Plethysmographic variability index and perfusion index in patients with axillary brachial plexus nerve catheters: An observational study.

Axillary nerve blocks are commonly using for forearm and hand surgery. Especially for finger replacement it has been shown continuous plexus blockade improves microcirculation. Addition to that benefit continuous blockade provides adequate analgesia. In this study perfusion index (PI) and plethysmographic variability index (PVI) changes were used to evaluate in blocks success. The PVI and PI values were detected by a Radical-7TM finger pulse oximetry device (Massimo Corp, USA) in both fingers of 50 plastic surgery patients, who received an axillary brachial plexus catheter before surgery. Data recorded at baseline, during catheter replacement, after catheter replacement, and before surgery. All periods hemodynamic data, visual analog scala, Ramsey sedation score and patient satisfaction score were collected. In all 110 patients blocks were successfully applied, PI values in blocked arm increased after local analgesic application (during catheter replacement), (P < .05), PVI values were decreased in the same period but there were no statistical significance. The PI increases after peripheral plexus blockade and may be used as an indicator for successful block placement in awake patient. And also, it may be used as an indicator for catheter effectiveness after surgery. But PVI values cannot detect that kind of relation with nerve blockade.

The chronicle of headache treatment throughout human history from trepanation to perisutural botulinum toxin injections.

To provide a historic snapshot as regards the evolution of headache treatment throughout the human history, i.e. starting from trepanation to perisutural botulinum toxin (BoNT) injections. Ancient surgeons had aimed to reach the cranium with trepanation (a surgical operation) for headache. As BoNT inhibits the release of nociceptive and pro-inflammatory neuropeptides, it has been recently suggested as an effective alternative in the prophylactic treatment of chronic migraine headache. Chronic migraine is a complex neurological disorder for which the underlying pathophysiology is yet not totally explained. According to the generally accepted hypotheses, peripheral neurogenic activation and central trigeminal sensitization are the two main mechanisms through which its pain develops. Since the headache most commonly occurs around the perisutural areas, and as the primary pathogenesis stem from the meningeal nerve fibers; collateral sensorial branches of the meningeal nerves can be optimal paths to transport BoNT inside the cranium. Concerning the therapeutic efficacy, we anticipate that perisutural injections would be technically challenging with blind techniques and actually possible only if performed under an imaging guidance, e.g. very conveniently with high frequency ultrasound.

Spatial and temporal heterogeneity in human mobility patterns in Holocene Southwest Asia and the East Mediterranean.

We present a spatiotemporal picture of human genetic diversity in Anatolia, Iran, Levant, South Caucasus, and the Aegean, a broad region that experienced the earliest Neolithic transition and the emergence of complex hierarchical societies. Combining 35 new ancient shotgun genomes with 382 ancient and 23 present-day published genomes, we found that genetic diversity within each region steadily increased through the Holocene. We further observed that the inferred sources of gene flow shifted in time. In the first half of the Holocene, Southwest Asian and the East Mediterranean populations homogenized among themselves. Starting with the Bronze Age, however, regional populations diverged from each other, most likely driven by gene flow from external sources, which we term "the expanding mobility model." Interestingly, this increase in inter-regional divergence can be captured by outgroup-f3-based genetic distances, but not by the commonly used FST statistic, due to the sensitivity of FST, but not outgroup-f3, to within-population diversity. Finally, we report a temporal trend of increasing male bias in admixture events through the Holocene.

A genomic snapshot of demographic and cultural dynamism in Upper Mesopotamia during the Neolithic Transition.

Upper Mesopotamia played a key role in the Neolithic Transition in Southwest Asia through marked innovations in symbolism, technology, and diet. We present 13 ancient genomes (c. 8500 to 7500 cal BCE) from Pre-Pottery Neolithic Çayönü in the Tigris basin together with bioarchaeological and material culture data. Our findings reveal that Çayönü was a genetically diverse population, carrying mixed ancestry from western and eastern Fertile Crescent, and that the community received immigrants. Our results further suggest that the community was organized along biological family lines. We document bodily interventions such as head shaping and cauterization among the individuals examined, reflecting Çayönü's cultural ingenuity. Last, we identify Upper Mesopotamia as the likely source of eastern gene flow into Neolithic Anatolia, in line with material culture evidence. We hypothesize that Upper Mesopotamia's cultural dynamism during the Neolithic Transition was the product not only of its fertile lands but also of its interregional demographic connections.

