Ayşegül Özgök

A comparison of the effects of ketamine and remifentanil on renal functions in coronary artery bypass graft surgery

Abstract We have investigated the effects of ketamine-based and remifentanil-based anesthetic protocol on perioperative serum cystatin-C levels, and creatinine and/or cystatin-C-based eGFR equations in terms of acute kidney injury in coronary artery bypass graft (CABG) surgery. Using a simple randomization method (coin tossing), patients were divided into the two groups and not-blinded to the anesthetist. Remifentanil–midazolam–propofol or ketamine–midazolam–propofol-based anesthetic regimen was chosen. Different eGFR formulas using creatinine (MDRD, CKD-EPI, Cockrauft Gault); cystatin-C (eGFR1, eGFR2) or a combination of creatinine and cystatin-C (eGFR 3) were used to calculate estimated glomerular filtration rates (eGFRs). High-sensitive troponin T was used to determine if ketamine use in coronary surgery contributed to myocardial cell damage. Thirty-seven patients were included in the study (remifentanil group = 19, ketamine Group = 18). Urea, creatinine, cystatin-C levels were comparable between the groups in all the measurement times and also postoperative day 2 samples showed statistically higher results compared to baseline (p < 0.001). Effects of ketamine and remifentanil on renal functions were found similar. Creatinine and cystatin-C-based eGFR equations resulted similar in our study. Reversible stage 1 acute kidney injury (AKI) was observed on postoperative day 2 in seven patients from the remifentanil group and six patients from the ketamine group. Hs-troponin T was found to be higher in postoperative day 1 samples; there were no significant difference between the groups. Our results indicated that patients who have normal renal functions undergoing on-pump coronary bypass surgery, effects of ketamine and remifentanil on renal functions in terms of AKI were found to be similar.

Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C

OBJECTIVE Numerous studies have indicated nephrotoxic effects of sevoflurane because of its two bioproducts compound A and fluoride. Cystatin C (CyC) is a more sensitive biomarker than creatinine to show early and mild changes in kidney function. We designed this prospective randomised study to compare the effects of low-flow sevoflurane anaesthesia and low-flow desflurane anaesthesia on renal functions based on CyC levels. No studies have evaluated the effects of low-flow sevoflurane anaesthesia on renal functions based on CyC levels to date. METHODS Thirty American Society of Anesthesiologists (ASA) physical status I-II patients who were scheduled for urological procedures were enrolled in this study. The patients were randomly assigned to 2 groups: low-flow sevoflurane anaesthesia or low-flow desflurane anaesthesia. Serum urea, creatinine and CyC levels were measured before the operation, just before extubation and 24 h after the operation. Creatinine clearance was calculated in the first 24-h urine sample. RESULTS There were no significant differences in serum urea, creatinine and CyC levels or 24 h creatinine clearance between the groups. CONCLUSION Our study demonstrates with a more sensitive biomarker, CyC, that low-flow sevoflurane anaesthesia is safe in terms of the effects on renal function.

Preliminary investigation of preoperative pregabalin and total intravenous anesthesia doses: a randomized controlled trial ☆

STUDY OBJECTIVE To determine the efficacy of 2 different doses (150-300mg) of preoperative pregabalin on propofol and remifentanil doses for total intravenous anesthesia in laparoscopic cholecystectomy. DESIGN Prospective, randomized, placebo-controlled, double-blinded study. SETTING Training and research hospital. PATIENTS Forty-eight adult, American Society of Anesthesiologists physical status 1 and 2 patients. INTERVENTIONS Patients were randomly assigned to 3 groups to receive orally 1hour before surgery, a placebo group (group 1), pregabalin 150mg (group 2), or pregabalin 300mg (group 3). MEASUREMENTS In the operating room, heart rate, systolic and diastolic blood pressures, SpO2, bispectral index, and body temperature were recorded just before anesthesia induction; 1 and 5minutes after induction; and at minutes 10, 15, 20, 25, 30, 35, and 40 of the surgery. Required propofol and remifentanil doses to obtain bispectral index value less than 60 were also recorded. MAIN RESULTS The remifentanil doses used in the pregabalin groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15, 20, 25, and 30 were statistically significantly lower in comparison to the placebo group. CONCLUSION The observations provide preliminary evidence that preoperative pregabalin may decrease anesthetic agent requirement in total intravenous anesthesia patients.

Intraoperative left atrium inversion after implantation of HeartMate III ventricular assist device

Abstract We report here a case of left atrium inversion after implanting HeartMate III LVAD, which is known to be the first in literature. LVAD can be functional only if there is adequate inflow to the device. Parameters and filling of left ventricle can be assessed by TEE. In our case, initial examination with TEE showed thrombus like images. HeartMate III has a reliable algorithm that automatically reduces pump speed if ‘suction effect’ is detected. HeartMate III demonstrates clean flow properties and good surface wash. Despite these positive features of the HeartMate III, left atrium inversion can still be seen with it, so users should be alert in this regard.

Postperfusion Syndrome in Cadaveric Liver Transplantations: A Retrospective Study.

