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.

Use of airway exchange catheter for bronchoscopy of a patient with Down's syndrome.

Tracheobronchial injuries (TBI) are highly fatal, and early diagnosis and repair are crucial for survival. The anesthesiologist and the surgeon must secure the integrity and patency of the airway for these cases. These injuries remain infrequent, and are becoming less fatal due to the availability of the resources necessary to achieve a secure airway, and thus some of them can be managed conservatively. We report an unusual case of upper airway compromise and extensive subcutaneous emphysema due to traumatic bronchial rupture and its conservative repair in a patient with Down's syndrome.

Respiratory mechanics with volume-controlled auto-flow ventilation mode in cardiac surgery.

AIM: We aimed to investigate the changes in respiratory mechanics in adult patients undergoing open heart surgery (OHS) while using volume-controlled auto-flow (VCAF) ventilation mode. MATERIALS AND METHODS: After obtaining ethics committee's approval and informed consent, 30 patients (17 males and 13 females; mean age: 57.3 ± 17.0 years; mean weight; 74.9 ± 13.6 kg) scheduled for OHS were enrolled. Mechanical ventilation was carried out using VCAF mode (VT: 5-8 mL/kg, I/E: 1/2, 10 ± 2 fr/min). Values of dynamic compliance (Cdyn) and resistance (R) were obtained at six time points (TPs). Normally distributed variables were analyzed with repeated measure of analysis of variance and Bonferroni tests. For abnormally distributed variables, Friedman variance analysis and Wilcoxon signed-rank tests were used. Values were expressed as mean ± standard deviation. P value <0.05 was considered significant. RESULTS: Cdyn (mL/mbar) and R (mbar/L/s) values were as follows - (1) before sternotomy (S): 49.9 ± 17.1 and 7.8 ± 3.6; (2) after S: 56.7 ± 18.3 and 7.1 ± 3.7; (3) after S and after sternal retractor placement: 48.7 ± 16.1 and 8.3 ± 4.4; (4) after weaning from cardiopulmonary bypass and following decannulation while retractor was in place: 49.6 ± 16.5 and 8.1 ± 4.0; (5) after retractor removal: 56.5 ± 19.6 and 7.4 ± 3.7; and (6) after sternal closure: 43.1 ± 14.2 and 9.6 ± 9.1, respectively. Significant differences were observed in Cdyn and R between; first and second TPs, second and third TPs, fourth and fifth TPs, and fifth and sixth TPs. Also, significant difference in Cdyn was found between first and sixth TPs, but it was not found in R. CONCLUSION: Cdyn decreases, but R remains the same in cardiac surgical patients when mechanical ventilation is performed with VCAF ventilation mode. Additionally, Cdyn is negatively affected by the presence of sternal retractor and the sternal closure in OHS.

Propofol and sevoflurane during epidural/general anesthesia: comparison of early recovery characteristics and pain relief.

We investigated the early recovery characteristics and pain relief of adult patients during combined anesthesia with (epidural and general), either with propofol or sevoflurane for maintenance in major abdominal surgery. Twenty-two patients (ASA I-III) were enrolled in this randomized, prospective study. After fluid preloading, 10 ml of bupivacaine 0.5% + 5 ml of prilocaine 0.5% + 1 ml of fentanyl 50 microg mL(-1) were administered via an epidural catheter. General anesthesia was induced with fentanyl and propofol after T6 sensorial blockade. Propofol group (n = 11) received propofol (2-5 mg kg(-1) h(-1)), sevoflurane group (n = 11) received sevoflurane (1-2%) for maintenance. Anesthesia was supplemented with N2O in O2 and intravenous fentanyl. Continuous epidural infusion of 0.125% bupivacaine + 1 microg fentanyl (5-7 mL h(-1)) was started forty-five min after the epidural bolus dose and 5 ml of it was given at the start of the wound closure. All anesthetics were discontinued except epidural infusion during the last suture. After emergence time was determined, the patients were transferred to the PACU. They were observed for orientation times of person and place. The pain scores (verbal analogue scale, 0-10) were assessed with 30 min intervals. When the patient's pain score was >3, rescue analgesic protocol (diclofenac Na 75 mg im followed by meperidine HCI approximately 0.25 mg kg(-1) iv at the latter period) was applied. In the case of inadequate pain relief during the latter assessment periods, meperidine HCI approximately 0.25 mg kg(-1) was administered. Mann-Whitney U test and Fisher's exact test were used for the statistical analysis. A value of p<0.05 was considered significant. Between the groups no statistical differences were observed in the emergence time (5 vs. 6 min, median) and in the orientation time to person (6 vs. 10 min). Recovery of orientation to place was found faster in propofol group (7 vs. 12 min, p = 0.041). Pain scores of the patients between the groups were not statistically different at 0, 30, 60, 90, 120 min postoperatively (3, 2, 3, 2, 2, and 2, 4, 4, 3, 3, respectively). Rescue analgesic protocol and additional meperidine HCI were applied to 63.6% and 45.4% of patients in the propofol group, 54.5% and 36.3% of patients in the sevoflurane group, respectively. There weren't any statistical differences in regard to these, either. Except orientation time to place, the times of emergence and orientation to person, the pain scores and the analgesic requirements of the patients in both groups were similar. Propofol or sevoflurane did not offer any advantages for postoperative pain relief on behalf of either one when combined with epidural anesthesia.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study.

