Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress.

OBJECTIVE: To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy. MATERIALS AND METHODS: Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. RESULTS: Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. CONCLUSIONS: Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.

Protective effect of ebselen on experimental testicular torsion and detorsion injury.

Ebselen is used as a drug in clinical trials against stroke, reperfusion injury with anti-atherosclerotic and renoprotective effects. The aim of this study is to investigate the protective effect of ebselen, on torsion/detorsion (T/D)-induced biochemical and histopathological changes in experimental testicular ischaemia/reperfusion injury. A total of 28 male Wistar Albino rats were divided into four groups: group 1(sham-operated group, n = 7), group 2(ebselen group, n = 7), group 3(torsion/detorsion + saline, n = 7) and group 4(T/D + 10 mg kg(-1) ebselen group, n = 7). The tissue homogenate samples were used for immediate nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase, catalase and glutathione measurement. Testes in all groups were evaluated for the biochemical assay and histopathological examinations. To evaluate spermatogenesis, Johnsen scoring system was used. Testicular tissue MDA and NO levels in group 3 were significantly higher than in group 1 and 4. In histological evaluation of the testicular tissues, ebselen administration improved tubular histology significantly compared with T/D group. Significant increase in histological score was observed in the testis of group 3 compared with group 1 and 2. Histological score in group 4 significantly decreased compared with group 3. Johnson score was significantly lower in T/D group compared with all other three groups, ebselen administration increased the score significantly compared with T/D group. Ebselen reduced oxidative biochemical and histopathological damage in our testicular T/D rat model.

Anaesthetic Management of Anaphylactic Shock Caused by Nonruptured Hydatid Cyst of the Liver.

Hepatic hydatid cyst (HC) caused by Echinococcus granulosus is still endemic in many parts of the world, and it is a common health problem, especially in developing countries. The rupture of the HC can cause anaphylactic shock or even death during surgical treatment. We present a case report regarding anaphylactic reaction due to surgery to the liver for HC which has an aberrant venous drainage incidentally detected during surgical operation in a 50-year old female patient. She was successfully treated with adrenaline, antihistamines, steroids, colloid or crystalloid fluids. After the surgery, she was transferred from the intensive care unit to the surgical ward on the first postoperative day. The possibility of anaphylaxis should be kept in mind; despite all the precautionary measures, nonrupture of the hydatic cyst and absence of spillage of the cyst to the circulation or into the surrounding tissues, anaphylaxis can still occur. Therefore, close monitoring for early diagnosis and appropriate management of anaphylaxis are essential to stabilize the patient and produce the best outcome.