Application of Cervical Epidural Anesthesia and Analgesia to the Patient With 90% Burnt Surface Area.

Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment, and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization, and nutrition applied to the patient's recovery.

Acute Kidney Injury in Intensive Care Unit Patients with Coronavirus Disease 2019.

OBJECTIVE: The incidence of acute kidney injury during the hospital stay in patients with coronavirus disease 2019 varies between 8% and 17% in studies. This rate is at the highest levels among the critical patient group monitored in the intensive care unit (23% [14-35%]). In this study, we aimed to assess the incidence of acute kidney injury development, effective factors, and clinical outcomes of patients monitored in the intensive care unit due to coronavirus disease 2019. METHODS: A total of 801 patients were analyzed. Patients were divided into 2 groups as those developing acute kidney injury (n = 408) and those not developing acute kidney injury (n=393). Patients developing acute kidney injury were staged according to the Kidney Disease Improving Global Outcomes criteria. RESULTS: In all patients, the mortality rate was 65.2%. The mortality rate for those developing acute kidney injury was identified to be high by a statistically significant degree compared to those not developing acute kidney injury. The mortality rate in Kidney Disease Improving Global Outcomes criteria stage 1 was 81.3%, in stage 2 was 88.3%, and in stage 3 was 91.5%. The frequency of diabetes mellitus type 2, coronary artery disease, and chronic obstructive pulmonary disease in the group developing acute kidney injury was found to be statistically significantly higher. We have found positive correlations between acute kidney injury development and age, sex, history of diabetes mellitus, and ferritin levels in the multivariate analysis. CONCLUSIONS: The development of acute kidney injury in intensive care unit patients with coronavirus disease 2019 is associated with increased mortality. Therefore, predisposing factors should be determined and effective treatment strategies should be established in the early period.

Comparison of Thoracolumbar Interfascial Plane Block with the Application of Local Anesthesia in the Management of Postoperative Pain in Patients with Lumbar Disc Surgery.

AIM: To compare the effect of ultrasound-guided modified thoracolumbar interfascial plane (TLIP) block versus local anesthetic infiltration on the wound site for post-operative analgesia in patients undergoing lumbar disc surgery with spinal anesthesia. MATERIAL AND METHODS: This prospective and observationally planned study included 42 patients from the ages of 18 to 75 years, American Society of Anesthesiologists classes I?III, who underwent lumbar disc surgery. In Group L, bupivacaine infiltration was performed on the surgical incision line. In Group T, TLIP block was performed with ultrasound. In the postoperative period, visual analogue scale (VAS) values were also investigated and recorded on the 10 < sup > th < /sup > day after discharge. Nausea, vomiting, and sedation score values and analgesic doses used by all patients in the postoperative period were recorded. RESULTS: During any of the postoperative follow-up hours, the VAS score was ? 3 (mild pain), and those who did not need tramadol were 80.9% (n=17) in Group T and 71.4% (n=15) in Group L. VAS scores at the 1 < sup > st < /sup > , 4 < sup > th < /sup > , and 8 < sup > th < /sup > hours were statistically lower in Group L than those in Group T (p values: 0.011, 0.028, and 0.029). The average amounts of tramadol consumption per patient were determined as 19.04 mg ± 40.23 in Group T and 27.38 ± 44.65 mg in Group L in the first 24 hours postoperatively. There was no statistically significant difference between groups (p=0.519). CONCLUSION: In this study, it was determined that the modified TLIP block application performed for the purpose of post-operative analgesia in lumbar disc surgery was not superior to local anesthetic infiltration in terms of postoperative opioid consumption and VAS scores.

