Ali Günerli

A cross-over, post-electroconvulsive therapy comparison of clinical recovery from rocuronium versus succinylcholine

STUDY OBJECTIVE To evaluate the effect of the neuromuscular blocking agent, rocuronium, on clinical recovery from electroconvulsive therapy (ECT) as compared with succinylcholine. DESIGN Cross-over study. SETTING University hospital. PATIENTS 13 ASA physical status I and II patients, ages 18 to 60 years, receiving ECT three times a week. INTERVENTIONS Each patient received either succinylcholine before the first ECT session (Group S) and rocuronium before the third ECT session (Group R). Muscle paralysis was produced with succinylcholine one mg kg(-1) intravenously (IV) or rocuronium 0.3 mg kg(-1) IV. Reversal of the residual neuromuscular block (Group R) was accomplished with 10 microg kg(-1)of atropine and 20 microg kg(-1)of neostigmine after completion of the ECT procedure. MEASUREMENTS Motor seizure duration time, time to first spontaneous breathing, eye opening, head lift, and tongue depressor test were recorded. MAIN RESULT Motor seizure duration and time to first spontaneous breath was longer (33.6 sec vs. 24.2 sec; 9.46 min vs 8.07 min, respectively) in the rocuronium group than the succinylcholine group. No significant difference was detected between the two groups in eye opening, head lift, or tongue depressor testing. CONCLUSION Rocuronium, when used in conjunction with a reversal agent, may be an adequate alternative to succinylcholine as a neuromuscular blocker during ECT.

Evaluation of the effectiveness of sugammadex for verapamil intoxication.

Previous studies have shown that medications from the cyclodextrin family bind to verapamil. The aim of our study was to determine whether sugammadex could bind to verapamil and prevent the cardiovascular toxicity of that drug. Twenty‐eight sedated Wistar rats were infused with verapamil at 37.5 mg/kg/h. Five minutes after the start of infusion, the animals were treated with a bolus of either 16 mg/kg, 100 mg/kg or 1000 mg/kg sugammadex. The control group was treated with an infusion without sugammadex. The heart rate and respiratory rate were monitored, and an electrocardiogram was recorded. The primary end‐point was the time to asystole. The verapamil infusion continued until the animals arrested. The asystole time for the S16 group was significantly longer compared to those for the control and S1000 groups (p < 0.05). The asystole time for the S1000 group was significantly shorter than those for all of the other groups (p < 0.05). Reflecting these data, there was a near doubling of the mean lethal dose of verapamil from 13.57 mg/kg (S.D. ±8.1) in the saline‐treated rats to 22.42 mg/kg (S.D. ±9.9) in the sugammadex 16 group (p < 0.05). However, for the sugammadex 1000 group, the mean lethal dose was found to be 6.28 ± 1.11 mg/kg. This dose is significantly lower than those for all of the other groups (p < 0.05). We found that treatment with 16 mg/kg sugammadex delayed verapamil cardiotoxicity in rats. However, 1000 mg/kg sugammadex accelerated verapamil cardiotoxicity in rats. Further studies must be conducted to investigate the interaction between verapamil and sugammadex.

Haemodynamic effects of physiotherapy programme in intensive care unit after liver transplantation.

Objective. To determine the haemodynamic effects of intensive care physiotherapy after liver transplantation. Patients and methods. Thirteen patients were included in the study after liver transplantation. The following physiotherapy programme were applied to the patients in intensive care unit: Respiratory physiotherapy, active joint movements, sitting in bed (first task), sitting at the edge of bed (second task), standing (third task), sitting out of bed (fourth task) and walking (fifth task). Heart rate (HR), mean, systolic and diastolic blood pressures (MBP, SBP, DBP), peripheral oxygen saturation (SpO2), respiration rate (RR) were recorded before treatment, after each task, after treatment and at the fifth minute of recovery. Pain level was assessed with Visual Analogue Scale (0–10). Results. When compared with supine position before treatment, all of the parameters except RR increased after the first task whereas HR, SBP, MBP and pain increased after the second task. After the third task only HR and pain increased. There was no significant difference between the fourth task and pre-treatment values while HR, DBP and pain increased after the fifth task. When measurements of pre-treatment, immediately after treatment and the fifth minute of recovery were compared HR, MBP and pain increased after treatment whereas HR, RR and pain decreased after recovery. There was no significant difference between pre-treatment values and fifth minute of recovery measurements. Conclusion. Returning to initial values after a 5-min period shows that cardiopulmonary changes caused by intensive care physiotherapy after liver transplantation are responded at physiological limits.

Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: a double-blind, randomized controlled trial.

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n=36) or meperidine (0.5 mg/kg; n=34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test,P=.772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P=.018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.