OBJECTIVE To evaluate the factors that affects the postperfusion syndrome in cadaveric liver transplantations and the effect of the postperfusion syndrome on discharge from the hospital. METHODS Patients who underwent cadaveric liver transplantations between 2007 and 2013 were scanned retrospectively. Intraoperative anaesthesia records, intensive care unit follow-up forms and discharge reports were examined from patient files. Overall, 43 patients having complete data were included in the study. The postperfusion syndrome is defined as asystoli or a decrease in mean arterial pressure of more than 30%, which occurred in the first 5 min of reperfusion and continued for 1 min. Patients were divided into two groups: those who had the postperfusion syndrome and those who did not. RESULTS The number of patients who had the postperfusion syndrome was 25 of 43 (58.1%). The MELD score of patients without the postperfusion syndrome was calculated as 16.9±3.2 and that of patients with the postperfusion syndrome was 19.7±3.6. A statistically significant relationship was detected between the postperfusion syndrome occurrence and a high MELD score (p=0.013). The diastolic blood pressure just before reperfusion was statistically lower in the group with the postperfusion syndrome than in the other group (p=0.023, 50±8 vs. 58±11). According to the logistic regression analysis, the MELD score and the decrease in diastolic blood pressure before reperfusion were defined as independent predictive factors. CONCLUSION According to the study, the ratio for having the postperfusion syndrome was found to be 58.1%. The independent predictor factors affecting the postperfusion syndrome were detected as the MELD score and the decrease in diastolic blood pressure before reperfusion. The postperfusion syndrome during orthotropic liver transplantation is an important issue for anaesthesiologists. The awareness of the related factors with the postperfusion syndrome may help in the development of various preventive strategies.

Investigation of the effects of preoperative hydration on the postoperative nausea and vomiting.

Introduction. Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy operations still continue to be a serious problem. Intravenous fluid administration has been shown to reduce PONV. Some patients have higher risk for PONV described by APFEL score. In this study, our aim was to determine the effects of preoperative intravenous hydration on postoperative nausea and vomiting in high Apfel scored patients undergoing laparoscopic cholecystectomy surgery. Patients and Methods. This study is performed with 50 female patients who had APFEL score 3-4 after ethics committee approval and informed consent was taken from patients. The patients were divided into 2 groups: group 1 (P1): propofol + preoperative hydration and group 2 (P2): propofol + no preoperative hydration. Results. When the total nausea VAS scores of groups P1 and P2 to which hydration was given or not given were compared, a statistically significant difference was detected at 8th and 12th hours (P = 0.001 and P = 0.041). It was observed that in group P1, which was given hydration, the nausea VAS score was lower. When the total number of patients who had nausea and vomiting in P1 and P2, more patients suffered nausea in P2 group. Discussion. Preoperative hydration may be effective in high Apfel scored patients to prevent postoperative nausea.

Pediyatrik Kalp Kateterizasyonunda Perkütan ASD, VSD ve PDA Kapatma Yapilan Olgularda NIRS Monitörizasyonu

Amac: Pediyatrik kalp kateterizasyonunda giderek artan sedoanaljezi-genel anestezi uygulamalari nedeniyle karsilasilabilecek hemodinamik sorunlar monitorizasyon yontemlerinin onemini vurgular. Kateterizasyonda yasanan herhangi bir sorunun serebral kan akimini dusurmesi veya uygulanan sant kapatma prosedurlerinin beyin kan akimini etkilemesi soz konusu olabilir. NIRS noninvaziv olarak beyin doku oksijenasyonunu gosteren bir tekniktir. Bu calismada kalp kateterizasyonunda konjenital kalp defekti kapatma islemi yapilacak pediyatrik olgularda islem sirasinda NIRS cihazi ile rSO takibi yapilarak serebral oksijenasyon farkliliklarinin ortaya konmasi amaclandi.Gerec ve Yontem: Yedi hasta bu prospektif calismaya dâhil edildi. Olgulara ASD, VSD ve PDA kapatma islemi planlandi. Hasta kateter laboratuvarina alindiginda bazal, islem oncesi ve islem sonrasi olmak uzere 3 donemde bilateral NIRS degerleri, hemodinamik veriler, kan gazi parametreleri ve periferik oksijen saturasyonu kaydedildi. Bulgular: Serebral oksijenasyon parametreleri acisindan donemler arasinda sag ve sol rSO degerleri arasinda fark saptanmadi. Yine hastalarin sag ve sol rSO degerleri acisindan istatistiksel anlamli fark bulunmadi. Calismaya alinan tum hastalarda basarili sekilde kapatma islemi uygulandi. Sonuc: Beyin oksijen saturasyonu pek cok faktorden etkilenmesine ragmen, pediyatrik kalp kateterizasyonunda kapatma islemi yapilan hastalari inceledigimiz calismamizda bazal, islem oncesi ve islem sonrasi donemlerde bilateral rSO degerleri arasinda farklilik saptanmadi. Kan basinci ve Hct degerlerinde dususten ve kapatma isleminden rSO degerlerinin etkilenmedigi goruldu.