Sex-specific cardiovascular remodeling leads to a divergent sex-dependent development of heart failure in aged hypertensive rats.

INTRODUCTION: The prevalence of heart failure with preserved ejection fraction (HFpEF) is continuously rising and predominantly affects older women often hypertensive and/or obese or diabetic. Indeed, there is evidence on sex differences in the development of HF. Hence, we studied cardiovascular performance dependent on sex and age as well as pathomechanisms on a cellular and molecular level. METHODS: We studied 15-week- and 1-year-old female and male hypertensive transgenic rats carrying the mouse Ren-2 renin gene (TG) and compared them to wild-type (WT) controls at the same age. We tracked blood pressure and cardiac function via echocardiography. After sacrificing the 1-year survivors we studied vascular smooth muscle and endothelial function. Isolated single skinned cardiomyocytes were used to determine passive stiffness and Ca2+-dependent force. In addition, Western blots were applied to analyse the phosphorylation status of sarcomeric regulatory proteins, titin and of protein kinases AMPK, PKG, CaMKII as well as their expression. Protein kinase activity assays were used to measure activities of CaMKII, PKG and angiotensin-converting enzyme (ACE). RESULTS: TG male rats showed significantly higher mortality at 1 year than females or WT male rats. Left ventricular (LV) ejection fraction was specifically reduced in male, but not in female TG rats, while LV diastolic dysfunction was evident in both TG sexes, but LV hypertrophy, increased LV ACE activity, and reduced AMPK activity as evident from AMPK hypophosphorylation were specific to male rats. Sex differences were also observed in vascular and cardiomyocyte function showing different response to acetylcholine and Ca2+-sensitivity of force production, respectively cardiomyocyte functional changes were associated with altered phosphorylation states of cardiac myosin binding protein C and cardiac troponin I phosphorylation in TG males only. Cardiomyocyte passive stiffness was increased in TG animals. On a molecular level titin phosphorylation pattern was altered, though alterations were sex-specific. Thus, also the reduction of PKG expression and activity was more pronounced in TG females. However, cardiomyocyte passive stiffness was restored by PKG and CaMKII treatments in both TG sexes. CONCLUSION: Here we demonstrated divergent sex-specific cardiovascular adaptation to the over-activation of the renin-angiotensin system in the rat. Higher mortality of male TG rats in contrast to female TG rats was observed as well as reduced LV systolic function, whereas females mainly developed HFpEF. Though both sexes developed increased myocardial stiffness to which an impaired titin function contributes to a sex-specific molecular mechanism. The functional derangements of titin are due to a sex-specific divergent regulation of PKG and CaMKII systems.

Comparison of spinal anaesthesia and erector spinae plane block in unilateral inguinal hernia: Randomised clinical trial.

INTRODUCTION: The objective of our study was to compare erector spinae plane block (ESP) with spinal anaesthesia (SA) for inguinal hernia repair with respect to anaesthetic efficacy, post-operative analgesia, mobilisation, discharge, complication and side effects. PATIENTS AND METHODS: The study included 52 patients over 50 years of age, with the American Society of Anaesthesia physical status Class I-III. Group ESP ( n = 26) was applied 30 ml of mixed local anaesthetic mixture applied at the L1 level to the plane of the erector spinae and 10 ml of tumescent when necessary, while Group SA ( n = 26) was applied 3 ml of 0.5% bupivacaine at the L3-L4/L2-L3 level. RESULTS: Intraoperative Visual Analogue Scale (VAS) value was lower in Group S, whereas the 6 th -h VAS value was lower in Group ESP ( P < 0.05). There was no significant difference between the VAS values at hour 12 and 24 ( P > 0.05). Reaching post-anaesthesia discharge criteria 9 and time to mobilisation and oral feeding was shorter in Group ESP, whereas post-procedure waiting time was shorter in Group S ( P < 0.05). While the need for post-operative analgesics was higher in Group S ( P < 0.05), there was a high level of patient satisfaction in Group ESP ( P = 0.05). Intraoperative midazolam requirement was lower in Group S, post-operative diclofenac requirement was lower in Group ESP ( P < 0.05), post-operative urinary retention and tremor were higher in Group S ( P = 0.05). CONCLUSION: ESP block provides adequate surgical anaesthesia compared to SA (non-inferiority) for inguinal hernia repair. It is associated with less analgesic requirement, low post-operative pain, less complication rate and high patient satisfaction in the post-operative period.

