The effect of post-reperfusion levosimendan in an experimental intestinal ischemia-reperfusion model.

BACKGROUND: Levosimendan has been reported to have a positive effect on ischemia-reperfusion injury. Herein, we aimed to evaluate the effects of levosimendan applied after reperfusion in an experimental intestinal injury-reperfusion (IR) model. METHODS: Twenty-one Wistar-albino male rats were separated into three groups: Sham group (n = 7): solely superior mesenteric artery (SMA) was dissected after laparotomy; intestinal ischemia-reperfusion group (IIR, n = 7): SMA was clamped for 60 min and unclamped for 120 min to cause ischemia-reperfusion; IIR + levosimendan group (IIR + L, n = 7): levosimendan was administered in ischemia-reperfusion model. The mean arterial pressures (MAP) were measured in all groups. MAP measurements were performed at the end of stabilization, at the 15th, 30th, and 60th minute of ischemia; at the 15th, 30th, 60th, and 120th minute of reperfusion; and at the end of levosimendan bolus application and when levosimendan infusion concluded. Reperfusion injury was evaluated with tissue malondialdehyde (MDA) and by Chiu score. RESULTS: MAP at 15 min, 30 min, and 60 min of reperfusion was lower in IIR and IIR + L groups compared with basal inter-group measurements. Decline in MAP at 30 min after reperfusion was statistically significant in IIR and IIR + L groups when compared with the sham group. There was no significant difference between MDA levels in the groups. Chiu score was significantly lower in the sham group when compared to IIR and IIR + L groups and higher in IIR when compared to the IIR + L group. CONCLUSION: Levosimendan leads to a decrease in intestinal damage although it did not affect lipid peroxidation and MAP when administered after reperfusion in an experimental intestinal IR model.

Comparison of Direct and Remote Ischaemic Preconditioning of Renal Ischaemia Reperfusion Injury in Rats.

OBJECTIVE: One of the methods that can be used to prevent ischaemia reperfusion (IR) injury is ischaemic preconditioning. The aim of this study was to evaluate and compare the effects of remote and direct ischaemic preconditioning (RIPC and DIPC) histopathologically in the rat renal IR injury model. METHODS: After obtaining an approval from the Dokuz Eylül University School of Medicine Ethics Committee, 28 Wistar Albino male rats were divided into four groups. In Group I (Sham, n=7), laparotomy and left renal pedicle dissection were performed, but nothing else was done. In Group II (IR, n=7), after 45 minutes of left renal pedicle occlusion, reperfusion lasting 4 hours was performed. In Group III (DIPC+IR, n=7), after four cycles of ischaemic preconditioning applied to the left kidney, renal IR was performed. In Group IV (RIPC+IR, n=7), after three cycles of ischaemic preconditioning applied to the left hind leg, renal IR was performed. All rats were sacrificed, and the left kidney was processed for conventional histopathology. RESULTS: The histopathological injury score of the kidney was significantly lower in the sham group compared with the other groups (p<0.01). The injury scores of the DIPC+IR and RIPC+IR groups were significantly lower than in the IR group (p<0.05). In the RIPC+IR group, the injury score for erythrocyte extravasation was found to be significantly lower than in the DIPC+IR group (p<0.05). CONCLUSION: In the present study, it was demonstrated that both DIPC and RIPC decreased renal IR injury, but RIPC was found to be more effective than DIPC. This protective effect requiresfurther detailed experimental and clinical studies.

Nuss procedure: Technical modifications to ease bending of the support bar and lateral stabilizer placement.

BACKGROUND: Modifications defined to ease bending of the support bar and lateral stabilizer placement during minimal invasive repair of pectus excavatum (MIRPE) have not been reported. We herein report our experience with MIRPE including several technical modifications. METHODS: A total of 87 patients who underwent MIRPE were evaluated retrospectively. Technical modifications are (1) a template drawn preoperatively according to the anthropometric measurements, (2) more laterally placed thoracal incisions, (3) single existing incision for multiple support bars, (4) to secure lateral stabilizers to support bar in inverted position. RESULTS: The mean patient age was 11.2 ± 3.8 years. The mean operating time was 63.7 ± 18.7 min. The mean Haller index was 5.4 ± 2.1. Eight patients necessitated two support bars. The support bars were removed in 69 patients after the completion of treatment. Support bars were left in place 26.8 ± 4.3 months. Final chest contours of the 56 patients were evaluated as 12 months passed after support bar removal and excellent repair results were determined in 84.2%. CONCLUSION: Preoperative bending of the support bar according to anthropometric measurements and fixation of the lateral stabilizers to the support bar in inverted position facilitates bar shaping and lateral stabilizer placement.