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors.

OBJECTIVE: This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU). METHODS: Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded. RESULTS: The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P <0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P <0.05). CONCLUSION: There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Variable kinship patterns in Neolithic Anatolia revealed by ancient genomes.

The social organization of the first fully sedentary societies that emerged during the Neolithic period in Southwest Asia remains enigmatic,1 mainly because material culture studies provide limited insight into this issue. However, because Neolithic Anatolian communities often buried their dead beneath domestic buildings,2 household composition and social structure can be studied through these human remains. Here, we describe genetic relatedness among co-burials associated with domestic buildings in Neolithic Anatolia using 59 ancient genomes, including 22 new genomes from Asikli Höyük and Çatalhöyük. We infer pedigree relationships by simultaneously analyzing multiple types of information, including autosomal and X chromosome kinship coefficients, maternal markers, and radiocarbon dating. In two early Neolithic villages dating to the 9th and 8th millennia BCE, Asikli Höyük and Boncuklu, we discover that siblings and parent-offspring pairings were frequent within domestic structures, which provides the first direct indication of close genetic relationships among co-burials. In contrast, in the 7th millennium BCE sites of Çatalhöyük and Barcin, where we study subadults interred within and around houses, we find close genetic relatives to be rare. Hence, genetic relatedness may not have played a major role in the choice of burial location at these latter two sites, at least for subadults. This supports the hypothesis that in Çatalhöyük,3-5 and possibly in some other Neolithic communities, domestic structures may have served as burial location for social units incorporating biologically unrelated individuals. Our results underscore the diversity of kin structures in Neolithic communities during this important phase of sociocultural development.

Readability of internet-sourced patient education material related to "labour analgesia".

We evaluated the readability of Internet-sourced patient education materials (PEMs) related to "labour analgesia." In addition to assessing the readability of websites, we aimed to compare commercial, personal, and academic websites.We used the most popular search engine (http://www.google.com) in our study. The first 100 websites in English that resulted from a search for the key words "labour analgesia" were scanned. Websites that were not in English, graphs, pictures, videos, tables, figures and list formats in the text, all punctuation, the number of words in the text is less than 100 words, feedback forms not related to education, (Uniform Resource Locator) URL websites, author information, references, legal disclaimers, and addresses and telephone numbers were excluded.The texts included in the study were assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (FOG) readability formulae. The number of Latin words within the text was determined.Analysis of 300-word sections of the texts revealed that the mean FRES was 47.54 ±â€Š12.54 (quite difficult), mean FKGL and SMOG were 11.92 ±â€Š2.59 and 10.57 ±â€Š1.88 years of education, respectively, and mean Gunning FOG was 14.71 ±â€Š2.76 (very difficult). Within 300-word sections, the mean number of Latin words was identified as 16.56 ±â€Š6.37.In our study, the readability level of Internet-sourced PEM related to "labour analgesia" was identified to be quite high indicating poor readability.

Comparison of different stylets used for intubation with the C-MAC D-Blade® Videolaryngoscope: a randomized controlled study / Comparação de diferentes estiletes usados para intubação com o videolaringoscópio C-MAC D-Blade®: um estudo randômico e controlado