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

Objective: In this study, considering the importance of platelet function in inflammatory processes, we explored whether there are relationships of platelet indices with postdural puncture headache (PDPH) and pain developing after use of spinal needles and whether patient characteristics contribute to the development of PDPH. Methods: This prospective, observational study included 76 patients (Group 1) with PDPH and 93 patients (Group 2) without PDPH. The postoperative hemoglobin, hematocrit, platelet count (PC), and mean platelet volume (MPV) values were recorded, along with age, blood type, Rh factor, gravida, parity, and gestational age. In addition, the time of the onset of pain was recorded in patients who complained of a postspinal headache. Results: Hemoglobin and hematocrit values in Group 1 were significantly lower than in Group 2 (both, p=0.024). The PC of Group 1 was significantly higher than that of Group 2 (p < 0.001), whereas the MPV was significantly lower (p < 0.001). The area under the curve (AUC) values were significant for hemoglobin, hematocrit, PC, and MPV (p=0.022, p=0.024, p < 0.001, and p < 0.001, resp.). For MPV, the AUC value was 0.293, sensitivity was 1%, and specificity was 99%. The highest likelihood ratio (LR+) value was 1.22 at a cut-off value of 13.3 fL. For the PC, the AUC value was 0.666, the sensitivity was 9%, and the specificity was 99%, while the highest LR + value was 8.56 at a cut-off value of 352 × 109/L. There was no significant relationship between the parameters examined and the onset of pain. Conclusion: In this study, the PC was higher and MPV was lower in obstetric patients with PDPH compared with the control group. However, we also found that these two values cannot be used as markers of PDPH.

Management of a Resistant Hypotension Developing After Reperfusion of a Living-Donor Kidney Transplant.

We present a case of hypotension developing after reperfusion of a living-donor kidney transplant and performing a graft nephrectomy and successful retransplant with the same kidney 12 hours later. Preemptive kidney transplant was performed on a 51-year-old woman who had a chronic kidney disease because of hypertension. Her 55-year-old husband was the living kidney donor. The patient was stable before reperfusion. After declamping, pink color of the transplanted kidney, thrill from the renal artery, and urinary output were seen. But shortly after reperfusion, the invasive arterial blood pressure of the patient abruptly decreased from 130/70 mm Hg to 70/40 mm Hg, her pulse was approximately 80 to 110 beats/minute. The thrill disappeared from the renal artery, but blood flow continued. A graft nephrectomy was performed 45 minutes after reperfusion. Invasive arterial blood pressure of the patient was stabilized at approximately 110/70 mm Hg in the intensive care unit, and the patient was retransplanted with the same kidney. The patient was well, with a serum creatinine level of 1.4 mg/dL, 12 months after the operation. Resistant hypotension that occurs after kidney transplant may cause a loss of the graft and the patient. To prevent graft loss, and to stabilize the patient, a graft nephrectomy and retransplant of the graft under suitable circumstances may be considered.

Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery.

Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

[Our percutaneous vertebroplasty applications in vertebral compression fractures]. / Vertebra kompresyon kiriklarinda perkütan vertebroplasti uygulamalarimiz.

OBJECTIVES: We aimed to investigate the effectiveness and complications of the percutaneous vertebroplasty (PVP) applications in vertebral compression fractures. METHODS: Our study was carried out as a retrospective study in which PVP was conducted on patients with vertebral compression fractures due to benign or malignant causes between October 2006 and December 2009. The patients' pain was evaluated on a visual analog scale (VAS). In addition, the amount of cement injected, whether or not any leakage from the vertebrae corpus was seen, and any complications resulting from the application during or after the operation were recorded. The age and gender of the patients, duration of pain, number and location of fractured vertebrae, and the duration of follow-up were also collected for evaluation. RESULTS: A total of 15 patients were included in the assessment. Of the patients, 13 were female, and the mean age was 69.5±8.5 years. A total of 19 PVPs were applied to the 15 patients. While initial VAS scores were 7.9±1.6, at the end of an average of 10.3±3.8 (range: 4-18) months of follow-up, VAS scores had fallen to 2.6±2.7. 80% of the patients reported at least a 50% reduction in pain scores compared to initial scores, and 86.7% of them reported at least a 2-point decrease in VAS scores. In three patients, leakage of cement into the intervertebral disc occurred. CONCLUSION: PVP may be used successfully in symptomatic vertebral compression fractures not responding to medical treatment, with a low rate of complications.

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.

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.

Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?

