Investigation of SARS-CoV-2 using RT-PCR in vaginal swab samples of female patients with a diagnosis of severe COVID-19.

OBJECTIVE: It is important to determine the presence of SARS-CoV-2 in the vaginal fluid samples of reproductive-aged women with severe disease during the acute stage of the disease and to determine the risks of transmission by sexual or vertical transmission. MATERIAL AND METHODS: Adult women with confirmed severe COVID-19 who were admitted to Ankara City Hospital intensive care unit (ICU) between December 1st, 2020, and January 1st, 2021, were enrolled in the study. Vaginal swab samples were collected within 48 h in the ICU using Dacron or rayon swabs and tested for SARS-CoV-2 using reverse transcription real-time polymerase chain reaction (RT PCR). RESULTS: Thirty women of reproductive age were included in the study, five (16.7%) of whom were pregnant. The mean age was 44.9 (±10.5) years. The most common symptoms were headache (100%), muscle soreness (86.7%), cough (76.7%), fever (60%), and nausea and vomiting (20%). Nineteen (63.3%) patients had underlying medical conditions. The time interval from obtaining vaginal swab samples to admission to the ICU was 48 h. The time between vaginal sampling and PCR positivity ranged from 2 to 18 days. SARS-CoV-2 was not detected in any vaginal samples. CONCLUSION: Our study showed that women with severe COVID-19 did not have SARS-CoV-2 in their vaginal fluids. Investigation of the presence of SARS-CoV-2 in vaginal secretions may help in determining the risks of sexual transmission and vertical transmission from mother to baby. Information on this subject is still limited. Larger studies on comprehensive biological samples are needed.

A Statistical Model for Early Recognition of Patients Requiring Transfer to Palliative Care (ERPAC).

OBJECTIVE: To develop a scoring system to identify patients at an early stage who will need palliative care during intensive care follow-up. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Ankara City Hospital, Neurology and Orthopaedics Hospital, General Intensive Care Unit, Ankara, Turkiye, from June 2019 to March 2020. METHODOLOGY: Intensive care patients were enrolled and divided into palliative care transfer (p1) and nontransfer groups (p2). The predicted logit value / probality score was calculated and a scoring system was developed, using the formula value, [logit= -3.275 + 0.194 (days of hospitalisation) - 0.345 (SOFAmax) +1.659 (ward admission) + 2.08 (cancer)]. RESULTS: One hundred and thirty five patients were analysed. Sixty-eight (50.4%) were males. The mean age was 67.2 ± 17.2 years. Length of hospital stay (p<0.001), highest sequential organ failure score (SOFAmax, p<0.001), previous hospitalisation (p=0.015), and cancer history (p=0.009) affect the need for palliative care significantly.  Predicted probability = epredicted togit / 1+epredicted logit If predicted probabilty >0.5, patient was candidate for palliative care transfer. CONCLUSION:  Every intensive care unit can calculate its own logit value and represent ERPAC score. ERPAC scores can predict which patients will be transferred to palliative care. Predictedlogit value will help to recognise which patients will need palliative care at an early stage. KEY WORDS: Palliative care, Scoring, Intensive care.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases.

BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis.

This study aimed to compare the value of lactate, albumin, and lactate/albumin ratio for the prediction of mortality in sepsis patients. Patients admitted to the intensive care unit (ICU) due to sepsis between January 2016 and January 2019 were evaluated retrospectively. Lactate, albumin, and lactate/albumin ratio values were compared between surviving and non-surviving patients and their predictive value for mortality was evaluated. A total of 1136 sepsis patients admitted to the ICU were included in the study. The mortality rate was 42.7% (485/1136 patients). In ROC analysis for mortality prediction, the area under the curve and optimal cut-off values were 0.816 and >2.2 mmol/L for lactate, 0.812 and ≤26 g/L for albumin, and 0.869 and >0.71 for lactate/albumin ratio, respectively. Our analysis of lactate, albumin, and lactate/albumin ratio in the largest patient sample to date showed that lactate/albumin ratio was a stronger parameter than lactate or albumin alone in predicting mortality among sepsis patients in the ICU. Lactate/albumin ratio is an easily obtained parameter with potential value for critically ill patients.

