Başar Erdivanlı

Anti-Nociceptive, Analgesic and Pathohistological Effects of Intrathecal Dexmedetomidine and Bupivacaine in Rats

BACKGROUND AND OBJECTIVES This study investigates analgesic and nociceptive effects of adding dexmedetomidine to bupivacaine neuraxial anesthesia through Tail-flick (TF) and Hot-plate (HP) tests and the pathohistological changes on spinal nerves and nerve roots through light microscopy. METHODS Forty anesthetized, male Sprague-Dawley rats were intrathecally catheterized. Basal values of TF and HP tests were measured before and after catheterization. Thirty-six successfully catheterized rats were assigned to four groups. Group B received 10 μg bupivacaine, Group BD3 received 10 μg bupivacaine + 3 μg dexmedetomidine, Group BD10 received 10 μg bupivacaine + 10 μg dexmedetomidine and Control group received 10 μL volume of artificial cerebrospinal fluid. TF and HP tests were performed between the 5(th) and 300(th) minutes of drug administration. Twenty-four hours after administration of drugs, rats were sacrificed and spinal cord and nerve roots were removed for pathological investigation. RESULTS Baseline values of the TF and HP tests were not statistically different among the groups (6.8±0.15s). TF and HP latencies in the Control group did not change significantly during the study. TF and HP test results showed that adding 3 and 10 μg dexmedetomidine caused a dose-dependent increase in duration and amplitude of analgesic and nociceptive effect of bupivacaine (TF: 37.52±1.08%, 57.86±1.16% respectively, HP: 44.24±1.15%, 68.43±1.24% respectively). CONCLUSIONS There were no apparent pathohistological changes at least 24 hours after the intrathecal administration of a single dose of dexmedetomidine 3 μg and 10 μg. Dexmedetomidine added to bupivacaine for spinal block improves analgesia and prolongs block duration.

Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility.

STUDY OBJECTIVE To compare sugammadex with conventional reversal of neuromuscular block in terms of postoperative gastrointestinal motility. DESIGN Double blinded, randomized, controlled clinical trial. SETTING Operating room, postoperative recovery area. PATIENTS Seventy-two patients with ASA physical status I or II, scheduled for total thyroid surgery were studied. INTERVENTIONS When 4 twitches were observed on train-of-four stimulation, neuromuscular block was reversed conversatively in the control group, and with sugammadex in the study group. MEASUREMENTS Time to first flatus and feces, incidence of postoperative nausea, vomiting, diarrhea and constipation were collected. MAIN RESULTS Median time of first flatus was 24 hours (18-32 [10-36]) in the neostigmine group, and 24 (18-28 [12-48]) in the sugammadex group (P > .05). Median (IQR) time of first feces was 24 hours (18-36 [10-48]) in neostigmine group, 32 hours (28-36 [12-72]) in sugammadex group (P > .05). There were no occurrences of nausea, vomiting, diarrhea, or constipation. CONCLUSIONS Sugammadex may be safely used in cases where postoperative ileus is expected.

Cardiac arrest following butane inhalation

Butane is a commonly misused volatile agent, and a cause of intoxication. We present a case, who had a syncope and persistent ventricular fibrillation during the course of resuscitation. We discussed the management of this case in the intensive care unit and the accompanying difficulties in the light of the current literature.

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n = 18) received total intravenous anesthesia, and EA group (n = 14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1 ± 7.0, EA group: 13.5 ± 7.1), perioperative blood pressure variability (TIVA group: 15.6 ± 18.1, EA group: 14.8 ± 11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4 ± 0.9, EA group: 1.8 ± 0.8, P < 0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status.

In vitro evaluation of antimicrobial features of vasopressors

BACKGROUND Drugs administered as intravenous infusion may be contaminated during several stages of production or preparation. However studies focusing on antibacterial effects of vasopressor drugs are very rare. This study investigates the in vitro antimicrobial activity of the clinically used forms of vasopressors. MATERIALS AND METHODS In vitro antimicrobial activities of vasopressor drugs of different concentrations were investigated by using the micro dilution technique. Microorganisms used in the test were Escherichia coli ATCC 25922, Yersinia pseudotuberculosis ATCC 911, Pseudomonas aeruginosa ATCC 10145, Listeria monocytogenes ATCC 43251, Enterococcus faecalis ATCC 29212, Staphylococcus aureus ATCC 25923, Bacillus cereus 702 Roma, Mycobacterium smegmatis ATCC607, Candida albicans ATCC 60193, and Saccharomyces cerevisiae RSKK 251. Antibacterial assays were performed in Mueller-Hinton broth at pH 7.3 and antifungal assays were performed in buffered Yeast Nitrogen Base at pH 7.0. RESULTS Two different dopamine preparations showed antimicrobial activity. No other study drug showed any antimicrobial activity. CONCLUSIONS In our opinion, dopamines antibacterial effects may be advantageous for inhibiting the spread of bacterial contamination during the preparation of the infusion solutions. However, it is important that strict guidelines regarding the need for sterile equipment and deliverables be adhered to during all procedures performed in the intensive care units.

