Assessment of oxygen extraction rate changes following red blood cell transfusion in the intensive care unit: a protocol for a prospective observational non-interventional study.

INTRODUCTION: Haemoglobin transfusion thresholds have been used in the intensive care unit (ICU) to guide red blood cell transfusion (RBCT) decisions. Recent research has also focused on physiological indicators of tissue oxygenation as trigger points for blood transfusion. This study aims to assess the oxygen extraction rate (O2ER) as a critical indicator of the oxygen delivery-consumption balance in tissues and investigate its potential as a reliable trigger for blood transfusion in ICU patients by analysing clinical outcomes. The utilisation of physiological indicators may expedite the decision-making process for RBCT in patients requiring immediate intervention, while simultaneously minimising the risks associated with unnecessary transfusions. METHODS AND ANALYSIS: This prospective, single-centre, observational cohort study will include 65 ICU patients undergoing RBCT. We will evaluate essential markers such as arterial oxygen content, central venous oxygen content, arteriovenous oxygen difference, O2ER and near-infrared spectroscopy before and 15 min after transfusion. The primary outcome is the percentage increase in O2ER between the two groups relative to the initial O2ER level. Secondary outcomes will assess complications and patient outcomes in relation to baseline O2ER. A 90-day comprehensive follow-up period will be implemented for all enrolled patients. ETHICS AND DISSEMINATION: This study has obtained ethics committee approval from the Izmir Katip Celebi University Non-Interventional Clinical Studies Institutional Review Board. Written informed consent will be obtained from all patients before their enrolment in the study. The findings will be disseminated through publication in peer-reviewed journals and presentation at national or international conferences. TRIAL REGISTRATION NUMBER: NCT05798130.

Determination of microbial contamination on the outer surface of needleless connectors before and after disinfection.

OBJECTIVES: The aim of this study was to determine bacterial contamination of needleless connectors before and after disinfection to assess the risk for the point of catheter-related bloodstream infections. RESEARCH METHODOLOGY/DESIGN: Experimental study design. SETTING: The research was carried out on patients with a central venous catheter hospitalized in the intensive care unit. MAIN OUTCOMES MEASURES: Bacterial contamination of needleless connectors integrated into central venous catheters was assessed before and after disinfection. Antimicrobial susceptibilities of colonized isolates were investigated. In addition, the compatibility of the isolates with the bacteriological cultures of the patients was determined over a one-month period. RESULTS: Bacterial contamination varied between 5×103 and 1×105 colony forming unit was detected before disinfection in 91.7% of needleless connectors. Most common bacteria were coagulase-negative staphylococci; others were Staphylococcus aureus, Enterococcus faecalis, and Corynebacterium species. While most isolates were resistant to penicillin, trimethoprim-sulfamethoxazole, cefoxitin, and linezolid, each was susceptible to vancomycin or teicoplanin. Bacterial survival was not detected on needleless connectors after disinfection. There was no compatibility between the one-month bacteriological culture results of the patients and the bacteria isolated from the needleless connectors. CONCLUSION: Bacterial contamination was detected on the needleless connectors before disinfection, although they were not rich in bacterial diversity. There was no bacterial growth after disinfection with an alcohol-impregnated swab. IMPLICATIONS FOR CLINICAL PRACTICE: The majority of needleless connectors had bacterial contamination before disinfection. Needleless connectors should be disinfected for 30 seconds before use, particularly in immunocompromised patients. However, the use of needleless connectors with antiseptic barrier caps may be a more practical and effective solution instead.

Are bacterial coinfections really rare in COVID-19 intensive care units?

OBJECTIVES: There are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital. METHODS: This study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020-15.01.2021 in a tertiary care intensive care unit in a university hospital. RESULTS: Bacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032-1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063-1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group. CONCLUSION: Bacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.

A Case Series of Problems That Can Occur During Open Heart Surgery in Patients With COVID-19 Infection.