General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial.

BACKGROUND: In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair. METHODS: 70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups. RESULTS: While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05). CONCLUSION SUBSECTIONS: In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.

Correlation of internal jugular vein, common carotid artery, femoral artery and femoral vein diameters with central venous pressure.

BACKGROUND: This study aimed to detect the correlation of central venous pressure (CVP) with the internal jugular vein (IJV), common carotid artery (CCA), femoral vein (FV), and femoral artery (FA) diameters measured with ultrasound (USG) in patients under mechanical ventilation to evaluate whether they are suitable to be used as an alternative low-cost and noninvasive method for the detection of CVP. METHODS: A total of 40 patients aged from 18 to 90 who had been receiving therapy in the intensive care unit (ICU) were included in the study. Central venous catheter was placed into the patients through right IJV or subclavian vein in their first 24-hour of hospitalization and the right atrium pressure (RAP) was measured from the catheter, the tip of which was confirmed to reach right atrium. In the same session, CCA, IJV, FA, and FV diameters were measured with USG and their correlations with CVP were calculated. In addition, correlations of the measured venous and artery diameters between each other were detected as well. RESULTS: There was a significantly high correlation between CVP and CCA diameter (R = 0.603, P < .000). There was a significantly low correlation between CVP and IJV diameter (R = 0.352, P = .026), a significantly low correlation between FA and FV diameters (R = 0.317, P = .047), a significantly low correlation between FA and CCA diameters (R = 0.330, P = .038), and a significantly low correlation between IJV and CCA diameters (R = 0.364, P = .020). CONCLUSION: CVP and CCA diameters exhibited a high correlation. For detection of CVP, the ultrasonographic CCA diameter measurement can be used as an alternative noninvasive method which is easy to use and minimally affected by measurement errors of individuals and which has low learning curve compared with the other measurement methods.

Spinal anesthesia versus combined sciatic nerve/lumbar plexus nerve block in elderly patients undergoing total hip arthroplasty: a retrospective study.

BACKGROUND: The most important cause of mortality due to long bone fractures in the elderly patients are femoral fractures that require total hip arthroplasty (THA). THA surgeries may cause severe postoperative pain, long hospital stays, a need for transfusion and mortality. OBJECTIVE: Compare outcomes of spinal anesthesia (SA) versus combined sciatic nerve/lumbar plexus block (CSLPB). DESIGN: Retrospective cohort trial. SETTING: University hospital in Turkey. PATIENTS AND METHODS: We selected patients from the electronic medical records by date of surgery (most recent first) and compared demographic and pre- and postoperative clinical characteristics including the amount of opioid use within the first 48 postoperative hours, 30-day mortality rates, length of hospital stay, intraoperative oxygen saturation (SpO2) and mean arterial pressure (MAP) values, duration of the surgery, and blood transfusion need. MAIN OUTCOME MEASURE: Opioid use within the first 48 postoperative hours. SAMPLE SIZE: 204, 102 patients in each group with overall median (IQR) age of 82 (10.2) years. RESULTS: There was no significant difference between the groups in terms of the amount of opioid use within the postoperative 48 hours, 30-day mortality rates, intensive care need, duration of the surgery, blood transfusion need, and length of hospital stay. While the intraoperative SpO2 value was lower in the CSLPB group (P=.03), MAP values were lower in the SA group (P=.046). Preoperative American Society of Anesthesiology score (ASA) scores (P=.039) and the number of comorbidities were higher in the CSLPB group. CONCLUSION: We prefer CSLPB used with standardized sedation protocols for anesthesia in THA surgery in elderly patients. LIMITATIONS: Retrospective design and single-centered. CONFLICT OF INTEREST: None.

Shall we use low-pressure CO2 pneumoperitoneum in laparoscopic cholecystectomy?

