Relationships between Interleukin 18 -607 C/A and -137 G/C, Osteopontin -9250 C/T Genetic Polymorphisms and Systemic Inflammatory Response Syndrome in Coronary Artery Bypass Graft Surgery.

Background and Objectives: Systemic inflammatory response syndrome (SIRS) is one of the most significant complications after on-pump heart surgery procedures. High cytokine levels have been shown after open-heart surgeries and a genetic predisposition seems to be an important underlying modulatory characteristic for SIRS. To investigate the association between interleukin 18 -607 C/A, interleukin 18 -137 G/C and osteopontin 9250 C/T genetic polymorphisms and SIRS in on-pump CABG patients. Materials and Methods: Two hundred consecutive elective on-pump CABG patients were recruited prospectively to the study. Genomic DNA was extracted from whole blood and genotyping was determined by sequence specific PCR or PCR-RFLP methods for related polymorphisms. Results: SIRS incidence was 60.2%, 38.1%, 18.9% on postoperative day 1, 2 and 3, respectively, in the whole study population. The SIRS rate on the second postoperative day was 13% and 43.4%, respectively, in osteopontin 9250 C/T T allele non-carriers and carriers (p = 0.004). WBC (White Blood Cell) counts were higher on day 2 and 3 in osteopontin 9250 C/T T allele carriers compared to non-carriers (day 2; 12.7 ± 4 vs. 10.5 ± 2.4 (p = 0.015), day 3; 11.8 ± 4 vs. 9.1 ± 4.7 (p = 0.035)). The average ICU stay was 3.1 ± 7.4, 1.28 ± 0.97 for IL 18-137 G/C C allele carriers and non-carriers, respectively (p = 0.003), and in the IL 18-137 G/C C allele carriers, SIRS developed in 42.2% by the second postoperative day whereas the rate was 57.8% in non-carriers (p = 0.025). Conclusions: The current research revealed a possible link between osteopontin 9250 C/T and IL18-137 G/C genetic polymorphism and SIRS and morbidity in on-pump CABG patients.

Dextrose administration may reduce the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double blind randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is the most common and undesirable of the complications associated with anesthesia, leading to discomfort in patients and extended hospital stays. The present study evaluates and compares the effects of preoperative/intraoperative dextrose infusion on PONV in patients undergoing laparoscopic cholecystectomy (LC). METHODS: This prospective, double-blind, randomized controlled study included 93 ASA I-II LC patients who were divided into three groups. Group P received a 10 mL/kg/h rate 5% Dextrose infusion, applied preoperatively for 30 minutes, followed by the same infusion rate of Ringer's lactate until the end of surgery. Group I received a 10 mL/kg/h rate of Ringer's lactate preoperatively for 30 minutes and the same infusion rate of 5% Dextrose during the operation. The control group (Group C) received a Ringer's lactate solution infusion in the pre- and intraoperative periods at a rate of 10 mL/kg/h. The demographic data, PONV, hemodynamic variables, pain scores, blood glucose (BG) values, and antiemetic and analgesic requirements of the participants were recorded. RESULTS: Preoperative BG values were similar in all groups, whereas intraoperative and postoperative BG levels were higher in Group P and Group I, respectively (P=0.020, P=0.010) than in Group C. The incidence of PONV was decreased in groups P and I (38.7% and 25.8%, respectively) compared to Group C (P=0.015). The antiemetic postoperative drug usage for 6 hours was significantly lower in Group P (P=0.005). CONCLUSIONS: Preoperative dextrose infusion may be suggested for PONV prophylaxis as a safe and effective method following LC.

Preliminary investigation of preoperative pregabalin and total intravenous anesthesia doses: a randomized controlled trial.

