Ageliki Pandazi

Cognitive Function and Oxidative Stress After Carotid Endarterectomy: Comparison of Propofol to Sevoflurane Anesthesia

OBJECTIVE To examine the antioxidant role of propofol in ischemia-reperfusion during carotid endarterectomy (CEA) and its influence on cognitive dysfunction after CEA. DESIGN A randomized prospective study. SETTING Single-center study in a university hospital. PARTICIPANTS Forty-four patients. INTERVENTIONS Patients underwent elective CEA under general anesthesia with either sevoflurane (group S, n = 21) or propofol (group P, n = 23). MEASUREMENTS AND MAIN RESULTS Cognitive function was assessed with the Mini-Mental State Examination (MMSE) before CEA, 1 hour after CEA, and 24 hours after CEA. Blood samples from the radial artery and the internal jugular vein were drawn before carotid clamping and 5 minutes following unclamping, and peripheral blood was obtained 24 hours postoperatively. Samples were analyzed for lactate, S100B, and P-selectin concentrations and for the antioxidative markers malondialdehyde/low-density lipoprotein ratio and nitrate + nitrite concentrations. Compared with group S, patients in group P exhibited a greater increase in their MMSE values 24 hours postoperatively. Patients who had their MMSE performance reduced at 24 hours also were significantly fewer in group P (13% v 43% in group S, p<0.05). Significantly lower levels of lactate and S100B were observed in arterial and jugular vein samples in group P. In addition, the jugular vein-arterial differences of malondialdehyde-to-low-density lipoprotein ratio and nitrates + nitrites concentrations were lower during propofol anesthesia. CONCLUSIONS Propofol seemed to improve cognitive performance after CEA. This improvement was associated with decreased indices of ischemic cerebral damage and seemed to be due to antioxidative effect in the ischemic cerebral circulation.

Music's use for anesthesia and analgesia.

This review article provides an overview of published data regarding the involvement of music in anesthesia practice. Music is an important topic for research in different fields of anesthesiology. The use of music preoperatively is aimed at reducing anxiety, stress, and fear. However, the effect of music on perception of pain intraoperatively is controversial, according to studies of both adults and children undergoing various surgical procedures under general and/or regional anesthesia. In postoperative pain management, postanesthesia care, and neonatal intensive care, music can be a complementary method for reducing pain, anxiety, and stress. Music is a mild anxiolytic, but it is relatively ineffective when a pain stimulus is severe. However, music is inexpensive, easily administered, and free of adverse effects, and as such, can serve as complementary method for treating perioperative stress and for acute and chronic pain management, even though musics effectiveness depends on each individual patients disposition and severity of pain stimulus.

Excretion of ropivacaine in breast milk during patient-controlled epidural analgesia after cesarean delivery.

Background: Few studies have been published concerning the excretion of bupivacaine and lidocaine into the breast milk and none concerning ropivacaine. Aim: The aim of this study was to determine the levels of ropivacaine in plasma and breast milk after combined spinal-epidural anesthesia for cesarean delivery and postoperative patient-controlled epidural analgesia (PCEA), as well as possible adverse effects from these levels on the neonate. Methods: Twenty-five parturients admitted for cesarean delivery under combined spinal-epidural anesthesia participated in the study. The PCEA regimen was prepared as 0.15% ropivacaine and fentanyl 2 &mgr;g/mL (basal rate, 6 mL/h; demand dose, 4 mL/20 min). Blood samples were collected before anesthesia and from the umbilical cord immediately after birth, followed by blood and breast milk samples 18 and 24 hrs after initiation of PCEA. The newborns were clinically appraised with the Apgar score at delivery and Neurological and Adaptive Capacity Score 24 hrs later. Local anesthetic side effects were recorded. Ropivacaine levels were determined by high-performance liquid chromatography with a UV detector. Results: Ropivacaine excretion into the breast milk produced concentrations that significantly correlated with those in the plasma 18 and 24 hrs after administration, achieving milk-plasma ratios (mean ± SD) of 0.25 ± 0.08 and 0.23 ± 0.07, respectively. Most newborns had maximal Apgar and Neurological and Adaptive Capacity Scores. No adverse effects from ropivacaine were noted in mothers or neonates. Conclusions: The milk-plasma concentration ratio of ropivacaine was found to be lower than that reported for other local anesthetics It seems that PCEA with ropivacaine/fentanyl after cesarean delivery is not associated with excessive milk-plasma concentrations of ropivacaine.