BACKGROUND E AIMS: We aimed to determine whether intraabdominal pressure change caused by pneumoperitoneum created during laparoscopic cholecystectomy (LC) has effects on abdominal and shoulder pain, nausea, vomiting, bowel movements, time of first flatus and defecation, and biochemical parameters. METHODS: Seventy patients that were diagnosed with cholelithiasis and would undergo LC, between the ages of 18-75, with the Society of Anesthesia Physical Status (ASA) I-III classifications were included in the study. Patients were divided into two groups as whose intervention was defined as low pressure (8-10 mm/hg) and whose intervention was defined as high pressure (14-16 mm/hg). Differences in the prognoses of patients in both groups were observed for statistical significance. RESULTS: Shoulder pain- visual analogue scale (VAS) values in 6th and 24th hours were lower in Group 1(p<0.005). There was no significant difference in abdominal pain-VAS values(p≥0.05). Mean intraoperative end-tidal carbon dioxide (ETCO2) values were higher in Group 2 (p<0.005). Differences in nausea and vomiting were not significant(p≥0.05). There was no significant difference in the first flatus times(p≥0.05). Bowel movements resumed earlier in Group 1(p<0.005). Changes were not significant for biochemical blood parameters in the preoperative and postoperative periods( p≥0.05). CONCLUSION: The use of low-pressure and high pressure carbon-dioxide (CO2)-pneumoperitoneum created during LC does not cause a significant difference in terms of clinical and laboratory results. Therefore, the surgical team should prefer an easy-to-apply pressure level which they are used to and in which they have low complication rates. KEY WORDS: Cholecystectomy, Pneumoperitoneum, Low-pressure CO2.

The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial.

INTRODUCTION: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not. METHODS: A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB. RESULTS: Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05). DISCUSSION: When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction. CONCLUSION: We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

Comparison of spinal anaesthesia versus ilioinguinal-iliohypogastric nerve block applied with tumescent anaesthesia for single-sided inguinal hernia.

BACKGROUND & AIMS: Primary aim of this study is to determine whether the use of local anaesthesia performed with IINB and IHNB against spinal anaesthesia in inguinal hernia repair is accepted as an alternative medicine. METHODS: 75 cases in the class of American Society of Anesthesia physical status (ASA) I-III between the ages of 18 and 75 diagnosed with single-sided inguinal hernia and hospitalized for surgery in general surgery clinic were prospectively and randomly included in this study. RESULTS: There was statistically significant difference between the groups (30.14 ± 8.2 and 35.51 ± 9.39) in terms of the duration of the surgery. The duration was shorter in Group 1 (p < 0.001). There was statistically significant difference between the groups in terms of the duration of the first mobilization. It was significantly shorter in Group 2 than in Group 1 (5.71 ± 1.7 and 2.70 ± 1.53 min) (p < 0.001). Mean duration of length of hospital stay criteria was significantly shorter in Group 2 than in Group 1 (26.00 ± 6.43 and 14.23 ± 5.40 h) (p < 0.001). Throughout the follow-up period in postoperative 24 h, the number of patients who needed analgesia was significantly higher in Group 1 than in Group 2 (91.4% and 45.7%) There was statistically significant difference between the groups in terms of patient satisfaction and urinary retention development (p < 0.005). Hematoma development or postoperative bleeding was not observed in either group. The time of sensory block onset was significantly higher in Group 2 than in Group 1 (9.66 ± 1.41 and 9.03 ± 0.98 min) (p < 0.005) CONCLUSION: The results of our study show that IINB and IHNB applied with local anaesthesia are superior to spinal anaesthesia in unilateral inguinal hernia repairs.

Comparison of ondansetron, tropisetron, and palonosetron for the prevention of postoperative nausea and vomiting after middle ear surgery.

