Protective Role of Dexmedetomidine on Ileum and Kidney Damage Caused by Mesenchymal Ischaemia in Rats.

OBJECTIVE: The aim of this study was to demonstrate ischaemia reperfusion (IR) injury on the ileum and kidney tissue in rats and to evaluate the effect of dexmedetomidine administered at different doses and dosing schedules on recovery. METHODS: A total of 30 rats were randomly divided into five groups. Group I: sham; Group II: control; Group III: dexmedetomidine before ischaemia; Group IV: dexmedetomidine after ischaemia; and Group V: dexmedetomidine before and after ischaemia. The malondialdehyde (MDA) and signal peptide-CUB-EGF (epidermal growth factor) domain-containing protein 1 (SCUBE-1) levels of all subjects were studied from the serum, ileum, and kidney tissues. Moreover, the histopathology of ileum and kidney tissues was examined. RESULTS: The SCUBE-1 levels were found to be highly similar to the MDA levels in ischaemic groups. The serum SCUBE-1 levels obtained were significantly lower in Group V compared to Groups II, III and IV (p<0.001, p=0.003, p=0.013, respectively). The apoptosis indexes were found to be lower in groups receiving dexmedetomidine compared to Group II. The groups receiving dexmedetomidine were detected to have normal morphological appearance when compared to Group II. CONCLUSION: In this study, the use of dexmedetomidine in the preoperative and peroperative periods may be beneficial in reducing the negative effects of IR injury.

Comparison of surgical conditions in 2 different anesthesia techniques of esmolol-induced controlled hypotension in breast reduction surgery.

BACKGROUND: Breast reduction surgery is a common cosmetic surgery with a high incidence of blood loss and transfusion. In this surgery, the reduction of blood loss related to surgical manipulation and the volume of resected tissue is a target. In the present study, we compared the effects of esmolol-induced controlled hypotension on surgical visibility, surgical bleeding, and the duration of surgery in patients anesthetized with propofol/remifentanil (PR) or sevoflurane/remifentanil (SR). METHODS: Patients in the American Society of Anesthesiologists I/II risk group undergoing breast reduction surgery were prospectively randomized into PR (n = 25) and SR (n = 25) groups. Controlled hypotension was induced with esmolol in both groups. During the intraoperative period, the heart rate (HR), mean arterial pressure (MAP), operation duration, volume of intraoperative blood loss, volume of blood received through postoperative drains, volume of resected tissues, and surgical area bleeding score were recorded. RESULTS: The duration of operation in the incisional period was shorter in group PR compared to group SR (P = 0.04). The change in HR was lower in incision and hemostasis periods in the group PR compared to the group SR (P < 0.001). Total intraoperative intraoperative bleeding volume and volume of blood received through drains on postoperative postoperative day 1, day 2, and in total were found to be significantly lower in group PR compared to group SR. Surgical visibility scoring was more effective in group PR compared to SR. CONCLUSION: In the breast reduction surgery performed under esmolol-induced controlled hypotension, the effect of propofol + remifentanil anesthesia on the duration of incisional surgery, surgical visibility, and volume of surgical blood loss was more reliable and effective compared to that of sevoflurane + remifentanil, which seems to be an advantage.

Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

Paresia transitória unilateral combinada do nervo hipoglosso e do nervo lingual após intubação para anestesia / Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia / Paresia transitoria unilateral combinada del nervio hipoglosoy del nervio lingual después de la intubación para anestesia

Lesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração. As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia). No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

Durante la anestesia general pueden lesionarse los nervios en la región faringolaríngea. Los nervios más a menudo lesionados son el hipogloso, lingual y laríngeo recurrente. Las lesiones pueden surgir como resultado de varios factores que pueden ser, durante la laringoscopia, intubación endotraqueal e inserción del tubo y por presión del balón, ventilación con mascarilla, maniobra aérea triple, vía aérea orofaríngea, modo de inserción del tubo, posición de la cabeza y del cuello, y aspiración. Las lesiones nerviosas en esa región pueden comprometer un solo nervio aislado o causar la parálisis de 2 nervios en conjunto, como la del nervio laríngeo recurrente hipogloso (síndrome de Tapia). Sin embargo, la lesión combinada de los nervios lingual e hipogloso, después de la intubación para la anestesia, es una condición mucho más rara. El riesgo de una lesión se puede reducir con medidas preventivas. A continuación describimos un caso de paresia unilateral combinada de los nervios hipogloso y lingual después de la intubación para la anestesia.

The effect of dexmedetomidine on oxidative stress during pneumoperitoneum.