[The effect of different doses of esmolol on hemodynamic, bispectral index and movement response during orotracheal intubation: prospective, randomized, double-blind study]. / Efeito de diferentes doses de esmolol sobre a resposta hemodinâmica, BIS e resposta de movimento durante a intubação orotraqueal: estudo prospectivo, randômico e duplo-cego.

OBJECTIVE: A prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation. MATERIALS AND METHODS: 120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5mgkg(-1) propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6mgkg(-1) rocuronium, a tourniquet was applied to one arm and inflated to 50mmHg greater than systolic pressure. The patients were divided into 3 groups; 1mgkg(-1)h(-1) esmolol was given as the loading dose and in Group Es50 50µgkg(-1)min(-1), in Group Es150 150µgkg(-1)min(-1), and in Group Es250 250µgkg(-1)min(-1) esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded. RESULTS: Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p<0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure. CONCLUSION: In clinical practise we believe that after 1mgkg(-1) loading dose, 150µgkg(-1)min(-1) iv esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects.

The effect of different doses of esmolol on hemodynamic, bispectral index and movement response during orotracheal intubation: prospective, randomized, double-blind study / Efeito de diferentes doses de esmolol sobre a resposta hemodinâmica, BIS e resposta de movimento durante a intubação orotraqueal: estudo prospectivo, randômico e duplo-cego / Efecto de diferentes dosis de esmolol sobre la respuesta hemodinámica, BIS y respuesta de movimiento durante la intubación orotraqueal: estudio prospectivo, aleatorizado y doble ciego

Objective: A prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation. Materials and methods: One hundred and twenty patients were randomly allocated to one of three groups in a double-blind fashion. 2.5 mg kg-1 propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6 mg kg-1 rocuronium, a tourniquet was applied to one arm and inflated to 50 mm Hg greater than systolic pressure. The patients were divided into 3 groups; 1 mg kg-1 h-1 esmolol was given as the loading dose and in Group Es50 50 μg kg-1 min-1, in Group Es150 150 μg kg-1 min-1, and in Group Es250 250 μg kg-1 min-1 esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded. Results: Incidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p < 0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure. Conclusion: In clinical practise we believe that after 1 mg kg-1 loading dose, 150 μg kg-1 min-1 iv esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects. .

Objetivo: Estudo prospectivo, randômico e duplo-cego planejado para identificar a dose ideal de perfusão de esmolol para suprimir o aumento dos valores do BIS e os movimentos e respostas hemodinâmicas à intubação traqueal. Materiais e Métodos: 120 pacientes foram randomicamente alocados um dos três grupos, usando o método duplo-cego. Propofol (2,5 mg kg-1) foi administrado para indução da anestesia. Após a perda da consciência e antes da administração de rocurônio (0,6 mg kg-1), um torniquete foi aplicado a um braço e insuflado a 50 mm Hg acima da pressão sistólica. Os pacientes foram divididos em três grupos; uma dose de 1 mg kg-1 h-1 de esmolol foi administrada como carga e perfusão de 50 μg kg-1 min-1 de esmolol foi iniciada no Grupo ES50, 150 μg kg-1 min-1 no Grupo Es150 e 250 μg kg-1 min-1 no Grupo ES250. Cinco minutos após o início da perfusão, a traqueia foi intubada; o total de movimentos no primeiro minuto após a intubação orotraqueal foi registrado. Resultados: A incidência da resposta de movimentos e os valores máximos de ΔBIS foram comparáveis nos grupos ES250 e Es150, mas esses valores foram significativamente mais elevados no Grupo ES50 que nos outros dois grupos. Nos três grupos, os valores de frequência cardíaca e pressão arterial média foram significativamente maiores no primeiro minuto pós-intubação, comparados aos valores pré-intubação (p < 0,05). Não houve diferença significativa entre os grupos em relação à frequência cardíaca e pressão arterial média durante o período de estudo. Conclusão: Na prática clínica, acreditamos que após uma dose com carga de 1 mg kg-1, uma dose de 150 μg kg-1 min-1 de esmolol IV é ...