Neuroprotective effects of ketorolac tromethamine after spinal cord injury in rats: an ultrastructural study.

IntroductionThe aim of this study was to investigate the effects of intrathecally administered ketorolac tromethamine on ultrastructural changes of the spinal cord in spinal cord-traumatised rats.MethodsMale Wistar rats were used and divided into three groups for this study. The rats in Group S (n=6) were control animals and received 10 μl of saline. Groups K50 (n=6) and K400 (n=6) received intrathecally 50 μg and 400 μg of ketorolac tromethamine, respectively, immediately after trauma was induced. All rats underwent laminectomy and the spinal cord was traumatised using the clip-compression technique. Electron microscopic examination of the cord samples was carried out 3 days after spinal cord injury.ResultsUltrastructural findings showed severe injury with extensive axoplasmic and cytoplasmic oedema in Group S. Minor neural damage occurred in Group K50 and increased ultrastructural protection was observed in the Group K400.ConclusionThis study demonstrates that intrathecal administration of ketorolac tromethamine protects the spinal cord following injury in rats.

What are the hemodynamic and respiratory effects of passive limb exercise for mechanically ventilated patients receiving low-dose vasopressor/inotropic support?

Passive limb exercises (PLEs) are used widely in the management of unconscious patients and an early start is recommended. The aim of this study was to determine the effects of PLEs on hemodynamic and respiratory parameters in mechanically ventilated critically ill patients receiving low-dose vasopressor/inotropic support. The charts of 120 mechanically ventilated patients who underwent PLEs were evaluated retrospectively between January 2000 and July 2002. Patients were grouped on the basis of administration of vasopressor/inotropic support. Thirty-eight patients did not get vasopressor/inotropic support (group 1) and 82 patients received low-dose vasopressor/inotropic support (dopamine <10 &mgr;g/kg/min, noradrenaline/adrenaline <0.1; group 2). Central venous pressure, heart rate, mean arterial pressure, and oxygen saturation were recorded before and immediately after PLEs. After PLEs in group 1 patients, central venous pressure and mean arterial pressure values increased significantly, and in group 2 patients, central venous pressure increased significantly (P < .05). No statistically significant difference was observed in the rate of change of hemodynamic or respiratory parameters between the 2 groups after the PLEs (P > .05). This retrospective study confirmed that PLEs result in similar hemodynamic and respiratory changes in critically ill patients who received low-dose vasopressor/inotropic support versus those who do not.

Effect of deep breathing exercises on oxygenation after major head and neck surgery

OBJECTIVES: To investigate respiratory and hemodynamic responses to deep breathing exercise (DBE) during the follow-up period in the intensive care unit after major head and neck surgery. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Thirty-five patients were instructed to perform DBE every hour for 3 consecutive hours during the first postoperative day. The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), oxygen saturation (SpO2), respiratory rate (RR), heart rate (HR), and mean arterial pressure (MAP) was recorded. RESULTS: DBE increased the PaO2/FiO2 ratio from 416.7 ± 143.6 to 453.4 ± 141.4 mm Hg and increased SpO2 from 97.4 ± 1.9 to 99.2 ± 0.9. DBE decreased the RR from 24.1 ± 3.3 to 21.8 ± 2.9 breaths/min (P < 0.05). No statistically significant difference in HR or MAP was observed after DBE (P > 0.05). CONCLUSION: DBE improves oxygenation after major head and neck surgery, without causing additional harmful hemodynamic effects.

Day-Time Isoflurane Administration Suppresses Circadian Gene Expressions in Both the Brain and a Peripheral Organ, Liver

OBJECTIVE The aim of this study is to investigate the effects of light and administration time of isoflurane on circadian gene expression in the brains and liver tissues of rats kept in light-dark cycle. METHODS Seventy two 15-days-old rats pups were divided into four groups. All animals were exposed to 1.5% concentration of isoflurane or to 6 L min-1 O2 for six hours between Zeitgeber Time (ZT) 0-ZT06 (day-time administration) or ZT12-ZT18 (night-time administration). Rats were sacrificed after six hours of anaesthesia with four-hour time intervals. Total RNA was isolated from brains and liver tissues. Circadian gene expression was examined using quantitative real-time Reverse transcription polymerase chain reaction (RT-PCR). RESULTS BMAL1, CLOCK, PER2 and CRY2 gene expression levels were markedly suppressed after day-time anaesthesia in the both brain and liver, but night-time administration caused only temporary suppression of gene expression. CONCLUSION The effect of isoflurane on the circadian clock is time-dependent, and administered isoflurane anaesthesia at night had minimal effect on clock gene expression. Additionally, when the treated animals were kept in a regular light-dark cycle, isoflurane-induced phase shift was not observed, possibly because of the light.