Effects of sevoflurane on apoptosis, BDNF and cognitive functions in neonatal rats.

OBJECTIVE: To evaluate the early and late effects of sevoflurane on the neonatal brain. BACKGROUND: Sevoflurane is the most used anaesthetics in neonatal subjects. METHODS: The study included 7-day-old male Wistar-Albino rats (n = 30), which were divided into the two groups according to the anaesthetic received: sevoflurane (S) and control group (C). Half of each group was sacrificed six hours after anaesthesia (early, E) while the remaining subjects were sacrificed six weeks later (late, L). The serum brain-derived-neurotrophic factor (BDNF), brain BDNF and caspase-3 were evaluated. In addition, elevated plus arm test and Morris water test were performed in the late group. RESULTS: BDNF levels were higher in the late groups than in the early ones (p < 0.05). BDNF levels in cerebral cortex were higher in the Group CE than in the Group CL and SL (p < 0.05). There was a significant negative correlation between serum BDNF and cortex BDNF levels (p = 0.003, r = -0.425). Cortex caspase 3 levels were significantly higher in the Groups SE and SL than in the Group CE and CL (p < 0.05). There was no significant difference between the groups in the terms of open arm index, locomotor activity and Morris water test. CONCLUSIONS: Although sevoflurane induced apoptosis, it didn't affect BDNF levels and showed no long-term negative effects on learning and anxiety in neonatal rats (Tab. 1, Fig. 3, Ref. 26).

Comparison of anaesthetic cost in open and laparoscopic appendectomy.

CONTEXT: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia. AIMS: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopic appendectomy under general anesthesia. SETTINGS AND DESIGN: The design is retrospective and records of 379 patients who underwent open or laparoscopic appendectomy under general anesthesia, falling under the category of I-III risk group according to the American Society of Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77. SUBJECTS AND METHODS: Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesia were evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluated the anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction, maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspiration probe), and intravenously administered fluids were evaluated. STATISTICAL ANALYSIS USED: We used Statistical Package for the Social Sciences software (SPSS version 17.0) for statistical analysis. RESULTS: Of the patients, 237 were males (62.53%) and 142 were females (37.47%). Anesthesia time limits were established as 70.30 ± 30.23 minute in Group I and 74.92 ± 31.83 minute in Group II. Mean anesthesia administration cost per patient was found to be 78.79 ± 30.01₺ (39.16 ± 14.15$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) in Group II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158). CONCLUSIONS: Although a statistical difference was not established in this study in terms of time and costs in appendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditions of drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update and revise cost analyses from time to time.

The relationship between serum bilirubin level with interleukin-6, interleukin-10 and mortality scores in patients with sepsis.

CONTEXT: Bilirubin has been shown to influence the mechanisms of both apoptosis and inflammation. AIMS: The aim of the following study is to investigate the relationship between the serum bilirubin level with sepsis progression. SETTINGS AND DESIGN: A total of 20 patients from intensive care unit were included for this study. MATERIALS AND METHODS: Patients were divided into two groups: Patients diagnosed with sepsis according to the American College of Chest Physicians/Society of Clinical Care Medicine consensus conference criteria (n0 = 10) and patients treated for various other diagnoses ( n = 10). Blood samples were collected for both groups at the time of origin (defined as the time of diagnosis) and 24 and 48 h after diagnosis. Serum interleukin (IL)-6, IL-10 and bilirubin levels were analyzed and compared. Acute physiology and chronic health evaluation (APACHE) II and sepsis related organ failure (SOFA) scores of the patients were also evaluated. STATISTICAL ANALYSIS USED: We used Statistical Package for Social Sciences (SPSS for Windows, version 17.0, SPSS Inc. 233 South Wacker Drive, Chicago) for statistical analysis. RESULTS: At all-time intervals, serum IL-6, IL-10 and total, direct and indirect serum bilirubin levels were significantly higher in the sepsis group ( P < 0.05); APACHE II and SOFA scores were also significantly higher. Both SOFA scores and serum IL-10 levels were positively correlated with bilirubin levels 24 h after diagnosis (P < 0.05, r = -0.76). CONCLUSIONS: Although levels of bilirubin and other associated parameters were higher for the sepsis group, only SOFA score and bilirubin levels were correlated. Because bilirubin is already a SOFA parameter, this correlation was not considered as clinically significant.

Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery.