PURPOSE: Spinal anesthesia for cesarean section is associated with a high incidence of maternal hypotension. The aim of this study was to assess the efficacy of low-dose bupivacaine with fentanyl to reduce the incidence of hypotension in spinal anesthesia for cesarean section. METHODS: Forty pregnant women undergoing elective cesarean section were randomly allocated to two groups; those receiving 10 mg bupivacaine to group B (n = 20) and those receiving 4 mg bupivacaine plus 25 microg fentanyl to group BF (n = 20); the agents were given intrathecally with patients in the sitting position, with a combined spinal-epidural technique. RESULTS: Sensory block was adequate for surgery in all patients. Hypotension occurred in all patients in group B (100%) and in 15 patients in group BF (75%). The incidence of hypotension, number of ephedrine treatments, and need for ephedrine were significantly greater in group B than group BF. Three patients in group BF required i.v. fentanyl supplementation after delivery. In 1 of these patients, i.v. fentanyl was not adequate, and epidural supplementation of 1% lidocaine was required. CONCLUSION: The development of hypotension after spinal block in subjects undergoing cesarean section was not prevented despite low-dose (4 mg) bupivacaine plus 25 microg fentanyl, but the severity of maternal hypotension, and the number of ephedrine treatments and the total dose of ephedrine were decreased.

Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia.

BACKGROUND: The aim was to investigate the effect of magnesium sulfate on postoperative pain and analgesic consumption after remifentanil-based anesthesia. MATERIAL/METHODS: Forty women 18 to 65 years old were enrolled in this prospective, randomized, double-blinded clinical study. The study solutions were randomly preoperatively prepared for groups M (magnesium) and R (normal saline). A bolus of 0.2 ml/kg of study solution (30 mg/kg magnesium or saline) was given before induction of anesthesia and infusion was started at a rate of 3.3 ml/h (500 mg/h magnesium or saline). A 1 microg/kg loading dose of remifentanil following infusion was started at a rate of 0.25 micro g/kg/min, subsequently increasing stepwise by 0.05 micro g/kg/min increments if insufficient anesthesia was suspected. All postoperative outcome data were collected by an anesthesiologist who was blinded to the anesthetic regimen. Pain intensity using a visual analogue scale (VAS) was recorded for 24 hours postoperatively. RESULTS: Hemodynamic and respiratory variables such as diastolic and systolic blood pressure, heart rate, and oxygen saturation were similar in both groups. The mean intraoperative remifentanil consumption in groups M and R was similar. The VAS score was significantly lower in the magnesium group at 15 and 30 minutes postoperatively. Total morphine consumption was significantly lower in the magnesium group than in the remifentanil-alone group. CONCLUSIONS: It was concluded that magnesium sulfate decreased the postoperative morphine requirement when remifentanil was used for intraoperative analgesia.

Surgical treatment of chronic subdural haematoma under monitored anaesthesia care.

QUESTIONS UNDER STUDY: General and local uses of anaesthesia are the preferred common methods in the surgical treatment of chronic subdural haematoma (CSDH). The literature provides no information regarding monitored anaesthesia care during surgery of CSDH. In this report we evaluate the clinical results of surgical treatment for CSDH under monitored anaesthesia care. METHOD: Between 2001 and 2006 twenty consecutive patients with 24 CSDHs were surgically treated under monitored anaesthesia care at one institution. The clinical success of the procedure under monitored anaesthesia care, patient satisfaction, length of hospitalisation, anaesthesia-related complications and neurological outcome were analysed. RESULTS: Mean age was 60.9 years, with 15 patients aged over 60. ASA physical condition score was IV in 11 patients, III in 1, II in 4 and I in 4. In all patients CSDH was successfully drained by burr hole craniotomy under monitored anaesthesia care. There was no anaesthesia-related morbidity or mortality. Mean hospital stay was 4.5 days. CONCLUSION: Preliminary results indicate that surgery for CSDH under monitored anaesthesia care is safe and effective. Conscious sedation using monitored anaesthesia care, that is a middle ground between general anaesthesia and local anaesthesia, may facilitate patient comfort and surgical competence during surgery for CSDH.

Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults.

