Effects of remifentanil and propofol on distant organ lung injury in an ischemia-reperfusion model.

Our aim was to evaluate lung injury due to oxidative stress and antioxidant activity levels in an infrarenal ischemia-reperfusion model and to compare prevention effects of single and combined use of propofol and remifentanil. In this study, a total of 40 adult Wistar Albino rats were randomly divided into five groups of eight rats as SHAM, physiological saline, intraperitoneal propofol, remifentanil, and propofol and remifentanil groups. Blood and tissue samples were obtained after 80 min of reperfusion. The malondialdehyde (MDA) level, a measure of lipid peroxidation, was measured in lung tissue samples and red blood cells; additionally, total oxidant status and total antioxidant capacity of lung tissues were measured and histopathological examination was performed. Distant organ (lung) injury developed due to lower extremity ischemia-reperfusion was created by infrarenal aortic clamping. The lipid peroxidation product MDA and total oxidant levels were increased, but there was insufficient antioxidant protection both in the lung tissues and red blood cells. While propofol prevented this injury consistent with its proposed antioxidant properties; no protective effect of remifentanil was observed. On the contrary, it showed oxidative stress increasing effect. This study concluded that the antioxidant effect of propofol was suppressed by remifentanil in the case of combined use.

Effects of Total Intravenous Anesthesia and Low- and High-Flow Anesthesia Implementation on Middle Ear Pressure.

BACKGROUND: The middle ear is an air-filled lacuna in the temporal bone. Inhaled anesthetic agents increase the pressure of this lacuna. Therefore, attention must be paid in choosing not only anesthetic agents but also anesthetic method. AIM: This study compared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear pressure. STUDY DESIGN: Randomized prospective double-blind study. METHODS: In this retrospective double-blind study, 90 patients (20-65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow desflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). The hemodynamic and respiratory parameters and tympanometry were measured before induction (T1), 10 minutes after intubation (T2), 10 minutes before the end of the operation (T3), and 5 (T4), 10 (T5), 15 (T6), and 30 (T7) minutes after the operation. RESULTS: No statistically significant differences were found in the age, gender, weight, height, body mass index, surgery duration, and anesthetic duration (p > 0.05). There were no statistically significant differences at T1, T3, T4, T5, T6, and T7 (p > 0.007), but there was a significant difference at T2 (p < 0.001), with Groups II and III having lower pressure than Group I (p < 0.001). CONCLUSION: The high-flow desflurane group had higher postinduction middle ear pressure values. Therefore, low-flow anesthesia and TIVA can be used more safely in middle ear surgeries, provided that a well-equipped anesthetic device and appropriate monitoring conditions are available.

Comparison between Colloid Preload and Coload in Bone Cement Implantation Syndrome under Spinal Anesthesia: A Randomized Controlled Trial.

BACKGROUND: Bone cement implantation syndrome (BCIS) is characterized by hypoxia hypotension cardiac arrest. There is not any research that investigated the hemodynamic effects of colloid use during and before cement implantation regarding BCIS development. AIMS: We aimed to compare the effects of colloid preloading before or coloading simultaneously at cement implantation on BCIS development and hemodynamic parameters in patients who underwent total knee arthroplasty. SETTINGS AND DESIGN: This is a prospective, randomized, clinical trial with the participation of 109 patients over 60 years of age and patients physical status American Society of Anesthesiologists Classes I and II to undergo knee surgery. The patients were administered spinal anesthesia, divided into three groups. SUBJECTS AND METHODS: The patients in Group I were infused 8 mL/kg hydroxyethyl starch (130/0.4) 20 min before the cement implantation, those in Group II were infused the same simultaneously during cement implantation. Group III was infused 8 mL/kg/h sodium chloride during the anesthesia management. Hemodynamic parameters of the patients were recorded at before and after cement implantation and once the tourniquet was removed. STATISTICAL ANALYSIS USED: The descriptive statistics were presented as the mean ± standard deviation for normally distributed variables, as the median for nonnormally distributed variables, and as the number of cases and (%) for nominal variables. Pearson's Chi-square test and Fisher's exact test were used in the analysis of categorical variables. RESULTS: Compared to the control group, Groups I and II were hemodynamically more stable. The development of moderate hypoxia during cement implantation was significantly different between the study groups (P < 0.05). CONCLUSIONS: We suggest that avoiding intravascular volume depletion by using the colloids, particularly in elderly patients, is important for preventing from the BCIS.

Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara.

BACKGROUND: Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. METHODS: The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. RESULTS: There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. CONCLUSION: The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital.

Our Anaesthetic Experiences in Patients Undergoing Percutaneous Mitraclip Implantation.

OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68.5±10.2 years) were retrospectively investigated in terms of anaesthetic management. RESULTS: Of the 84 patients undergoing percutaneous mitraclip implantation under general anaesthesia, 84.5% had sodium thiopental and 75% had midazolam for anaesthesia induction. For the maintenance of anaesthesia, 57% of the patients were reported to have sevoflurane, whereas the rest had desflurane. The mean duration of the procedure and anaesthesia was 140.9±48.2 mins and 165.7±50.6 min, respectively. Seventy seven patients were transported to the intensive care unit and intubated after the procedure. The median extubation time was 3 h. Length of stay in the intensive care unit was 2 days, whereas it was 4 days for hospital stay. One patient died during the procedure and six patients died after the procedure. CONCLUSION: Percutaneous mitraclip implantation procedure is quite difficult for anaesthesiologists because of the procedure itself and the population on which the procedure is performed. The primary aim of anaesthesia management is to provide haemodynamic stability. The preoperative preparation and anaesthesia methods should be the same as for patients undergoing cardiac surgery. It is reported that as the experience regarding this subject increases, success of the procedure increases, with better protected haemodynamic stability, less inotropic and vasopressor requirement and shorter length of hospital stay.

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy in aortic stenosis patients with high operative risk. Advances in experiences have shifted the choice of anesthesia from general to local anesthesia and sedation for these patients. We compared our anesthetic experiences in our institute in a period of 2.5 years. MATERIALS AND METHODS: A total of 151 (86 females, 65 males, mean age 76 years) symptomatic aortic stenosis patients undergoing transfemoral TAVI under general anesthesia (GA) (n = 79) and local anesthesia and sedation (LAS) (n = 72) were evaluated retrospectively in regards to anesthetic issues. RESULTS: The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) values of patients in the GA and LAS groups were 17 and 12, respectively. The anesthesia duration was significantly shorter in the LAS group (P < 0.001) and 16.7% of the patients in the LAS group were switched to general anesthesia. Length of stay in the intensive care unit was similar in the two groups. CONCLUSION: TAVI, applied in high-risk populations, has many challenges for anesthesiologists. With technological advances, it is possible to perform these procedures under sedation with variable advantages. Thus, future studies in regard to anesthesia are required for the success of the procedure and patient safety.

Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy.

Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer's assessment of alertness/sedation score.

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine.

BACKGROUND: The goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperative analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery. METHODS: Sixty patients undergoing arthroscopic shoulder surgery were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine 0.25 % (group B) 40 ml or levobupivacaine 0.25 % (group L) 40 ml. BIS scores or respiratory and hemodynamic parameters during the operation, recovery characteristics, consumed doses of desflurane and pain intensities were evaluated. RESULTS: The eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p < 0.05). Group B and group L saved 36 % and 25 % desflurane per unit time respectively when compared with group C (p < 0.001and p < 0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p < 0.05). CONCLUSIONS: Because of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, general anaesthesia in combination with interscalene block may be preferred in arthroscopic shoulder surgery. TRIAL REGISTRATION: The trial registration number is ACTRN12613000381785.

The Effects of Different Anaesthetic Techniques on Surgical Stress Response During Inguinal Hernia Operations.

OBJECTIVE: The aim of this study is to compare the effects of 3 different kinds of anaesthesia on stress response induced by surgery. METHODS: Sixty patients aged between 25-70 American Society of Anesthesiologists (ASA) I-II group to undergo inguinal herniography were included in this study. Patients were randomly divided into 3 groups of 20. Group 1 received general anaesthesia with sevoflurane/air/remifentanil, patients in Group 2 received total intravenous anaesthesia (TIVA) with propofol/air/remifentanil and Group 3 received spinal anaesthesia induced by hyperbaric bupivacaine, adjoined by remifentanil sedation. Mean arterial pressure (MAP), heart rate and SpO2 values were recorded preoperatively, intraoperatively and postoperatively at certain periods. Cortisol, leptin and glucose levels were preoperatively detected. Intervals were as; 15 minutes prior to the induction of anaesthesia, at intraoperative first hour and at the postoperative third and twenty-forth hours. RESULTS: MAP and heart rate values were similar in the inhalational anaesthesia and TIVA groups but relatively higher in the spinal anaesthesia group. Blood glucose levels were elevated, insulin levels were decreased in all groups, at the intraoperative first hour. Biphasic variation in blood leptin levels was observed in all groups, as the levels were lower than the preoperative control values at the intraoperative first and postoperative third hours and significantly higher at the postoperative twenty-forth hour. There was a significant decrease in cortisol level percentage change in the TIVA group at the intraoperative 1st hour, increasing in the other groups. CONCLUSION: We concluded that TIVA supresses the stress response induced by surgery better by lowering cortisol levels, leading to a lower increase in blood glucose levels and a lower decrease in blood insulin levels when compared to others. Furthermore, leptin levels were increased at the postoperative twenty-forth hour. The lower increase at the postoperative twenty-forth hour in the TIVA group can be correlated with the anaesthetic agent.

Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study / Prostatectomia robótica: análise anestesiológica de cirurgias urológicas robóticas: estudo prospectivo / Prostatectomía robótica: análisis anestesiológico de cirugías urológicas robóticas, un estudio prospectivo

Background and objectives: Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room. Methods: Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Results: Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits. Conclusion: Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study. .

Justificativa e objetivos: Embora muitas características da prostatectomia robótica sejam semelhantes àquelas de laparoscopias urológicas convencionais (como a prostatectomia por laparoscopia), o procedimento está associado a alguns inconvenientes, incluindo acesso intravenoso limitado, tempo cirúrgico relativamente longo, posição de Trendelenburg profunda e pressão intra-abdominal alta. O objetivo principal foi descrever as alterações respiratória e hemodinâmica e as complicações relacionadas à pressão intra-abdominal elevada e à posição de Trendelenburg profunda em pacientes submetidos à prostatectomia robótica. O objetivo secundário foi revelar critérios seguros de alta do centro cirúrgico. Métodos: Foram inscritos prospectivamente 53 pacientes submetidos à prostatectomia robótica entre dezembro de 2009 e janeiro de 2011. As medidas de desfecho primário foram: monitoramento não invasivo, monitoramento invasivo e gasometria feita em decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg + pneumoperitônio (T2), Trendelenburg pré-desinsuflação (T3), Trendelenburg pós-desinsuflação (T4) e posições supinas (T5). Resultados: O principal desafio clínico em nosso grupo de estudo foi a escolha da estratégia de ventilação para controlar a acidose respiratória, que é detectada por meio da pressão de dióxido de carbono expirado e da gasometria. Além disso, a pressão arterial média permaneceu inalterada e a frequência cardíaca diminuiu significativamente e precisou de intervenção. Os valores da pressão venosa central também estavam acima dos limites normais. Conclusão: A acidose respiratória e sintomas clínicos "semelhantes à obstrução ...

Justificación y objetivos: Aunque muchas características de la prostatectomía robótica sean similares a las de las laparoscopias urológicas convencionales (como la prostatectomía laparoscópica), el procedimiento está asociado con algunos inconvenientes, incluyendo el acceso intravenoso limitado, tiempo quirúrgico relativamente largo, posición de Trendelenburg profunda y presión intraabdominal alta. El objetivo principal fue describir las alteraciones respiratorias y hemodinámicas y las complicaciones relacionadas con la presión intraabdominal elevada y con la posición de Trendelenburg profunda en pacientes sometidos a prostatectomía robótica. El objetivo secundario fue revelar criterios seguros de alta del quirófano. Métodos: Cincuenta y tres pacientes sometidos a prostatectomía robótica entre diciembre de 2009 y enero de 2011 fueron incluidos en un estudio prospectivo. Las principales medidas de resultado fueron: monitorización no invasiva, monitorización invasiva y gasometría realizada en decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg + neumoperitoneo (T2), Trendelenburg predesinsuflación (T3), Trendelenburg posdesinsuflación (T4) y posiciones supinas (T5). Resultados: Cincuenta y tres pacientes sometidos a prostatectomía robótica fueron incluidos en el estudio. El principal reto clínico en nuestro grupo de estudio fue la elección de la estrategia de ventilación para controlar la acidosis respiratoria, que es detectada por medio de la presión de dióxido de carbono espirado y la gasometría. Además, la presión arterial media permaneció inalterada, y la frecuencia cardíaca disminuyó significativamente y fue necesario intervenir. Los valores de la presión venosa central también estaban por encima de los límites normales. ...