BACKGROUND: Following maternal administration, local anesthetics pass into breast milk. In the present study, we aimed to compare the passage of levobupivacaine and bupivacaine into breast milk following epidural anesthesia for cesarean delivery. METHODS: A total of 20 women undergoing elective cesarean delivery under epidural anesthesia were randomized to receive either 0.5% levobupivacaine or 0.5% racemic bupivacaine via an epidural catheter. Immediately before and 30min, 1h, 2h, 6h, 12h and 24h after administration of epidural local anesthetic, maternal blood and breast milk samples were taken simultaneously. Drug concentrations in plasma and milk were determined via high-performance liquid chromatography. The infant's drug exposure was determined by calculating milk/plasma ratios of levobupivacaine and bupivacaine. RESULTS: Both levobupivacaine and bupivacaine were detected in breast milk 30min after epidural administration. Concentrations of both agents showed constant and similar decreases in milk and plasma and were nearly undetectable at 24h. The milk/plasma ratios were 0.34±0.13 for levobupivacaine and 0.37±0.14 for bupivacaine. CONCLUSIONS: Both levobupivacaine and bupivacaine pass into breast milk following epidural administration. The concentration of both drugs was approximately three times lower in breast milk than in maternal plasma.

Comparison of unilateral spinal anesthesia and L1 paravertebral block combined with psoas compartment and sciatic nerve block in patients to undergo partial hip prosthesis.

OBJECTIVES: Just as hip prosthesis, most of the patients undergoing orthopedic lower extremity surgery (OLES) belong to the advanced age group. Sciatic nerve block combined with psoas compartment block is used as a technique alternative to central neuraxial block and GA. In geriatric patients that will undergo partial hip prosthesis, the effects of the methods of unilateral spinal anesthesia (SA) and L1 paravertebral block combined with psoas compartment block (PCB) and sciatic nerve block (PCSL) on peroperative hemodynamic parameters and the duration of need for postoperative analgesia were studied. PATIENTS AND METHODS: Fifty patients from the ASA III-IV group were randomly divided into two groups. Group SA was administered spinal anesthesia with hyperbaric bupivacaine (2 ml, 0.5%) from the selected intervertebral distance (L4-L5 or L3-L4) in lateral position. Group PCSL was administered L1 paravertebral block combined with PCB and sciatic nerve block with bupivacaine hydrochloride (total 35 ml). Hemodynamic parameters (HR: heart rate and MAP: mean artery pressure) were recorded in pre- and post-intervention 5-minute intervals. The initial time of the need for analgesia of patients were evaluated postoperatively. RESULTS: Any failure in methods implemented on patients in either group was not observed. Times of anesthesia and surgical preparation of patients were observed to have significantly prolonged in the PCSL compared to Group SA (p < 0.005). Hundred and 5th and 110th min. mean arterial pressures of patients was found to be significantly higher in Group SA compared to Group PCSL (p < 0.05). The initial time of the need for analgesia was observed to be significantly prolonged in Group PCSL (432.80 ± 236.77 min) compared to Group SA (185.40 ± 171.40 min) (p < 0.001). CONCLUSIONS: Unilateral SA conducted with bupivacaine hydrochloride and PCSL block technique provided a hemodynamically similar activity in the perioperative period in patients that underwent partial hip operation. However, PCSL block implementation extended the initial time of the need for analgesia in postoperative period. PCSL method could be selected in cases belonging to such group of patients. PCSL block can be a alternative anesthetic tecniques in patients that underwent partial hip operation.

The effect of adrenaline on desflurane-induced prolonged QTc interval: a randomized double-blind trial.

BACKGROUND AND AIM: We investigated the effect of adrenaline on desflurane-induced prolonged corrected QT (QTc) interval. PATIENTS AND METHODS: Sixty-two adult patients scheduled for nasal surgery were included. Following intubation, packs soaked in physiological saline were used for Group C (control) and packs soaked in adrenaline (1/200,000, 5 ml) were used for Groups A1 and A2. Group A2 was given desflurane simultaneously with nasal packing; other groups were given desflurane following removal of the packs. QTc interval was evaluated at 9 periods, from prior to induction of anaesthesia to postoperative first hour. RESULTS: QTc interval was significantly reduced in Groups A1 and A2 compared to Group C during packaging (p < 0.001, p < 0.05 respectively), while QTc interval gradually prolonged after desflurane administration (p < 0.05 in Groups C compared to Groups A1 and A2). Patients did not develop arrhythmia. CONCLUSIONS: Our findings show that desflurane caused progressive prolongation of the QTc interval, and adrenaline shortened QTc interval only at application period of packs.