Thiol/Disulfide Homeostasis as an Early Biomarker to Differentiate Sepsis from Pneumonia in Intensive Care Units.

BACKGROUND: It is possible that patients with pneumonia may also have sepsis and the separation of these two clinical entities may cause some trouble to clinicians. OBJECTIVE: In order to separate a patient with pneumonia and a patient with sepsis, we qualify thiol/disulfide homeostasis as a potential biomarker. METHODS: This study was designed between February 2018 - February 2019 prospectively. All patients in the intensive care unit with pneumonia and sepsis were enrolled in the study. At the time of hospitalization, thiol/disulfide homeostasis was measured. Patients diagnosed with sepsis and pneumonia were compared, in regards to thiol/disulfide homeostasis. RESULTS: During research period, 103 patients with sepsis and 120 patients with pneumonia were enrolled into the study. When we compared native-thiol, total-thiol, and disulfide levels in both sepsis and pneumonia patients, we had similar results (p>0.05). In sepsis group, index-1 (disulfide/native thiol ratio) and index-2 (disulfide/total thiol ratio) were found to be statistically higher than the pneumonia group, and index-3 (native thiol/total thiol ratio) was statistically lower than the pneumonia group (p=0.020, p= 0.021, p=0.021, respectively). CONCLUSION: In this study, we showed that thiol/disulfide homeostasis could be used as new markers in the early period in order to separate patients with sepsis and patients with pneumonia.

Clinical and laboratory features of COVID-19: Predictors of severe prognosis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged first in December 2019 in Wuhan, China and quickly spread throughout the world. Clinical and laboratory data are of importance to increase the success in the management of COVID-19 patients. METHODS: Data were obtained retrospectively from medical records of 191 hospitalized patients diagnosed with COVID-19 from a tertiary single-center hospital between March and April 2020. Prognostic effects of variables on admission among patients who received intensive care unit (ICU) support and those who didn't require ICU care were compared. RESULTS: Patients required ICU care (n = 46) were older (median, 71 vs. 43 years), with more underlying comorbidities (76.1% vs. 33.1%). ICU patients had lower lymphocytes, percentage of large unstained cell (%LUC), hemoglobin, total protein, and albumin, but higher leucocytes, neutrophils, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocytes ratio (PLR), urea, creatinine, aspartate amino transferase (AST), lactate dehydrogenase (LDH), and D-dimer when compared with non-critically ill patients (p < 0.001). A logistic regression model was created to include ferritin, %LUC, NLR, and D-dimer. %LUC decrease and D-dimer increase had the highest odds ratios (0.093 vs 5.597, respectively) to predict severe prognosis. D-dimer, CRP, and NLR had the highest AUC in the ROC analysis (0.896, 0.874, 0.861, respectively). CONCLUSIONS: The comprehensive analysis of clinical and admission laboratory parameters to identify patients with severe prognosis is important not only for the follow-up of the patients but also to identify the pathophysiology of the disease. %LUC decrease and D-dimer, NLR, and CRP increases seem to be the most powerful laboratory predictors of severe prognosis.

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy.

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

Unexplained neuropsychiatric symptoms in intensive care: A Fahr Syndrome case.

Fahr Syndrome is a rare disease where calcium and other minerals are stored bilaterally and symmetrically in the basal ganglia, cerebellar dentate nucleus and white matter. Fahr Syndrome is associated with various metabolic disorders, mainly parathyroid disorders. The presented case discusses a 64-year old male patient admitted to the intensive care unit of our hospital diagnosed with aspiration pneumonia and urosepsis. The cranial tomography examination to explain his nonspecific neurological symptoms showed bilateral calcifications in the temporal, parietal, frontal, occipital lobes, basal ganglia, cerebellar hemisphere and medulla oblongata posteriorly. His biochemical test results also indicated parathormone-calcium metabolic abnormalities. Fahr Syndrome must be considered for a definitive diagnosis in patients with nonspecific neuropsychiatric symptoms and accompanying calcium metabolism disorders in order to control serious morbidity and complications because of neurological damage.

