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Systemic Inflammatory Response Related to Cardiopulmonary Bypass and Its Modification by Methyl Prednisolone: High Dose Versus Low Dose

AbstractThe objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.

Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone

STUDY OBJECTIVES To compare the efficacy of injectable lornoxicam with diclofenac, ketoprofen, and dipyrone for acute postoperative pain. DESIGN Prospective, randomized, placebo-controlled, double-blind study. SETTING University hospital. PATIENTS 200 ASA physical status I patients who were scheduled for elective septoplasty with general anesthesia. INTERVENTIONS Patients were divided into 5 groups according to the intramuscularly administered analgesic drug: lornoxicam 8 mg (twice daily), diclofenac 75 mg (twice daily), ketoprofen 100 mg (twice daily), dipyrone 1 g (three times daily), and placebo (twice daily). MEASUREMENTS Pain intensity was evaluated with a 0 to 100 mm Visual Analog Scale (VAS) at the 2nd, 4th, 6th, 8th, 12th, 16th, 20th, and 24th hour postoperatively. Intramuscular pethidine 1 mg/kg was administered to patients requiring additional analgesia, and treatment-related adverse effects were noted. MAIN RESULTS Pethidine requirement was found to be significantly higher in the placebo group (1.8 mg/kg per 24 hours; 95% confidence interval, 1.5-2.2) than in the other groups (P = 0.001). No significant difference in opioid requirement was found among the treated groups (P > 0.05). Postoperative VAS scores were significantly lower at specific hours in the treatment groups when compared with placebo group (P < 0.05). No statistically significant difference in adverse effects was found among the groups studied (P > 0.05). CONCLUSIONS Efficacy of lornoxicam in the management of acute postoperative pain was not superior to that of other nonopioid analgesics used in this study.

The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery

OBJECTIVE To investigate the effect of a single induction dose of etomidate on plasma cortisol and adrenocorticotrophic hormone (ACTH) levels in pediatric patients with congenital heart disease. DESIGN A prospective, randomized study. SETTING A university hospital. PARTICIPANTS Thirty children undergoing cardiopulmonary bypass. INTERVENTIONS Patients were randomly allocated into two groups to receive etomidate, 0.3 mg/kg, and fentanyl, 1 microg/kg, or ketamine, 1 mg/kg, and fentanyl, 1 microg/kg intravenously, for anesthesia induction. Anesthesia was maintained with 50% nitrous oxide and 0.5% isoflurane in oxygen. Plasma cortisol and ACTH levels were measured on five occasions: preoperatively, after induction of anesthesia, after cross-clamping, at the end of surgery, and 24 hours postoperatively. MEASUREMENTS AND MAIN RESULTS Plasma cortisol levels of the etomidate group decreased with anesthesia induction and remained significantly low during cardiopulmonary bypass, at the end of operation, and 24 hours postoperatively. Plasma cortisol levels of the etomidate group after the anesthesia induction, during cardiopulmonary bypass, and at the end of the operation were significantly lower than the ketamine group. CONCLUSION These results show that etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects, and can be used safely.

Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study.

Background and objective: We compared the efficacy of intravenous lornoxicam vs. dipyrone in patient‐controlled analgesia for postoperative analgesia. Methods: The study included 105 patients who had undergone elective septorhinoplasty after receiving general anaesthesia. Patients were divided into three groups to receive lornoxicam (24 mg day−1), dipyrone (5 g day−1) or placebo. Pain was evaluated using a 0‐100 mm visual analogue scale at 2, 4, 6, 8, 12, 16, 20 and 24 h postoperatively. Pethidine (1 mg kg−1) was administered intramuscularly to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment‐related adverse effects were noted. Results: Postoperative pain scores were significantly lower with lornoxicam compared with dipyrone at 8 h (P = 0.016). No significant differences regarding pain scores at 2, 4, 6, 12, 16, 20 and 24 h were found. Significantly fewer patients in the lornoxicam group required rescue analgesics (vs. dipyrone, P = 0.046; vs. placebo, P = 0.001); fewer patients in the dipyrone group required rescue analgesics compared with placebo (P = 0.008). Significantly fewer patients in the lornoxicam group had nausea (vs. dipyrone, P = 0.022; vs. placebo, P = 0.006); no significant differences were found between the other two groups. Antiemetic use was significantly lower in the lornoxicam group (vs. dipyrone, P = 0.002; vs. placebo, P = 0.001). Conclusions: Lornoxicam has better tolerability and is a more effective analgesic than dipyrone when administered by patient‐controlled analgesia for postoperative analgesia after septorhinoplasty.

Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind studyin Turkish patients