Abstract Objective The angle of the C-MAC D-Blade® videolaryngoscope, which is used for difficult airway interventions, is not compatible with routinely used endotracheal tubes. Methods A prospective randomized crossover study was performed comparing five intubation methods for use with standardized airways, including using different stylets or no stylet: Group HS, hockey-stick stylet; Group DS, D-blade type stylet; Group CS, CoPilot® videolaryngoscope rigid stylet®; Group GEB, gum elastic bougie; and Group NS, no stylet. A manikin was used to simulate difficult intubation with a Storz C-MAC D-Blade® videolaryngoscope. The duration of each intubation stage was evaluated. Results Participants in this study (33 anesthesiology residents and 20 anesthesiology experts) completed a total of 265 intubations. The number of attempts made using no stylet was significantly greater than those made for the other groups (p < 0.05 for group NS- group GEB, group NS- group DS, group NS- group CS and group NS- group HS). The duration to pass the vocal cords significantly differed among all groups (p < 0.001). The total intubation duration was shortest when using D-blade stylet, CoPilot stylet and hockey stick stylet. Although no difference was observed between stylet groups, a significant difference was found between each of these three and no stylet and gum elastic bougie (p < 0.05 and p < 0.001, respectively). Conclusion Use of the correct stylet leads to a more efficient use of the Storz C-MAC D-Blade®. In our study, the use of the D-blade stylet, the CoPilot stylet and the hockey stick stylet provided quicker intubation, allowed easier passage of the vocal cords, and decreased the total intubation duration. To confirm the findings of our study, randomized controlled human studies are needed.

Resumo Objetivo O ângulo do videolaringoscópio C-D-MAC Blade®, usado para intervenções em via aérea difícil, não é compatível com os tubos endotraqueais rotineiramente usados. Métodos Um estudo prospectivo, randômico e cruzado foi conduzido para comparar cinco métodos de intubação em modelo de via aérea, com o uso de diferentes estiletes em cinco grupos: taco de Hockey; D-blade; CoPilot VL® rígido; Gum Elastic Bougie e controle (sem estilete). Um manequim foi utilizado para simular intubação difícil com o laringoscópio Storz C-MAC D-Blade®. Foi avaliada a duração de cada fase de intubação. Resultados Os participantes deste estudo (33 residentes de anestesiologia e 20 especialistas em anestesiologia) concluíram 265 intubações no total. O número de tentativas realizadas sem estilete foi significativamente maior que o dos outros grupos (p < 0,05 para SE-GEB, SE-DB, SE-CP e SE-HS). O tempo para passar pelas cordas vocais foi significativamente diferente entre todos os grupos (p < 0,001). O tempo total de intubação foi menor com o uso de D-blade, CoPilot VL® rígido e taco de Hockey. Embora não tenha havido diferença entre D-blade, CoPilot VL® rígido e taco de Hockey, uma diferença significativa foi observada entre cada um desses três e os grupos sem estilete e Gum Elastic Bougie (p < 0,05 e p < 0,001, respectivamente). Conclusão A escolha do estilete certo leva ao uso mais eficiente do videolaringoscópio Storz C-MAC D-Blade®. Em nosso estudo, o uso do D-blade, CoPilot VL® rígido e taco de Hockey proporcionou intubação mais rápida, facilitou a passagem pelas cordas vocais e diminuiu o tempo total de intubação. Para confirmar os resultados de nosso estudo, estudos controlados e randômicos com humanos são necessários.

[Comparison of different stylets used for intubation with the C-MAC D-Blade® Videolaryngoscope: a randomized controlled study]. / Comparação de diferentes estiletes usados para intubação com o videolaringoscópio C­MAC D­Blade®: um estudo randômico e controlado.

