Aysu Hayriye Tezcan

Locomotor stimulation by acute propofol administration in rats: Role of the nitrergic system.

BACKGROUNDnThe addictive potential of propofol has been scientifically discussed. Drugs psychostimulant properties that can be assessed via measurements of locomotor activity are linked to their addictive properties. No studies that have investigated the effects of propofol on locomotor activity have been reported to date. The present study sought to investigate the effects and possible mechanisms of action of propofol on locomotor activity in rats.nnnMETHODSnAdult male albino Wistar rats (250-330g) were used as subjects. The locomotor activities of the rats were recorded for 30min immediately following intraperitoneal administration of propofol (20 and 40mg/kg), saline or vehicle (n=8 for each group). NG-nitro arginine methyl ester (l-NAME, 15-60mg/kg), a nitric oxide (NO) synthase inhibitor, and haloperidol (0.125-5mg/kg), a non-specific dopamine receptor antagonist, were also administered to other groups of rats 30min prior to the propofol (40mg/kg) injections, and locomotor activity was recorded for 30min immediately after propofol administration (n=8 for each group).nnnRESULTSnPropofol produced significant increases in the locomotor activities of the rats in the first 5min of the observation period [F(2,21)=9.052; p<0.001]. l-NAME [F(4,35)=3.112; p=0.02] but not haloperidol [F(4,35)=2.440; p=0.067] pretreatment blocked the propofol-induced locomotor hyperactivity. l-NAME did not cause any significant change in locomotor activity in naïve rats [F(2,21)=0.569; p=0.57].nnnCONCLUSIONSnOur results suggest that propofol might cause a short-term induction of locomotor activity in rats and that this effect might be related to nitrergic but not dopaminergic mechanisms.

A Case Report of the First Propofol Addiction in Turkey.

Propofol is a potent anaesthetic drug and also an effective sedative agent. Also, propofol may be used for non-anaesthetic purposes such as the treatment of seizures, migraine and tension headache in clinical practice. It has been abused, particularly among healthcare providers with high mortality rate. This report presents the case of a propofol-dependent patient who was an emergency medicine doctor with no difficulties in obtaining the drug. He himself visited our clinic for the treatment of propofol dependence. We started the patients treatment with pharmacotherapeutic medicines and individual psychotherapy. Fourteen days after starting the therapy, the patient was discharged from hospital on his own will and he did not attend the follow-up visits in the outpatient clinic. Then, we were informed of his death, which was suspected to have occurred owing to drug intoxication in the hospital in which he worked. Nevertheless, the reason of death was important; the importance of this case report is to provide information regarding the drugs dependence profile. This is the first case report indicating propofol dependence in Turkey. Because of its easy access, rapid onset time and short duration of action, propofol dependence is increasing. We think that adding propofol to the controlled drug list and improving the knowledge of the clinicians regarding its abuse potential may limit the dependence cases.

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

OBJECTIVEnOur aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block.nnnMETHODSnIn this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender.nnnRESULTSnThe shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients.nnnCONCLUSIONnAppropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.

A Mild Type Propofol Infusion Syndrome Presentation in Critical Care

Propofol infuzyon sendromu (PRIS) nadir ama olumcul bir hastaliktir. Bu sendrom cogunlukla ilacin yuksek dozda uzun sureli infuzyonundan sonra olusur. Metabolik asidoz, hipotansiyon, miyoglobinuri, artmis karaciger ve kas enzimleri, kardiyak aritmiler ve kalp durmasi sendromun genel ozellikleridir. Bu olgu sunumunda uzun sureli dusuk doz (25–50 mcg/kg/dk) ilac infuzyonundan sonra ortaya cikan hafif tipte bir PRIS tartisilmistir. Bu olguda ilac infuzyonu esnasinda ciddi metabolik asidoz, hipotansiyon yada aritmi gozlenmemistir. Sadece AST, ALT, CK, CKMB, LDH duzeylerinde artis saptanmistir. Propofol infuzyonu boyunca hastanin hic klinik durumunda bozulma olmadan sadece bahsedilen parametrelerdeki bozuklugun devam etmesi olguyu hafif tipte bir PRIS olarak tanimlamamiza neden oldu. Ek olarak ilacin kesilmesi sonrasi bozulan kimyasal parametrelerdeki duzelmeler teshisimizin dogrulugunu da kanitlamis oldu.

Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index

To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78u2009±u200915.45xa0years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (pu2009=u20090.74), ulnar (pu2009=u20090.35) and radial (pu2009=u20090.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (pu2009=u20090.02). The localization of the median (pu2009=u20090.85), ulnar (pu2009=u20090.27) and radial (pu2009=u20090.88) nerves did not differ remarkably between patients with BMIu2009<u200925xa0kg/m2 and patients with BMIu2009≥u200925xa0kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMIu2009≥u200925xa0kg/m2 (pu2009=u20090.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.

The beneficial effects of ozone therapy in acetaminophen-induced hepatotoxicity in mice

BACKGROUNDnThe aim of the present study was to determine the therapeutic effects of medical ozone therapy on acute acetaminophen (APAP)-induced hepatotoxicity which were not clearly demonstrated in prior studies.nnnMETHODnTwenty-four mice were randomly assigned into three equal groups: Group 1 (control), Group 2 (APAP) and Group 3 (APAP +ozone). Hepatotoxicity was induced by APAP given as a single dose of 300mg/kg intraperitoneally in Groups 2 and 3. Additionally, Group 3 received 20mcg/0.5mL ozone intraperitoneal twice a day for the remaining of the study. Other groups received saline injections. On the fourth day of the study, biochemical variables (AST, ALT, ALP) and liver histopathology was assessed.nnnRESULTSnIntraperitoneal administration of a single dose of APAP induced hepatocellular damage that was shown by both liver enzymes and histopathological changes (p<0.001). AST, ALT, ALP levels were elevated in both groups 2 and 3 and the difference from group 1 was statistically significant (p<0.01).Mean ALT and AST levels of group 2 were statistically significantly higher versus group 3 (p<0.01). In histopathological examinations; necrosis and inflammation were more prominent in Group 2 compared to Group 3 (p<0.01).nnnCONCLUSIONnOzone showed beneficial effects on APAP hepatotoxicity at a statistically significant level. It is known that ozone has therapeutic effects in various diseases owing to its antioxidant effects. The present study suggests that ozone may be utilized as a routine supplementary therapy in acute APAP hepatotoxicity.

The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

Amac: Hasta konforu, kardiyopulmoner stabilite ve zihinsel bozukluklar olmaksizin hizli derlenme icin en ideal sedatif ajan secimi uzerine arastirmalar devam etmektedir. Bu calismadaki hedefimiz, sedasyonda propofol-ketamin veya propofol uygulanan gruplarda hemodinamik parametreleri, derlenme suresi, derlenme komplikasyonlari, kusma ve hasta memnuniyet oranlari acisindan karsilastirmakti. Materyal ve Metot: Spinal anestezi altinda elektif ortopedik alt ekstremite cerrahisi planlanan ASA I-III 61 eriskin hasta calismaya alindi. Tum hastalara preoperatif ve postoperatif Mini-Mental Test uygulandi. Ameliyat oncesi, ameliyat sirasinda ve derlenme sirasinda vital bulgular kaydedildi. Spinal blok elde edildikten sonra, hastalara 0,4 mg kg-1 propofol yukleme dozu verildi ve takibinde ilac infuzyonlari baslatildi (Grup P, salin+ propofol; Grup KP, 3: 1 oraninda ketamin+propofol). Ameliyat sonrasi derlenme unitesinde hastalarin vital bulgulari, yan etkiler ve memnuniyet oranlari kaydedildi. Bulgular: Gruplar demografik degiskenlerde farklilik gostermedi. Preoperatif ve postoperatif MMT muayene skorlarinda, sistolik kan basincinda, ortalama kan basincinda, kalp atim hizinda, solunum sayisi veya oksijen saturasyonunda gruplar arasinda istatistiksel olarak anlamli fark yoktu (p>0,05). Ancak Grup P’de dort hastada derin hipotansiyona gozlendi ve ikisinde sedasyon durduruldu. Grup KP ve Grup P’nin ortalama derlenme zamani sirasiyla 14 ve 7 dakika idi. Hicbir solunum sistemi yan etkisi gozlenmedi. Grup KP’de dort hasta da kusma gozlendi. Hicbir psikomimetik advers reaksiyon gelismedi. Sonuc: Ketamin infuzyonunun (3: 1 orani) ciddi hemodinamik fayda saglamasinin yaninda derlenme suresini uzattigi gozlemlendi. Ayrica bu doz kombinasyonuyla propofolun ketaminin psikomimetik etkilerini baskilayabildigini ama kusmayi engelleyemedigini sonucuna varildi.