PURPOSE: This study was intended to investigate the effect of dexmedetomidine on oxidative stress response in pneumoperitoneum established in rats. METHODS: Animals were randomized into three groups, group S: with no pneumoperitoneum, group P: with pneumoperitoneum established, and group D: given 100 mcg intraperitoneal dexmedetomidine 30 min before establishment of pneumoperitoneum. Plasma total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) activity were measured 30 min after conclusion of pneumoperitoneum. RESULTS: The mean TOS level was significantly higher in group P than in the other two groups, and the TOS level was significantly higher in group D than in group S (P < 0.05). Plasma TAS level was found to be lower in group P than in the other two groups, and the TAS level was lower in group D than in group S (P < 0.05). Consequently, the OSI was significantly higher in group P than in groups D and S (P < 0.05). CONCLUSIONS: Ischemia-reperfusion phenomenon that occurs during pneumoperitoneum causes oxidative stress and consumption of plasma antioxidants. Dexmedetomidine decreases oxidative stress caused by pneumoperitoneum and strengthens the antioxidant defense system.

Sevoflurane/remifentanil versus propofol/remifentanil for electroconvulsive therapy: comparison of seizure duration and haemodynamic responses.

OBJECTIVE: To compare the anaesthetic and convulsive effects of sevoflurane/remifentanil versus propofol/remifentanil combination in electroconvulsive therapy (ECT). METHODS: In this prospective, randomized double-blind study, patients diagnosed with treatment-resistant depression were included for ECT. Prior to treatment, 1 µg/kg remifentanil was intravenously administered to all patients, followed by anaesthetic induction with either 0.5 mg/kg propofol or 8% sevoflurane. Following muscular paralysis with succinylcholine and hypnosis, bitemporal ECT was applied. Vital signs, depth of sedation, recovery parameters, motor and electroencephalography (EEG) convulsion activity and postictal suppression index scores were recorded. RESULTS: A total of 120 sessions of ECT were administered to 12 patients. Heart rate was higher in the sevoflurane group than the propofol group. Compared with the sevoflurane group, bispectral index level was lower in the propofol group during the induction period and higher during the recovery period. Anaesthetic induction and recovery times were lower, and average motor and EEG convulsion activity was longer, in the propofol group than in the sevoflurane group. CONCLUSION: Propofol/remifentanil is more successful compared with sevoflurane/remifentanil in anaesthesia management during ECT since it provides quick induction and recovery, longer seizure activity and stable haemodynamics.

A comparison of levobupivacaine and levobupivacaine-tramadol combination in bilateral infraorbital nerve block for postoperative analgesia after nasal surgery.

BACKGROUND: Our aim in this study was to investigate the effect of levobupivacaine and a levobupivacaine + tramadol combination on postoperative analgesia in intraoperative nerve block under standard general anesthetic. METHODS: Forty-five patients undergoing outpatient nasal surgery under general anesthesia were randomized into 3 groups. Group L: 0.25% levobupivacaine, group T: 0.25% levobupivacaine and 50 mg tramadol, group S: normal saline solution; 2 mL of each being injected into the infraorbital foramen. Intraoperative hemodynamic changes were recorded. Verbal numeric rating scale (NRS) values were checked at 30 minutes and 1, 2, 8, and 12 hours postoperatively, and the need for rescue analgesic treatment in the first 12 hours of all patients was recorded. Also antiemetic drug requirement and side effects (nausea, edema, erythema, hematoma, and sedation) were recorded. RESULTS: At 30 minutes and 1 hour postoperatively, NRS pain scores were lower in group T than in group S (P < 0.0001, P = 0.01, respectively). NRS pain score was lower in group T compared with group L at 1 hour postoperatively (P = 0.01). Effective analgesia time (sec) in the control group (142.67 ± 77.31) was shorter than levobupivacaine (240 ± 96.39) and levobupivacaine added to tramadol groups (277 ± 11.60) (P < 0.05). Additional analgesic requirement in the control group was higher than the other 2 groups in early postoperative period (P < 0.05). CONCLUSIONS: Bilateral infraorbital nerve block with 0.25% levobupivacaine is an effective, reliable, and simple technique in the treatment of postoperative pain in nasal surgery. In addition, the addition of tramadol as an adjuvant to local anesthetics in this technique is safe.

Use of dexmedetomidine to prevent pulmonary injury after pneumoperitoneum in ventilated rats.