[Robotic prostatectomy: The anesthetist's view for robotic urological surgeries, a prospective study]. / Prostatectomia robótica: análise anestesiológica de cirurgias urológicas robóticas: estudo prospectivo.

BACKGROUND AND OBJECTIVES: Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room. METHODS: Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. RESULTS: Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits. CONCLUSION: Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study.

Anesthetic considerations for robotic cystectomy: a prospective study.

BACKGROUND AND OBJECTIVES: Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients. PATIENTS: Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg+pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. RESULTS: There were significant differences between T0-T1 and T0-T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean f values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0. CONCLUSIONS: Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created.

Considerações anestésicas para cistectomia robótica: estudo prospectivo / Anesthetic considerations for robotic cystectomy: a prospective study / Consideraciones anestésicas para la cistectomía robótica:estudio prospectivo

Experiência e objetivos: a cistectomia robótica vem rapidamente se tornando parte do repertório cirúrgico de rotina para o tratamento do câncer de próstata. Nosso objetivo foi descrever os desafios respiratórios e hemodinâmicos e as complicações observadas em pacientes de cistectomia robótica. Pacientes: foram prospectivamente recrutados 16 pacientes tratados com cistectomia robótica entre dezembro de 2009 e janeiro de 2011. As medidas de desfecho primário foram monitoração não invasiva, monitoração invasiva e análise de gases sangüíneos feita nas posições supina (T0), Trendelenburg (T1), Trendelenburg + pneumoperitônio (T2), Trendelenburg antes da dessuflação (T3), Trendelenburg depois da dessuflacão (T4) e supina (T5). Resultados: houve diferencas significativas entre T0 - T1 e T0 - T2 com frequências cardíacas mais baixas. O valor médio para a pressão arterial em T1 foi significativamente mais baixo do que em T0. O valor da pressão venosa central foi significativamente mais elevado em T1, T2, T3 e T4 versus T0. Não foi observada diferença significativa no valor de PET-CO2 em qualquer ponto temporal, em comparação com T0. Também não foram notadas diferenças significativas na frequência respiratória em qualquer ponto temporal, em comparação com T0. Os valores médios de ƒ em T3, T4 e T5 foram significativamente mais elevados versus T0. A ventilação minuto média em T4 e T5 foi significativamente mais elevada versus T0. As pressões de platô e de pico médias em T1, T2, T3, T4 e T5 foram significativamente mais elevadas versus T0. Conclusões: embora a maioria dos pacientes geralmente tolere satisfatoriamente a cistectomia robótica e perceba os benefícios, os ...

Background and objectives: Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients. Patients: Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Results: There were significant differences between T0 - T1 and T0 - T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean ƒ values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0. Conclusions: Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created. .

Antecedentes y objetivos: la cistectomía robótica se ha convertido rápidamente en parte del repertorio quirúrgico de rutina para el tratamiento del cáncer de próstata. Nuestro objetivo ha sido describir los retos respiratorios y hemodinámicos, junto con las complicaciones observadas en pacientes sometidos a cistectomía robótica. Pacientes: diesiséis pacientes tratados con cistectomía robótica entre diciembre de 2009 y enero de 2011 se reclutaron de forma prospectiva. Las medidas de resultado primario fueron la monitorización no invasiva, la monitorización invasiva y la gasometría sanguínea realizada en las posiciones supina (T0), Trendelenburg (T1), Trendelenburg + neumoperitoneo (T2), Trendelenburg antes del desinflado (T3), Trendelenburg después del desinflado (T4), y supina (T5). Resultados: hubo diferencias significativas entre T0-T1 y T0-T2 con frecuencias cardíacas más bajas. El valor medio para la presión arterial en T1 fue significativamente más bajo que en T0. El valor de la presión venosa central fue significativamente más elevado en T1, T2, T3, y T4 versus T0. No se observó diferencia significativa en el valor de PET-CO2 en ningún momento en comparación con T0. Tampoco se encontraron nunca diferencias significativas en la frecuencia respiratoria en comparación con T0. Los valores medios de ƒ en T3, T4, y T5 fueron significativamente más elevados versus T0. La ventilación minuto promedio en T4 y T5 fue significativamente más elevada versus T0. Las presiones de meseta y de pico promedios en T1, T2, T3, T4, y T5 fueron significativamente más elevadas versus T0. Conclusiones: aunque la mayoría de los pacientes generalmente tolere satisfactoriamente la cistectomía robótica y se dé cuenta de los beneficios, los anestesiólogos deben tener ...

