Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach, and the Macintosh laryngoscope

Background/aim/AIM: The optimal technique for airway management in patients with cervical pathology remains unclear. Intubating laryngeal mask airway devices such as LMA CTrach and LMA Fastrach have not been compared for cervical spine (C-spine) movements in the context of cervical pathology. The present study aimed to determine upper C-spine movements by radiography during intubation with different devices as well as comparing the duration and success of intubation in cervical surgery. Materials and methods: Sixty patients scheduled for elective cervical surgery were registered in this prospective, randomized study. Patients with cervical trauma/injury, previous neck surgery, and body mass index (BMI) of >35 kg/m2 were excluded. Participants were randomized to one of the 3 groups: LMA CTrach, LMA Fastrach, or the Macintosh laryngoscope. C-spine motion was evaluated by measuring angles created by bordering vertebrae at cervical 1/2 and 2/3 (C1/2, C2/3) segments on 2 lateral cervical radiographs for each patient. Intubation time, ease of intubation, number of attempts, and success rate were also documented. Results: Demographic data were similar in all the groups. The cervical movement with LMA CTrach and LMA Fastrach compared to the Macintosh laryngoscope were similar at C1/2. However, LMA CTrach significantly reduced extension compared to LMA Fastrach and Macintosh laryngoscopes at C2/3. Duration of intubation was significantly shorter with the Macintosh laryngoscope. The rate of successful intubation was 80% with LMA Fastrach and 100% with both LMA CTrach and the Macintosh laryngoscopes. Conclusion: The LMA CTrach laryngoscopy involves less upper C-spine movement than the LMA Fastrach and does not increase the duration of the intubation period.

Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study.

BACKGROUND: This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. METHODS: Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 µg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded. RESULTS: Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D. CONCLUSION: Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration. TRIAL REGISTRATION: Retrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016.

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine mode

Background/aim: This study was undertaken to evaluate the effects of positive end-expiratory pressure (PEEP) levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to determine the appropriate PEEP level during steep Trendelenburg position combined with pneumoperitoneum.Materials and methods: Ten pigs were included in this study. Pneumoperitoneum and Trendelenburg position were maintained and PEEP titration was initiated. Arterial pressure, heart rate, arterial blood gas, ICP, and CPP were recorded at the following time points: baseline (T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2), PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5).Results: MAP significantly increased at T1 compared to T0 and decreased at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at T0. CO2 insufflation and steep Trendelenburg position did not cause any significant difference in ICP and CPP. ICP increased and CPP decreased significantly at T4 and T5 compared to both T0 and T1. PaO2 and PaO2/FiO2 decreased significantly at T1 and T2 compared to T0, while both increased significantly at T3, T4, and T5 compared to T1.Conclusion: PEEP of 10 cmH2O was effective for providing oxygenation while preserving hemodynamic stability, ICP, and CPP in this model.

Volatile anesthetic preconditioning attenuated sepsis induced lung inflammation.

BACKGROUND: This study aimed to evaluate the differential protective effects of isoflurane or sevoflurane on lung inflammation in a rat model of cecal ligation and puncture (CLP) induced sepsis. METHODS: Seventy-two rats were assigned to control, sevoflurane, or isoflurane groups. At 2 and 4 h, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1ß (IL-1ß), nitrate/nitrate levels (NO), total antioxidant capacity (TAC), and intercellular cell adhesion molecule-1 (ICAM-1) were determined. At 12 and 24 h, malondialdehyde (MDA), myeloperoxidase (MPO), and histologic changes were evaluated. Survival was monitored for 7 d after CLP. RESULTS: Sevoflurane (75%) and isoflurane (63%) significantly improved survival rate compared with control rats (38%). When sevoflurane and isoflurane groups were compared, sevoflurane pretreatment showed significant decrease in NO at 2 h [1045 (803-1274)/1570 (1174-2239) and 4 h [817 (499-1171)/1493 (794-2080)]; increase in TAC at 4 h [580.0 (387-751)/320 (239-512)]; decrease in MDA at 12 h [2.5 (1.1-4.2)/5.4 (4-73)] and 24 h [10.8 (6.0-14.0)/15.9 (9-28)]; and decrease in MPO at 24 h [145.8 (81-260)/232 (148-346)]. The difference in the ICAM-1 expression of the isoflurane and sevoflurane groups was not significant at both measurement times. The architectural integrity of the alveoli was preserved in all the groups. The injury scores of the three groups at 12 and 24 h did not show any significant difference. CONCLUSIONS: Both sevoflurane and isoflurane attenuated inflammatory response, lipid peroxidation, and oxidative stress. Furthermore, sevoflurane was more effective in modulating sepsis induced inflammatory response at the chosen concentration in sepsis model.

