Dexmedetomidine and Magnesium Sulfate: A Good Combination Treatment for Acute Lung Injury?

Objectives: In this study, we aimed to investigate the therapeutic effects of magnesium sulfate (MgSO4) and dexmedetomidine (dex) in a model of acute lung injury (ALI). We determined whether concomitant administration decreased the inflammatory effects of hydrochloric acid (HCl)-induced ALI in a synergistic manner. Materials and Methods: In this study, 42 Sprague-Dawley rats were randomized into six groups: Group S (saline), Group SV (saline + mechanical ventilation), Group HCl (HCl), Group Dex (Dex), Group Mag (MgSO4), and Group DM (Dex + MgSO4). All groups except Group S were mechanically ventilated prior to HCl-induced ALI. Saline or HCl was administered via tracheostomy. Prior to treatment, HCl was administered to Group HCl, Group Dex, Group Mag, and Group DM to induce ALI. Dex and MgSO4 were administered intraperitoneally. The rats were monitored for 4 h after treatment to measure oxidative stress parameters in blood, and prolidase enzyme activity. Lung tissue damage were determined via histopathology. Results: A significant increase in heart rate and rapid desaturation was observed in HCl-administered groups. Treatment administration decreased the pulse values. Increased saturation values and decreased oxidative stress indices were observed in groups that were subsequently administered​ Dex and MgSO4. Serum prolidase activity increased significantly in Group HCl. Severe pathological findings were detected following HCl-induced ALI. Group Mag showed greater improvement in the pathology of HCl-induced ALI than did Group Dex. Administration of both Dex and MgSO4 did not improve the pathological scores. Conclusions: The antioxidant and anti-inflammatory effects of Dex and MgSO4 ameliorated the detrimental effects of HCI-induced ALI. However, adverse effects on hemodynamics and lung damage were observed when the two drugs were administered together.

Effect of Anaesthesia Method on Preoperative Anxiety Level in Elective Caesarean Section Surgeries.

OBJECTIVE: In this study, the effect of the anaesthesia method on preoperative anxiety in parturients scheduled to undergo elective caesarean surgery was investigated. METHODS: After Dicle University Ethics Committee approval, 100 American Society of Anesthesiologists (ASA) II parturients, aged between 18 and 45 years, were included in this study from 2011 to 2012 at the Dicle University Faculty of Medicine, Department of Anaesthesiology. The parturients were divided into two groups, with 50 patients in each group: general anaesthesia (GA) and spinal anaesthesia (SA). Patients were evaluated during the preoperative visit. Demographic data and STAI TX-1 form to measure preoperative anxiety were recorded. RESULTS: There were no significant differences between the two groups in maternal age, gestational age, level of education and number of children (p>0.05). The average anxiety score was significantly higher in the SA group than in the GA group (p<0.05). CONCLUSION: In conclusion, spinal anaesthesia is associated with a higher preoperative anxiety level than general anaesthesia in obstetric patients. Therefore, it is necessary to take prevention against preoperative anxiety for the patients undergoing caesarean section surgeries under spinal anaesthesia.

Anesthesia Management in Patients With Choanal Atresia.

BACKGROUND: In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature. METHODS: The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records. RESULTS: The patients were divided into 2 groups: Group I-bilateral choanal atresia and Group II-unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3-72), and the mean age of the 17 patients in Group II was 171.08 days (81-365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack-Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients. CONCLUSIONS: Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.

Evaluation of obstetrical patients with disseminated intravascular coagulopathy - tertiary center experience.