Changes of ghrelin and brain natriuretic peptide levels in systemic vascular resistance after cardiopulmonary bypass

The application of cardiopulmonary bypass (CPB) using a heart-lung machine inopen heart surgery is associated with numerous pathophysiological changes in thevascular system and the neurohormonal environment. In this study our purpose wasto investigate whether the hormones brain natriuretic peptide (BNP) and ghrelin areinvolved in changes in the systemic vascular resistance index (SVRI) after CPB, usingdata from 20 patients who had undergone coronary artery bypass grafting accompaniedby CPB. Hemodynamic measurements were obtained using a thermodilutioncatheter and included cardiac index and systemic vascular resistance index. Bloodsamples were taken before CPB, after CPB, and at 0 and 24 h postoperatively. Theblood levels of total and acylated ghrelin were quantified by radioimmunoassay.Blood levels of BNP were measured by a fluorescence immunoassay kit. The SVRIwas significantly higher at the end of CPB and at 0 h postoperatively than beforeCPB (end of CPB: 4282±1035 dyne . s . cm-5 . m-2 , 0 h postoperatively: 3239±635dyne . s . cm-5 .m-2 vs. before CPB: 2289±330 dyne . s . cm-5 .m-2, p < 0.05). Total andacylated ghrelin levels decreased until 0 h postoperatively but the change was not statisticallysignificant. However, at 24 h after surgery, they showed a statistically significantincrease over the initial ghrelin values (total before CPB: 1413.71 ± 287.93pg/ml vs. 24 h postoperatively: 1736.85 ± 236.89 pg/ml; acylated ghrelin before CPB:55.85 ± 25.53 pg/ml vs. 24 h postoperatively: 106.28 ± 30.86 pg/ml; p < 0.05 for both).BNP values were markedly lower after than before CPB (before CPB: 69.07 ± 48pg/ml vs. after CPB: 21.96 ± 13 pg/ml, p<0.05) and reached a maximum value 24 hpostoperatively (before CPB: 56.3 ± 42 vs. after CPB: 454.7 ± 229 pg/ml, p<0.05). There was a weak negative correlation between the changes in SVRI and total andacylated ghrelin levels after the CPB period, but this was not statistically significant.However, there was a statistically significant negative correlation between SVRI andBNP after CPB and at 24 h postoperatively (r:-0.709, p<0.01 and r:-0.649, p<0.03,respectively). Taken together, our results show that the observed initial increases inghrelin and/or BNP in the postoperative period (at 24 h) might be causally related tothe decrease in the SVRI in the same period. However, further investigations areneeded to clarify the significance of this observation with respect to that of SVRI (AU)

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Changes of ghrelin and brain natriuretic peptide levels in systemic vascular resistance after cardiopulmonary bypass.

The application of cardiopulmonary bypass (CPB) using a heart-lung machine in open heart surgery is associated with numerous pathophysiological changes in the vascular system and the neurohormonal environment. In this study our purpose was to investigate whether the hormones brain natriuretic peptide (BNP) and ghrelin are involved in changes in the systemic vascular resistance index (SVRI) after CPB, using data from 20 patients who had undergone coronary artery bypass grafting accompanied by CPB. Hemodynamic measurements were obtained using a thermodilution catheter and included cardiac index and systemic vascular resistance index. Blood samples were taken before CPB, after CPB, and at 0 and 24 h postoperatively. The blood levels of total and acylated ghrelin were quantified by radioimmunoassay. Blood levels of BNP were measured by a fluorescence immunoassay kit. The SVRI was significantly higher at the end of CPB and at 0 h postoperatively than before CPB (end of CPB: 4282 +/- 1035 dyne x s x cm(-5) x m(-2), 0 h postoperatively: 3239 +/- 635 dyne x s x cm(-5) x m(-2) vs. before CPB: 2289 +/- 330 dyne x s x cm(-5) x m(-2), p < 0.05). Total and acylated ghrelin levels decreased until 0 h postoperatively but the change was not statistically significant. However, at 24 h after surgery, they showed a statistically significant increase over the initial ghrelin values (total before CPB: 1413.71 +/- 287.93 pg/ml vs. 24 h postoperatively: 1736.85 +/- 236.89 pg/ml; acylated ghrelin before CPB: 55.85 +/- 25.53 pg/ml vs. 24 h postoperatively: 106.28 +/- 30.86 pg/ml; p <0.05 for both). BNP values were markedly lower after than before CPB (before CPB: 69.07 +/- 48 pg/ml vs. after CPB: 21.96 +/- 13 pg/ml, p < 0.05) and reached a maximum value 24 h postoperatively (before CPB: 56.3 +/- 42 vs. after CPB: 454.7 +/- 229 pg/ml, p < 0.05). There was a weak negative correlation between the changes in SVRI and total and acylated ghrelin levels after the CPB period, but this was not statistically significant. However, there was a statistically significant negative correlation between SVRI and BNP after CPB and at 24 h postoperatively (r:-0.709, p < 0.01 and r:-0.649, p < 0.03, respectively). Taken together, our results show that the observed initial increases in ghrelin and/or BNP in the postoperative period (at 24 h) might be causally related to the decrease in the SVRI in the same period. However, further investigations are needed to clarify the significance of this observation with respect to that of SVRI.

