Comparison of hemodynamic responses and QTc intervals to tracheal intubation with the McGRATH MAC videolaryngoscope and the Macintosh direct laryngoscope in elderly patients.

Our hypothesis was that intubations with the McGRATH MAC videolaryngoscope in elderly patients would produce less hemodynamic responses and ECG changes than the Macintosh direct laryngoscope. The patients were divided into two groups: patients who were intubated using the McGRATH MAC (Group V, n = 45) and patients who were intubated using the Macintosh direct laryngoscope (Group L, n = 45). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR) were recorded before induction with anesthesia (baseline), immediately after induction and at 1 min, 3 min, and 5 min after intubation, with simultaneous ECG. When Group L was compared to Group V, there was an increase in the first, third and fitth minutes after intubation in terms of HR. SBP, MAP increased only at 1 min after intubation and DBP increased in the first and third minutes after intubation in Group L. In Group L, there was a significant difference in the HR values immediately after induction and the first minute after intubation compared with the baseline values. There was a difference in the SBP values immediately after induction and at 3 min and 5 min after intubation compared with the baseline values. There was a difference in DBP and MAP values immediately after induction and at 5 min after intubation. When the McGRATH MAC videolaryngoscope was compared with the Macintosh direct laryngoscope in elderly patients, the McGRATH MAC videolaryngoscope decreased the hemodynamic fluctuations due to tracheal intubation.

A mitochondrial neurogastrointestinal encephalomyopathy with intestinal pseudo-obstruction resulted from a novel splice site mutation.

Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is an autosomal recessive disorder characterized by gastrointestinal dysmotility, cachexia, ptosis, peripheral neuropathy and leukoencephalopathy. The diagnosis is often not made until 5-10 years after the onset of symptoms. MNGIE is caused by mutations in thymidine phosphorylase gene TYMP. Here, we present a 19-year-old boy with MNGIE who had a chronic intestinal pseudo-obstruction, and we describe his family history. Genetic analysis revealed a novel homozygous c.765+1G>C intronic mutation which is expected to disrupt splicing of TYMP in the patient. Family screening revealed that the brother was also affected and the mother was a carrier. MNGIE should be considered and genetic testing instigated if individuals with cachexia have neuromuscular complaints or symptoms of chronic intestinal pseudo-obstruction.

Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study.

BACKGROUND: Transversus abdominis plane (TAP) block provides effective postoperative analgesia after abdominal surgeries. It can be also a useful strategy to reduce perioperative opioid consumption, support intraoperative hemodynamic stability, and promote early recovery from anesthesia. The aim of this prospective randomized double-blind study was to assess the effect of subcostal TAP blocks on perioperative opioid consumption, hemodynamic, and recovery time in living liver donors. METHODS: The prospective, double-blinded, randomized controlled study was conducted with 49 living liver donors, aged 18-65 years, who were scheduled to undergo right hepatectomy. Patients who received subcostal TAP block in combination with general anesthesia were allocated into Group 1, and patients who received general anesthesia alone were allocated into Group 2. The TAP blocks were performed bilaterally by obtaining an image with real-time ultrasound guidance using 0.5% bupivacaine diluted with saline to reach a total volume of 40 mL. The primary outcome measure in our study was perioperative remifentanil consumption. Secondary outcomes were mean blood pressure (MBP), heart rate (HR), mean desflurane requirement, anesthesia recovery time, frequency of emergency vasopressor use, total morphine use, and length of hospital stay. RESULTS: Total remifentanil consumption and the anesthesia recovery time were significantly lower in Group 1 compared with Group 2. Postoperative total morphine use and length of hospital stay were also reduced. Changes in the MAP and HR were similar in the both groups. There were no significant differences in HR and MBP between groups at any time. CONCLUSIONS: Combining subcostal TAP blocks with general anesthesia significantly reduced perioperative and postoperative opioid consumption, provided shorter anesthesia recovery time, and length of hospital stay in living liver donors.

Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam.