STUDY OBJECTIVE: To determine the efficacy of 2 different doses (150-300mg) of preoperative pregabalin on propofol and remifentanil doses for total intravenous anesthesia in laparoscopic cholecystectomy. DESIGN: Prospective, randomized, placebo-controlled, double-blinded study. SETTING: Training and research hospital. PATIENTS: Forty-eight adult, American Society of Anesthesiologists physical status 1 and 2 patients. INTERVENTIONS: Patients were randomly assigned to 3 groups to receive orally 1hour before surgery, a placebo group (group 1), pregabalin 150mg (group 2), or pregabalin 300mg (group 3). MEASUREMENTS: In the operating room, heart rate, systolic and diastolic blood pressures, SpO2, bispectral index, and body temperature were recorded just before anesthesia induction; 1 and 5minutes after induction; and at minutes 10, 15, 20, 25, 30, 35, and 40 of the surgery. Required propofol and remifentanil doses to obtain bispectral index value less than 60 were also recorded. MAIN RESULTS: The remifentanil doses used in the pregabalin groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15, 20, 25, and 30 were statistically significantly lower in comparison to the placebo group. CONCLUSION: The observations provide preliminary evidence that preoperative pregabalin may decrease anesthetic agent requirement in total intravenous anesthesia patients.

Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C.

OBJECTIVE: Numerous studies have indicated nephrotoxic effects of sevoflurane because of its two bioproducts compound A and fluoride. Cystatin C (CyC) is a more sensitive biomarker than creatinine to show early and mild changes in kidney function. We designed this prospective randomised study to compare the effects of low-flow sevoflurane anaesthesia and low-flow desflurane anaesthesia on renal functions based on CyC levels. No studies have evaluated the effects of low-flow sevoflurane anaesthesia on renal functions based on CyC levels to date. METHODS: Thirty American Society of Anesthesiologists (ASA) physical status I-II patients who were scheduled for urological procedures were enrolled in this study. The patients were randomly assigned to 2 groups: low-flow sevoflurane anaesthesia or low-flow desflurane anaesthesia. Serum urea, creatinine and CyC levels were measured before the operation, just before extubation and 24 h after the operation. Creatinine clearance was calculated in the first 24-h urine sample. RESULTS: There were no significant differences in serum urea, creatinine and CyC levels or 24 h creatinine clearance between the groups. CONCLUSION: Our study demonstrates with a more sensitive biomarker, CyC, that low-flow sevoflurane anaesthesia is safe in terms of the effects on renal function.

A randomized, placebo-controlled study of pregabalin for postoperative pain intensity after laparoscopic cholecystectomy.

STUDY OBJECTIVE: To determine the efficacy of two different doses (150 mg and 300 mg) of preoperative pregabalin on pain relief and total opioid consumption after laparoscopic cholecystectomy. DESIGN: Prospective, randomized, placebo-controlled, double-blinded study. SETTING: Training and research hospital. PATIENTS: 90 adult, ASA physical status 1 and 2 patients. INTERVENTIONS: Patients were randomly assigned to three groups to receive orally one hour before surgery, a placebo (Group 1), pregabalin 150 mg (Group 2), or pregabalin 300 mg (Group 3). Patients were observed for pregabalin side effects, somnolence via Ramsay Sedation Scale, dizziness, confusion, and ataxia. MEASUREMENTS: In the operating room, heart rate and noninvasive systolic and diastolic blood pressures were measured. Visual analog scale (VAS), Ramsay Sedation Scale, and Aldrete scores were also recorded on arrival at the Postanesthesia Care Unit (time 0), 15, 30, 60, 120 minutes and 3, 4, 6, 8, 10, 12 and 24 hours after surgery. Additional doses of drugs (fentanyl and/or metoclopramide) were also recorded. MAIN RESULTS: Preemptive pregabalin decreased pain scores and postoperative fentanyl consumption in patients after laparoscopic cholecystectomy in a dose-dependent manner. There were no differences between the groups in side effects. CONCLUSION: Preoperative pregabalin may be a useful analgesic for patients after laparoscopic cholecystectomy, as it lowers pain intensity and opiod consumption, and does not increase the frequency of side effects.