The effect of sugammadex on postoperative cognitive function and recovery.

BACKGROUND AND OBJECTIVE: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

[The effect of sugammadex on postoperative cognitive function and recovery]. / O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório.

BACKGROUND AND OBJECTIVE: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

[Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy]. / Ventilação mecânica não invasiva e anestesia peridural em colecistectomia aberta de emergência.

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

[Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate]. / Impacto do anestesiologista em treinamento sobre as pressões do manguito de máscara laríngea e incidência de eventos adversos.

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2±14.0, 104.3±20.5cm H2O and 105.2±18.4cm H2O respectively (p>0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2±3.9; 3.3±1.1 and 6.6±3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate / Impacto do anestesiologista em treinamento sobre as pressões do manguito de máscara laríngea e incidência de eventos adversos

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 ± 14.0, 104.3 ± 20.5 cm H2O and 105.2 ± 18.4 cm H2O respectively (p > 0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 ± 3.9; 3.3 ± 1.1 and 6.6 ± 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

OBJETIVO: Planejamos avaliar as pressões do manguito de máscara laríngea (PMML) inflado por profissionais da área de anestesiologia com tempos de serviço variados, sem o uso de manômetro. MÉTODOS: 180 pacientes agendados para cirurgia de curta duração com máscara laríngea foram incluídos no estudo. Cinco especialistas em anestesia (Grupo E), 10 residentes (Grupo R) e seis técnicos (Grupo T) inflaram os manguitos das máscaras laríngeas; subsequentemente, as PMML foram medidas com manômetro de pressão. Os participantes repetiram essa prática em pelo menos cinco casos diferentes. As PMML superiores a 60 cm H2O na colocação inicial ou no intraoperatório foram ajustadas para valores normais. Os pacientes foram questionados sobre a presença de dor de garganta no período pós-operatório. Os grupos foram comparados quanto à média das PMML e experiência profissional. RESULTADOS: Ao inserirem a ML, as pressões do manguito dentro da faixa normal foram determinadas em 26 (14,4%) casos. As médias das PMML após a inserção da ML pelos grupos E, R e T foram 101,2 ± 14,0, 104,3 ± 20,5 cm e 105,2 ± 18,4 cm H2O, respectivamente, (p > 0,05). A média dos valores das PMML em todos os períodos de mensuração entre os grupos estava acima do limite normal (60 cm H2O). Quando os grupos foram comparados quanto às PMML, nenhuma diferença foi encontrada entre os valores das pressões. A experiência profissional era de 14,2 ± 3,9; 3,3 ± 1,1 e 6,6 ± 3,8 anos para especialistas, residentes e técnicos, respectivamente, e os valores das pressões mensuradas não foram diferentes em relação à experiência profissional. Sete pacientes (3,9%) apresentaram dor de garganta durante a entrevista realizada na 24a hora. CONCLUSÃO: Levando-se em consideração uma possibilidade menor de ajuste da pressão do manguito da máscara laríngea (PMML) e da ineficácia da experiência profissional para a obtenção de valores normais das pressões, é adequado que todos os profissionais de anestesia ajustem as PMML com manômetro.

Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate.

