are clinically significant in the anesthetic management of patients, particularly those undergoing cardiac surgery. OBJECTIVE: We aimed to compare the cardiac effects of these compounds, such as heart rate and developed force, in one species under identical experimental conditions in isolated rat atria. METHODS: The left or right atria of rats were removed and suspended in organ baths. Pancuronium, vecuronium, rocuronium, or mivacurium were added cumulatively (10(-9)-10(-5) M) in the presence and absence of the nonselective ß-blocker propranolol (10(-8) M) and the noradrenaline reuptake inhibitor desipramine (10(-7) M), and heart rate changes were recorded in spontaneously beating right atria. Left atrial preparations were stimulated by electrical field stimulation using a bipolar platinum electrode, and the effects of cumulative concentrations of these nondepolarizing neuromuscular blocking agents on the developed force in the presence and absence of propranolol (10(-8) M) and desipramine (10(-7) M) were recorded. RESULTS: Pancuronium increased heart rate in a dose-dependent manner compared with the control group (P < 0.027). Vecuronium, rocuronium, and mivacurium also increased heart rate in a dose-dependent manner, but the changes were not statistically significant. Although propranolol decreased the pancuronium heart rate effect (P < 0.05), it did not change the heart rate effects with vecuronium, rocuronium, or mivacurium. Desipramine did not change the heart rate effects of vecuronium, rocuronium, mivacurium, or pancuronium. All 4 drugs increased developed force in a dose-dependent manner; the increases were significant at 10(-5) M concentration for pancuronium and at 10(-6) and 10(-5) M concentrations for vecuronium, rocuronium, and mivacurium (P < 0.038). These increases in developed force were abolished with the addition of propranolol. Desipramine did not change the developed force effects of any of the 4 drugs. CONCLUSIONS: The heart rate effect of pancuronium and developed force effects of pancuronium, vecuronium, rocuronium, and mivacurium may occur via direct stimulation of ß receptors. Although our investigation was an in vitro study, the effects found may be important especially under pathologic conditions, such as hypertension, in which patients usually use ß-blocking agents, which cause ß receptor upregulation.

Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: A double-blind, randomized, controlled trial.

BACKGROUND: Controlled hypotension is a technique that is used to limit intraoperative blood loss to provide the best possible surgical field during surgery. OBJECTIVE: The aim of this double-blind, randomized, controlled study was to compare the effects of desflurane combined with esmolol or dexmedetomidine on the amount of blood in the surgical field, recovery time, and tolerability in adult patients undergoing tympanoplasty. METHODS: Turkish patients aged 18 to 60 years, classified as American Society of Anesthesiologists physical status I or II, who were scheduled for tympanoplasty were randomly divided into 2 groups: the esmolol group or the dexmedetomidine group. After the anesthesia induction in the esmolol group, a loading dose of esmolol was infused intravenously over 1 minute at 1 mg/kg, followed by a maintenance rate of 0.4 to 0.8 mg/ kg/h. In the dexmedetomidine group, a loading dose of dexmedetomidine was infused intravenously over 10 minutes at a rate of 1 µg/kg, followed by a maintenance rate of 0.4 to 0.8 µg/kg/h. The infusion rates were then titrated to maintain mean arterial pressure (MAP) of 65 to 75 mm Hg. General anesthesia was maintained with desflurane 4% to 6%. Heart rate (HR) and MAP were recorded during anesthesia. The following 6-point scale was used to assess the amount of bleeding in the operative field: 0 = no bleeding, a virtually bloodless field; 1 = bleeding that was so mild that it was not a surgical nuisance; 2 = moderate bleeding that was a nuisance but did not interfere with accurate dissection; 3 = moderate bleeding that moderately compromised surgical dissection; 4 = bleeding that was heavy but controllable and that significantly interfered with surgical dissection; and 5 = massive bleeding that was uncontrollable and made dissection impossible. Scores ≤2 were considered to be optimal surgical conditions. The sedation score was determined at 15, 30, and 60 minutes after tracheal extubation using the following scale: 1 = anxious, agitated, or restless; 2 = cooperative, oriented, and tranquil; 3 = responsive to commands; 4 = asleep, but with brisk response to light, glabellar tap, or loud auditory stimulus; 5 = asleep, sluggish response to glabellar tap or auditory stimulus; and 6 = asleep, no response. Time to extubation and to total recovery from anesthesia (Aldrete score ≥9 on a scale of 0-10), adverse effects (eg, intraoperative hypotension [blood pressure <65 mm Hg], bradycardia [HR <50 beats/min]), intraoperative fentanyl consumption, and postoperative nausea and vomiting were recorded. Arterial blood gas analysis and kidney and liver function tests were conducted. All patients were evaluated by the same attending surgeon and anesthesiologist, both of whom were blinded to the administered study drugs. RESULTS: Fifty-two consecutive white patients undergoing tympanoplasty were identified. Two patients had to be excluded because of hypertension and 2 refused to participate. Forty-eight patients were equally randomized to either the esmolol group (n = 24 [16 women, 8 men]; mean [SD] age, 38.4 [10.5] years) or the dexmedetomi-dine group (n = 24 [17 women, 7 men]; mean age, 35.5 [14.7] years). Sedation scores were not collected for 1 patient in the esmolol group; therefore, analysis was conducted for 23 patients. The median (range) of the scores for the amount of blood in the surgical field in the esmolol and dexmedetomidine groups was 1 (0-3) and 1 (0-2), respectively (P = NS). Mean intraoperative fentanyl consumption in the esmolol group was significantly higher than in the dexmedetomidine group (50.0 [3.0] vs 25.0 [2.5] µg/min; P = 0.002). In the esmolol group, the mean times to extubation and to recovery from anesthesia were significantly shorter than those of the dexmedetomidine group (7.0 [1.4] vs 9.1 [1.9] minutes, respectively; 5.9 [2.1] vs 7.9 [2.3] minutes; both, P = 0.001). The mean sedation scores were significantly lower in the esmolol group (n = 23, because of intent-to-treat analysis) compared with the dexmedetomidine group at 15 minutes (2.5 [0.6] vs 3.6 [0.5]; P = 0.001) and 30 minutes (2.6 [0.6] vs 3.3 [0.6]; P = 0.001) postoperatively. No significant differences were found between the study groups in regard to blood urea nitrogen or creatinine concentration, aspartate aminotransferase or alanine aminotransferase activities, pH, partial pressure of carbon dioxide, or bicarbonate, before or after the operation. CONCLUSIONS: Both esmolol and dexmedetomidine, combined with desflurane, provided an effective and well-tolerated method of achieving controlled hypotension to limit the amount of blood in the surgical field in these adult patients undergoing tympanoplasty. Esmolol was associated with significantly shorter extubation and recovery times and significantly less postoperative sedation compared with dexmedetomidine.

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model.

INTRODUCTION: We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. MATERIALS AND METHODS: Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm(2), 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). RESULTS: The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). DISCUSSION: We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.

The effects of different doses of remifentanil on intraocular pressure after tracheal intubation: a randomized, double-blind and prospective study.

We investigated the effects of alfentanil and different doses of remifentanil on intraocular pressure (IOP) and hemodynamic responses during laryngoscopy and endotracheal intubation in 60 patients. IOP values decreased significantly from 30 seconds before the intubation to 5 minutes after intubation measurements compared to baseline values in all the groups. However, a significant increase in IOP was recorded in the 0.5-microg remifentanil group after tracheal intubation.