The utilization of open cardiac surgery on patients infected with coronavirus disease 2019 (COVID-19) has resulted in a very challenging perioperative management method. High rates of morbidity and mortality have been documented in the literature for patients who have undergone open heart surgery while infected with COVID-19; however, data on complications that may occur during and after surgery in patients with COVID-19 infection are limited. In this article, we aimed to present the clinical course and perioperative consequences of three patients with preoperative COVID-19 infection.

A Case of Late-Onset Local Anesthetic Toxicity Observed as Seizure Activity.

Most of the local anesthetic toxicity cases develop within the first five minutes of peripheral block administration. Late local anesthetic toxicity has been rarely reported in the literature. However, it is an important life-threatening problem that can lead to seizures, hemodynamic collapse, and cardiac arrest if it is ignored and not considered. Here we present the case of an 18-year-old male patient who had ultrasonography-guided infraclavicular brachial plexus block administration with a 30 mL local anesthetic. The patient had convulsions 210 minutes after the block administration and was treated with intravenous diazepam. Intraoperative and postoperative courses were uneventful. He had no neurologic signs or symptoms afterward. All laboratory tests and radiologic investigation tests were normal. This report demonstrates that late local anesthetic toxicity is still possible after several hours of the uneventful peripheral neural blockade, although it is rarely reported.

Surgical Management of Left Sinus of Valsalva Aneurysm Presenting with Exertional Chest Pain.

Left sinus of Valsalva aneurysm (SVA) is a very infrequent clinical entity. Valsalva aneurysms are often asymptomatic in right and non-coronary sinuses and the diagnosis is often incidental. A left SVA which presents with exertional chest pain due to compression of left coronary system arteries is extremely rare. In this case, we present a successful surgical repair of left SVA without aortic regurgitation or myocardial infarction in a 59-year-old male patient.

Surgical management of left sinus of valsalva aneurysm presenting with exertional chest pain

Abstract Left sinus of Valsalva aneurysm (SVA) is a very infrequent clinical entity. Valsalva aneurysms are often asymptomatic in right and non-coronary sinuses and the diagnosis is often incidental. A left SVA which presents with exertional chest pain due to compression of left coronary system arteries is extremely rare. In this case, we present a successful surgical repair of left SVA without aortic regurgitation or myocardial infarction in a 59-year-old male patient.

The Feasibility of the Ultrasound-Guided Femoral Nerve Block Procedure with Low-Dose Local Anesthetic in Intracapsular and Extracapsular Hip Fractures.

BACKGROUND: The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management. OBJECTIVES: The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED. METHODS: Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction. RESULTS: Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p < 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p < 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups. CONCLUSIONS: The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.

Transient Horner's syndrome after single shot paravertebral block / Síndrome de Horner transitória após bloqueio paravertebral em injeção única

Abstract Background Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. Case report We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15 mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. Conclusions It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

Resumo Justificativa O bloqueio paravertebral torácico pode proporcionar analgesia para cirurgia torácica unilateral e está associado a um baixo índice de complicações. A síndrome de Horner (também denominada paralisia oculossimpática) é uma constelação neurológica clássica de blefaroptose ipsilateral, miose pupilar e anidrose facial devido a distúrbio da via simpática que fornece inervação para a cabeça, os olhos e o pescoço. Relato de caso Apresentamos o caso de um paciente com síndrome de Horner transitória ipsilateral após a administração de injeção única de 15 mL de levobupivacaína a 0,25% para bloqueio paravertebral torácico ao nível de T5-6 guiado por ultrassom. Conclusões Devemos considerar que mesmo um bloqueio paravertebral torácico bem-sucedido com a administração de injeção única e guiado por ultrassom pode ser complicado com a síndrome de Horner devido à distribuição imprevisível do anestésico local.

[Transient Horner's syndrome after single shot paravertebral block]. / Síndrome de Horner transitória após bloqueio paravertebral em injeção única.

BACKGROUND: Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. CASE REPORT: We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. CONCLUSIONS: It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia / A relação entre os níveis de ansiedade no período pré-operatório e os incidentes vasovagais durante a administração de raquianestesia

Abstract Background: It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. Methods: The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. Results: Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. Conclusion: The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.

