Cavidan Arar

Preoperative oral celecoxib versus preoperative oral rofecoxib for pain relief after thyroid surgery.

Background and objective: The study compared the analgesic efficacy and safety of two preoperatively administered cyclo‐oxygenase‐2 inhibitors, celecoxib and rofecoxib. Methods: Ninety adult patients undergoing thyroid surgery were divided into three groups (each n = 30). They were given a single oral dose of placebo, celecoxib 200 mg or rofecoxib 50 mg 1 h before induction of anaesthesia. All patients received a standard anaesthetic. Intraoperative blood loss was measured. Pain scores, sedation scores, heart rate, mean arterial pressure and respiratory rate were noted at 0, 1, 2, 4, 6, 12 and 24 h postoperatively. Analgesic (meperidine) requirements and adverse effects were recorded during the first postoperative 24 h. Results: Compared with placebo, pain scores were significantly lower with rofecoxib at all time points (P < 0.05) and were significantly lower with celecoxib (P < 0.05) during the first 4h. Pain scores were significantly lower with rofecoxib compared with celecoxib at 6, 12 and 24h (P < 0.05). The average cumulative 24h meperidine dose was significantly lower with both celecoxib (54.9 ± 34.4mg) and rofecoxib (42.8 ± 40.9 mg) compared with placebo (76.8 ± 6.2 mg) (P < 0.01 and P < 0.001, respectively). There were no differences in the intraoperative blood loss, heart rate, mean arterial pressure, respiratory rate, sedation scores and incidence of adverse effects among groups. Conclusions: The preoperative administration of rofecoxib 50mg and less so of celecoxib 200 mg provide a significant analgesic benefit with regard to postoperative pain relief and decrease in additional opioid requirements after thyroid surgery.

The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting

Background and Objective: The haemodynamic responses during extubation can cause complications after open‐heart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses. Methods: Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg−1 (group I, n = 40), magnesium 30 mg kg−1 (Group II, n = 40) or normal saline (Group III, n = 40). Study medication was administered as a 20‐min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and 1 min after extubation. Results: Heart rate was lower in Group I than in Groups II (P < 0.05) and III (P < 0.001) and lower in Group II than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and II during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation, lower in Group II than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation. Conclusion: We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.

Analysis of C-Reactive Protein and Biochemical Parameters in Pericardial Fluid

This study was designed to examine the relationship between pericardial fluid and plasma CRP levels, and to alterations in other biochemical parameters in patients undergoing Coronary Artery Bypass Grafting (CABG). The study group consisted of 96 Coronary Artery Disease (CAD) patients who were referred to our clinic for a CABG procedure and from whom sufficient amount of pericardial fluid could be collected. The patients were classified into 3 groups: Stable Angina Pectoris (SAP) (n = 27), Unstable Angina Pectoris (USAP) (n = 36), and Post-Myocardial Infarction (PMI) (n = 33). Levels of CRP, glucose, albumin, total protein, Creatine Kinase (CK), Creatine Kinase-MB (CK-MB), and Lactate Dehydrogenase (LDH) were determined in pericardial fluid samples and in simultaneously collected blood samples from radial artery. The pericardial CRP and LDH levels in the PMI group were higher than in the SAP (p = 0.015 and p = 0.000, respectively) and USAP (p = 0.011, p = 0.047) groups. Serum CRP levels in USAP (p = 0.014) and PMI (p = 0.000) groups were higher than those in the SAP group. Pericardial albumin levels in the PMI group were higher than in the USAP group (p = 0.038). In all groups, the pericardial fluid/serum protein ratio was > 0.5, the LDL ratio was > 0.6, and pericardial fluid LDH concentrations were > 300 mg/dl. CRP level of pericardial fluid was significantly higher in the PMI group than in other groups. However, pericardial fluid LDH levels were higher than blood LDH levels in this group and were also higher than pericardial fluid LDH levels of other groups.

Effects of sevoflurane, isoflurane and propofol infusions on post-operative recovery criteria in geriatric patients.