OBJECTIVE: The purpose of the present study is twofold: (a) to investigate the etiology of disseminated intravascular coagulopathy (DIC) caused by obstetrical conditions and (b) to present parameters that can be used in predicting DIC-related mortality in obstetrical patients. MATERIAL AND METHOD: Obstetrical patients who had a delivery at or were referred (after delivery) to Obstetrics and Gynecology Clinic of Dicle University between July 2006 and December 2013 were retrospectively analyzed in this study. Those patients diagnosed with DIC were included in the study. RESULTS: Fifty-six obstetrical patients carrying the diagnosis of DIC were included in this study. The overall mortality rate was 25% among these patients. More specifically, the mortality rate was 10.7% among patients with a DIC score ≤5 and 40.7% among those with a DIC score > 5. Multiple logistic regression analysis resulted in the finding that international normalized ratio (INR) and urea were among those factors affecting mortality in obstetrical DIC [OR: 8.44 (CI: 1.9-36.8), OR: 1.05 (CI: 1.0-1.1), respectively]. CONCLUSION: DIC is a syndrome that might be caused by obstetrical conditions. It is associated with high mortality and morbidity rates. In obstetrical DIC, urea is the most important factor affecting mortality. In addition, we are of the opinion that DIC score might guide mortality predictions as a determinant of prognosis.

A miracle that accelerates operating room functionality: sugammadex.

BACKGROUND: Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape. METHODS: In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF <0.9) with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered. RESULTS: Time elapsed until sugammadex administration following neostigmine 37 ± 6 min, following sugammadex it took 2.1 ± 0.9 min to reach TOF ≥0.9, and the extubation time was 3.2 ± 1.4 min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period. CONCLUSION: Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient.

Magnetic resonance imaging in children under anesthesia: the relationship between the degree of information provided to parents and parents' anxiety scores.

BACKGROUND: We aimed to investigate the correlation between the anxiety scores of parents whose children are administered anesthesia for magnetic resonance imaging (MRI) and the level of information provided to them before the MRI. The study included 146 children and their parents. The demographic information of the children and their parents was recorded. The parents were divided into two groups. In Group I, the patient's medical history and physical exam findings were recorded on a standard consultation form by an anesthesiologist. In Group II, the parents were additionally provided with more detailed information on how the anesthesia would be administered and the drugs to be used and their side effects and complications. The anxiety scores of the parents were found to be lower in Group II. A higher level of education was associated with higher anxiety scores. Intergroup comparison detected lower anxiety scores for Group II parents whose education levels were up to high school. However, no change upon receiving detailed information was detected in the anxiety scores of parents with higher education levels. In conclusion, this may lower the anxiety scores in parents informed about details of anesthesia administration and may raise parents' sense of confidence in the doctor.

The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in rats.

AIM: To investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury. METHODS: Forty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 µg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups. RESULTS: According to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs. CONCLUSION: This study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver.

Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery.

BACKGROUND: The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery. METHODS: Forty patients with ASA I-II physical status, who were scheduled for elective laparoscopic (group I) or open abdominal surgery (group II) were enrolled in the study. Tracheal intubation was always performed by an experienced anesthesiologist. The endotracheal tube cuff was inflated with air through a 10-ml syringe. The cuff was connected to a manometer. The endotracheal cuff pressure was registered every 5 min after tracheal intubation. At the time of discharge from the Post-Anesthesia Care Unit (PACU) and 12 h after tracheal extubation, patients were asked about their laryngotracheal condition by an independent observer who was uninformed of the patient allocation groups. We investigated laryngotracheal complaints such as sore throat, dysphasia, and hoarseness. RESULTS: The endotracheal cuff pressures in group I were significantly higher than those in the group II at all time points studied (P < 0.05). The endotracheal cuff pressures exceeded the critical pressure of 30 cmH(2)O after 5 min in the group I (intra-abdominal pneumoperitoneum was started). The incidence of sore throat was higher in group I than in group II in the PACU and at 12 h. CONCLUSION: This study indicates that the CO(2) pneumoperitoneum and Trendelenburg position used during laparoscopy increase endotracheal cuff pressure and lead to discomfort in the postoperative patient. Measurement of endotracheal cuff pressure is a simple and inexpensive procedure and should be applied in patients under going laparoscopic surgery.

Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short- and mid-term effectiveness of intra-articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. METHODS: This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra-articular PRF were retrospectively reviewed. The antero-lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra-articularly. PRF was started as 42°C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. RESULTS: Although the mean initial VAS scores of the patients were 6.1 ± 0.9 cm, it was found, respectively, to be 3.9 ± 1.9 cm and 4.1 ± 1.9 cm at the first- and sixth-month follow-ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow-up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of ≥50% in their pain was calculated as 35.5%. CONCLUSION: PRF applied to the knee joint appears to be an effective and safe method.