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 ± 14.0, 104.3 ± 20.5 cm H2O and 105.2 ± 18.4 cm H2O respectively (p > 0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 ± 3.9; 3.3 ± 1.1 and 6.6 ± 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

Rectal dexmedetomidine in rats: evaluation of sedative and mucosal effects / Dexmedetomidina retal em ratos: avaliação dos efeitos sedativos e sobre a mucosa / La dexmedetomidina rectal en ratones: evaluación de los efectos sedativos y sobre la mucosa

BACKGROUND AND OBJECTIVES: In this study, we investigated the anesthetic and mucosal effects of the rectal application of dexmedetomidine to rats. METHODS: Male Wistar albino rats weighing 250-300 g were divided into four groups: Group S (n = 8) was a sham group that served as a baseline for the normal basal values; Group C (n = 8) consisted of rats that received the rectal application of saline alone; Group IPDex (n = 8) included rats that received the intraperitoneal application of dexmedetomidine (100 µg kg-1); and Group RecDex (n = 8) included rats that received the rectal application of dexmedetomidine (100 µg kg-1). For the rectal drug administration, we used 22 G intravenous cannulas with the stylets removed. We administered the drugs by advancing the cannula 1 cm into the rectum, and the rectal administration volume was 1 mL for all the rats. The latency and anesthesia time (min) were measured. Two hours after rectal administration, 75 mg kg-1 ketamine was administered for intraperitoneal anesthesia in all the groups, followed by the removal of the rats' rectums to a distal distance of 3 cm via an abdominoperineal surgical procedure. We histopathologically examined and scored the rectums. RESULTS: Anesthesia was achieved in all the rats in the Group RecDex following the administration of dexmedetomidine. The onset of anesthesia in the Group RecDex was significantly later and of a shorter duration than in the Group IPDEx (p < 0.05). In the Group RecDex, the administration of dexmedetomidine induced mild-moderate losses of mucosal architecture in the colon and rectum, 2 h after rectal inoculation. CONCLUSION: Although 100 µg kg-1 dexmedetomidine administered rectally to rats achieved a significantly longer duration of anesthesia compared with the rectal administration of saline, our histopathological evaluations showed that the rectal administration of 100 µg kg-1 dexmedetomidine led to mild-moderate damage to the mucosal structure ...

JUSTIFICATIVA E OBJETIVOS: Neste estudo pesquisamos os efeitos anestésicos e sobre a mucosa da aplicação retal de dexmedetomidina em ratos. MÉTODOS: Ratos machos albinos Wistar, com 250-300 g, foram divididos em quatro grupos: Grupo S (n = 8) foi um grupo sham que serviu de parâmetro para os valores basais normais; Grupo C (n = 8) consistiu em ratos que receberam a aplicação retal apenas de soro fisiológico; Grupo IPDex (n = 8) consistiu em ratos que receberam aplicação intraperitoneal de dexmedetomidina (100 µg kg-1) e Grupo RecDex (n = 8) consistiu em ratos que receberam a aplicação retal de dexmedetomidina (100 µg kg-1). Para a administração dos fármacos por via retal, usamos cânulas intravenosas de calibre 22, com os estiletes removidos. A administração consistiu em avançar a cânula 1 cm no reto e o volume de administração retal foi de 1 mL para todos os ratos. Os tempos (min) de latência e de anestesia foram registrados. Duas horas após a administração por via retal, 75 mg kg-1 de cetamina foram administrados a todos os grupos para anestesia intraperitoneal, seguido por remoção dos retos dos ratos a uma distância 3 cm distal por meio de procedimento cirúrgico abdominoperineal. Os retos foram histopatologicamente examinados e classificados. RESULTADOS: A anestesia foi feita em todos os ratos do grupo RecDex após a administração de dexmedetomidina. O tempo de início da anestesia no Grupo RecDex foi significativamente mais longo e com uma duração mais curta do que no Grupo IPDEx (p < 0,05). No Grupo RecDex, a administração de dexmedetomidina induziu perdas leves a moderadas da arquitetura da mucosa do cólon e reto duas horas após a inoculação retal. CONCLUSÃO: Embora a administração de 100 µg kg-1 de dexmedetomidina por via retal em ratos tenha resultado em uma duração significativamente maior da anestesia, em comparação com a administração retal de soro fisiológico, nossas avaliações histopatológicas mostraram que a administração ...