A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy.

AIM: This study was conducted to compare the efficacy and safety of tramadol with those of fentanyl and to evaluate the impact of age in pediatric patients undergoing upper gastrointestinal endoscopy (UGIE). METHODS: Eighty patients with ASA I-II, aged 1-16 years, undergoing UGIE were included in this study. Baseline anesthesia was maintained with 1 mg·kg(-1) propofol, and then, the patients were randomly assigned to receive 2 µg·kg(-1) fentanyl (group F, n = 40) or 2 mg·kg(-1) tramadol (group T, n = 40). Additional propofol, 0.5-1 mg·kg(-1), was administered when needed. Heart rate, mean arterial pressure, oxygen saturation (SpO(2)), and sedation scores were recorded at baseline, induction, and every 5 min. Endoscopy duration, recovery time, and adverse effects were recorded. The data were separated for subgroup analyses based on the age of 0-2, 2-12, and over 12 years. RESULTS: Fentanyl significantly decreased the saturation at induction, 5th min and 10th min in patients of 0-2 years; at 5th and 10th min in 2-12 years; and at 5th min in >12 years. In all age subgroups, sedation scores at 10th, 15th, and 20th min, the overall frequency of adverse effects, and the recovery time were significantly lower in group T compared with group F. CONCLUSION: Tramadol in pediatric patients undergoing UGIE provided sedation as efficient as fentanyl with a better hemodynamic and respiratory stability and provided a superior safety and tolerance in younger children.

Thoracic epidural bupivacaine attenuates inflammatory response, intestinal lipid peroxidation, oxidative injury, and mucosal apoptosis induced by mesenteric ischemia/reperfusion.

BACKGROUND: We conducted this study to evaluate the effects of thoracic epidural anesthesia (TEA) on inflammatory response, lipid peroxidation, and oxidative stress in a rat model of mesenteric ischemia/reperfusion (I/R). METHOD: Rats were divided into 4 groups: sham group (n=6; sham laparotomy), control group (n=6; I/R), bupivacaine group (n=6; mesenteric I/R and 20 µL/h 0.5% bupivacaine), and saline group (n=6, mesenteric I/R and 20 µL/h 0.9% saline). I/R injury was established by occluding the superior mesenteric artery for 1 hour followed by 12 hours reperfusion. Blood gas, tumor necrosis factor-α, interleukin-6, interleukin-1ß, glutathione peroxidise, superoxide dismutase, catalese, myeloperoxidase concentrations, immunohistochemical examinations (intracellular adhesion molecule-1), apoptosis determination, and wet/dry ratio of intestinal edema were determined. RESULTS: Bupivacaine significantly decreased the cytokine, malondialdehyde, and myeloperoxidase levels and increased the antioxidant enzyme levels. Wet/dry ratio comparison showed a significant decrease in the bupivacaine (2.88±0.17) group in comparison with control (5.45±0.67) and saline (5.87±0.17) groups. The intestinal injury score was significantly decreased in rats in the epidural bupivacaine (2 [1-2]) infusion group in comparison with rats in the control (3 [2-3]) and saline (3 [2-4]) groups. Bupivacaine (63%) caused a significant decrease in the percentage of apoptotic cells in comparison with control (85%) only. ICAM-1 levels in the bupivacaine (27.4±7.1) group decreased in comparison with control (12.3±7.4) and saline (24.9±3.2) groups. CONCLUSION: This study demonstrated that epidural bupivacaine attenuates the mesenteric I/R-related inflammatory response and intestinal damage.