Objetivo: Estudio prospectivo, aleatorizado y doble ciego para identificar la dosis ideal de perfusión de esmolol con el fin de suprimir el aumento de los valores del BIS y los movimientos y respuestas hemodinámicas a la intubación traqueal. Materiales y métodos: 120 pacientes fueron aleatoriamente ubicados en uno de los 3 grupos usando el método doble ciego. El propofol (2,5 mg kg-1) se administró para la inducción de la anestesia. Después de la pérdida de la conciencia y antes de la administración del rocuronio (0,6 mg kg-1), se aplicó un torniquete a un brazo y se insufló a 50 mmHg por encima de la presión sistólica. Los pacientes fueron divididos en 3 grupos; se administró una dosis de 1 mg kg-1 h-1 de esmolol como carga, y se inició la perfusión de 50 1-g kg-1 min-1 de esmolol en el grupo ES50, de 150 1-g kg-1 min-1 en el grupo Es150, y de 250 1-g kg-1 min-1 en el grupo ES250. Cinco minutos después del inicio de la perfusión, la tráquea se intubó, y se registró el total de movimientos al primer minuto después de la intubación orotraqueal. Resultados: La incidencia de la respuesta de movimientos y los valores máximos de ΔBIS fueron comparables en los grupos ES250 y Es150, pero esos valores fueron significativamente más elevados en el grupo ES50 que en los otros 2 grupos. En los 3 grupos, los valores de frecuencia cardíaca y presión arterial promedio fueron significativamente mayores en el primer minuto postintubación, comparados con los valores preintubación (p < 0,05). No hubo diferencia significativa entre los grupos con relación a la frecuencia cardíaca y a la presión arterial promedio durante el período de estudio. Conclusión: En la práctica clínica, creemos que después de una dosis con carga de 1 mg kg-1, una dosis de 150 1-g ...

Ischemic preconditioning attenuates lipid peroxidation and apoptosis in the cecal ligation and puncture model of sepsis.

Sepsis and septic shock are are among the major causes of mortality in intensive care units. The lung and kidney are the organs most affected by sepsis. Evidence exists that lipid peroxidation and apoptosis may be responsible for the high mortality due to sepsis. Ischemic preconditioning (IP) is a method for the protection of tissues and organs against ischemia/reperfusion injury by reducing reactive oxygen species levels, lipid peroxidation and apoptosis. In the present study, the effects of IP were investigated in cecal ligation and puncture (CLP)-induced sepsis in rats. The three groups of animals used in the present controlled study were the sham-operated group (sham, n=7), which only underwent a laparotomy; the sepsis group (sepsis, n=7), which underwent cecal ligation and perforation; and the IP + sepsis group (IP+sepsis, n=7), which underwent CLP immediately prior to the application of three cycles of IP to the hind limb. The study was terminated at 6 h after the induction of CLP. Blood, kidney and lung tissue samples were collected for the determination of serum creatinine, blood urea nitrogen (BUN), neutrophil gelatinase-associated lipocalin (NGAL) and lung tissue malondialdehyde (MDA) levels, as well as histological examination. The serum creatinine, plasma NGAL and lung tissue MDA levels in the sepsis group were significantly increased compared with those in the sham and the IP+sepsis groups (P<0.05). Alveolar macrophage counts, histological kidney and lung injury scores, kidney (caspase 3) and lung tissue immuonreactivity (M30) scores in the sepsis group were also significantly increased compared with those in the sham and IP+sepsis groups (P<0.05). The alveolar macrophage count in the IP+sepsis group was increased compared with that in the sham group (P<0.05). In conclusion, IP inhibits lipid peroxidation and attenuates histological injury and apoptosis in the lung and kidney during sepsis.

The effects of dexmedetomidine on secondary acute lung and kidney injuries in the rat model of intra-abdominal sepsis.

In the present study, the effects of dexmedetomidine on secondary lung and kidney injuries were studied in the rat model of intra-abdominal sepsis by immunohistological and biochemical examinations. We measured serum creatinine, kidney tissue malondialdehide and plasma neutrophil gelatinase-associated lipocalin levels. In order to evaluate tissue injury we determined kidney tissue mononuclear cell infiltration score, alveolar macrophage count, histological kidney and lung injury scores and kidney and lung tissue immunoreactivity scores. We demonstrated that dexmedetomidine attenuates sepsis-induced lung and kidney injuries and apoptosis in the rat model of sepsis. There is still need for comparative studies in order to determine the effects of dexmedetomidine on organ functions in early human sepsis.

Ischaemic preconditioning attenuates haemodynamic response and lipid peroxidation in lower-extremity surgery with unilateral pneumatic tourniquet application: a clinical pilot study.