JUSTIFICACIÓN Y OBJETIVOS: En este estudio investigamos los efectos anestésicos y sobre la mucosa de la aplicación rectal de la dexmedetomidina en los ratones. MÉTODOS: Ratones machos albinos Wistar, con un peso de 250-300 g, fueron divididos en 4 grupos: el grupo S (n = 8) fue un grupo simulado que sirvió de base para los valores basales normales; el grupo C(n = 8) consistió en ratones que recibieron aplicación rectal solamente de suero fisiológico; el grupo IPDex (n = 8) estaba formado por en ratones que recibieron aplicación intraperitoneal de dexmedetomidina (100 µg/kg-1); y el grupo RecDex (n = 8) consistió en ratones que recibieron la aplicación rectal de dexmedetomidina (100 µg/kg-1). Para la administración de los fármacos por vía rectal usamos cánulas intravenosas de calibre 22 sin estiletes. La administración consistió en avanzar la cánula 1 cm en el recto y el volumen de administración rectal fue de 1 mL para todos los ratones. Los tiempos (min) de latencia y de anestesia fueron registrados. Dos horas después de la administración por vía rectal, fueron administrados 75 mg/kg-1 de ketamina a todos los grupos para la anestesia intraperitoneal, seguido de la retirada de los rectos de los ratones a una distancia 3 cm distal por medio de un procedimiento quirúrgico abdominoperineal. Los rectos fueron histopatológicamente examinados y clasificados. RESULTADOS: La anestesia fue realizada en todos los ratones del grupo RecDex después de la administración de dexmedetomidina. El inicio de la anestesia en el grupo RecDex fue significativamente más tarde y con una duración más corta que en el grupo IPDEx (p < 0,05). En el grupo RecDex, la administración de dexmedetomidina indujo pérdidas leves a moderadas de la arquitectura de la mucosa del colon y del recto 2 h después de la inoculación rectal. CONCLUSIÓN: Aunque la administración de 100 µg/kg-1 de dexmedetomidina por vía rectal en ratones logra una duración significativamente más ...

[Rectal dexmedetomidine in rats: evaluation of sedative and mucosal effects]. / Dexmedetomidina retal em ratos: avaliação dos efeitos sedativos e sobre a mucosa.

BACKGROUND AND OBJECTIVES: In this study, we investigated the anesthetic and mucosal effects of the rectal application of dexmedetomidine to rats. METHODS: Male Wistar albino rats weighing 250-300g were divided into four groups: Group S (n=8) was a sham group that served as a baseline for the normal basal values; Group C (n=8) consisted of rats that received the rectal application of saline alone; Group IPDex (n=8) included rats that received the intraperitoneal application of dexmedetomidine (100µgkg(-1)); and Group RecDex (n=8) included rats that received the rectal application of dexmedetomidine (100µgkg(-1)). For the rectal drug administration, we used 22G intravenous cannulas with the stylets removed. We administered the drugs by advancing the cannula 1cm into the rectum, and the rectal administration volume was 1mL for all the rats. The latency and anesthesia time (min) were measured. Two hours after rectal administration, 75mgkg(-1) ketamine was administered for intraperitoneal anesthesia in all the groups, followed by the removal of the rats' rectums to a distal distance of 3cm via an abdominoperineal surgical procedure. We histopathologically examined and scored the rectums. RESULTS: Anesthesia was achieved in all the rats in the Group RecDex following the administration of dexmedetomidine. The onset of anesthesia in the Group RecDex was significantly later and of a shorter duration than in the Group IPDEx (p<0.05). In the Group RecDex, the administration of dexmedetomidine induced mild-moderate losses of mucosal architecture in the colon and rectum, 2h after rectal inoculation. CONCLUSION: Although 100µgkg(-1) dexmedetomidine administered rectally to rats achieved a significantly longer duration of anesthesia compared with the rectal administration of saline, our histopathological evaluations showed that the rectal administration of 100µgkg(-1) dexmedetomidine led to mild-moderate damage to the mucosal structure of the rectum.