PURPOSE: This study examined the effectiveness of dexmedetomidine in preventing lung injury resulting from pneumoperitoneum in a ventilated rat model. METHODS: Animals (n=18) were allocated randomly into 3 groups: control group, no pneumoperitoneum; sham group, pneumoperitoneum with intra-abdominal pressure of 12 mm Hg for 60 minutes; and dexmedetomidine group, dexmedetomidine administration 30 minutes before pneumoperitoneum. The rats were rested for 30 minutes after abdominal deflation. Then, blood samples were obtained for plasma malondialdehyde and ischemia-modified albumin (IMA) analyses. Tissue samples were taken for histopathologic examination and malondialdehyde analysis. RESULTS: Compared with the control group, the sham group had a significantly higher level of plasma IMA. Pretreatment with dexmedetomidine significantly reduced the IMA level. Histopathologically, tissues from sham rats exhibited moderate or severe tissue damage, compared with control tissues. Dexmedetomidine-treated rats showed significantly less tissue damage than sham rats. CONCLUSIONS: Dexmedetomidine prophylaxis resulted in significantly less IMA production and significantly less neutrophil infiltration, thereby helping to protect the lungs from injury after pneumoperitoneum.

Conduta no perioperatório de paciente pediátrico com trombastenia de glanzmann durante adenoidectomia / Perioperative management of a pediatric patient with glanzmann's thrombasthenia during adenoidectomy / Conducta en el perioperatorio de paciente pediátrico con trombastenia de glanzmann durante la adenoidectomía

JUSTIFICATIVA E OBJETIVOS: Trombastenia de Glanzmann (TG) é uma doença autossômica recessivamente hereditária das plaquetas. Não há nenhum tratamento específico. A transfusão de plaquetas é atualmente o tratamento padrão quando o sangramento não responde a medidas locais e/ou a medicamentos antifibrinolíticos, podendo, entretanto, resultar em aloimunização. O fator VII recombinante ativado (rFVIIa) pode ser usado para evitar a transfusão recorrente de plaquetas. RELATO DE CASO: Apresentamos um tratamento precoce com dose baixa de rFVIIa associada à transfusão de plaquetas em um caso pediátrico (cinco anos de idade), com diagnóstico de TG e apresentando sangramento prolongado durante adenoidectomia eletiva. Uma dose total de 1.200 mg (60 µg.kg-1) de rFVIIa obteve sucesso em estancar o sangramento, o que pode ser aceito como uma dose baixa. CONCLUSÕES: Relatos de casos podem encorajar o uso de tratamento precoce com baixas doses de rFVIIa em hemorragias graves que não estacam a despeito da transfusão de plaquetas e na prevenção de sangramento em procedimentos cirúrgicos em pacientes com TG. Estudos adicionais são necessários para definir a dose mínima eficaz. Portanto, as tentativas para determinar a dose eficaz mais baixa desse composto devem ser incentivadas consideando o resultado deste caso em face de restrições financeiras no sistema de saúde.

BACKGROUND AND OBJECTIVE: Glanzmann's thrombasthenia (GT) is an autosomal recessively inherited platelet disorder. There is not any specific treatment. Platelet transfusion is currently the standard treatment when bleeding does not respond to local measures and/or antifibrinolytic treatment, although it may result in alloimmunization. Recombinant activated factor VII (rFVIIa) might be used to avoid recurrent platelet transfusion. CASE REPORT: We present early treatment with low-dose rFVIIa additional to platelet transfusion in a 5-year-old pediatric case with diagnosis of GT who developed prolonged bleeding under an elective adenoidectomy surgery. A total dose of 1,200 µg (60 µg.kg-1) rFVIIa could successfully stop bleeding, what can be accepted as low dose usage. CONCLUSIONS: Such case reports may encourage the use of early treatment with low doses of rFVIIa in severe bleeds that did not stop despite of platelet transfusion, as well as in preventing bleeding in surgical procedures in patients with GT. Actually, additional studies are needed to define the minimal effective dose and attempts to determine the lowest effective dose may be encouraged by the result of this case, considering financial restrictions in the health care system.

JUSTIFICATIVA Y OBJETIVOS: La Trombastenia de Glanzmann (TG) es una enfermedad autosómica recesivamente hereditaria de las plaquetas. No hay ningún tratamiento específico. La transfusión de plaquetas es hoy por hoy, el tratamiento estándar cuando el sangramiento no responde a medidas locales y/o a medicamentos antifibrinolíticos, pudiendo sin embargo, resultar en una aloinmunización. El factor VII recombinante activado (rFVIIa) puede ser usado para evitar la transfusión recurrente de plaquetas. RELATO DE CASO: Presentamos aquí un rápido tratamiento con una dosis baja de rFVIIa asociada a la transfusión de plaquetas en un caso pediátrico (5 años de edad), con diagnóstico de TG y presentando un sangramiento prolongado durante la adenoidectomía electiva. Una dosis total de 1.200 mg (60 µg.kg-1) de rFVIIa tuvo éxito al estancar el sangramiento, lo que puede aceptarse como una dosis baja. CONCLUSIONES: Relatos de casos pueden estimular el uso de tratamiento rápido con bajas dosis de rFVIIa en las hemorragias graves que no estancan, pese a la transfusión de plaquetas y a la prevención de sangramiento en los procedimientos quirúrgicos en pacientes con TG. Sin embargo, estudios adicionales se hacen necesarios para definir la dosis mínima eficaz. Por tanto, los intentos para determinar la dosis eficaz más baja de un compuesto tan caro deben ser incentivados debido al resultado de este caso cuando existan restricciones financieras en el sistema de Sanidad.