SCIENTIFIC ARTICLEAnti-Nociceptive, Analgesic and Pathohistological Effects of Intrathecal Dexmedetomidine and Bupivacaine in Rats☆

BACKGROUND AND OBJECTIVES This study investigates analgesic and nociceptive effects of adding dexmedetomidine to bupivacaine neuraxial anesthesia through Tail-flick (TF) and Hot-plate (HP) tests and the pathohistological changes on spinal nerves and nerve roots through light microscopy. METHODS Forty anesthetized, male Sprague-Dawley rats were intrathecally catheterized. Basal values of TF and HP tests were measured before and after catheterization. Thirty-six successfully catheterized rats were assigned to four groups. Group B received 10 μg bupivacaine, Group BD3 received 10 μg bupivacaine + 3 μg dexmedetomidine, Group BD10 received 10 μg bupivacaine + 10 μg dexmedetomidine and Control group received 10 μL volume of artificial cerebrospinal fluid. TF and HP tests were performed between the 5(th) and 300(th) minutes of drug administration. Twenty-four hours after administration of drugs, rats were sacrificed and spinal cord and nerve roots were removed for pathological investigation. RESULTS Baseline values of the TF and HP tests were not statistically different among the groups (6.8 ± 0.15 s). TF and HP latencies in the Control group did not change significantly during the study. TF and HP test results showed that adding 3 and 10 μg dexmedetomidine caused a dose- dependent increase in duration and amplitude of analgesic and nociceptive effect of bupivacaine (TF: 37.52 ± 1.08%, 57.86 ± 1.16% respectively, HP: 44.24 ± 1.15%, 68.43 ± 1.24% respectively). CONCLUSIONS There were no apparent pathohistological changes at least 24 hours after the intrathecal administration of a single dose of dexmedetomidine 3 μg and 10 μg. Dexmedetomidine added to bupivacaine for spinal block improves analgesia and prolongs block duration.

Spinal anestezi altında yapılan lomber disk cerrahilerinin retrospektif değerlendirmesi

Objective: We investigated feasibility, possible advantages and disadvantages of spinal anesthesia in lomber disc surgery. Methods: We retrospectively analyzed a total of 100 patients operated for elective lomber spinal surgery under spinal anesthesia. Results: Spinal anesthesia was sufficient for lumbar disc surgery in 97 of 100 patients. Three patients received general anesthesia due to insufficient spinal block. Aller gic reaction was observed in one patient receiving general anesthesia, and treated with intravenous steroid and antihistaminic drugs. We observed bradycardia and hypotension necessitating ephedrine administration in eight patients, post dural puncture headache in 10 patients (two patients were discharged at 4 and 7 days later therefore), who received spinal anesthesia. Following spinal anesthesia, patients required first analgesic at 10th hour. Patients receiving general anesthesia demanded first an algesic in the post operative care unit. Conclusion: We are of the opinion that spinal anesthesia may be safely used in lumbar disc surgeries, provided that patients are not positioned until sufficient anxiolytic and spinal block are established. J Clin Exp Invest 2014; 5 (1): 54-58 Key word: Spinal anesthesia, spinal surgery, intraoperative complications, postoperative pain OZET Amac: Lomber disk cerrahisinde spinal anestezinin uygu

The role of cultural interaction in Tianeptine Abuse and Different Tianeptine Application Methods.

Tianeptine is a selective serotonin reuptake enhancer, possessing strong antidepressant and anxiolytic properties. Its relative lack of sedative, anticholinergic and cardiovascular side effects makes it a highly tolerable substance of abuse. However, physical dependence quickly develops and withdrawal symptoms are common. Abusers in Georgia and Armenia use tianeptine by intravenous injection. Drug abusing behaviour usually starts during puberty, since it stems from psychological, social and cultural circumstances. Sociodemographic studies show that drug abusing behaviour in Turkey varies according to region and substance. This paper investigates differences between Georgian foreigners and the local population in the eastern Black Sea region in terms of tianeptine abuse and discusses complications resulting from intravenous injection of tiapentine.

Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

BACKGROUND AND OBJECTIVES We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. METHODS A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. RESULTS AND CONCLUSIONS First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p>0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4s, p<0.001), and time to intubation (95% CI 3-4.6s, p<0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4s, p<0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p<0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Complication of Peribulbar Block: Brainstem Anaesthesia

Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.