OBJECTIVE: The angle of the C-MAC D-Blade® videolaryngoscope, which is used for difficult airway interventions, is not compatible with routinely used endotracheal tubes. METHODS: A prospective randomized crossover study was performed comparing five intubation methods for use with standardized airways, including using different stylets or no stylet: Group HS, hockey-stick stylet; Group DS, D-blade type stylet; Group CS, CoPilot® videolaryngoscope rigid stylet®; Group GEB, gum elastic bougie; and Group NS, no stylet. A manikin was used to simulate difficult intubation with a Storz C-MAC D-Blade® videolaryngoscope. The duration of each intubation stage was evaluated. RESULTS: Participants in this study (33 anesthesiology residents and 20 anesthesiology experts) completed a total of 265 intubations. The number of attempts made using no stylet was significantly greater than those made for the other groups (p<0.05 for group NS- group GEB, group NS- group DS, group NS- group CS and group NS- group HS). The duration to pass the vocal cords significantly differed among all groups (p<0.001). The total intubation duration was shortest when using D-blade stylet, CoPilot stylet and hockey stick stylet. Although no difference was observed between stylet groups, a significant difference was found between each of these three and no stylet and gum elastic bougie (p<0.05 and p<0.001, respectively). CONCLUSION: Use of the correct stylet leads to a more efficient use of the Storz C-MAC D-Blade®. In our study, the use of the D-blade stylet, the CoPilot stylet and the hockey stick stylet provided quicker intubation, allowed easier passage of the vocal cords, and decreased the total intubation duration. To confirm the findings of our study, randomized controlled human studies are needed.

Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block on postoperative pain and morphine consumption in varicocelectomy.

OBJECTIVES: To evaluate the analgesic effect of transversus abdominis plane (TAP) block administered before varicocele surgery. METHODS: This study was completed at the Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey, between January 2011 and April 2013. In a prospective, double blind, randomized, placebo controlled clinical study, 40 male patients scheduled for elective varicocele operations were randomized to group T (treatment group) or group C (controls). After receiving general anesthesia, group T received a TAP block using 20 mL 0.25% bupivacaine on the operation side, whereas group C received a control block using 20 mL 0.9% Sodium chloride. During the first 24 hours after surgery, the patient pain was evaluated using the visual analogue scale (VAS) at rest and while coughing. Postoperative patient controlled analgesia morphine consumption, VAS scores, and side effects were recorded. RESULTS: Of 34 patients, Group T (n=18) had significantly lower VAS pain scores than Group C (n=16) both at rest and while coughing. The total morphine consumed was  lower (7.7 ± 4.0) versus 21.6 ± 12.4 mg, p less than 0.001) in the 24 hours after surgery. CONCLUSION: As part of a multimodal analgesic regime after varicocelectomy surgery, morphine consumption and VAS pain scores were significantly lower among those receiving 20 mL 0.25% bupivacaine administered for a TAP block than among controls.

The effect of intraoperative sounds of saw and hammer on psychological condition in patients with total knee arthroplasty: prospective randomized study.

PURPOSE: Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. METHODS: A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. RESULTS: The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. CONCLUSION: It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

Effects of smoking on venous cannulation pain: a randomized prospective trial / Efeitos do tabagismo sobre a dor durante o cateterismo venoso: um estudo prospectivo e randomizado / Efectos del tabaquismo sobre el dolor durante el cateterismo venoso: un estudio prospectivo y aleatorizado

BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective surgery were enrolled in the study and were divided into two groups (Group S and C, n = 110 for each) according to their smoking habits. Numerical rating scale was introduced to the patients and then peripheral venous cannulation at the dorsum of the hand was made with a 20 G intracath. Pain perception of the patients was scored by subsequent numerical rating scale questioning. RESULTS: The demographic characteristics of the groups were identical. Numerical rating scale scores in Group S and C were 3.31 ± 1.56 and 1.65 ± 1.23, respectively (p < 0.001). CONCLUSION: Pain perception due to peripheral venous cannulation is higher in smokers. Future studies on pain treatment should consider the smoking habits of patients. .

