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Perception of Bronchoconstriction in Elderly Asthmatics

The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37; group 2, ≥ 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, ≥ 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 ± 0.17; group 2, PS20 = 1.37 ± 0.12; p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (1A, 2.63 ± 0.30 and IB, 2.07 ± 0.16; p = 0.101; 2A, 1.36 ± 0.19 and 2B, 1.59 ± 0.120; p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and %FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

Four analgesic techniques for shockwave lithotripsy: eutectic mixture local anesthetic is a good alternative.

BACKGROUND AND PURPOSE Various sedative and analgesic medication has been used for shockwave lithotripsy (SWL). The aim of this study was to evaluate the efficacy of different anesthesia modalities in these patients. PATIENTS AND METHODS One hundred patients were randomly divided into four groups. The first (Group F) received fentanyl 1 microg/kg intravenously (IV), the second (Group D) received diclofenac sodium 1 mg/kg intramuscularly (IM), the third (Group T) received tramadol 1.5 mg/kg IM, and the fourth (Group E) was given 15 g of eutectic mixture local anesthetic (EMLA) cream containing lidocaine and prilocaine. After routine preoperative evaluation, all patients received midazolam 2 mg IV 5 minutes before lithotripsy for sedative premedication. In all groups, a supplemental 25-microg bolus of fentanyl was administered IV when patients complained of pain, moved, or grimaced in response to the shockwaves. Pain intensity was evaluated on a 0- to 100-mm visual analog scale (VAS). The level of sedation was determined using the Observers Assessment of Alertness/Sedation (OAS/S). Side effects such as bradypnea, oxygen desaturation, bradycardia, pruritus, and nausea and vomiting were recorded. RESULTS There were no statistically significant differences among the four groups with regard to VAS, OAS/S scores, or side effects. In Group F, the mean arterial pressure was decreased significantly at 10 and 20 minutes. The patients in this group also manifested a decrease of oxygen saturation at the first, tenth, and twentieth minutes and the end of SWL. CONCLUSION Application of EMLA cream was as safe and effective as fentanyl, diclofenac, and tramadol, and reduction of the fentanyl dose during SWL was possible.

Postoperative magnesium sulphate infusion reduces analgesic requirements in spinal anaesthesia

Background and objectives: Magnesium sulphate infusion during general anaesthesia reduces anaesthetic consumption and analgesic requirements. The aim of this study was to assess the effects of postoperative magnesium infusion on duration of block, sedation and analgesic consumption after spinal anaesthesia. Methods: Fifty ASA I-II patients were included in the randomized double blind study. Spinal anaesthesia was performed at L3-4 or L4-5 interspace with 12.5 mg 0.5% heavy bupivacaine, using a 25 G Quincke needle. Patients received a 5 mg kg−1 bolus of magnesium sulphate followed by a 500 mg h−1 infusion or saline in the same volumes for 24 h. Time to first pain, analgesic request, return of motor function, visual analogue pain and sedation scores were evaluated every 4 h during the 24 h postoperative period. The t- and U-tests were used for statistical analyses. Data were expressed as mean ± SD, with P < 0.05 being considered significant. Results: Vital signs were stable during spinal anaesthesia and postoperative period. When compared to the control group, time to analgesic need was increased and total analgesic consumption was reduced in the magnesium group (meperidine consumption 60.0 ± 73.1 mg control group, 31.8 ± 30.7 mg magnesium group, P = 0.02). Conclusions: Magnesium sulphate infusion may be used as an adjunct for reducing analgesic consumption after spinal anaesthesia.

Comparison of Three Analgesics for Extracorporeal Shock Wave Lithotripsy

Objective: The aim of the study was to compare the clinical efficacy of three different analgesic drugs with respect to their level of sedation, analgesia and quick mobilisation without cardiopulmonary depression, for outpatient extracorporeal shock wave lithotripsy (ESWL) procedure. Material and Methods: Sixty outpatients undergoing elective ESWL using a third generation lithotriptor were studied. The patients were randomly divided into three groups of twenty patients. All patients received midazolam (2 mg) intravenously five minutes before the procedure. In group F, fentanyl was given (1 w g kg -1 IV) at the same time with midazolam. In group D, diclofenac sodium was given (1 mg kg -1 , IM) intramuscularly 45 minutes before ESWL. In group T, tramadol was given (1.5 mg kg -1 ) 30 minutes before ESWL. Arterial pressure, heart rate, respiratory rate and oxygen saturation were recorded before the procedure, after sedation, at the first minute, and every ten minutes during the procedure. Pain intensity was identified with a Visual Analogue Scale. The level of sedation was evaluated by using the Observers Assessment of Alertness/Sedation Scale. All patients were asked to assess their satisfaction with the seven point Verbal Rating Scale before discharge. Side-effects were also recorded during the procedure. Results: The incidence of nausea and vomiting was higher in fentanyl group compared with the other groups. In patients who received fentanyl, the decrease of oxygen saturation at the first and tenth minute of the procedure was statistically significant ( p < 0.05). Conclusions: Diclofenac sodium and tramadol were found to be safe and effective analgesics with lower side-effects than fentanyl.