Resumo Justificativa: O objetivo deste estudo foi investigar a relação entre a ansiedade no período pré-operatório e os sintomas vasovagais observados durante a administração de raquianestesia a pacientes submetidos à cirurgia nas regiões perianal e inguinal. Métodos: O estudo incluiu pacientes com cirurgias agendadas para correção de hérnia inguinal, fissura anal, hemorroidas e excisão de fístula pilonidal. Foram incluídos 210 pacientes entre 18-65 anos e estado físico ASA I-II. A avaliação dos pacientes compreendeu história de tabagismo e consumo de álcool, classificação ASA e nível de escolaridade. As correlações foram avaliadas entre o número de tentativas de aplicação da raquianestesia e história de anestesia com sintoma vasovagal, nível de escolaridade, sexo, tabagismo e consumo de álcool, história anestésica e escores de ansiedade. O inventário do estado (transitório) de ansiedade, parte do Inventário de Ansiedade Traço-Estado (State Trait Anxiety Inventory - IDATE), foi usado para determinar os níveis de ansiedade dos participantes. Achados clínicos de vasodilatação periférica, hipotensão, bradicardia e assistolia observados durante a administração da raquianestesia foram registrados. Resultados: Observamos aumento dos incidentes vasovagais durante a administração da raquianestesia em casos com escores elevados de ansiedade, pacientes do sexo masculino e pacientes sem história anestésica. O nível de escolaridade e o número de punções com agulha espinhal não mostraram ter qualquer efeito sobre os incidentes vasovagais. Conclusão: Determinar as causas que desencadearam os incidentes vasovagais observados durante a aplicação da raquianestesia, fornecer boa informação ao paciente sobre a anestesia regional e promover alívio da ansiedade com tratamento ansiolítico no pré-operatório contribuirão para eliminar possíveis incidentes vasovagais.

[The relationship between preoperative anxiety levels and vasovagal incidents during the administration of spinal anesthesia]. / A relação entre os níveis de ansiedade no período pré­operatório e os incidentes vasovagais durante a administração de raquianestesia.

BACKGROUND: It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. METHODS: The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. RESULTS: Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. CONCLUSION: The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.

Comparison of Risk Scoring Systems to Predict the Outcome in ASA-PS V Patients Undergoing Surgery: A Retrospective Cohort Study.

Operative decision in American Society of Anesthesiology Physical Status (ASA-PS) V patient is difficult as this group of patients expected to have high mortality rate. Another risk scoring system in this ASA-PS V subset of patients can aid to ease this decision. Data of ASA-PS V classified patients between 2011 and 2013 years in a single hospital were analyzed in this study. Predicted mortality of these patients was determined with acute physiology and chronic health evaluations (APACHE) II, simplified acute physiology score (SAPS II), Charlson comorbidity index (CCI), Porthsmouth physiological and operative severity score for enumeration of mortality and morbidity (P-POSSUM), Surgical apgar score (SAS), and Goldman cardiac risk index (GCRI) scores. Observed and predicted mortality rates according to the risk indexes in these patients were compared at survivor and nonsurvivor group of patients. Risk stratification was made with receiver operator characteristic (ROC) curve analysis. Data of 89 patients were included in the analyses. Predicted mortality rates generated by APACHE II and SAPS II scoring systems were significantly different between survivor and nonsurvivor group of patients. Risk stratification with ROC analysis revealed that area under curve was 0.784 and 0.681 for SAPS II and APACHE II scoring systems, respectively. Highest sensitivity (77.3) is reached with SAPS II score. APACHE II and SAPS II are better predictive tools of mortality in ASA-PS V classified subset of patients. Discrimination power of SAPS II score is the best among the compared risk stratification scores. SAPS II can be suggested as an additional risk scoring system for ASA-PS V patients.

The effect of combined hyperbaric oxygen and iloprost treatment on the prevention of spinal cord ischaemia-reperfusion injury: an experimental study.