OBJECTIVE: We aimed to investigate the attitudes and behaviors of anaesthesiologists in "non-operating room anaesthesia" applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey. METHODS: Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program. RESULTS: A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants' institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05). CONCLUSION: Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed.

Comparison of the effect of sevoflurane and propofol on oxygenation during gradual transition to one-lung ventilation.

BACKGROUND: It is known that hypoxic pulmonary vasoconstriction increases as a result of intermittent regional hypoxic challenges. The aim of this study was to compare the effects of sevoflurane and propofol on oxygenation and shunt fraction during one-lung ventilation in a novel model of hypoxic preconditioning before one-lung ventilation. METHODS: Sixteen Wistar-albino rats were anesthetized intra-peritoneally before venous and arterial cannulations and tracheotomized. The animals were randomly allocated to receive either sevoflurane 2% or 10mg/kg/h propofol infusion and ventilated with 100% oxygen at an inspiratory rate of 80 breaths/min for 30min. Three cycles of one-lung ventilation and two-lung ventilation were performed and one-lung ventilation was continued for 15min. Arterial blood gas samples were obtained as follows: after cannulation and tracheotomy, following 30min of treatment with sevoflurane or propofol, and at the 5th and 15th min of one-lung ventilation. RESULTS: The PaO2 levels were higher and shunt fractions were lower in rats receiving propofol compared to rats treated with sevoflurane but the difference was not significant; the two groups were comparable in terms of PaCO2. CONCLUSIONS: The similar effects of sevoflurane and propofol on PaO2 during one-lung ventilation following hypoxic preconditioning may be due to other causes beside the inhibition of hypoxic pulmonary vasoconstriction. Gradual transition to one-lung ventilation is a novel technique for preconditioning experiments for one-lung ventilation.

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.

Comparação do efeito de sevoflurano e propofol na oxigenação durante a transição gradual para ventilação monopulmonar / Comparison of the effect of sevoflurane and propofol on oxygenation during gradual transition to one-lung ventilation / Comparación del efecto de sevoflurano y propofol en la oxigenación durante la transición gradual para la ventilación monopulmonar