Effect of bispectral index monitoring on sevoflurane consumption.

Background and objective: The bispectral index, a parameter derived from the electroencephalograph, has been shown to correlate with the loss of consciousness and sedation. This study was designed to assess the effects of bispectral index monitoring on sevoflurane and its recovery profiles. Methods: Sixty ASA I and II patients undergoing open abdominal surgery were randomized into two groups: one monitored using the bispectral index (Group BIS) and the other without its use (controls). After a standardized induction, anaesthesia was maintained with sevoflurane in both groups. In Group BIS, sevoflurane was titrated to maintain the bispectral index in the range 40‐60. In the control group, the administered sevoflurane concentration was adjusted according to the signs of anaesthesia. The end‐tidal sevoflurane concentration, bispectral index and routine haemodynamic variables were noted every 5 min during surgery. The consumption of sevoflurane was computed. At the conclusion of surgery operations, the time to ‘open eyes on verbal command’, ‘motor response to verbal command’ and Aldretes score were recorded by a blinded anaesthesiologist. Results: The difference in the consumption of sevoflurane was not significant between the groups. Bispectral index monitoring was associated with a reduction of 4.73% in sevoflurane usage and 2.19 mLh−1 was saved. Conclusions: Bispectral index monitoring during anaesthesia provides only a small advantage related to the need to monitor the depth of anaesthesia.

Surface landmarks of brachial plexus: ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation

The present study is able to describe a certain line, under which brachial plexus (BP) lies underneath in the supraclavicular region. A line drawn between midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered for BP. Surface landmarks were evaluated by applying ultrasound (US) on 30 volunteers (15 female, 15 male). Axial and sagittal views of BP were taken and distances between skin and BP were measured. Coronal magnetic resonance (MR) sections were taken from 7 volunteers according to the second line after applying two fat capsules on each line. The sonographic views were seen at the same line. Mean distances from skin were found as 16.5+/-0.7 mm for male and 14.5+/-0.5 mm for female volunteers. MR images were obtained bilaterally, which were parallel and posterior from sonographic lines. Surface landmarks, as presented in this study, are simple to accomplish and are not dependent on structural variations as external jugular vein.

Efficacy of topotecan treatment on antioxidant enzymes and TBA-RS levels in submandibular glands of rabbits: An experimental study

OBJECTIVE: The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits. STUDY DESIGN AND SETTING: The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, sub-mandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the sub-mandibular glands of the rabbits were examined. RESULTS: SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05). CONCLUSION: It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits.

Efficacy of topotecan treatment on an experimental model of transient evoked otoacoustic emissions

OBJECTIVE The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on Transient Evoked Otoacoustic Emissions (TEOAEs) of the rabbits. We planned to investigate whether this test might provide a method for monitoring early ototoxic influence of drug administration to the cochlea. METHODS The study was conveyed in two groups each consisting of five rabbits with a total of ten ears. Rabbits in group I received i.v. topotecan (0.5 mg/kg once daily) for 3 days. Rabbits in group II received i.v. topotecan (0.25 mg/kg once daily) for 3 days. Cochlear function was serially monitored using transient evoked otoacoustic emissions before administration (BA) and on the 4th and 15th days after administration of topotecan. TEOAEs were analysed in terms of mean stimulus, stability and emission amplitude at 1.0-4.0 kHz. RESULTS For group I and II, intergroup and intragroup differences were not statistically significant in the mean stimulus, stability and emission amplitudes at 1.0-4.0 kHz. CONCLUSIONS We evaluated the potential role of TEOAEs in early identification of cochlear dysfunction induced by topotecan. It was concluded that topotecan did not have ototoxic effects on the cochlea in the early period of administration. TEOAEs may be useful to monitor the cochlear function and to detect the late stage of ototoxicity especially in the presence of potentially toxic factors for the prevention of permanent damage.