Placement of a double lumen tube in a patient with difficult intubation due to ankylosing spondylitis--a case report.

During insertion of the double lumen tube in patients with ankylosing spondylitis, cervical neutral position should be maintained to avoid vertebral and spinal injuries. Although flexible fiberoptic bronchoscopic intubation is the gold standard, available FOB size is not compatible with that of the endobronchial lumen of the double lumen tube. This problem should be solved according to institutional capabilities. In this report we present a case of insertion of double lumen tube in neutral position using flexible fiberoptic bronchoscope and airway exchanger catheter in a thoracotomy patient with extremely limited neck mobility due to ankylosing spondylitis.

Dose-related effects of dexmedetomidine on sepsis-initiated lung injury in rats.

BACKGROUND: Sepsis is one of the leading causes of death in intensive care units. Dexmedetomidine is a sedative agent with anti-inflammatory properties. This study is designed to differentiate the impact of two different doses of dexmedetomidine on lung injury induced by sepsis. METHODS: Adult male Wistar rats were randomly divided into four groups: sham (n = 6), control (n = 12), 5DEX (n = 12), and 10DEX (n = 12). Cecal ligation puncture (CLP) was applied for sepsis initiation. The 5DEX group received 5 µg.kg-1.h-1 and the 10DEX group received 10 µg.kg-1.h-1 dexmedetomidine intravenous infusions for a 1-hour period. Six hours after CLP, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and intercellular adhesion molecule-1 (ICAM-1) levels were analyzed in blood samples. Twenty-four hours after CLP, lung samples from the remaining rats were collected for the measurement of myeloperoxidase (MPO) activity, histological examination, and TdT- (terminal deoxynucleotidyl transferase) mediated fluorescent-dUTP labeling staining for apoptosis detection. RESULTS: Serum cytokine release, MPO activity, and apoptosis in the lung were significantly increased in the CLP group compared with the sham and dexmedetomidine groups (p < 0.05). TNF-α, ICAM-1, and MPO were significantly lower in the 10DEX group compared with both 5DEX and control groups, while IL-1ß, total injury score, and apoptotic cell count had significantly lower values in both 10DEX and 5DEX groups compared with the control group (p < 0.05). CONCLUSION: Dexmedetomidine administration played a protective role against CLP-induced lung injury. High-dose dexmedetomidine was needed for suppressing the leukocyte-mediated lung injury and apoptosis of lung tissue.

Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate.

The objective of this study was to assess the effects of lidocaine on the incidence and severity of myoclonic movements induced by etomidate. Sixty patients were randomly assigned to receive either 20 mg lidocaine or saline (n = 30, each), 30 s before administration of etomidate (0.3 mg/kg). One minute after etomidate administration we assessed severity of myoclonus. Pretreatment with lidocaine significantly reduced both the incidence and severity of myoclonic movements. As a conclusion, lidocaine is an effective and safe drug to reduce the etomidate-induced myoclonus without significant side effects.

Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the postoperative analgesic efficacy and side-effects of intravenous tramadol with peritonsillar infiltration of tramadol in children undergoing adenotonsillectomy. METHODS: Sixty-six children were randomized into two groups: group I received 2 mg kg(-1) tramadol intravenously and group II received 2 mg kg(-1) tramadol in 2 ml of normal saline (1 ml per tonsil) via peritonsillar infiltration. Modified Hannallah pain scale, nausea, vomiting, bleeding, rescue analgesia, sedation and Aldrete scores were recorded at the 1st, 15th, 30th and 60th minute postoperatively. The Aldrete score was used to determine the postanaesthesia care unit discharge criteria. Patients were evaluated for the analgesic requirement, nausea and vomiting, bleeding and sedation. RESULTS: There were no differences between groups during the first 1 h. In the postanaesthesia care unit, groups I and II had comparable pain scores that were not statistically significant (P > 0.05). But during the first 24 h the additional analgesic requirement of group I (141.81 mg) was more than group II (83.63 mg) (P = 0.002). Pain scores in the postoperative ward at 6, 12 and 24 h were significantly higher in group I than in group II (P < 0.001). Also four patients (12.12%) from group I and one patient (3.05%) from group II had nausea and vomiting in the postanaesthesia care unit and none of the patients had rescue analgesics. There were no differences between groups regarding nausea and vomiting, sedation and bleeding in the postoperative ward. CONCLUSION: In adenotonsillectomy cases, peritonsillar infiltration of tramadol maintains efficient pain relief with lower incidence of nausea and vomiting.