Perioperative management of a pediatric patient with Glanzmann's thrombasthenia during adenoidectomy.

BACKGROUND AND OBJECTIVE: Glanzmann's thrombasthenia (GT) is an autosomal recessively inherited platelet disorder. There is not any specific treatment. Platelet transfusion is currently the standard treatment when bleeding does not respond to local measures and/or antifibrinolytic treatment, although it may result in alloimmunization. Recombinant activated factor VII (rFVIIa) might be used to avoid recurrent platelet transfusion. CASE REPORT: We present early treatment with low-dose rFVIIa additional to platelet transfusion in a 5-year-old pediatric case with diagnosis of GT who developed prolonged bleeding under an elective adenoidectomy surgery. A total dose of 1,200µg (60µg.kg(-1)) rFVIIa could successfully stop bleeding, what can be accepted as low dose usage. CONCLUSIONS: Such case reports may encourage the use of early treatment with low doses of rFVIIa in severe bleeds that did not stop despite of platelet transfusion, as well as in preventing bleeding in surgical procedures in patients with GT. Actually, additional studies are needed to define the minimal effective dose and attempts to determine the lowest effective dose may be encouraged by the result of this case, considering financial restrictions in the health care system.

Comparison of the effect of propofol and N-acetyl cysteine in preventing ischaemia-reperfusion injury.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the effects of propofol and N-acetyl cysteine (NAC) on tourniquet-induced ischaemia-reperfusion injury by determining malonyldialdehyde, ischaemia-modified albumin, lactate, blood gas and haemodynamic levels in arthroscopic knee surgery. METHODS: Sixty ASA I or II patients were randomized into three groups. Intrathecal anaesthesia was administered using 0.5% heavy bupivacaine in all patients. In group P, propofol was administered in a 0.2 mg kg(-1) bolus, followed by infusion at a rate of 2 mg kg(-1) h(-1); in group NAC, NAC was administered as an infusion at a rate of 5 mg kg(-1) h(-1), and, in group C (the control group), an equal volume of isotonic saline was administered to patients until 30 min after reperfusion. Blood samplings were obtained immediately before intrathecal anaesthesia (t1), 1 min before tourniquet release (t2), 5 min after tourniquet release (t3) and 30 min after tourniquet release (t4). RESULTS: Plasma malonyldialdehyde, ischaemia-modified albumin and lactate levels increased significantly in group C at t3 and t4 compared with the baseline values. Plasma concentrations of malonyldialdehyde, ischaemia-modified albumin and lactate in groups P and NAC were significantly lower than those in group C at t3 and t4. In blood gas analyses, pH, HCO3 and base excess were found to be significantly lower at t3 and t4 compared with t1 and t2 in group C. Comparisons between groups P and NAC revealed no significant differences. CONCLUSION: Small-dose infusions of both propofol and NAC appear to provide similar protection against ischaemia-reperfusion injury in arthroscopic knee surgery.

The effects of oxidative stress on the liver and ileum in rats caused by one-lung ventilation.

BACKGROUND AND AIM: Reactive oxygen radicals that cause remote organ injury are increased after the one-lung ventilation frequently used in thoracic surgery. The aim of this study was to examine the effects of one-lung ventilation on the liver and ileum. MATERIALS AND METHODS: Thirty rats were divided into five groups: a sham group; 3- and 4-h mechanical ventilation groups; and 1- and 2-h left lung collapse/2-h re-expansion groups (n = 6 for each group). In the collapse groups, the left lung was collapsed by bronchial occlusion for 1 and 2 h and then re-expanded and ventilated for an additional 2 h. At the end of the study, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were determined to assess liver functions. Myeloperoxidase (MPO) and malondialdehyde (MDA) activity were determined in the liver and ileum tissues. The tissues were also examined by light and electron microscope. Apoptosis was assessed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay. RESULTS: Plasma ALT and AST, tissue MDA, and MPO activities in both tissues were significantly higher in the 2-h collapse/2-h re-expansion group than in the 4-h mechanical ventilation group (P < 0.05). Moreover, the levels were significantly higher in the 2-h collapse group compared to the 1-h collapse group (P < 0.016). Tissue damage and apoptotic index were most prominent in the 2-h collapse/2-h re-expansion group. CONCLUSION: Our findings showed that one-lung ventilation causes tissue damage in the liver and ileum and that this damage increases as occlusion duration rises.