INTRODUCTION: The harmful effects of ischaemia-reperfusion on skeletal muscle during extremity surgery can be diminished by using medications or ischaemic preconditioning METHODS: Twenty patients undergoing lower-limb surgery with use of a tourniquet for at least 1 hour were included in the study and randomised into two groups: a control group with only tourniquet application (T group; n=10); and an ischaemic preconditioning plus tourniquet group (IP-T group; n=10). Blood samples were obtained from the femoral vein of the relevant extremity before tourniquet application (baseline), immediately after tourniquet deflation (TD), at 10 minutes after the tourniquet deflation (TD(10min)) in the T group and additionally after ischaemic preconditioning in the IP-T group. Venous blood pH, partial oxygen pressure (P(vO2)), partial carbon dioxide pressure (P(vCO2)), lactate, potassium, sodium and glucose levels were analysed using a blood gas analyser. Plasma thiobarbituric acid reactive substances (TBARS) level, an index of lipid peroxidation and oxidative stress, was measured. Heart rate, noninvasive mean arterial pressure (MAP) and spontaneous breathing rate (SBR) were recorded at baseline, at TD, and TD(1min), TD(5min) and TD(10min). RESULTS: MAP decreased and SBR increased significantly at TD, TD(1min) and TD(5min) compared with baseline, and venous blood TBARS level significantly increased at TD and TD(10min) compared with baseline in the T group (all P<0.05). No significant changes were observed in the IP-T group. Ischaemic preconditioning caused a rise in PvO2 and a decrease in venous blood pH, P(vCO2), and lactate levels, which was significant compared with baseline (P<0.05) CONCLUSION: Ischaemic preconditioning attenuates haemodynamic response and lipid peroxidation during lower-extremity surgery with unilateral tourniquet application.

The safe limits of mechanical factors in the apnea testing for the diagnosis of brain death.

Apneic oxygenation is an apnea testing method in the diagnosis of brain death. In this method, oxygen (O2) is delivered into the trachea via an O2 catheter (O2C). However, barotrauma may develop during O2 insufflation into the trachea. Oxygen catheter diameters, O2 catheter tip position in the trachea, and O2 flow rate have been proposed as causes of barotrauma. This study was designed to highlight the airway pressure changes during apneic oxygenation in a model consisting of an anesthesia bag, which was connected to a pressure transducer and to an endotracheal tube (ETT). The pressure of the system was monitored while delivering O2 continuously to the system through O2C of different diameters, which were placed in the ETT. Tested variables were ETT/O2C ratio, O2C tip position in ETT (proximal 1/3 of the ETT, mid point of the ETT, and distal 1/3 of the ETT) and O2 flow rate (6, 8, and 10 L min(-1)). The increase in the airway pressure significantly correlated with O2C tip position in ETT (p = 0.017). ETT/O2C ratio smaller than 1.75 caused significantly high airway pressures (p < 0.05). The pressure was significantly higher at the flow rate of 10 L min(-1) O2 compared with the flow rate of 6 L min(-1) O2 (p < 0.01). Thus, ETT/O2C ratio, O2C tip position in ETT and O2 flow rate are the important factors that determine the airway pressure in the trachea during O2 insufflation. In conclusion, overlooked mechanical factors dangerously increase airway pressure during apnea testing.

Dilution of rocuronium to 0.5 mg/mL with 0.9% NaCl eliminates the pain during intravenous injection in awake patients.

In a randomized, double-blinded, controlled study, we evaluated the effect of diluting rocuronium 10 mg/mL to 1 or 0.5 mg/mL with 0.9% NaCl on the pain associated with IV administration of rocuronium with small doses given before succinylcholine or nondepolarizing agent administration. One hundred fifty patients undergoing surgical procedures that required general anesthesia were randomized into three groups. Group 1 received rocuronium 10 mg/mL. Groups 2 and 3 received 1 and 0.5 mg/mL of rocuronium, respectively. Patient demographics, pain scores, osmolality, and the pH of the solutions were recorded. Group 1 had the most intense and frequent pain response. Eighty percent of patients in this group reported pain on injection. In Group 2, the incidence and intensity of pain were significantly less when compared with those of Group 1. In this group, 38% of patients reported pain during injection. In Group 3, none of the patients experienced pain on injection. The pH values and osmolalities of study solutions were not significantly different among groups. In conclusion, in awake patients, dilution of rocuronium 10 mg/mL at small doses given before succinylcholine or nondepolarizing agent administration of 0.06 mg/kg to 0.5 mg/mL with 0.9% NaCl is a simple and cost-effective strategy for preventing pain during IV rocuronium injection.