Ultrasonographic evaluation and morphometric measurements of the suprascapular notch.

BACKGROUND: The aim of this study was to define the sonographic evaluation and morphometric measurements of the suprascapular notch. METHODS: The suprascapular notch was evaluated by ultrasound on both sides in 50 volunteers (25 males, 25 females). By means of ultrasound, the notch width, the notch depth and the distance between the skin and the notch base (skin-notch base interval) were measured and imaging of the superior transverse scapular ligament was attempted. Furthermore, imaging of the suprascapular artery and vein was performed by Doppler ultrasound. RESULTS: On the measurements performed, the notch was found to be deeper in men than in women on both the right (P = 0.022) and the left (P = 0.011) sides. Taking all volunteers into account without grouping sex, no differences were detected between the two sides with respect to the measurements of the notch width, notch depth and distance between the skin and the notch base. The superior transverse scapular ligament was demonstrated in 48 (96%) of 50 volunteers. On color Doppler ultrasound, the artery-vein complex was visualized in a total of 43 (86%) volunteers. CONCLUSIONS: Suprascapular notch measurements and the visualization of the anatomical neighborhood, which may be beneficial for the suprascapular nerve blockade procedure, can be successfully performed by the use of high-frequency ultrasound imaging.

Hepatic energy metabolism and the differential protective effects of sevoflurane and isoflurane anesthesia in a rat hepatic ischemia-reperfusion injury model.

BACKGROUND: We investigated the effects of isoflurane and sevoflurane in a warm liver ischemia-reperfusion (IR) model on cytokines, hepatic tissue blood flow (HTBF), energy content, and liver structure. METHODS: Seventy-two Wistar rats were randomly assigned into 1 of 3 groups: Control group, no volatile anesthetics; sevoflurane group, 2% sevoflurane; isoflurane group, 1.5% isoflurane. Thirty minutes after the start of volatile anesthetics, rats were subjected to 45 min hepatic ischemia and 2 and 4 h of reperfusion. Rats were killed at the end of ischemia, 2 and 4 h of reperfusion. Aspartate aminotransferase and alanine aminotransferase, HTBF, malondialdehyde, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, energy charge, and histologic examination were used to evaluate the extent of liver injury. RESULTS: Serum alanine aminotransferase and aspartate aminotransferase levels were similar in control and isoflurane groups while there was a significant decrease in the sevoflurane group in the postischemic period (P < 0.01). HTBF was remarkably better in the sevoflurane group than in the isoflurane group and worse in the control group. Tissue malondialdehyde levels were significantly low in the sevoflurane group compared with the isoflurane group at 2 h of reperfusion (P < 0.05) and reached its maximum value in the postischemic period in the control group. After ischemia, 2 and 4 h of reperfusion, tumor necrosis factor-alpha and interleukin-1beta values were lowest in the sevoflurane group and highest in the control group but it was not statistically significant (P > 0.05). In the sevoflurane group, hepatic adenosine triphosphate and energy charge were significantly high at all measurement times. At the postischemic period, energy charge was lower compared with the sevoflurane and isoflurane groups. The degree of hepatocyte injury was small in the sevoflurane group. CONCLUSIONS: Clinically relevant concentrations of sevoflurane given before, during, and after hepatic ischemia protected the liver against IR injury, whereas the effects of isoflurane on hepatic IR injury were not notable.

Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery: A case report with the literature review.