Neuroprotective effects of racemic ketamine and (S)-ketamine on spinal cord injury in rat

BACKGROUND The aim of this study was to investigate and to compare the potential neuroprotective effects of racemic ketamine, (S)-ketamine and methylprednisolone after an experimental spinal cord injury model in rats. METHODS Fifty-nine Wistar albino rats were divided into three main groups as acute stage (A), subacute stage (SA) and sham groups and then acute and subacute stage groups were divided into four groups regarding the used drug as control (CONT), racemic ketamine (RK), (S)-ketamine (SK) and methylprednisolone (MP) groups. A dorsal laminectomy was performed; and spinal cord injury was induced by using a temporary aneurysm clip. Four hours later from the clip compression, except those of the sham and control groups, the drugs (60 mg/kg racemic ketamine, 60 mg/kg (S)-ketamine or 30 mg/kg methylprednisolone) were administered intraperitoneally. At 72th h and 7th days of the study, the spinal cords of rats were removed from T8 level to the conus medullaris level. The specimens were and evaluated histopathologically, tissue lipid peroxidation (LPO) and myeloperoxidation (MPO) levels were measured and biochemically. RESULTS The histopathological results were similar both in the acute and in the subacute stage groups. There was a statistically significant difference among all groups regarding the tissue LPO levels (p<0.001). There was a statistically significant difference between the CONT-A group and the MP-A, RK-A and SK-A groups (p=0.004, p<0.001 and p=0.007, respectively) in acute stage and between the CONT-SA group and SK-SA group (p=0.002) in subacute stage. There was a statistically significant difference among all groups regarding the tissue MPO levels (p=0.001). The median MPO levels were similar among acute stage groups (p=0.057), but there was a statistical difference among subacute stage groups (p=0.046). CONCLUSION (S)-ketamine is more effective than methylprednisolone and racemic ketamine to reduce the LPO levels in subacute stage of spinal cord injury in rats. And, it is as effective as methylprednisolone in preventing secondary spinal cord injury histopathologically.

Effects of intrauterine and extrauterine exposure to GSM-like radiofrequency on distortion product otoacoustic emissions in infant male rabbits.

OBJECTIVES The aim of this study was to investigate the potential hazardous effects of intrauterine (IU) and/or extrauterine (EU) exposure to 1800 MHz Global System for Mobile Communications-like (GSM-like) radiofrequency (RF) on the cochlear functions of infant rabbits by measuring distortion product otoacoustic emission (DPOAE) response amplitudes. METHODS Thirty-six white infant male New Zealand rabbits each 1-month-old were included in the study. The animals were randomly divided into four groups. Nine infant rabbits (Group 1) were not exposed to 1800 MHz GSM-like RF (Control-C). Nine infant rabbits (Group 2) were exposed to 1800 MHz GSM-like RF, 15 min daily for 14 days after they reached 1-month of age (extrauterine-EU). Nine infant rabbits (Group 3) were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days in the intrauterine period (between 15th and 22nd days of the gestational period) (intrauterine-IU). Nine infant rabbits (Group 4) were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days in the intrauterine period (between 15th and 22nd days of the gestational period) and 15 min daily for 14 days after they reached to 1-month of age (IU+EU). The cochlear functions were assessed by DPOAEs at 1.0-8.0 kHz. RESULTS At 1.5 kHz, the mean DPOAE amplitude of Group 3 was higher than that of the controls and Group 2; and the mean DPOAE value of Group 4 was higher than that of the controls and Group 2. At 2.0 kHz, the mean DPOAE amplitude of Group 4 was higher than that of Group 2. At 3.0 kHz, the mean DPOAE amplitude of Group 4 was higher than that of the controls and Group 2. At 4.0 kHz, the mean DPOAE amplitude of Group 2 was lower than that of the controls, while the mean value of Group 4 was higher than the mean value of the controls and Group 2. At 6.0 kHz, the mean DPOAE amplitude of Group 2 was lower than that of the control group; however, the mean value of Group 4 was higher than that of Group 2. At 1.0 and 8.0 kHz, no significant differences were found among the four groups. CONCLUSION Prolonged exposure and hyperthermia related to the power density of applied RF, increasing the temperature in the ear canal, may affect DPOAE amplitudes. Harmful effects of RF are mainly observed as a decrease in DPOAE amplitudes at 4.0-6.0 kHz during extrauterine exposure in infancy. During the intrauterine period, the water content of the middle and inner ear and amnion fluid may play a protective role. Therefore, children must be protected from RF exposure. The use of mobile phones at short distances from the ear of the infants should be avoided because of the lower thickness of the anatomical structure in infancy.