JUSTIFICATIVA E OBJETIVOS: Sabe-se que o tabagismo aumenta a percepção de dor; porém, o efeito do tabagismo sobre a percepção da dor durante o cateterismo venoso não é conhecido. O objetivo deste estudo foi determinar se o tabagismo tem ou não algum efeito sobre a percepção da dor durante a punção venosa periférica. MÉTODOS: Foram incluídos no estudo 220 pacientes agendados para cirurgia eletiva randomicamente alocados em dois grupos: Grupo S (n = 110) e Grupo C (n = 110), de acordo com seus hábitos tabagísticos. Os pacientes foram instruídos sobre o uso da escala numérica de classificação da dor e, em seguida, a punção venosa periférica foi feita no dorso da mão com um cateter de calibre 20G (Intracath(r)). A percepção de dor dos pacientes foi posteriormente registrada de acordo com os escores da escala numérica. RESULTADOS: As características demográficas dos grupos eram idênticas. Os escores da escala numérica de dor dos grupos S e C foram 3,31 ± 1,56 e 1,65 ± 1,23, respectivamente (p < 0,001). CONCLUSÃO: A percepção da dor por causa da punção venosa periférica é maior em fumantes. Estudos futuros sobre o tratamento da dor devem considerar os hábitos tabagísticos dos pacientes. .

JUSTIFICACIÓN Y OBJETIVOS: Se sabe que el tabaquismo aumenta la percepción de dolor; sin embargo, el efecto del tabaquismo sobre la percepción del dolor durante el cateterismo venoso no se conoce. El objetivo de este estudio fue determinar si el tabaquismo tiene o no algún efecto sobre la percepción del dolor durante la punción venosa periférica. MÉTODOS: Fueron incluidos en el estudio 220 pacientes programados para cirugía electiva aleatoriamente ubicados en 2 grupos: grupo S (n = 110) y grupo C (n = 110), de acuerdo con sus hábitos tabáquicos. A los pacientes se les informó sobre el uso de la escala numérica de clasificación del dolor y a continuación se realizó la punción venosa periférica en el dorso de la mano con un catéter de calibre 20 G (Intracath(r)). La percepción de dolor de los pacientes fue posteriormente registrada de acuerdo con las puntuaciones de la escala numérica. RESULTADOS: Las características demográficas de los grupos eran idénticas. Las puntuaciones de la escala numérica de dolor de los grupos S y C fueron 3,31 ± 1,56 y 1,65 ± 1,23 respectivamente (p < 0,001). CONCLUSIÓN: La percepción del dolor por punción venosa periférica es mayor en los fumadores. Estudios futuros sobre el tratamiento del dolor deben tener en cuenta los hábitos tabáquicos de los pacientes. .

Use of Succinylcholine by Anaesthetists in Turkey: A National Survey.

OBJECTIVE: Although succinylcholine (SCh) has side effects, it is among the most commonly used muscle relaxants for rapid induction because of the faster onset of its effects and short effect duration. However, there is no information regarding the frequency of use of SCh by anaesthetists in Turkey. This study aims to investigate the use of SCh by anaesthetists working in Turkey. METHODS: A web-based survey form was sent by e-mail to anaesthetists working in Turkey. The form comprised a total of 24 questions. RESULTS: E-mails were sent to a total of 1882 addresses at two separate times. E-mail replies were received from 433 (23%) anaesthetists. Based on those who responded to the survey, 54.27% anaesthetists routinely used SCh for adult elective cases, 29.33% for paediatric elective cases and 74.13% for emergency cases. In adult elective cases, SCh was most frequently chosen for caesarean section (20.5%), and in paediatric elective and emergency cases, SCh was chosen most frequently because difficult intubation was expected (31.3 and 21.4%, respectively). CONCLUSION: Our study reveals that SCh is still widely used by anaesthetists in Turkey. Majority of physicians who participated our survey were aware of the side effects; however, they reported using SCh in certain special situations. It is evident that creation of a standard care guide for departments is essential. The first stage of creating a standard care guide is to analyse and document the current application. With this aim, more wide-ranging advanced studies should be completed.

[Effects of smoking on venous cannulation pain: a randomized prospective trial]. / Efeitos do tabagismo sobre a dor durante o cateterismo venoso: um estudo prospectivo e randomizado.

BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective surgery were enrolled in the study and were divided into two groups (Group S and C, n=110 for each) according to their smoking habits. Numerical rating scale was introduced to the patients and then peripheral venous cannulation at the dorsum of the hand was made with a 20G intracath. Pain perception of the patients was scored by subsequent numerical rating scale questioning. RESULTS: The demographic characteristics of the groups were identical. Numerical rating scale scores in Group S and C were 3.31±1.56 and 1.65±1.23, respectively (p<0.001). CONCLUSION: Pain perception due to peripheral venous cannulation is higher in smokers. Future studies on pain treatment should consider the smoking habits of patients.

In vitro evaluation of antimicrobial features of sugammadex.

BACKGROUND: Drugs administered by intravenous routes may be contaminated during several stages of production or preparation. Sugammadex is a modified gamma cyclodextrin. While research into the antibacterial effects of varieties of cyclodextrin is available, there are no studies focusing on the antibacterial effects of sugammadex. This study investigates the in vitro antimicrobial activity of sugammadex. MATERIALS AND METHODS: The in vitro antimicrobial activity of sugammadex was investigated using the broth microdilution method. The pH of the test solution was determined using a pH meter. The test microorganisms included Staphylococcus aureus ATCC 29213, Enterococcus fecalis ATCC 29212, Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. In the second phase of the study 100mg/mL sugammadex (50µg) was contaminated with test microorganisms (50µg), including S. aureus ATCC 29213, E. fecalis ATCC 29212, E. coli ATCC 25922 and P. aeruginosa ATCC 27853, left to incubate for 24h and then the bacterial production in sugammadex was evaluated. RESULTS: The pH of the test solutions ranged between 7.25 and 6.97. Using the microdilution method, sugammadex had no antibacterial effect on S. aureus, E. fecalis, E. coli and P. aeruginosa at any concentration. In the second phase of the study bacterial production was observed after 24h in 100mg/mL sugammadex contaminated with the test microorganisms S. aureus, E. fecalis, E. coli and P. aeruginosa. CONCLUSIONS: Sugammadex had no antimicrobial effect on the test microorganisms, S. aureus, E. fecalis, E. coli and P. aeruginosa. Care should be taken that sterile conditions are maintained in the preparation of sugammadex; that the same sugammadex preparation not be used for more than one patient; and that storage conditions are adhered to after sugammadex is put into the injector.

Avaliação in vitro das características antimicrobianas de sugamadex / In vitro evaluation of antimicrobial features of sugammadex / Evaluación in vitro de las características antimicrobianasdel sugammadex

Justificativa e objetivo: os medicamentos administrados por via intravenosa podem ser contaminados durante as várias fases de produção ou preparação. Sugamadex é uma gama-ciclodextrina modificada. Embora muitas pesquisas sobre os efeitos antibacterianos de uma variedade de ciclodextrinas estejam disponíveis, não há estudos dos efeitos antibacterianos de sugamadex. Este estudo investigou a atividade antimicrobiana in vitro de sugamadex. Materiais e métodos: a atividade antimicrobiana in vitro de sugamadex foi investigada pelo método de microdiluição em meio de cultura. O pH da solução de ensaio foi determinado com o uso de um medidor de pH. Os microrganismos-teste analisados incluíram Staphylococcus aureus ATCC 29213, Enterococcus fecalis ATCC 29212, Escherichia coli ATCC 25922 e Pseudomonas aeruginosa ATCC 27853. Na segunda fase do estudo, 100 mg/mL de sugamadex (50 μg) foram contaminados com microrganismos-teste (50 μg), incluindo S. aureus ATCC 29213, E. fecalis ATCC 29212, E. coli ATCC 25922 e P. aeruginosa ATCC 27853, incubados por 24 horas e, em seguida, a produção bacteriana foi avaliada. Resultados: o pH das soluções da análise variaram entre 7,25 e 6,97. Com o uso do método de microdiluição, sugamadex não apresentou efeito antibacteriano contra S. aureus, E. fecalis, E. coli e P. aeruginosa em qualquer concentração. Na segunda fase do estudo, a produção bacteriana foi observada após 24 horas em 100 mg/mL de sugamadex contaminados com os microrganismos-teste S. aureus, E. fecalis, E. coli e P. aeruginosa. .