A comparison of the effects of desflurane and isoflurane on rat pulmonary parenchyme histopathology and malondialdehyde levels.

OBJECTIVE: To evaluate the lipid peroxidation and pulmonary histopathology after desflurane and isoflurane anaesthesia in rats. METHODS: The study was conducted in the faculty of Veterinary.Medicine Animal Laboratories, Ankara University, between January and December 2009. Twenty-four Wistar-Albino rats were studied and classified randomly into three equal groups. The control group (n=8) was made to inhale 50% O2 for 60 minutes; the isoflurane group (n=8) received 50% O2+1.2% isoflurane for 60 minutes; and the desflurane group (n=8) was given 50% O2+6% desflurane, again for 60 minutes. As the sham group, one rat was sacrificed via intracardiac blood aspiration. Rat pulmonary tissue parenchyma samples were evaluated for peribronchial inflammatory infiltration, alveolar septal infiltration, alveolar oedema, exudation, alveolar histiocyte and tissue malondialdehyde levels. RESULTS: When compared with the control group, peribronchial inflammatory infiltration levels were found to be considerably high in the desflurane and isoflurane groups (p= 0.0031). In addition, the alveolar hystiocytes were much higher in the desflurane group than in the control group (p<0.05). Tissue malondialdehyde levels were found to be significantly higher in both groups than in the control group. CONCLUSION: Desflurane significantly increased pulmonary inflammation more than isoflurane in rat pulmonary parenchyma that indicates an inflammatory response. Besides, it was determined that the significantly higher malondialdehyde levels in both the desflurane and the isoflurane groups resulted in an increase in the membrane lipid peroxidation via volatile anaesthetics.

The role of the ADRA2A C1291G genetic polymorphism in response to dexmedetomidine on patients undergoing coronary artery surgery.

The existence of interindividual drug response variability has been known for a long time. Individual susceptibility which might cause toxicity or inadequate treatment is important in drug therapy. Genetic polymorphisms in genes responsible for drug response are expected to be useful in keeping track of differences among individuals. Dexmedetomidine is a sedative drug, whose use in intensive care unit patients was confirmed by USA-Food Drug Administration (FDA) by the end of 1999. It was proven that dexmedetomidine shows its clinic effect via the α(2)-AR. However, to the best of our knowledge, to date, there is no investigation in clinic indicating the relation between dexmedetomidine and α(2A)-AR gene polymorphism. The aim of our study was to investigate the association between the effect of α(2A)-Adrenergic Receptor (ADRA2A) C-1291G gene polymorphism in the promoter region of the candidate gene and clinical effects (sedative and haemodynamics effects) of dexmedetomidine. One hundred and ten patients undergoing coronary artery surgery were prospectively studied. Anesthetic technique was standardized with fentanyl, midazolam and rocuronium bromide. Patients were monitorized with Bispectral Index (BIS) monitor in addition to the routine invasive haemodynamic monitorization in the operation room. The Ramsay Sedation Scale was also used in order to determine the sedation level just arriving to Intensive Care Unit (ICU). The genotyping of ADRA2A C1291G was done by Restriction Fragment Length Polymorphism-Polymerase Chain Reaction (RFLP-PCR). We found the frequencies of C1291C, C1291G and G1291G genotypes, as 43.6, 45.5 and 10.9%, respectively. Patients who carry variant genotype had higher BIS and Ramsay Sedation Scores, indicating a longer period for falling asleep. The results of our study are promising, considering the association between ADRA2A polymorphism and response to dexmedetomidine. However, further investigations on other ADRA2A locus or haplotypes might be useful to clarify the relation between this gene and dexmedetomidine activity.