RATIONALE: Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration. PATIENT CONCERNS: A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil. At the end of the operation, sugammadex was administered and resulted in initially hypotension and bradycardia then the situation worsened by premature ventricular contraction and bigeminy with tachycardia, bronchospasm, and hypoxia. DIAGNOSIS: The Ring and Messmer clinical severity scale grade 3 anaphylactic reaction occurred just after sugammadex injection and the patient developed prolonged hypotension with recurrent cardiac arrhythmias in postoperative 12 hours. INTERVENTIONS: Treatment was initiated bolus injections of ephedrine, epinephrine, lidocaine, steroids and antihistaminic and continued with lidocaine bolus dosages and norepinephrine infusion for the postoperative period. OUTCOMES: The general condition of the patient improved to normal 3 hours after the sugammadex injection, and she was moved to the intensive care unit. At 2nd and 8th hours of intensive care unit follow-up, she developed premature ventricular contraction and bigeminy with the heart rate of 130 to 135 beats/min, which returned to sinus rhythm with 50 mg lidocaine. After that, no symptoms were observed and the patient was discharged to plastic surgery clinic at the following day. LESSONS: Sugammadex may result in life-treating anaphylactic reaction even in a patient who did not previously expose to drug. Moreover, prolonged cardiovascular collapse and cardiac arrhythmias may occur.

Sevoflurane exerts brain-protective effects against sepsis-associated encephalopathy and memory impairment through caspase 3/9 and Bax/Bcl signaling pathway in a rat model of sepsis.

Objective We compared the effects of sevoflurane and isoflurane on systemic inflammation, sepsis-associated encephalopathy, and memory impairment in a rat sepsis model of cecal ligation and puncture (CLP)-induced polymicrobial peritonitis. Methods Twenty-four rats were assigned to sham, CLP, CLP + sevoflurane, and CLP + isoflurane groups. At 72 hours after CLP, the rats underwent behavior tests. Serum cytokines were evaluated. Brain tissue samples were collected for determination of glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase; the wet/dry weight ratio; myeloperoxidase (MPO) and malondialdehyde (MDA); apoptotic gene release; and histologic examinations. Results The MPO level, wet/dry weight ratio, and histopathology scores were lower and the Bcl2a1 and Bcl2l2 expressions were upregulated in both the CLP + sevoflurane and CLP + isoflurane groups compared with the CLP group. The interleukin-6, interleukin-1ß, MDA, and caspase 3, 8, and 9 levels were lower; the GPX, SOD, Bax, Bcl2, and Bclx levels were higher; and non-associative and aversive memory were improved in the CLP + sevoflurane group compared with the CLP + isoflurane group. Conclusion Sevoflurane decreased apoptosis and oxidative injury and improved memory in this experimental rat model of CLP. Sevoflurane sedation may protect against brain injury and memory impairment in septic patients.

Effects of steep Trendelenburg position and pneumoperitoneum on middleear pressure in patients undergoing robotic radical prostatectomy.

BACKGROUND/AIM: The aim of this study was to quantify the changes in middle ear pressure (MEP) during robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS: Thirty patients undergoing RARP were included in this study. MEP was obtained at the following time points: awake (T1), postintubation (T2), pneumoperitoneum + 1 h of Trendelenburg position (T3), pneumoperitoneum + 2 h of Trendelenburg position (T4), pneumoperitoneum + 3 h of Trendelenburg position (T5), desufflation + supine position (T6), and 1 h after extubation in the postanesthesia care unit (T7). Heart rate, mean arterial pressure (MAP), peak airway pressure (PAP), tidal volume, minute ventilation, EtCO2, and blood gas values were recorded. RESULTS: MEP was significantly higher at T4, T5, T6, and T7 as compared to T1 values. PAP values were significantly increased at T3, T4, and T5 compared to T2. MAP values at T3, T4, and T5 were significantly higher compared to T1. PaCO2 increased significantly at T4, T5, and T6 and pH decreased significantly at T4 and T5 when compared to T2. CONCLUSION: The combination of steep Trendelenburg position and pneumoperitoneum during RARP caused a significant increase in MEP, PaCO2, and EtCO2 levels. This propensity for increased MEP may cause problems in patients with preexisting ear disease.