Effectiveness of nucleoplasty applied for chronic radicular pain.

BACKGROUND: Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year. MATERIAL/METHODS: Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. RESULTS: Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating "good" and "excellent" satisfaction was 66% (23 persons) on the last follow-up. CONCLUSIONS: While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

Cooled radiofrequency application for treatment of sacroiliac joint pain.

BACKGROUND: The unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation. METHODS: Patients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients' pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI). RESULTS: Cooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7-9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1-4), 2 (1-3) and 3 (2-4). The baseline median ODI score (interquartile range) was 36 (32-38), while at the 1st, 3rd and 6th month, it was 16 (8-20), 12 (9-18) and 14 (10-20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores. CONCLUSION: It was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.

Would pulsed radiofrequency applied to different anatomical regions have effective results for chronic pain treatment?

OBJECTIVE: To observe the effect of Pulsed radiofrequency on patients presenting with complaints of chronic pain. METHODS: It was a retrospective cross sectional study which included patients with chronic pain who did not respond to conventional treatment.The study was conducted at the Pain Management Centre, Dicle University, Diyarbakir, Turkey from October 2008 to September 2010. The applications of Pulsed radiofrequency (PRF) were made under the guidance of C-arm fluoroscopy, local anaesthesia, and sedoanalgesia. The intervention types applied consisted of sacroiliac intraarticular, heel, sciatic nerve and impar ganglion Pulsed radiofrequency. Visual Analogue Scale (VAS) was used for pain assessment.Sacroiliac intraarticular PRF was applied to nine patients, impar ganglion PRF to eight patients, heel PRF to four patients and sciatic nerve PRF was applied to three patients. RESULTS: The mean age of the patients was 41.3 +/- 16.9 (range 15-77) years, 15 (62.5%) were females. The mean follow-up period was 8.5 +/- 5.4 months. A minimum 50% decrease was determined in the VAS scores of 16 (66.7%) patients compared to the initial values. The patients who had > or = 50% decrease in their VAS scores in the sacroiliac group was 55.6. This value was 75.0, 75.0 and 66.7 in the impar, heel and sciatic nerve groups respectively. No early- or late-term complications were observed in any of the patients. CONCLUSIONS: P Pulsed Radiofrequency implementation was found to be an effective and safe method for chronic pain treatment in our centre.

6-month results of TransDiscal Biacuplasty on patients with discogenic low back pain: preliminary findings.

STUDY DESIGN: Prospective observational study. OBJECTIVE: Our aim is to investigate the efficacy and safety of TransDiscal Biacuplasty. SUMMARY OF BACKGROUND DATA: Chronic discogenic pain is one of the leading causes of low back pain; however, the condition is not helped by most non-invasive methods. The results of major surgical operations for these patients are unsatisfactory. Recently, attention has shifted to disk heating methods for treatment. TransDiscal Biacuplasty is one of the minimally invasive treatment methods. The method was developed as an alternative to spinal surgical practices and Intradiscal Electrothermal Therapy for treatment of patients with chronic discogenic pain. METHODS: The candidates for this study were patients with chronic discogenic pain that did not respond to conservative treatment. The main criteria for inclusion were: the existence of axial low back pain present for 6 months; disc degeneration or internal disc disruption at a minimum of one level, and maximum of two levels, in MR imaging; and positive discography. Physical function was assessed using the Oswestry Disability Index when measuring the pain with VAS. Patient satisfaction was evaluated using a 4-grade scale. Follow-ups were made 1, 3, and 6 months after treatment. RESULTS: 15 patients were treated at one or two levels. The mean patient age was 43.1 ± 9.2 years. We found the mean symptom duration to be 40.5 ± 45.7 months. At the sixth month, 57.1% of patients reported a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. In the final check, 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values. No complications were observed in any of the patients. CONCLUSIONS: TransDiscal Biacuplasty is an effective and safe method.