BACKGROUND: Many patients experience pain on injection of propofol. The use of lidocaine to prevent propofol injection pain is common. The analgesic effect of pre-injected lidocaine has been found to increase when a tourniquet is used. OBJECTIVE: The aim of this study was to compare the effectiveness of various venous occlusion times with lidocaine analgesia to prevent pain during propofol injection. METHODS: In this prospective, randomized, double-blind, controlled study, women aged 18 to 45 years, classifed as American Society of Anesthesiologists physical sta- tus I or II, who were scheduled to undergo elective surgery under general anesthesia induced with propofol, were randomly assigned to 1 of 5 groups: group 1, 2% lidocaine 20 mg in saline in a total volume of 10 mL and no venous occlusion; group 2, 2% lidocaine 20 mg in saline in a total volume of 10 mL plus venous occlusion for 15 seconds; group 3, 2% lidocaine plus venous occlusion for 30 seconds; group 4, 2% lidocaine plus venous occlusion for 60 seconds; and group 5, saline 10 mL and no venous occlusion. When the first 25% of the calculated propofol dose was administered, patients were asked about propofol-induced pain using a verbal pain scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). All patients and the anesthesiologist who evaluated pain severity were blinded to the study preparation being used. RESULTS: The study comprised 100 women who were randomly divided into 5 groups of 20 patients each. Significantly more patients in group 5 (18 [90%] patients; P < 0.05) reported pain compared with the other treatment groups. In groups 2, 3, and 4, in which venous occlusion was applied, pain was reported during propofol injection in 6 (30%), 7 (35%), and 2 (10%) patients, respectively. The incidence of reported pain was significantly greater in group 1 (lidocaine without venous occlusion) than in group 4 (P < 0.05); however, the incidence of pain was similar in group 1 compared with groups 2 and 3. CONCLUSIONS: The present study found that pretreatment with lidocaine 20 mg with or without venous occlusion significantly reduced the incidence and the severity of pain during the injection of propofol when compared with the group with no venous occlusion administered saline. In addition, pretreatment with lidocaine 20 mg plus venous occlusion for 60 seconds significantly reduced the incidence of propofol-induced pain compared with lidocaine without venous occlusion.

Comparison of lornoxicam versus tramadol analgesia for transrectal prostate biopsy: a randomized prospective study.

INTRODUCTION: We compared the efficacy of lornoxicam and tramadol to provide analgesia and comfort during transrectal ultrasound-guided biopsy of the prostate (TRUSP) as a noninvasive method. MATERIALS AND METHODS: A total of 62 men undergoing TRUSP were enrolled in this study. Patients were randomized to three groups. Group 1 (n = 21) received 8 mg of lornoxicam, group 2 (n = 21) received 100 mg of tramadol, and group 3 (n = 20) received saline as a control. The drugs were given intramuscularly half an hour prior to the procedure. All patients were asked to indicate the level of pain experienced after the procedure by visual analog score (VAS), and the patient's comfort level was scored by a comfort score. Additionally, the patients were asked if they were willing to undergo a future TRUSP. RESULTS: The data obtained revealed that both experimental groups receiving lornoxicam and tramadol had lower VAS scores compared to the control group (3.4 and 2.4 vs. 6.4, respectively; P < 0.0001). There were also significant differences in VAS scores between group 1 and group 2 (P = 0.027). There was a significant difference in the comfort score between the drug groups and control (P > 0.0001) and between the lornoxicam and tramadol group (P < 0.05). Pain and discomfort were least in the tramadol group. The percentage of patients who would not consent to future TRUSP was lower in the drug groups compared to control (P < 0.0001). But there were not any differences between the drug groups. CONCLUSIONS: The use of lornoxicam or tramadol for pain relief in TRUSP is a practical, effective and comfortable method compared to the results of the control group. In addition, tramadol was found to be more effective than lornoxicam.

[Beneficial effects of single dose multimodal epidural analgesia on relief of postoperative microdiscectomy pain]. / Multimodal epidural analjezinin lomber diskektomi sonrasi agrida etkinligi.