OBJECTIVES: Hyperbaric oxygen (HBO) has been shown to be effective in preventing neurological injuries in animal models of ischaemia, whereas iloprost (IL) prevents ischaemia-related mitochondrial dysfunction and reduces infarction size after focal cerebral ischaemia in animal models. The aim of the present study was to investigate the effect of combined HBO and IL treatment on spinal cord ischaemia-reperfusion (IR) injury by neurological, histopathological and biochemical methods in an experimental study. METHODS: Eighty New Zealand white male rabbits were randomly allocated into one of five study groups. The HBO group received a single session of HBO treatment and the IL group received an infusion of 25 ng/kg/min IL; the HBO + IL group received both HBO and IL and the control group received only 0.9% saline; the fifth group was the sham group. Levels of S100ß protein, neuron-specific enolase (NSE) and nitric oxide (NO) were measured at onset, at the end of ischaemia period and at the 24th and 48th hour of reperfusion. Physical activity was assessed using Tarlov criteria 24, and the spinal cords of the sacrificed rabbits were evaluated histopathologically. Additionally, tissue malondialdehyde (MDA) and antioxidant enzyme activities [total superoxide dismutase (SOD); catalase (CAT) and glutathione peroxidase (GSH-Px) were assessed. RESULTS: Neurological scores in the HBO, IL and HBO + IL groups were statistically significantly better compared with the control group at the 24th (P = 0.001 for all) and 48th hour (P = 0.001 for all). Histopathological scores in the HBO, IL and HBO + IL groups were also significantly better compared with the control group (P = 0.003, 0.001 and 0.001, respectively). Whereas MDA, NSE, S100ß protein and NO concentrations were significantly lower, CAT and GSH-PX levels were significantly higher in either sham or treatment groups compared with the control group. CONCLUSIONS: Since we demonstrated beneficial effects on spinal cord IR injury, we think that both HBO and IL, either alone or in combination, may be reasonable in the treatment of IR injury. Furthermore, there did not appear to be synergistic effects with combined treatment. More research is needed for practical application in humans, following thoracoabdominal aortic surgery.

Assessment of protective effects of pheniramine maleate on reperfusion injury in lung after distant organ ischemia: a rat model.

OBJECTIVE: The aim of this study is to investigate the protective effects of methylprednisolone (MP) and pheniramine maleate (PM) on reperfusion injury of lungs developing after ischemia of the left lower extremity of rats. MATERIALS AND METHODS: A total of 28 randomly selected male rats were divided into 4 groups, each consisting of 7 rats. Group 1 was the control group. Group 2 was the sham group (ischemia/reperfusion [I/R]). Rats in group 3 were subjected to I/R and given PM (Ph group) and rats in group 4 were subjected to I/R and given MP (Pn group). RESULTS: Malondialdehyde levels were significantly lower in Ph group than in I/R group (P < .05). Superoxide dismutase and glutathione peroxidase enzyme activities were found to be significantly higher in Ph group than in the I/R group (P < .05). Histological examination demonstrated that PM had protective effects against I/R injury. CONCLUSIONS: The PM has a protective effect against I/R injury in rat lung.

Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study.

BACKGROUND: The association between the infusion of continuous epidural anesthesia and the anastomotic strength of colonic anastomosis was examined in an animal model. METHODS: Fourteen white male New Zealand rabbits were included in the study and randomly assigned to two groups. Group 1 (n=7) had continuous epidural 0.9% NaCl infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion) and Group 2 (n=7) had continuous epidural 1% lidocaine infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion). Infusions started at the beginning of the operation and were continued for six hours postoperatively. All experimental animals underwent right colon resection and colo-colonic anastomosis under general anesthesia. On the fourth postoperative day, relaparotomy was applied and the bursting pressures of the anastomosis (BPA) were measured in situ. Segments 1-cm long consisting of the complete suture lines were excised, and the levels of hydroxyproline and collagen were measured. RESULTS: BPAs were statistically higher in the epidural lidocaine group (median: 248 mmHg; min 117 - max 300) than in the saline group (median: 109 mmHg; min 47 - max 176) (p=0.006). There was no difference between the groups in terms of hydroxyproline and collagen levels in the sample tissues (p>0.05). CONCLUSION: We concluded that the strength of colonic anastomosis may be increased by epidural lidocaine infusion.