Background: Drugs administered by intravenous routes may be contaminated during several stages of production or preparation. Sugammadex is a modified gamma cyclodextrin. While research into the antibacterial effects of varieties of cyclodextrin is available, there are no studies focusing on the antibacterial effects of sugammadex. This study investigates the in vitro antimicrobial activity of sugammadex. Materials and methods: The in vitro antimicrobial activity of sugammadex was investigated using the broth microdilution method. The pH of the test solution was determined using a pH meter. The test microorganisms included Staphylococcus aureus ATCC 29213, Enterococcus fecalis ATCC 29212, Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. In the second phase of the study 100 mg/mL sugammadex (50 μg) was contaminated with test microorganisms (50 μg), including S. aureus ATCC 29213, E. fecalis ATCC 29212, E. coli ATCC 25922 and P. aeruginosa ATCC 27853, left to incubate for 24 h and then the bacterial production in sugammadex was evaluated. Results: The pH of the test solutions ranged between 7.25 and 6.97. Using the microdilution method, sugammadex had no antibacterial effect on S. aureus, E. fecalis, E. coli and P. aeruginosa at any concentration. In the second phase of the study bacterial production was observed after 24 h in 100 mg/mL sugammadex contaminated with the test microorganisms S. aureus, E. fecalis, E. coli and P. aeruginosa. Conclusions: Sugammadex had no antimicrobial effect on the test microorganisms, S. aureus, E. fecalis, E. coli and P. aeruginosa. Care should be taken that sterile conditions are maintained in the preparation of sugammadex; that the same sugammadex preparation not be used for more than one patient; and that storage conditions are adhered to after sugammadex is put into the injector. .

Justificación y objetivo: Los medicamentos administrados por vía intravenosa pueden ser contaminados durante las diversas fases de producción o preparación. El sugammadex es una gamaciclodextrina modificada. Aunque estén disponibles muchas investigaciones sobre los efectos antibacterianos de una variedad de ciclodextrinas, no existen estudios de los efectos antibacterianos del sugammadex. Este estudio investigó la actividad antimicrobiana in vitro del sugammadex. Materiales y métodos: La actividad antimicrobiana in vitro del sugammadex fue investigada por el método de microdilución en medio de cultivo. El pH de la solución de ensayo fue determinado usando un medidor de pH. Los microorganismos testados analizados incluyeron Staphylococcus aureus (S. aureus) (ATCC 29213), Enterococcus faecalis (E. faecalis) (ATCC 29212), Escherichia coli (E. coli) (ATCC 25922) y Pseudomonas aeruginosa (P. aeruginosa) (ATCC 27853). En la segunda fase del estudio, se contaminaron 100 mg/mL de sugammadex (50 µg) con microorganismos testados (50 µg), incluyendo S. aureus (ATCC 29213), E. faecalis (ATCC 29212), E. coli (ATCC 25922) y P. aeruginosa (ATCC 27853), incubados durante 24 h e inmediatamente se calculóla producción bacteriana. Resultados: El pH de las soluciones del análisis varió entre 7,25 y 6,97. Usando el métodode microdilución, el sugammadex no tuvo ningún efecto antibacteriano contra S. aureus, E. faecalis, E. coli y P. aeruginosa en ninguna concentración. En la segunda fase del estudio, la producción bacteriana fue observada después de 24 h en 100 mg/mL de sugammadex contaminados con los microorganismos testados S. aureus, E. faecalis, E. coli y P. aeruginosa. Conclusiones: El sugammadex no presentó ningún efecto antimicrobiano sobre los microorganismos testados S. aureus, E. faecalis, E. coli y P. aeruginosa. ...

The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: a randomized controlled study.

OBJECTIVE: Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia. METHODS: Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30 min into the procedure, as well as from serum taken from cord blood after double clamping. RESULTS: At total of 51 healthy pregnant women underwent either general anaesthesia (n = 28) or combined spinal epidural anaesthesia (n = 23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30 min of surgery compared with the immediate preoperative period. CONCLUSIONS: Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.