Dexmedetomidine did not reduce the effects of tourniquet-induced ischemia-reperfusion injury during general anesthesia.

Ischemia reperfusion injury causes the release of free oxygen radicals. Free oxygen radicals initiate the production of toxic metabolites, such as malondialdehyde (MDA), through the lipid peroxidation of cellular membranes. Following lipid peroxidation, the antioxidant enzyme system is activated against reactive oxygen species (ROS) and attempts to protect cells from oxidative damage. There is a balance between the scavenging capacity of antioxidant enzymes and ROS. Because of this balance, the total antioxidant capacity (TAC) measurement is a sensitive indicator of the overall protective effects of the antioxidants. Alpha(2) receptor agonists are effective in preventing hemodynamic reactions during extremity surgeries by preventing the release of catecholamines secondary to tourniquet application. They have also been shown to possess preventive effects in various ischemia-reperfusion injury models. In our study, we examined the effects of dexmedetomidine on tourniquet-induced ischemia-reperfusion injury in lower extremity surgeries performed under general anesthesia. The effects of dexmedetomidine were measured with serum MDA and TAC levels. We studied 60 adult American Society of Anesthesiologists (ASA) physical status I or II patients undergoing one-sided lower extremity surgery with tourniquet. The patients were randomly divided into two groups. Group D was administered a dexmedetomidine infusion at a rate of 0.1µg/kg/minute(-1) for 10 minutes prior to induction and then at 0.7µg/kg/hour(-1) until 10 minutes before the end of the operation. The control group (Group C) received a saline infusion of the same amount and for the same period of time. General anesthesia was induced with thiopental, fentanyl, and rocuronium and maintained with nitrous oxide and sevoflurane in both groups. Venous blood samples were obtained before the administration of the study drugs (basal) at 1 minute before tourniquet release and at 5 and 20 minutes after tourniquet release (ATR). In both groups, MDA levels decreased at 5 and 20 minutes ATR when compared with the basal values (p<0.05). TAC levels decreased at 1 and 5 minutes ATR and then returned to basal values at 20 minutes ATR (p<0.05). In reference to the prevention of lipid peroxidation in tourniquet-induced ischemia-reperfusion injury, the results from the two groups in our study showed that dexmedetomidine did not have an additional protective role during routine general anesthesia.

The effect of levobupivacaine and bupivacaine on QT, corrected QT (Qtc), and P wave dispersions in cesarean section.

BACKGROUND AND OBJECTIVES: In our study we aimed to investigate the effect of bupivacaine and levobupivacaine on QT, corrected QT (QTc), and P wave dispersion durations during spinal anesthesia in cesarean section. METHODS: Sixty parturients scheduled for elective cesarean section in ASA I-II risk groups were included in the study. Baseline electrocardiographic (ECG) records of the patients were obtained in the operation room. Heart rate (HR), non-invasive blood pressure (NIBP), peripheral oxygen saturation (SpO2) and respiration rates (RR) were recorded. Venous cannulation was performed with 18G cannula and fluid preload made with 10 mL.kg(-1). Lactated Ringer solution. After fluid preload, second ECG recordings were taken and the patients were randomly separated into two groups. Group B (n = 30) received 10mg of bupivacaine and Group L (n = 30) received 10mg of levobupivacaine for spinal anesthesia. ECG recordings were repeated at 1, 5 and 10 minutes after spinal block. HR, NIBP, SpO2, RR and sensory block levels were also recorded at the same time intervals. At predetermined time intervals of spinal anesthesia, P wave dispersion (Pwd), QT dispersion (QTd), and QTc dispersion (QTcd) durations were measured from ECG records. QT and QTc durations are calculated with Bazzett formula. RESULTS: There was no difference between two groups according to block levels, hemodynamic parameters, Pwd, QTd, QTc and QTcd durations. CONCLUSION: Bupivacaine and levobupivacaine may be preferred in spinal anesthesia in pregnant patients who have extended Pwd and QTcd preoperatively.