Effect of cigarette smoking on the washout time of sevoflurane anesthesia.

BACKGROUND: Cigarette smoking affects the pharmacodynamic and pharmacokinetic behavior of many drugs and causes deterioration of pulmonary mechanics. We have evaluated the effect of cigarette smoking on washout time after one minimum alveolar concentration-h (1 MAC-h) of sevoflurane anesthesia. METHODS: We investigated the washout time of sevoflurane in 30 non-smoking and 30 healthy cigarette smoking (>/=20 cigarettes/day for>1 year) ASA I-II physical status patients, aged 18-63 years, who were candidates for otorhinolaryngologic elective surgery under 1MAC-h standardized sevoflurane anesthesia. At the end of the surgery, the sevoflurane vaporizer was turned off and the time taken for the sevoflurane concentration to decrease to MAC-awake (0.3) and 0.1 MAC levels were recorded. In addition, the ratio of the fractions of inspired concentration (Fi) and expired concentration of sevoflurane (Fexp) at 1 MAC and Fexp of sevoflurane at 0.1MAC were recorded. The patients were mechanically ventilated during the washout time. RESULTS: We found no difference between the 2 study groups with regard to washout time of sevoflurane. The times of 1MAC down to MAC-awake (106 +/- 48 sec in non-smokers vs 97 +/- 37 sec in smokers, p > 0.05) and down to 0.1MAC (491 +/- 187 sec in non-smokers vs 409 +/- 130 sec in smokers, p > 0.05) were similar. Similarly, there were no significant differences in the ratios of Fi/Fexp at 1MAC (1.18 in non-smokers vs. 1.19 in smokers, p > 0.05) and Fexp of sevoflurane at 0.1MAC (0.26 in non-smokers vs. 0.25 in smokers, p > 0.05). CONCLUSIONS: Washout time of 1MAC-h sevoflurane anesthesia is not appear to be effected by cigarette smoking in patients without significant pulmonary disease.

The relationship between vasopressor dose and anastomotic leak in colon surgery: an experimental trial.

BACKGROUND: The effect of vasopressors on the healing of gastrointestinal anastomoses is still controversial. The purpose of our study was to research the relationship between dose of dopamine, which is used generally as a vasopressor in shock status, and anastomotic leak in colonic surgery. METHODS: Forty-two male New Zealand rabbits were included in the study. Under general anesthesia, the right colon was identified, incised, and divided 5 cm distal to the ileocecal valve. Colonic integrity was then established with end-to-end anastomosis in all animals. The animals were randomized into 6 groups. While group 1 was not given any vasopressors, groups 2, 3, 4, 5, and 6 were administered 5, 10, 15, 20, and 25 microgkg(-1)h(-1) dopamine infusions, respectively, for 2h. On the 4th postoperative day, relaparotomy was performed under general anesthesia. The bursting pressures of anastomoses (BPA) were measured in situ, and then the lines of anastomoses were excised. The levels of hydroxyproline and collagen were measured in this tissue. RESULTS: When compared with the control group (140+/-39 mmHg), BPA were found to be statistically increased only in group 5 (238+/-91 mmHg) (p=0.03) and group 6 (277+/-64 mmHg) (p=0.002). There were no differences between groups in terms of the hydroxyproline and collagen levels in the tissue (p>0.05). CONCLUSIONS: Although vasopressors appeared to increase the risk of anastomotic leakage as a result of splanchnic vasoconstriction, deterioration of microcirculation, and local hypoxia, we found that BPA were increased with high doses of vasopressor. We speculated that the use of vasopressors without shock might increase blood supply to the anastomotic line by increasing cardiac output.