BACKGROUND Preemptive analgesia used for postsurgical pain management has been shown to reduce the requirements of postoperative analgesics. OBJECTIVE The aim of this study was to compare the preemptive analgesic effects of diflunisal, naproxen sodium, meloxicam, acetaminophen, and rofecoxin (no longer available in some markets) in patients undergoing ambulatory dental surgery and the need for postoperative pain management in these patients. METHODS This prospective, randomized, single-blind study was conducted at the Departments of Anesthesiology and Reanimation and Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey. Turkish outpatients aged ≥ 16 years with American Society of Anesthesiologists physical status 1 (ie, healthy) and scheduled to undergo surgical extraction of an impacted third molar were enrolled. Patients were randomly assigned to receive diflunisal 500 mg, naproxen sodium 550 mg, meloxicam 7.5 mg, acetaminophen 500 mg, or rofecoxib 12.5 mg. All medications were administered orally 1 hour before surgery as preemptive analgesia and after surgery if needed, up to the maximum recommended dose. Surgery was performed with the patient under local anesthesia (articaine hydrochloride). Pain intensity was assessed using a 100-mm visual analog scale (VAS) (0 = none to 100 = worst possible pain) at 2, 4, 6, and 12 hours after ambulatory surgery. The use of additional analgesics was recorded for 24 hours using patient diaries. Postoperative adverse events were recorded using the diaries. RESULTS One hundred fifty patients (108 women, 42 men; mean [SE] age, 26.8 [0.6] years; 30 patients per group) had data available for analysis. Demographic data were similar between the 5 groups. No significant differences in mean VAS scores were found between the 5 groups at any time point. All mean VAS scores indicated minor pain. The rate of additional postoperative analgesics required was significantly lower in the diflunisal group compared with groups receiving naproxen sodium, meloxicam, acetaminophen, and rofecoxib (3 [10%] patients vs 11 [37%], 15 [50%], 15 [50%], and 14 [47%] patients, respectively; all, P < 0.05). Bleeding at the surgical site was reported in 2 patients each in the diflunisal, naproxen sodium, meloxicam, and acetaminophen groups, and in 1 patient in the rofecoxib group; the between-group differences were not significant. No significant differences in the prevalences of other adverse effects (eg, nausea, vomiting, allergy, gastrointestinal symptoms) were found between the 5 treatment groups. CONCLUSIONS In the present study in patients undergoing third molar extraction, adequate preemptive analgesia, based on VAS scores, was found with all of the nonopioid analgesic agents used. Fewer patients required rescue medication with diflunisal. All 5 study drugs were similarly well tolerated.

Dexmedetomidine during coronary artery bypass grafting surgery: is it neuroprotective?--A preliminary study.

Background:  In the present study, we aimed to determine whether during coronary artery bypass grafting (CABG) surgery, dexmedetomidine has protective effects against cerebral ischemic injury.

Syringe pumps take too long to give occlusion alarm.

Background:  The aim of this study was to assess the time needed to trigger an occlusion alarm, and the influence of the type of infusion pump, type and size of the syringe, and the set infusion rate.

Gabapentin premedication for postoperative analgesia and emergence agitation after sevoflurane anesthesia in pediatric patients.

OBJECTIVES The aim of this study was to investigate the effect of gabapentin premedication on postoperative 24th hour total analgesic consumption and the incidence of emergence agitation after sevoflurane based anesthesia in pediatric patients undergoingtonsillectomyandadenoidectomy. METHODS 46 healthy, ASA class I or II, aged 3-12 year old children were included into the study. The patients were randomly assigned to one of the control (Group C) or gabapentin group (Group G) consisting of 23 patients in each. Group C received 10 ml of saline, Group G received gabapentin 15 mg.kg-1 dissolved in 10 ml of saline orally 30 min. before the induction of anesthesia. After anesthesia induction with 8% sevoflurane in 50% O2-N2O. General anesthesia was maintained with 1 MAC sevoflurane in 50% O2-N2O. Emergence agitation was assessed with a 5 point scale and recorded every 10 min. of first 30 min. of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate pain, total analgesic consumption, parent satisfactionandanysideeffect. RESULTS Agitation scores were significantly lower in group G compared to group C in the postoperative 20th and 30th minutes (p<0.01, 0.05 respectively). Total analgesic requirement in postoperative 24 hour was significantly lower in group G (p<0.01). Satisfaction scores of parents was also higher in group G (p<0.05). CONCLUSION Gabapentin premedication decreases postoperative 24th hour analgesic consumption and attenuates emergence agitation after sevoflurane anesthesia.

The effects of diltiazem and dopamine on early graft function in renal transplant recipients

ABSENCE OF, or poor, graft function in the early postoperative period following kidney transplantation remains a serious problem. To date, infusion of lowdose dopamine or administration of calcium channel blockers (CCB) has been used to reduce the incidence of acute tubular necrosis. The aim of this study was to investigate the effects of diltiazem and dopamine infusions on early graft function in renal transplant recipients, and to compare these effects with outcome in graft recipients who did not receive these agents.

Does left molar approach to laryngoscopy make difficult intubation easier than the conventional midline approach

Background and objective It has been reported that the left molar approach of laryngoscopy can make difficult intubation easier. The aim of this study was to investigate whether left molar approach to laryngoscopy provided a better laryngeal view in cases of unexpected difficult intubation. Methods Following the approval of local Ethics Committee and written informed consent from the patients, out of 1386 patients who underwent general anaesthesia for surgery, 20 patients who could be ventilated by face mask but could not be intubated with conventional midline approach on the first attempt were included in the study. Those 20 patients, who had Grade III‐IV laryngeal views on laryngoscopy by conventional midline approach, were subjected to left molar laryngoscopy, and their laryngeal views were evaluated. The external laryngeal compression was routinely used to improve the laryngeal view. When endotracheal intubation failed by left molar laryngoscopy, we performed the conventional midline approach again. All data were recorded. Results Of the 20 patients studied, 18 had a Grade III laryngeal view and two had a Grade IV laryngeal view. Eighteen of them had a better laryngeal view with left molar laryngoscopy. Eleven of the 20 patients underwent successful intubation with the left molar laryngoscopy, which provided a significantly better laryngeal view and success rate of tracheal intubation than did the conventional midline approach (P < 0.01 and P < 0.01, respectively). Conclusions Left molar laryngoscopy can make unexpected difficult intubation easier and should be attempted in cases of difficult intubation.