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience.

BACKGROUND/AIM: To describe the anesthetic management and early results of transcatheter aortic valve implantation (TAVI) in a single center in Turkey. MATERIALS AND METHODS: We evaluated 79 (54 females, 25 males; mean age: 76 ± 9 years) consecutive symptomatic patients with severe aortic stenosis who underwent TAVI under general anesthesia between July 2011 and September 2012. We preferred a transfemoral approach as the first option. RESULTS: The duration of anesthesia was 149 ± 49 min. Thirty-eight percent of the patients were extubated in the cardiac catheterization laboratory. Three patients required a permanent pacemaker, while 8 patients required inotropic support in the postoperative period. Mortality rate was 9% within 30 days. Fifteen patients had vascular complications, of which 53% were treated surgically. CONCLUSION: Today, as a result of developments in technology, TAVI can be considered as a beneficial alternative treatment option for inoperable aortic stenosis patients. Thus, anesthesiologists will be confronted with a number of TAVI cases, and so they should be prepared to face issues related to the patient's safety both during the administration of anesthesia and in the postoperative period in the near future.

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery.

The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥ 4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.

Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients.

OBJECTIVES: The aim of this prospective randomized, double-blind study was to evaluate the analgesic efficacy and opioid-sparing effects of preemptive single dose of dexketoprofen trometamol in comparison with that of paracetamol or placebo for elective lumbar disc surgery, over a 24-hour (h) investigation period. METHODS: After institutional approval and informed consent had been obtained, 75 patients scheduled for single level lumbar disc surgery were randomly allocated into three equal groups. Patients received oral dexketoprofen 25 mg (Group D), 500 mg paracetamol (Group P) or placebo tablets (Group C) 30 minutes (min) before induction of standard anesthesia. Patient-controlled analgesia was supplied postoperatively using morphine. Hemodynamics, visual analogue scale (VAS), sedation score, morphine consumption, and side effects were recorded every 15 min in the first hour and at 2, 6 and 24 h after surgery. RESULTS: The mean pain scores were similar among groups (p>0.05). The cumulative (SD) 24-h morphine consumption was 28.1 mg, 40.6 mg, and 43.6 mg for Groups D, P and C, respectively. The amount of morphine use at 2, 6 and 24 h was significantly lower in Group D (p<0.006). Hemodynamic parameters, sedation scores and side effects did not differ among the groups (p>0.05). CONCLUSION: The study demonstrated that preemptive dexketoprofen trometamol 25 mg is associated with a decrease of up to 35% in morphine consumption compared with placebo over the first 24 h following lumbar disc surgery; however, paracetamol 500 mg did not show the expected opioid-sparing effect comparatively.

The impact of OGG1, MTH1 and MnSOD gene polymorphisms on 8-hydroxy-2'-deoxyguanosine and cellular superoxide dismutase activity in myocardial ischemia-reperfusion.

Ischemia-reperfusion (I/R) injury, by inducing oxidative DNA damage, is one of the leading causes of increased patient morbidity and mortality in coronary artery by-pass grafting (CABG) surgery. 8-Hydroxyguanine (8-OHG) is an important oxidative base lesion. The 8-oxoguanine glycosylase (hOGG1) and hMTH1, which have several polymorphisms, remove 8-OHdG from the nucleotide pool. We investigated whether there are any correlations the biomarkers of oxidative stress (superoxide dismutase; SOD and 8-OHdG in serum) with genotype for two DNA repair genes (OGG1 and MTH1) and an antioxidant enzyme gene (manganese superoxide dismutase; MnSOD). Therefore, we measured DNA damage (8-hydroxy-2-deoxyguanosine; 8-OHdG) and endogenous antioxidant activity (SOD) at five different time points (T1, before anesthesia; T2, after anesthesia; T3, after ischemia; T4, after reperfusion and T5, after surgery). and also, MnSOD and MutT homolog 1 (MTH1) genes polymorphisms were genotyped by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) in patients undergoing coronary artery by-pass grafting (CABG) surgery. No statistically significant differences were detected in the levels of 8-OHdG and SOD in serum in terms of OGG1 Ser326Cys, MTH1 Val83Met and MnSOD Ala16Val genetic polymorphisms. Our results suggest that OGG1, MTH1 and MnSOD gene polymorphisms are not genetic risk factors for I/R injury.