We aimed to assess the efficacy of multimodal epidural analgesia in decreasing postoperative pain after microdiscectomy. Fourty patients, ASA physical status I or II, undergoing microsurgical lumbar discectomy were enrolled in this prospective, randomised, controlled, double-blinded study. 10 ml study solution consisting of 2 mg of morphine, 15 mg of bupivacaine, 80 mg of methylprednisolone, and 0.05 mg of adrenaline was prepared for epidural administration. At the end of the procedure but prior to wound closure, the surgeon inserted an 18-gauge epidural catheter into the epidural space. After closure of incision, patients were assigned to receive either study solution (Group E) or saline (Group C). The epidural catheter was then removed. Patient controlled analgesia with morphine was used for postoperative analgesia. Visual Anologue Scale (VAS) pain scores and morphine consumptions were lower in Group E. Time to first ambulation was shorter in Group E. Patients in Group E were more satisfied with their analgesic regimen. Single dose multimodal epidural analgesia administered after wound closure provided better postoperative analgesia after lumbar microdiscectomy.

Effect of the frequency of transcutaneous electrical nerve stimulation on analgesia during extracorporeal shock wave lithotripsy.

In this prospective, randomised, sham controlled study, we set out to determine which transcutaneous electrical nerve stimulation (TENS) therapy modality (conventional vs acupuncture-like) is more effective as a supplementary analgesic regimen during extracorporeal shock wave lithotripsy (ESWL). Patients were prospectively randomised to one of three groups. In Group I (n=22), conventional TENS (impulse pattern: continuous at 80 Hz; intensity: 10-30 mA) was applied. In Group II (n=22) acupuncture-like TENS (impulse pattern: burst at 2 Hz; intensity: 15-50 mA) was applied. In Group III (n=22) (control group), stimulation was started at 1 mA and the intensity increased to no more than 10 mA until it produced a tickling sensation. Alfentanil was administered through a patient controlled analgesic device. Alfentanil consumption, hemodynamics and respiratory parameters, a 10-cm visual analogue pain scale, patient satisfaction, recovery and discharge times were evaluated. The consumption of alfentanil was significantly lower in Group I than in Groups II and III (P<0.0001). Pain scores were lower in Group I than in the other two groups (P<0.05). Patients in Group I were more satisfied with their analgesic medication than those in the other two groups (P<0.05). Both the time to an Aldrete score >8 and a modified post-anaesthetic discharge score >8 were significantly shorter in Group I (2.3+/-1.8, 49.1+/-14.6) than those of Groups II (4.6+/-2.2, 60.2+/-18.1) and III (4.9+/-2.8, 58.4+/-16.5) (P<0.0001 and P<0.05, respectively). We conclude that the use of conventional TENS is effective in decreasing the analgesic requirements and the incidence of alfentanil-related side effects during ESWL.

Oral ketamine premedication can prevent emergence agitation in children after desflurane anaesthesia.

BACKGROUND: The purpose of the present study was to determine whether oral ketamine premedication affected the incidence of emergence agitation in children. METHODS: Thirty minutes before induction of anaesthesia, 80 children who were undergoing adenotonsillectomy with or without bilateral myringotomy and insertion of tubes received either ketamine 6 mg.kg(-1) per oral in group K or sour cherry juice alone in group C. Anaesthesia was maintained with desflurane. Emergence and recovery times were recorded. Tramadol was used for postoperative analgesia. Fentanyl (1 microg.kg(-1)) was administered for the treatment of emergence agitation or severe pain that still continued after tramadol administration. Postoperative behaviour was evaluated using a 5-point agitation scale. RESULTS: The incidence of emergence agitation was 56% in group C, and 18% in group K (P = 0.001). There was no significant difference with respect to emergence times except from time to eye opening that was significantly longer in group K (P < 0.0001). CONCLUSION: Oral ketamine premedication reduced the incidence of postanaesthesia emergence agitation in children without delaying recovery.

N-acetylcysteine reduces lung reperfusion injury after deep hypothermia and total circulatory arrest.