Anesthetic and perioperative management of intestinal and multivisceral allograft recipient in nontransplant surgery.

As the survival rate of the intestinal and multi‐visceral transplant recipients continues to improve, an increasing number of these patients present for either elective or emergency surgery related or unrelated to transplantation. The aim of this review is to focus on clinical issues related to the anesthetic and perioperative management of the intestinal or multi‐visceral transplant recipient for nontransplant surgery. Specific issues concerning perioperative assessment and medications, choice of anesthetic drugs and techniques, and postoperative care management are reviewed.

Acetaminophen-induced liver injury and oxidative stress: protective effect of propofol.

Background and objective We evaluated the effects of propofol on oxidative stress and acute liver injury and regeneration produced by acetaminophen administration in rats. Methods Acetaminophen (3.5 g kg−1) was administered by gastric tube to 50 adult male Wistar rats. One minute before acetaminophen, propofol was administered intraperitoneally (60 mg kg−1) to 25 rats and diethyl ether to the other 25 animals. All rats were sacrificed. Markers of oxidative stress (malondialdehyde levels, cholesterol/high-density lipoprotein cholesterol fraction and glutathione-S-transferase-π activity), liver injury (aspartate aminotransferase alanine aminotransferase and alkaline phosphatase and histological signs of inflammation and in-situ apoptosis) and liver regeneration (rate of [3H]thymidine incorporation into hepatic DNA, activity of liver thymidine kinase and mitotic index in hepatocytes) were determined. Unpaired Students t-test and one-way analysis of variance were used for statistical analysis and a P value of 0.05 or less was considered significant. Results All markers of oxidative stress were significantly decreased in propofol-treated animals. Biochemical and histological markers of liver injury and regeneration in propofol-treated animals did not show any significant decrease compared with those observed in the control group. Conclusion The antioxidant capacity of propofol, verified in our study, did not manage to prevent liver injury and accelerate regeneration after acetaminophen administration in rats.

The impact of intraoperative propofol administration in the prevention of postoperative pruritus induced by epidural morphine

Background and objective: We examined the efficacy of intraoperative propofol administration to prevent pruritus induced by epidural morphine. Methods: Seventy patients ASA I–II undergoing combined epidural and general anaesthesia for hysterectomy were randomly assigned to two groups, Group P where anaesthesia was induced with propofol and fentanyl and maintained with propofol‐nitrous oxide and Group S in which anaesthesia was induced with thiopental and fentanyl and maintained with sevoflurane‐nitrous oxide. All patients received a ropivacaine epidural bolus with 3 mg morphine 1 h before the end of surgery. The incidence and severity of pruritus were evaluated every 4 h for the first 12 h postoperatively by blinded observers. Results: The total incidence of pruritus was significantly higher (P = 0.024) in Group S (65.6%) compared to Group P (29%) between 4 and 8 h postoperatively. There were also significantly more patients (P = 0.03) reporting severe pruritus in Group S (22%) compared to Group P (0). Conclusion: Propofol‐based general anaesthesia compared to thiopental–sevoflurane‐based anaesthesia reduces the incidence and severity of pruritus induced by a single injection of 3 mg epidural morphine with ropivacaine.

Comparative effects of sevoflurane and propofol based general anaesthesia for elective surgery on memory.

Introduction Unconscious processing of words during general anaesthesia has been suggested. We used the process dissociation procedure (PDP) to test memory performance during sevoflurane and propofol anaesthesia in relation to hypnotic depth. Material and methods One hundred participants anaesthetised for elective surgery (50 with propofol and 50 with sevoflurane) and 50 non-anaesthetized listened to a list of words. The bispectral index (BIS) of the anaesthetised patients was recorded. Within 36 h after word presentation, memory was assessed using a word stem completion task, based on Buchners model applied on the PDP. Results There was evidence of memory for words presented during light (BIS 61-80) (p = 0.001) and adequate (BIS 41-60) (p = 0.008) but not deep anaesthesia (BIS 21-40) (p = 0.09). The PDP showed a significant implicit but not explicit memory contribution (mean total explicit memory scores: 0.04 ±0.07 in all BIS categories; mean implicit memory scores: 0.01 ±0.04, 0.1 ±0.08, and 0.05 ±0.09 at BIS = 21-40, 41-60, and 61-80, respectively). There was a statistically significant difference between the mean implicit memory score (I) of the propofol and sevoflurane group in the BIS category 41-60 in general (p = 0.016), and after incision (IA.I.) (p = 0.005) in particular, with propofol depressing I more than sevoflurane in both cases. Memory performance of nonanaesthetized participants was better, with a higher contribution of explicit and a comparable contribution of implicit memory. Conclusions During general anaesthesia, implicit memory persists even in adequate hypnotic states. Sevoflurane affects the implicit memory of adequately anaesthetised subjects less than propofol.

