Serum levels of magnesium and their relationship with CRP in patients with OSA.

BACKGROUND: Low levels of magnesium (Mg) are associated with chronic inflammatory stress. Some animal studies have reported that a moderate deficiency of Mg, similar to that which occurs in humans, may increase inflammatory or oxidative stress stimulated by other factors, such as disrupted sleep or sleep deficiency. PURPOSE: This cross-sectional study evaluated the relationship between serum levels of Mg and the inflammatory response in patients with a new diagnosis of obstructive sleep apnea (OSA). METHODS: This clinical, retrospective study registered 68 patients with newly diagnosed mild to severe OSA and 30 without OSA. The Apnea-Hypopnea Index (AHI), oxygen desaturation index (ODI), time until blood hemoglobin oxygen saturation <90 % (SpO2 <90 %), and mean blood hemoglobin SpO2 were measured. Serum levels of Mg, plasma C-reactive protein (CRP), and total sleep time (TST) by polysomnography were also measured. RESULTS: Mg levels were lower in patients with OSA than those in controls matched for age, sex, and body mass index (BMI). Patients with OSA had substantially higher plasma CRP concentrations than controls. A negative correlation was observed between the AHI and ODI and Mg levels. Significant differences in Mg and CRP levels were observed between patients with AHI scores of 5-15 and scores ≥30 based on OSA severity but independent of BMI. Furthermore, the AHI, ODI, TST <90 %, and mean SpO2 significantly correlated with CRP. A significant negative correlation was observed between Mg and CRP levels (p < 0.0001). CONCLUSION: Our results show that Mg levels changed depending on the presence and severity of OSA. Low levels were associated with a higher CRP concentration in patients with OSA.

The effect of desflurane on postoperative olfactory memory.

OBJECTIVE: In this study, we investigated the effects of desflurane 6%, on olfactory memory. PATIENTS AND METHODS: This is a prospective clinical study performed with 40 patients aged 18-60 who had elective surgery and American Society of Anesthesiologists (ASA) physical status I-III. The Brief Smell Identification Test (BSIT) was used for evaluating patients' olfactory memories before and after the surgery. Patients received standard general anesthesia protocol and routine monitoring. For induction, 1.5 mg/kg of fentanyl, 2 mg/kg of propofol, and 0.5 mg/kg of rocuronium bromide were administered. Anesthesia was maintained with the inhalational of anesthetic desflurane (6%). The scores are recorded 30 minutes before the surgery and when the Aldrete Recovery Score reached 10 in the postoperative period. Preoperative and postoperative results were compared and p-values <0.05 were considered statistically significant. RESULTS: The patients' mean age was 41.1±12.0. Preoperative total correct answer rate to odorous substances was 92.7%, and postoperative rate was 92.1%. Percentage of the odor substance identification by the patients revealed no statistically significant difference when pre and post-operative rates have been compared (p-value >0.05). CONCLUSIONS: We have observed for the first time in the literature that general anesthesia using desflurane (6%) did not affect short-term olfactory memory. Further studies will be necessary to confirm our findings with larger sample size.

Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection.

OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36ºC) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46±0.39; postop 35.68±0.59, paired sample t-test, p<0.001). Also in all patients, postoperative QTc dispersions were found to be significantly longer than the preoperative QTc dispersions (preop 59.66±32.69; postop 74.57±37.47 ms, p<0.05). When we divided the patients; hypothermic and normothermic, postoperative QTc dispersions were significantly different between two groups (68.23±33.43 ms, and 83.20±41.50 ms; p=0.009). CONCLUSIONS: The prevalence of inadvertent intraoperative hypothermia in patients undergoing transurethral resection is relatively high. QTc dispersion of mild hypothermic patients was significantly longer than normothermic patients'.

Relationship between red cell distribution width levels and severity of coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries. Inflammation is thought to be important in the pathogenesis of CAE. Red blood cell distribution width (RDW) is also an inflammatory marker. In this study, we examined the association between RDW levels and CAE severity. PATIENTS AND METHODS: A total of 6737 patients who were admitted to the Cardiology Clinic of our hospital between January 2010 and December 2015 and diagnosed with coronary artery disease (CAD) were evaluated for inclusion. Of them, 126 patients who had CAE as a result of retrospective scanning, 104 randomly selected patients with CAD, and 76 patients who had normal coronary arteries were included in the study (n = 306). RESULTS: The severity and prevalence of CAE were evaluated according to the Markis ectasia classification, and the RDW value for type 1 CAE was significantly higher than that of other types of CAE. The RDW values for types 1-4 were 19.48 ± 11.81, 15.26 ± 9.17, 15.51 ± 8.07, and 15.33 ± 7.26, respectively (p= 0.098; r = 0.114). CONCLUSIONS: High RDW values are associated with CAE and CAD, and correlate with the severity of CAE. These findings indicate that RDW values can be used to estimate the severity of CAE disease.

Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy.

BACKGROUND AND STUDY AIMS: In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption. MATERIALS AND METHODS: A totally 60 patients were enrolled in the study. Propofol group (Group 1): A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70-75 was achieved. RESULTS: In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed. CONCLUSIONS: The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.

Lower recurrence rate with full-thickness mesh fixation in incisional hernia repair.

PURPOSE: To share the lower recurrence rate achieved during long-term follow-up by repairing incisional hernias (IHs) with full-thickness fixation of onlay mesh. METHODS: We retrospectively analyzed 196 IH cases operated on by the same surgeon between 2002 and 2013. After exclusions (unrelated death, lack of follow-up), 154 cases were included. Abdominal examination findings, recurrence dates (if accessible), and imaging results were obtained from computer records and evaluated. Intraoperatively, all hernial sac adhesions were separated to reveal the anterior abdominal wall, and full-thickness suspension sutures were placed 6-8 cm lateral to the fascial edge at 2-cm intervals, excluding the peritoneum. The primary fasciae were closed, suspension sutures were passed through the mesh holes, and the mesh was fixed as an onlay, leaving no space between the fasciae. RESULTS: In total, 154 subjects with IHs were analyzed: 107 (69.5%) females and 47 (30.5%) males. The mean patient age was 52.60 years [standard deviation (SD) 11.24 years], and the mean fascial defect diameter was 77 cm(2). The average operation time was 128 min (SD 42.5 min), and the average patient follow-up time was 54 months (SD 22.8 months). Eight (5.2%) patients developed recurrences after full-thickness mesh fixation, and ten subjects (6.5%) had persistent pain in the operative area for longer than 3 months. CONCLUSIONS: Full-thickness mesh fixation mechanically supports the fascia, especially in the early postoperative period, and enables homogeneous fibrous healing in a wide area, preventing mesh migration; we believe that these attributes are crucial in reducing the IH recurrence rate.

A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension.

BACKGROUND: The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine. METHODS: Patients with essential hypertension who were under ≤ 65 years old, scheduled for elective surgery with a Mallampati score of I-II were included in the study. Patients were randomly divided into three groups; group M (n = 20) received magnesium sulfate, group L was prescribed lidocaine, and group C (control group) received saline. Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation. RESULTS: There were no statistically significant differences between the groups in terms of age, sex and demographic characteristics. There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups. In group M, QTd values were significantly lower at the first and fifth minutes than before induction. There were no statistically significant differences in QTd values at different times in group L and group C. CONCLUSION: QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.

Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial.

OBJECTIVES: When added to local anaesthetics, dexamethasone can prolong the duration of peripheral blocks. Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. The aim of this study was to determine the effect of dexamethasone on the block duration added to levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. PATIENTS AND METHODS: Forty-two patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I-II risk group were included in the study and divided into two groups. Bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl for the levobupivacaine group and bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone (8 mg) for the dexamethasone group were administered in a TAP block performed with ultrasonography. The time need for the first analgesic in the postoperative period was recorded. The numeric evaluation scale, and the total additional analgesic amounts were recorded. RESULTS: The time before the administration of the first additional analgesic dose was prolonged significantly in the dexamethasone group compared to the levobupivacaine group (p = 0.004). The pain scores were lower in the dexamethasone group for superficial pain. A significant difference for the dexamethasone group was observed in the evaluation of deep pain. The total consumption of tramadol was significantly lower in the dexamethasone group (p = 0.001). CONCLUSIONS: The utilization of dexamethasone, which has a prolonging effect on the transversus abdominis plane block, may be an alternative to epidural opioid analgesia in caesarean section. We observed that dexamethasone added to levobupivacaine in a TAP block applied for analgesia following a caesarean section procedure prolonged the time required for analgesia.

Evaluation of the olfactory memory after spinal anesthesia: a pilot study.

BACKGROUND: The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT). PATIENTS AND METHODS: This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked. RESULTS: Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05). CONCLUSIONS: We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware?

BACKGROUND: The gynecological laparoscopic surgery requires pneumoperitoneum (PP) with CO2 gas insufflation. CO2 PP may influence cardiac automic function (CAF). This study was conducted to assess its significance and the prolonged effects of CO2 PP on the activity of the cardiac autonomic function 24 hours after the operation by heart rate turbulence (HRT) and heart rate variability (HRV), first time in the literature. PATIENTS AND METHODS: Fifty patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with midazolam, propofol, fentanyl, rocuronium, and sevoflurane was administered. ECG recordings were carried out between before 4 h from surgery and the beginning of anesthesia (T1), induction of PP and CO2 evacuation (T2) and a 24-h period postoperatively (T3). The Holter recordings of all patients were analyzed by HRT and HRV. RESULTS: There were significant reductions in in HRV and HRT parameters peri-op period compared to the pre-op values (p < 0.05). In the first 3 h of post-op period, were calculated all HRT and some HRV (SDNN, LF) parameters were also found to be significantly reduced than the values of pre-op period (p < 0.05). CONCLUSIONS: This study described adverse effects of CO2 PP on cardiac autonomic regulation in the early postoperative period according to the long-term HRV and HRT frequency analysis, for the first time in the literature. The early postoperative monitorization may supply efficacious information for arrhythmic complications.

Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. METHODS: We assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300 mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80). RESULTS: CIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43 mg/dL [1.1-4.15 mg/dL] to 1.35 mg/dL [0.7-4.15 mg/dl] at 48 h and to 1.27 mg/dL [0.66-4.37 mg/dL] at 4 days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48 mg/dL [1.1-2.96 mg/dL] to 1.43 mg/dL [0.73-3.02 mg/dL] and to 1.45 mg/dL [0.86-3.71 mg/dL] (p=0.045 and p=0.57, respectively) 48 h and 4 days after radiocontrast administration. CONCLUSIONS: Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.

Low serum bilirubin concentrations are associated with impaired aortic elastic properties, but not impaired left ventricular diastolic function.

Elevated serum bilirubin concentrations protect from atherosclerotic diseases; however,it is not clear whether higher serum bilirubin concentrations in physiological ranges do the same. To investigate the association of high and low serum bilirubin concentrations with left ventricular diastolic function and aortic elastic properties.We evaluated left ventricular diastolic function and aortic elastic properties of 42 healthy subjects with hypobilirubinemia (total bilirubin 0.40 ± 0.08 mg / dl; mean age 37.0 ± 3.9) and 40 healthy subjects with hyperbilirubinemia (total bilirubin 1.56 ± 0.49 mg / dl; mean age 36.2 ± 6.0) using transthoracic second harmonic Doppler echocardiography. Age, gender, body mass index and coronary risk factors were similar between the groups, except high-sensitivity C-reactive protein (hsCRP).Left ventricular diastolic parameters were similar between the two groups. Aortic distensibility (AoD) was found to be significantly lower (11.1 ± 3.9 vs. 13.2 ± 4.9,p = 0.03) and aortic stiffness index (AoSI) (1.99 ± 0.30 vs. 1.85 ± 0.26,p = 0.02) and elastic modulus (AoEM) (2.06 ± 0.83 vs. 1.73 ± 0.68, p = 0.03;the low and high bilirubin groups, respectively) higher in the low bilirubin group.Serum total bilirubin concentration correlated with hsCRP levels, AoD, AoSI and AoEM. In conclusion, left ventricular systolic and diastolic functions were similar between hypo- and hyperbilirubinemic subjects, but aortic elastic properties were impaired in subjects with lower serum bilirubin concentrations.

Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults.

Although uric acid (UA) is considered as an antioxidant, the relationship between serum UA levels and cardiovascular diseases is not clear yet. Higher brachial artery resting diameter (BD), impaired brachial artery flow-mediated dilatation (FMD), increased carotid intima-media thickness (IMT), decreased aortic distensibility (AoD), and increased aortic stiffness index (AoSI) and elastic modulus (AoEM) are predictors for development and/or progression of atherosclerosis. In this study, BD, FMD, carotid IMT, AoD, AoSI and AoEM were studied in healthy subjects with UA concentrations in physiological range. One hundred 24 healthy volunteers between 26 and 55 years of age were included in this study. Each subject had a serum UA levels in normal range. Carotid IMT, BD and brachial FMD were measured by means of high-resolution vascular ultrasound. AoD, AoSI, AoEM were examined by transthoracic echocardiography. Endothelium-dependent dilatation (EDD) was assessed by establishing reactive hyperemia and endothelium-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate. Although carotid IMT and EDD were significantly correlated with UA concentrations (r = 0.346, p < 0.0001; r = -0.255, p < 0.05, respectively), EID measurements were not significantly correlated with serum UA concentrations (r = - 0.105, p > 0.05). In addition, AoSI and AoEM were significantly correlated with serum UA levels (r = 0.368, p < 0.0001; r = -0.366, p < 0.0001, respectively), and there was a significant inverse correlation between AoD and serum UA concentrations (r = -0.366, p < 0.0001). Furthermore, in multivariate analysis, we found that serum UA concentrations were correlated with increased carotid IMT, reduced FMD and increased aortic stiffness independent of other cardiovascular risk factor (beta = 256, p = 0.002; beta = -193, p = 0.03; beta = 0.295, p < 0.0001, respectively). In healthy subjects, increased serum UA concentrations, even in physiological range, are a risk factor for increased carotid IMT, reduced FMD and increased aortic stiffness independent of other cardiovascular risk factor, and other factors related to the metabolic syndrome.