BACKGROUND: The study aim was to compare the efficacy of dexmedetomidine vs midazolam for sedation during the early postoperative period in adolescents who underwent scoliosis surgery. METHODS: We performed a prospective, randomized trial in an intensive care unit (ICU) in a tertiary care center. In this study, 42 patients (American Society of Anesthesiology physical status I and II) who underwent scoliosis surgery were divided into two groups according to sedation protocols: group dexmedetomidine (DEX) (n = 22) and group midazolam (MDZ) (n = 20). Adolescents (12-18 years) requiring mechanical ventilation underwent a continuous infusion of either dexmedetomidine (group DEX; starting dose, 0.4 µg·kg(-1) ·h(-1)) or midazolam (group MDZ; starting dose, 0.1 mg·kg(-1) ·h(-1)) with intermittent fentanyl, as needed. The efficacy of sedation was assessed using the Richmond Agitation Sedation Scale (RASS). Quality of pain relief was measured using the Numeric Visual Analog Scale (NVAS). Delirium was determined in patients in the RASS range of -2 to +1 using the Confusion Assessment Method for the ICU (CAM-ICU). Fentanyl consumption, incidence of delirium, NVAS scores, and hemodynamics were recorded postoperatively at 2, 4, 6, and 24 h in the ICU. RESULTS: The NVAS pain scores and fentanyl consumption at all the evaluation time points were significantly higher in group MDZ than those in group DEX (P < 0.05). Further, total fentanyl consumption in group MDZ was significantly higher than that in group DEX (P < 0.05). Delirium was significantly higher in the group MDZ than that in group DEX (31.3% vs 12.5%) when analyzed as the endpoint of CAM-ICU (P < 0.05). The heart rate was significantly lower in group DEX compared with that in group MDZ at all the evaluation time points (P < 0.05). CONCLUSION: Dexmedetomidine was associated with the decreased postoperative fentanyl consumption, NVAS scores, and a decreased incidence of delirium. These findings may be beneficial for managing sedation protocols in adolescents who have undergone scoliosis surgery.

The effects of cognitive impairment on anaesthetic requirement in the elderly.

CONTEXT: Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls. OBJECTIVES: The primary aim was to compare the BIS and the dose of propofol required for induction in patients suffering from cognitive impairment with that in those who had normal cognitive function. This study also evaluated the effects of cognitive impairment in the elderly on anaesthetic agent consumption during surgery and on emergence from anaesthesia. DESIGN AND SETTING: This randomised controlled study was carried out in a university hospital. Patients over 65 years of age, ASA I-II and scheduled for elective orthopaedic procedures were allocated to one of two groups. INTERVENTIONS: Patients (n = 92) were allocated according to their Mini Mental State Examination score: 25 or higher (group 1) or 21 or less (group 2). All patients received propofol 0.5 mg kg(-1) following the commencement of a remifentanil infusion at 0.5 µg kg(-1) min(-1). After incremental doses of propofol up to loss of consciousness, a propofol infusion was started at 75 µg kg(-1) min(-1). Propofol and remifentanil infusion doses were adjusted to keep the BIS value between 45 and 60 during surgery. MAIN OUTCOME MEASURE: MMSE score was evaluated 24 h before and after surgery. The anaesthetic consumption, mean arterial pressure, HR and BIS values of the patients were recorded. RESULTS: Before surgery, mean Mini Mental State Examination scores were 26.8 ± 1.6 and 16.6 ± 4.2 in group 1 and 2, respectively. These returned to baseline value 24 h after surgery in group 1 (26.6 ± 1.5) and group 2 (15.6 ± 4.3). Before induction, four of 45 patients (8.9%) in group 1 had a BIS value less than 93 compared with 13 of 47 (27.7%) in group 2 (P = 0.02). The mean BIS value was significantly lower in group 2 than in group 1 before induction, during loss of consciousness, 3 and 5 min after discontinuation of the anaesthetic agents and before extubation (P < 0.05). The induction dose of propofol was lower in group 2 than in group 1 (P = 0.02). The eye opening time was significantly longer in group 2 than in group 1 (P = 0.03). CONCLUSION: The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment.

Short-term effects of irbesartan treatment on microalbuminuria in patients with normotensive type 2 diabetes.

OBJECTIVE: To observe the short-term effects of irbesartan treatment on microalbuminuria in patients with normotensive type 2 diabetes. METHODS: A total of 40 normotensive type 2 diabetes patients (mean age 55.1+/-11.4 years) who had microalbuminuria were included in this non-comparative and prospective research study. The study took place in Ege University Hospital, Bornova-Izmir, Turkey, between January 2005 and April 2005. Patients were treated with irbesartan 300mg/day for 3 months. Physical examination, medical history, systolic and diastolic blood pressure levels, microalbuminuria, diabetes markers fasting and non-fasting blood glucose, glycosylated hemoglobin [HbA1c], lipid profile, creatinine and urea were obtained at baseline and after 3 months of irbesartan treatment. The primary assessment criterion was the change in microalbuminuria. RESULTS: The mean microalbuminuria level at baseline was 110.8+/-93.1mg/24 hours. It significantly decreased to 45.6+/-62.5mg/24 hours at the end of 3 months of irbesartan treatment (p<0.001). When patients were stratified according to the change in the microalbuminuria status after treatment, 90% of them either returned to normo albuminuria or their microalbuminuria decreased. Both diastolic and systolic blood pressures, fasting and non-fasting blood glucose, and HbA1c were found to be significantly decreased after 3 months of irbesartan treatment compared to pre-treatment values. The positive effect of irbesartan on microalbuminuria occurs independently from HbA1c, fasting blood glucose, and blood pressures. CONCLUSION: The short-term treatment of irbesartan is effective to decrease microalbuminuria in normotensive type 2 diabetes patients, independent of its antihypertensive effect. There is a need for multicenter prospective studies to investigate this further.