[Postoperative pain therapy after laparoscopic cholecystectomy: paracetamol versus diclofenac]. / Laparoskopik kolesistektomilerde cerrahi sonrasi agri tedavisi: Parasetamol ile diklofenak karsilastirmasi

OBJECTIVES: Laparoscopic cholecystectomy is the first treatment choice for symptomatic gallstone disease. We compared the efficacy of intravenous (i.v.) paracetamol and intramuscular (i.m.) diclofenac Na(+) after laparoscopic cholecystectomy. METHODS: Following approval from the Local Ethics Committee and receipt of written informed consent, 40 ASA physical status I-II patients who underwent laparoscopic cholecystectomy were enrolled into the study. General anesthesia was standardized. The patients received 1 g i.v. Paracetamol (Group I, n: 20) or 75 mg diclofenac Na+ i.m. (Group II, n: 20) 15 minutes (min) before the end of the operation. Pain was assessed by numeric rating scale (NRS) after arrival in the postanesthesia care unit (PACU) (NRS 1) and at the 30th minute (NRS 2) and 1st hour (NRS 3) of the PACU stay. 10 mg i.v. Pethidine HCL was administered to the patient with NRS >5. The following measures were recorded: intensity of pain by NRS at arrival and after 30 and 60 min, total consumption of pethidine HCL, and nausea and vomiting. RESULTS: All assessments were performed by an anesthesiologist blinded to the study protocol. NRS 3 scores were significantly higher in Group I than Group II (p<0.05). Opioid consumption was not different between the groups. Two patients in each group had postoperative nausea and vomiting; no other adverse effects were noted. CONCLUSION: We recommend the use of i.v. Paracetamol as an opioid adjuvant. Regarding its use as a unique drug for postoperative pain therapy, further comparative studies with higher doses of paracetamol are needed.

Tracheostomy: how and when should it be done in cardiovascular surgery ICU?

BACKGROUND: The aim of this study was to assess the effect of timing and techniques of tracheostomy on mortality and morbidity in cardiovascular surgery patients. METHODS: Between January 2000 and October 2007, a total of 19,559 cardiac and vascular operations were performed in our hospital, and 205 of these patients (1.04%) who underwent a tracheostomy procedure were included in this retrospective study. RESULTS: Surgical tracheostomy (ST) was employed in 134 (65.4%) and percutaneous tracheostomy (PT) in 71 (34.6%) of the cases. There were 17 complications related to all tracheostomy procedures in 15 (7.3%) patients. Bleeding, requiring surgical intervention, occurred in five (3.7%) ST patients and in one (1.4%) PT patient. Cardiac arrest related to the procedure occurred in two (1.5%) ST patients. Pneumothorax occurred in three (2.2%) ST patients and in one (1.4%) PT patient, subcutaneous emphysema in three (2.2%) ST patients and in one (1.4%) PT patient, and tracheoesophageal fistula in one (0.7%) ST patient (p>0.05). The postoperative infection rate was significantly lower, and cooperation of the patients, postoperative patient mobilization, and oral feeding rates were higher in the early tracheostomy group. The multifactorial mortality rates of early (

Release of alpha-glutathione S-transferase (alpha-GST) and hepatocellular damage induced by Helicobacter pylori and eradication treatment.

Helicobacter pylori (H. pylori) is a gram negative, spiral, microaerophylic bacterium that infects the stomach of more than 50% of the human population worldwide. H. pylori is well recognized as a critical factor in the majority of patients with peptic ulcer disease and successful treatment results in cure of the disease. On the other hand, H. pylori infection has been associated with several extra-intestinal diseases such as hepatic encephalopathy. In this study, a triple treatment was used in management and eradication of H. pylori infection. We hypothesized that H. pylori infection and/or eradication treatment increased the releasing of alpha-glutathione S-transferase (alpha-GST). We also investigated whether alpha-GST is a more sensitive marker than aminotransferases (traditional liver function tests) for hepatocellular damage. However, we did not find any association between both H. pylori infection and eradication treatment and alpha-GST levels. According to our data, eradication treatment did not cause hepatocellular damage.