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.

Relevance of nutritional route and intercellular adhesion molecule-1 in patients with acute renal failure and its prognostic implications.

OBJECTIVE: Nutritional support and the route of nutrition are important conditions for patients with acute renal failure (ARF) in intensive care units (ICUs). Enteral nutrition (EN) is the primary route of nutrition in these patients because of a lower rate of complications. A lack of enteral feeding was reported to increase intercellular adhesion molecule-1 (ICAM-1) in experimental models. Serum soluble ICAM-1 (sICAM-1) level is an independent predictor of mortality in predialysis patients. However, the effect of nutritional route on serum ICAM-1 level is unknown in ARF patients. The aim of this study was to investigate the relationship between route of nutrition and serum ICAM-1 level and its prognostic implications in ICU ARF patients. METHODS: In total, 64 ICU patients with ARF were assessed according to their clinical features, route of nutrition, laboratory parameters, serum sICAM-1 levels, presence of infection, Acute Physiology and Chronic Health Evaluation (APACHE) III scores, and outcomes on their first nephrology consultation day. RESULTS: Thirty-two patients died during the follow-up period. The mortality rate and infection rate were higher in the parenteral nutrition (PN) group compared with the EN group (64% vs 42%, P = .05, and 84% vs 64%, P = .05, respectively). The route of nutrition influenced the serum sICAM-1 level. Parenteral nutrition was associated with a higher serum sICAM-1 level compared to EN (434 ng/mL [range 255 to 1,240] vs 217 ng/mL [range 123 to 296], respectively, P = .0004). The APACHE III score was found to be an independent prognostic factor among the parameters of nutritional route, presence of infection, serum albumin level, and serum sICAM-1 level. CONCLUSIONS: Patients with ARF as supported by PN had a lower serum albumin level, and a higher APACHE III score, sICAM-1 level, and mortality and infection rate. Serum sICAM-1 levels did not independently predict mortality in the present set of ARF patients.

[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.

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.

Protective role of caffeic acid phenethyl ester on serum cholinesterase inhibition by acute exposure to diazinon in rats.

AIM: To evaluate whether caffeic acid phenethyl ester (CAPE), a flavonoid-like natural compound plentifully found in beeswax, has a protective effect on diazinon-induced serum cholinesterase (ChE) inhibition in rats. MATERIALS AND METHODS: Animals were divided into 4 groups. The first animal group was not treated with any substance. The second animal group was orally given a 200 mg/kg body weight (bw) sublethal dose of diazinon. The third animal group was injected intraperitoneally with 2.84 mg (10 micromol)/kg bw of CAPE 1 day prior to administration of 200 mg/kg bw of diazinon orally. The fourth animal group was intraperitoneally injected with 2.84 mg (10 tmol)/kg bw of CAPE 30 min after 200 mg/kg bw of diazinon was orally administered. RESULTS: Analysis of the animal blood samples obtained 48 h after diazinon administration revealed that diazinon decreased serum ChE activity by 75%, while CAPE administration 24 h prior to and 30 min following diazinon application improved serum ChE activity by 25%-32% as compared to levels with diazinon administration only. In silico studies suggest that CAPE prevents diazinon from binding to butyryl ChE due to a higher binding affinity than that of diazinon. CONCLUSION: Our laboratory findings suggest that CAPE plays a protective role against butyryl ChE inhibition by diazinon.

Effects of vitamin C and E combination on element and oxidative stress levels in the blood of operative patients under desflurane anesthesia.

We investigated effects of vitamin C and E (VCE) administration on desflurane-induced oxidative toxicity and element changes in the blood of operative patients under desflurane general anesthesia. Forty American Society of Anesthesiologists I or II Physical Status adult patients were scheduled for elective surgery. The patients were randomly divided into two groups. Control and VCE group was introduced to anesthesia with desflurane. VCE was administreted to patients in the control and VCE group before 1 hour of anesthesia with desflurane. Baseline (preoperative) and postoperative (at the 1(st), the 24(th), and 72(th) h), blood samples were taken from the first and second groups. Erythrocyte and plasma lipid peroxidation levels at the 1(st), 24(th), and 72(th) hours were higher in the control than in baseline group, although their levels at the same periods were lower in the VCE group than in the control. Vitamin E levels at the postoperative 1(st) and 24(th) hours and erythrocyte glutathione peroxidase (GSH-Px) activity at the postoperative 1(st), 24(th), and 72(th) hours was lower than in baseline values. Erythrocyte GSH-Px activity and plasma vitamins A, C, and E levels at the postoperative 1(st), 24(th), and 72(th) hours were higher in the VCE group than in the control group. Erythrocyte and plasma reduced glutathione, plasma ß-carotene, and serum copper, while zinc, selenium, aluminum, iron, magnesium, and calcium levels did not differ between preoperative and postoperative periods in both groups. In conclusion, VCE combination prevented the desflurane-induced vitamin E and GSH-Px consumptions to strengthen the antioxidant levels in the blood of operative patients.

[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.

Removal of a laryngeal leech: A safe and effective method.

This article presents a case of hoarseness, dysphagia, and hemoptysis caused by the laryngeal localization of a leech. This pathological condition is extremely rare in urban areas but is frequent in endemic rural areas. Laryngoscopic evaluation of our patient has shown a leech lodged on the left arytenoid region hanging down to larynx. We present a patient living in an urban area with laryngeal leech that was removed under general induction anesthesia of sevoflurane via a face mask without endotracheal intubation.

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.