BACKGROUND: Postoperative nausea and vomiting (PONV) are 2 of the most frequent adverse effects of anesthesia. PONV prolongs hospital stays and also delays the recovery of patients. OBJECTIVE: In this study, the effects of ondansetron, tropisetron, and palonosetron on PONV in patients who had undergone middle ear surgeries such as mastoidectomy or tympanoplasty were compared. METHODS: The study included 165 American Society of Anesthesiologists grade 1 and 2 patients aged 18 to 65 years. Patients were randomized into 3 groups by a closed envelope method. Neither the patients nor the nurses administering the treatments knew which patient belonged to which group. The anesthetic technique was standardized for all groups. During skin closure, 0.075 mg palonosetron, 5 mg tropisetron, and 8 mg ondansetron were administered intravenously to the palonosetron, tropisetron, and ondansetron groups, respectively. After completion of the surgery, the patients were followed for 48 hours. Diclofenac sodium (100 mg IM) was administered to patients experiencing pain and metoclopramide chloride (10 mg IM) was administered to patients with nausea or vomiting. Potential side effects such as headache and constipation were recorded in the postanesthesia care unit and ear, nose, and throat clinic. RESULTS: There was no significant difference in the effects of all 3 antiemetic agents on the severity of PONV (P = 0.081). At 48 hours postoperatively, the incidence of PONV was significantly lower in the palonosteron group (38.2%) than the ondansetron group (63.6%) and tropisetron group (61.8%) (P = 0.011). At 48 hours postoperatively, the incidence of postoperative nausea was significantly lower in the palonosetron group (32.7%) than in the ondansetron group (63.6%) and the tropisetron group (56.4%) (P = .003). The incidence of PONV between hours 12 and 24 postoperatively was significantly higher in the ondansetron group (27.3%) than in the palonosetron group (9.1%) (P = 0.013). The antiemetic requirement in the first hour after surgery was significantly higher in the tropisetron group (25.5%) than in the palonosetron group (7.3%) (P = .019). CONCLUSIONS: The results of the current study support those of earlier studies that suggest that palonosetron was statistically more effective than the other 2 formulations in the prevention of PONV in patients who have undergone middle ear surgery. (Curr Ther Res Clin Exp. 2019; 80:XXXXXX).

Effects of naloxone and flumazenil on antinociceptive action of acetaminophen in rats.

BACKGROUND: Studies of acetaminophen suggest that multiple nociceptive pathways are involved in the drug's analgesic action. OBJECTIVE: The purpose of this study was to determine whether naloxone and flumazenil were able to modify or antagonize the antinociceptive effect of acetaminophen in rats. METHODS: Adult albino Wistar rats were used in the study and randomly allocated to 1 of 4 groups. The acetaminophen group (A group) was administered IP saline and then 300 mg/kg IP acetaminophen 5 minutes thereafter. The acetaminophen + naloxone group (AN group) was pretreated with 1 mg/kg IP naloxone, followed by 300 mg/kg IP acetaminophen 5 minutes later. The acetaminophen + flumazenil group (AF group) was pretreated with 1 mg/kg IP flumazenil, followed by 300 mg/kg IP acetaminophen 5 minutes later. The control group received 2.5 mL IP saline, followed by an additional 2.5 mL IP injection of saline 5 minutes later. The paw-withdrawal latency period of the rats was assessed by an investigator blinded to treatment using the hot-plate test at 30, 45, 60, and 90 minutes after administration of acetaminophen. RESULTS: Thirty-two rats were evenly randomized by envelope method into 4 groups of 8 rats each. Baseline values for the A, AN, AF, and control groups were not significantly different (9.1 [2.3], 10.5 [2.7], 9.8 [3.0], and 8.9 [1.4] sec, respectively). In the AF group, flumazenil appeared to antagonize the analgesic effect exerted by the acetaminophen in the hot-plate test (30 min, 10.3 [3.7] sec; 45 min, 11.7 [5.1] sec; 60 min, 12.1 [5.1] sec; and 90 min, 12.2 [4.9] sec) and values were not significantly different from those obtained in the control group (30 min, 9.8 [2.2] sec; 45 min, 9.0 [1.6] sec; 60 min, 9.2 [1.6] sec; and 90 min, 8.5 [2.0] sec). In the AN group, naloxone did not significantly affect the values observed in the hot-plate test (30 min, 18.0 [4.5] sec; 45 min, 21.5 [7.8] sec; 60 min, 20.5 [5.9] sec; and 90 min, 22.3 [7.4] sec) and values at all time points were not significantly different from those obtained in the A group (30 min, 17.8 [7.6] sec; 45 min, 20.9 [6.9] sec; 60 min, 21.5 [7.3] sec; and 90 min, 23.8 [8.6] sec). All postbaseline values in the A and AN groups were significantly increased versus baseline and versus the control group values (all, P < 0.05). All postbaseline values in the A group were significantly greater than those in the AF group (all, P < 0.05). CONCLUSION: Flumazenil antagonized the analgesic effect exerted by acetaminophen, while naloxone had no significant effect on acetaminophen's antinociceptive action in this pain model in rats.