A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy.

STUDY OBJECTIVE: The purpose of this study was to compare the clinical activities of ketamine and fentanyl when used in combination with propofol for outpatients undergoing endometrial biopsy. The investigated parameters were respiration, sedation, recovery rate, side effects, time to discharge, and patient satisfaction. DESIGN: Prospective, randomized, double-blind study. SETTING: University hospital. PATIENTS: Forty American Society of Anesthesiologists physical status I and II patients (age range 38-61 years) scheduled for elective endometrial biopsy. INTERVENTIONS: Patients received intravenous bolus doses of either fentanyl 1 microg/kg and propofol 1 mg/kg in (group 1 n = 20) or ketamine 0.5 mg/kg and propofol 1 mg/kg in (group 2 n = 20). MEASUREMENTS: Heart rate, systolic and diastolic blood pressure, respiratory rate, and peripheral O(2) saturation were monitored in all patients. Depth of sedation was assessed by the Ramsay sedation score. The Aldrete score was used for postoperative recovery evaluation. The time to Aldrete score >/=8, side effects, and time to discharge were recorded. MAIN RESULTS: Respiratory depression was observed in 5 patients from group 1 and 1 patient from group 2, but the difference was not significant (P > .05). Nausea, vertigo, and visual disturbances were more frequent in group 2 (P < .05). The time to Aldrete score >/=8 was similar in the 2 groups (6.2 +/- 3.5 minutes in group 1 and 7.0 +/- 3.1 minutes in group 2); the time to discharge was significantly longer in group 2 (71.2 +/- 9.7 minutes in group 1 and 115.2 +/- 25.6 minutes in group 2). Frequency of patient satisfaction was 95% in group 1 and 60% in group 2. CONCLUSIONS: Hemodynamic change and degrees of sedation showed that fentanyl-propofol and ketamine-fentanyl combinations can be used safely in patients undergoing endometrial biopsy. However, with regard to side effects and patient satisfaction, the fentanyl-propofol was superior.

Comparison of the Effects of Dexmedetomidine vs. Ketamine in Cardiac Ischemia/Reperfusion Injury in Rats - Preliminary Study.

OBJECTIVES: Following ischemia/reperfusion injury, antioxidant defense mechanisms may remain insufficient depending on the duration of ischemia which is caused by any reason (MI, after percutaneous coronary intervention, during cardiac surgery). After that, free oxygen radicals increasing within the cell cause structural deterioration. Cytokines which activate a series of reactions that cause tissue damage and inflammatory response are released during reperfusion of ischemic tissues. In this study, we aimed to compare the effects of dexmedetomidine and ketamine in cardiac ischemia/reperfusion injury. MATERIAL AND METHODS: The study included 18 rats randomly divided into three groups. Group I/R (n = 6): control, Group I/R-K (n = 6): ketamine, and Group I/R-D (n = 6): dexmedetomidine. Before the 10 min surgery, after the 20 min ischemia and 20 min reperfusion period, hemodynamic parameters were compared among the three groups. After the 45 min ischemia and 120 min reperfusion period, tissue samples were obtained from the rat hearts, and MDA, SOD, GSH-Px, IL-1ß and TNF-α levels were compared. RESULTS: MDA and GSH-Px levels were significantly higher in the control group compared to the ketamine and dexmedetomidine groups. However, both levels were similar in the ketamine and dexmedetomidine groups. SOD levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group, but they were similar in the ketamine and dexmedetomidine groups. IL-1ß levels were similar in all groups. TNF-α levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group. They were similar in the ketamine and dexmedetomidine groups. CONCLUSIONS: According to our study, it can be concluded that dexmedetomidine and ketamine have similar effects on reducing myocardial ischemia reperfusion injury. Dexmedetomidine provides better heart rate control but causes hypotension, so, because of cardiac depression, we think that its clinical use may necessitate further investigation.