Justificativa e objetivo: sabe-se que a vasoconstrição pulmonar hipóxica aumenta como resultado de desafios hipóxicos regionais intermitentes. O objetivo deste estudo foi comparar os efeitos de sevoflurano e propofol na oxigenação e fração de shunt durante a ventilação monopulmonar em um novo modelo de hipóxia pré-condicionado antes da ventilação monopulmonar. Métodos: foram anestesiados intraperitonealmente antes das canulações venosa e arterial e traqueostomizados 16 ratos albinos Wistar. Os animais foram randomicamente distribuídos para receber perfusão de sevoflurano a 2% ou 10 mg/kg/h de propofol e ventilados com oxigênio a 100%, a uma taxa inspiratória de 80 respirações/minuto por 30 minutos. Três ciclos de ventilação monopulmonar e ventilação de ambos os pulmões foram feitos e a ventilação monopulmonar foi continuada por 15 min. Amostras de gasometria arterial foram obtidas da seguinte forma: após punção e traqueotomia, após 30 minutos de tratamento com sevoflurano ou propofol e aos cinco e 15 minutos de ventilação monopulmonar. Resultados: os níveis de PaO2 foram maiores e as frações de shunt menores nos ratos que receberam propofol em comparação com os ratos tratados com sevoflurano, mas a diferença não foi significante. Os dois grupos foram comparáveis em termos de PaCO2. Conclusões: os efeitos similares de sevoflurano e propofol na PaO2 durante a ventilacão monopulmonar após pré-condicionamento hipóxico podem ter resultado de outras causas além da inibição da vasoconstrição pulmonar hipóxica. A transição gradual para a ventilação monopulmonar é uma técnica nova de pré-condicionamento de experimentos para ...

Background: It is known that hypoxic pulmonary vasoconstriction increases as a result of intermittent regional hypoxic challenges. The aim of this study was to compare the effects of sevoflurane and propofol on oxygenation and shunt fraction during one-lung ventilation in a novel model of hypoxic preconditioning before one-lung ventilation. Methods: Sixteen Wistar-albino rats were anesthetized intra-peritoneally before venous and arterial cannulations and tracheotomized. The animals were randomly allocated to receive either sevoflurane 2% or 10 mg/kg/h propofol infusion and ventilated with 100% oxygen at an inspiratory rate of 80 breaths/min for 30 min. Three cycles of one-lung ventilation and two-lung ventilation were performed and one-lung ventilation was continued for 15 min. Arterial blood gas samples were obtained as follows: after cannulation and tracheotomy, following 30 min of treatment with sevoflurane or propofol, and at the 5th and 15th min of one-lung ventilation. Results: The PaO2 levels were higher and shunt fractions were lower in rats receiving propofol compared to rats treated with sevoflurane but the difference was not significant; the two groups were comparable in terms of PaCO2. Conclusions: The similar effects of sevoflurane and propofol on PaO2 during one-lung ventilation following hypoxic preconditioning may be due to other causes beside the inhibition of hypoxic pulmonary vasoconstriction. Gradual transition to one-lung ventilation is a novel technique for preconditioning experiments for one-lung ventilation. .

Justificación y objetivo: se conoce que la vasoconstricción pulmonar hipóxica aumenta como resultado de los retos hipóxicos regionales intermitentes. El objetivo de este estudio fue comparar los efectos del sevoflurano y del propofol en la oxigenación y fracción de shunt durante la ventilación monopulmonar, en un nuevo modelo de hipoxia preacondicionado antes de la ventilación monopulmonar. Métodos: dieciséis ratones albinos Wistar fueron anestesiados intraperitonealmente antes de las canalizaciones venosa y arterial, y fueron traqueostomizados. Los animales fueron aleatoriamente distribuidos para recibir una perfusión de sevoflurano al 2% o 10 mg/kg/h de propofol y ventilados con oxigeno al 100%, a una tasa inspiratoria de 80 rpm durante 30min. Se realiza-ron 3 ciclos de ventilación monopulmonar y ventilación de ambos pulmones y la ventilación monopulmonar se continuó durante 15 min. Se obtuvieron muestras de gasometría arterial de la siguiente forma: posteriormente a la punción y a la traqueotomia, y después de 30 min de tratamiento con sevoflurano o propofol, y a los 5 y 15 min de ventilación monopulmonar. Resultados: los niveles de PaO2 fueron más elevados y las fracciones de shunt menores en los ratones que recibieron propofol en comparación con los ratones tratados con sevoflurano, pero la diferencia no fue significativa, ya que los 2 grupos fueron comparables en términos de PaCO2. Conclusiones: los efectos similares de sevoflurano y propofol en la PaO2 durante la ventilación monopulmonar después del preacondicionamiento hipóxico pueden deberse a otras causas ade-más de por la inhibición de la vasoconstricción pulmonar hipóxica. La transición gradual hacia la ventilación monopulmonar es una técnica nueva de preacondicionamiento de experimentos para la ventilación ...