Reconstruction of the vena cava with the peritoneum: the effect of temporary distal arteriovenous fistula on patency (an experimental study).

OBJECTIVE: To determine the effect of increasing inferior vena cava blood flow by means of distal arteriovenous fistula on the patency of a peritoneal tube graft. MATERIALS AND METHODS: In 16 mongrel dogs, a 3-4 cm long circular defect was created at the infrarenal inferior vena cava. The defect was interposed with peritoneal tube graft. A temporary distal femoro-femoral arteriovenous fistula was also constructed in 8 dogs just after the caval interposition. Graft patency was evaluated by Doppler ultrasonography and angiography. Histological evaluation was also performed. RESULTS: Seven dogs in each group survived. All control grafts occluded within the first week, compared to no occlusions in fistula group (Fisher's exact test, p<0.005). However one 'fistula' dog with a still patent graft was sacrificed on the 18th day due to ultrasonographically occluded arteriovenous fistula. CONCLUSION: In dogs, the peritoneum may be used as graft material for reconstruction of the inferior vena cava, provided a distal arteriovenous fistula is constructed.

Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass?

OBJECTIVE: The role of aprotinin in the prevention of lung reperfusion injury was investigated in the patients undergoing cardio-pulmonary bypass (CPB) for coronary artery bypass grafting (CABG) operations. METHODS: The study was planned randomly and prospectively. Two hundred milliliters of physiological saline solution was added to the prime solution of patients in group I (n=10) whereas, 200 ml aprotinin (Trasylol, Bayer AG) was given to patients in group II (n=10). In order to measure lung tissue malondialdehyde (MDA) levels, glutathion peroxidase (GSH-Px) activity levels and polymorphonuclear leukocytes (PMNs) numbers, lung tissue samples were taken before CPB and 5 min after removing the cross clamp. In addition, alveolo-arterial oxygen difference (AaDO(2)) for tissue oxygenation was calculated by obtaining arterial blood gas samples. RESULTS: MDA levels before CPB increased from 41.72+/-21.00 nmol/g tissue to 66.71+/-13.44 nmol/g tissue in group I and from 43.44+/-5.16 nmol MDA/g tissue to 53.22+/-10.95 nmol MDA/g tissue in group II after cross clamp removal (P=0.001 and P=0.021, respectively). The increase in group II was found to be significantly lower than group I (P=0.048). With the initiation of reperfusion, GSH-Px activity decreased in group I from 3.05+/-0.97 to 2.31+/-0.46 U/mg protein (P=0.015) whereas GSH-Px activity in group II decreased from 3.18+/-1.01 to 2.74+/-0.81 U/mg protein (P=0. 055). This decrease in the group II was less than group I (P=0.049). AaDO(2) significantly increased in the group I and II (P=0.012 and P=0.020, respectively), but elevation in the group I was significant than in the Group II (P=0.049). In histopathological examination, it was observed that neutrophil counts in the lung parenchyma rose significantly following removal of cross clamp in both groups (P=0. 001). The increase in group I was significantly larger than in group II (P=0.050). CONCLUSION: Results represented in our study indicate that addition of aprotinin (2 million units) into the prime solution during CPB can reduce lung reperfusion injury.