Epidural haematoma after epidural catheter removal under multiple anticoagulant therapy: report of two cases.

We report two cases of epidural haematoma that probably developed after removal of the epidural catheter in patients receiving multiple anticoagulant and antiplatelet therapy. The first case is a 77-year-old male patient who underwent femoropopliteal artery bypass grafting surgery. The second case is a 77-year-old woman who underwent a semi-total replacement of the right hip, three days after she had a subtrochanteric fracture. Emergency laminectomy was performed in both patients but none experienced a full recovery.

Role of Lipid Emulsion Administration in Acute Lung Injury During Liver Transplant Rejection : A Case Report

We report the case of a 58-year-old woman who developed rejection and acute lung injury 10 days after an orthotopic liver transplantation while receiving total parenteral nutrition. Examination of bronchoalveolar lavage fluid revealed large lipid droplets in the alveolar macrophages. Intensification of the immunosuppressive therapy attenuated the liver allograft rejection followed by resolution of lung injury.

The effect of 6% hydroxyethyl starch 130/0.42 vs lactated Ringerʼs preload on the haemodynamic status of parturients undergoing spinal anaesthesia for elective caesarean delivery using arterial pulse contour analysis: 11AP1-4

Background and Goal of study: Fluid loading appears to be the key in attenuating the hypotensive response to spinal anaesthesia (SA) in obstetric patients. The aim of this prospective study was to compare the preload efficacy of a hydroxyethyl starch (HES) vs lactated Ringers in the prevention of hypotension af ter SA for elective caesarean delivery (CD) using arterial pulse contour analysis. Material and methods: Af ter receiving approval by the institutional Ethics and Research Commit tee, 32 ASA I and II parturients scheduled for elective CD under SA were allocated to receive either 1 L lactated Ringers (Group R/L, n=16) or 0.5 L balanced HES 6% 130/0.42 (Tetraspan®) preload (Group T, n=16). FloTrac/VigileoTM was applied to all participants. Maternal haemodynamic measurements including systolic arterial pressure (SAP) and cardiac output (CO) were recorded at predefined time points; before volume preload (baseline values), immediately af ter volume preload, immediately af ter SA and at one minute intervals thereaf ter. SA induced hypotension, defined as 20% drop of SAP from baseline or SAP< 100 mmHg, was treated with vasopressor administation according to a predetermined algorithm. The end points of the study included the incidence and duration of hypotension and the total dose of rescue vasopressors given. Longitudinal analysis was performed employing a linear mixed random ef fects piecewise model in order to assess changes in haemodynamic variables over time. Results and Discussion: Although preloading increased similarly CO in both groups (p>0.05), the incidence of SA induced hypotension was 73.3% in R/L Group compared to 46.7% in T Group (p>0.05). Overall duration of haemodynamic instability was significantly prolonged in the R/L group (p< 0.001). The total amount of ephedrine and phenylephrine administered was significantly greater in the R/L group (p=0.015 and p=0.029, respectively). The mixed random ef fects model revealed statistical significant dif ferences within groups (p< 0.001) concerning all haemodynamic measurements up to the 14th minute af ter SA. However, overall, no statistical dif ference was detected between groups over time due to prompt rescue vasopressor administration. Conclusion: Preloading with HES 6% 130/0.42 (Tetraspan®) contributed to lower incidence of hypotension and less rescue vasopressor treatment, and resulted in bet ter haemodynamic stability compared to lactated Ringer’s preload in obstetric patients under spinal anaesthesia.