Suspected central anticholinergic syndrome related to cycloplegic eye drop in a premature baby.

The therapeutic approach for the central anticholinergic syndrome after application of cycloplegic eye drops in a premature infant patient who was scheduled for laser photocoagulation under general anesthesia is reviewed in the light of the relevant literature.

Sevoflurane and isoflurane preconditioning provides neuroprotection by inhibition of apoptosis-related mRNA expression in a rat model of focal cerebral ischemia.

BACKGROUND: This study aimed to examine the effects of sevoflurane or isoflurane preconditioning on cerebral ischemia/reperfusion-induced inflammation, oxidative stress, and lipid peroxidation and test the hypothesis that the underlining mechanism of the protective effect of preconditioning involves changes in the apoptotic gene expression profiles in an experimental model of middle cerebral artery occlusion in rats. METHODS: Twenty-four adult male rats were randomly divided into 3 groups: control (n=8), sevoflurane (n=8), and isoflurane (n=8). For preconditioning, these 3 groups were exposed to 40% O2, 2% sevoflurane, and 1.5% isoflurane, respectively, for 60 minutes, followed immediately by 1 hour of middle cerebral artery occlusion and then 6 hours of reperfusion. Blood and brain tissue samples were collected for determination of blood gas tension, tumor necrosis factor-α, interleukin-6, and interleukin-1ß. Brain tissue samples were collected for determination of the wet/dry ratio, myeloperoxidase, malondialdehyde, and total RNA and also for histologic examinations. RESULTS: Tumor necrosis factor-α, interleukin-1ß, and myeloperoxidase levels decreased and antioxidant enzyme levels increased in the sevoflurane group compared with the control and isoflurane groups. Proapoptotic genes (Tnf, Tnfrsf10b, and Tp53) downregulated and antiapoptotic genes (Aven, Bcl2, Bcl2l2, and Prok2) upregulated with sevoflurane treatment compared with the isoflurane and control groups. Both isoflurane and sevoflurane pretreatment decreased malondialdehyde, Dffb, the wet/dry ratio, and injury score and upregulated Bax and Apaf 1 compared with the control group. CONCLUSIONS: Sevoflurane and isoflurane preconditioning ameliorates inflammation, cerebral lipid peroxidation, and histologic injury. Downregulation of proapoptotic molecules and upregulation of antiapoptotic molecules may be associated with this effect.

Preincisional local infiltration of tramadol at the trocar site versus intravenous tramadol for pain control after laparoscopic cholecystectomy.

STUDY OBJECTIVE: To compare the effects of preoperative intravenous (IV) tramadol and preoperative tramadol infiltration of trocar sites on postoperative pain and postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. DESIGN: Prospective, randomized study. SETTING: Operating room, recovery room, and surgical ward. PATIENTS: 70 ASA physical status 1 and 2 patients, aged 20-70 years, scheduled for elective laparoscopic cholecystectomy. INTERVENTIONS: In Group I, patients received IV 2.0 mg/kg of tramadol; in Group II, trocar insertion points were infiltrated with 2.0 mg/kg of tramadol in 20 mL of 0.9% NaCl. MEASUREMENTS: Pain scores, sedation scores, postoperative analgesic requirement, and PONV were recorded at 0 and 30 minutes and one, three, 6, 12, and 24 hours. At 30 minutes and one hour, pain localization (incisional or diffuse abdominal) was also recorded. MAIN RESULTS: Visual analog scale scores at 30 minutes were significantly lower in Group II [3 (0-7)] than Group I [6 (3-8)] (P < 0.001). In Group I, 91.4% of patients received sodium diclofenac, while 68.6% of Group II patients received sodium diclofenac (P = 0.002). The time to first analgesic requirement was significantly lower in Group II (P = 0.004). At the 30-minute measurement time, a significant difference was recorded between the groups in incisional pain (P < 0.001). There was also a significant difference between groups in the frequency of PONV. CONCLUSIONS: Trocar site infiltration of tramadol improves early postoperative pain and decreases PONV.