OBJECTIVE: We hypothesized that the use of N-acetylcysteine would ameliorate the lung reperfusion injury observed after deep hypothermia and total circulatory arrest (DHTSA). METHODS: Experiments were carried out on 12 adult mongrel dogs of either sex weighing 25 to 30 kg. The animals were randomly divided into two groups of six animals each. All animals were cooled to an esophageal temperature of 15 degrees C during 30 minutes and underwent 60 minutes of DHTSA, followed by the reinstitution of cardiopulmonary bypass (CPB) and rewarming. Before rewarming, while 100 mL physiologic saline solution was added into the pump in group I, 50 mg/kg N-acetylcysteine(NAC) was given in group II. Heart rate, mean arterial pressure, pulmonary arterial pressure, left atrial pressure, central venous pressure, and cardiac output were recorded. To measure lung tissue malondialdehyde (MDA), water content and polymorphonuclear leukocytes (PMNs) count, lung tissue samples were taken before CPB and after weaning CPB. In addition, alveolar-arterial oxygen difference (AaDO(2))()for tissue oxygenation was calculated by obtaining arterial blood gas samples. Dynamic lung compliance (DLC) was measured before CPB and after CPB. RESULTS: MDA levels before CPB of 44.2 +/- 3.9 nmol/g tissue rose to 76.6 +/- 5.6 nmol/g tissue after weaning CPB in group I (p = 0.004). In group II also, the MDA levels increased from 43.5 +/- 4.2 to 57.4 +/- 5.6 nmol MDA/g tissue after weaning CPB (p = 0.006). The MDA increase in group II after CPB was found to be significantly lower than in group I (p = 0.006). The wet-to-dry lung weight ratio in the NAC group was 5.1 +/- 0.2, significantly less than in the control group (5.9 +/- 0.3), (p = 0.004). AaDO(2) significantly increased in the group I and II (p = 0.002 and p = 0.002, respectively); this elevation in group I was significant than in group II (p = 0.044). In histopathological examination, it was observed that neutrophil counts in the lung parenchyma rose significantly after CPB in both groups (p < 0.001). The increase in group I was significantly larger than group II (p < 0.001). CONCLUSIONS: Results represented in our study indicate that addition of NAC into the pump after DHTSA can reduce lung reperfusion injury.

Effects of whole blood, crystalloid, and colloid resuscitation of hemorrhagic shock on renal damage in rats: an ultrastructural study.

PURPOSE: The aim of this study was to determine the effects of whole blood, crystalloid, and colloid treatment on histopathologic damage of kidney induced by hemorrhagic shock in rats. METHODS: Fifty-six male Sprague Dawley rats were divided into 8 groups. The carotid artery was cannulated, and systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), and rectal temperature (RT) were observed during the procedure. The jugular vein also was cannulated, and the SAP was decreased by aspiration of 75% of blood through the jugular vein in the control (nonresuscitated) and study (resuscitated) groups, whereas blood was not diminished in the sham group. The hemorrhagic shock was permitted to last 45 minutes; then, the study group rats were resuscitated with heparinized shed autologous whole blood (WB), normal saline (NS), Lactated Ringer's solution (LR), hydroxyethyl starch 6% (HES6), hydroxyethyl starch 10% (HES10), or dextran 40 (D40). Histopathologic evaluation was performed under light and electron microscope. RESULTS: The RT, SAP, and DAP decreased, and HR increased significantly in the control and study groups during the shock period compared with those of sham group. After volume resuscitation, these parameters changed to preshock levels. Electron and light microscopic examinations of kidneys showed severe proximal tubular degeneration with moderate glomerular damage in the control group; moderate proximal tubular degeneration with mild glomerular damage in the NS, LR, HES6, and HES10 groups; and mild proximal tubular degeneration with no evidence of glomerular damage in the WB and D-40 groups. CONCLUSIONS: The characteristic ultrastructural features of hemorrhagic shock appear to be severe tubular degeneration and mild to moderate changes in glomeruli. Resuscitation of hemorrhagic shock with whole blood or dextran 40 solution appears to be most favorable therapy in preventing ultrastructural renal damage in rats.