We compared the effects of sevoflurane, isoflurane and propofol infusions on postoperative recovery criteria in geriatric patients. Sixty patients aged > 65 years, classified as American Society of Anesthesiologists (ASA) group 1 or 2 and undergoing gynaecological or urological procedures were randomized equally into three groups. Group 1 received 1 minimum alveolar concentration (MAC) sevoflurane in a 50% O2/N2O mixture and group 2 received 1 MAC isoflurane in a 50% O2/N2O mixture. Group 3 received a 50% O2/N2O mixture plus propofol total intravenous anaesthesia (8 mg/kg for the first 30 min, followed by 6 mg/kg for maintenance). Recovery criteria comprising the times to spontaneous eye opening, extubation, response to verbal stimuli and orientation were recorded following the discontinuation of anaesthesia. Recovery times were significantly shorter in groups 1 and 3 compared with group 2. We conclude that sevoflurane and propofol had similar effects on recovery criteria and were associated with a faster recovery than isoflurane.

Endotrakeal tüp kafının doğru basınçta şişirilmesinde anestezistin deneyimi önemli mi

Objectives: Cuff pressure in endotracheal tubes should be in the range of 26–30 cm H 2 O. In this study we aimed to examine whether anesthesiologist’s experience is important while inflating the endotracheal tube correctly af ter the intubation. Materials and methods: The patients who were included to the study were intubated after the induction of general anesthesia. The patients were divided into 4 groups according to the training year of the anesthesia research assistant resident inflating the endotracheal tube (ET) cuff. Group I (n=64) the cuff pressure which were inflated by the first year residents; Group II (n=92) the cuff pressure which were inflated by the 2 nd year residents; Group III (n=144) the cuff pressure which were inflated by the 3 rd year residents; Group IV (n=93) the cuff pressure which were inflated by the 4 th year residents were measured by manometer. Results: When we compared the cases in which the cuff pressure were between 26-30cm H 2 O we found that the best results were in Group II and respectively in Group III and IV and the worst results were in Group I. The difference between Group II and Group I were statistically significant (p<0.05).

Combined Spinal-Epidural Anesthesia or Local Anesthesia + Sedoanalgesia in Abdominal Aortic Aneurism Repair?Combined Spinal-Epidural Anesthesia or Local Anesthesia + Sedoanalgesia in Abdominal Aortic Aneurism Repair?

Objective: Anesthesia for the repair of abdominal aortic aneurism can be performed with different modalities of anesthesia or their combinations. The risk level for the morbidity and mortality of the patients, is increased in geriatric patients with the existence of accompanying pathology. To compare two different anesthesia methods (local anesthesia and sedation vs combined spinal and epidural anesthesia) for the repair of endovascular aneurism in a geriatric patient.

Effects of Bupivacaine Versus Levobupivacaine on Pulmonary Function in Patients With Chronic Obstructive Pulmonary Disease Undergoing Urologic Surgery: A Randomized, Double-Blind, Controlled Trial

BACKGROUND There are limited data to determine the impact of subarachnoid blockade with local anesthetics on perioperative pulmonary function. The effects of local anesthetics used in spinal anesthesia are very important in terms of respiratory function in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE The aim of this study was to evaluate the effects of bupivacaine versus levobupivacaine on pulmonary function in patients with COPD undergoing urologic surgery. METHODS Patients were randomized into 2 groups: group B (n = 25) received 3 mL of hyperbaric 0.5% bupivacaine; group L (n = 25) received 3 mL of isobaric 0.5% levobupivacaine. Both agents were administered intrathecally. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEFR), vital capacity (VC), and FEV1/FVC ratio were measured using spirometry 10 and 30 minutes after spinal anesthesia and 30 minutes after completion of the operation. An arterial blood gas test was performed before and after spinal anesthesia. RESULTS Fifty male patients aged 40 to 80 years completed the study. There were no differences in the results of preoperative and postoperative FVC, FEV1, PEFR, VC, FEV1/FVC ratio, and arterial blood gas between the bupivacaine (n = 25) and levobupivacaine (n = 25) groups. However, patients who took bupivacaine showed a significant decrease in intraoperative PEFR at 30 minutes compared with baseline, a result not seen in patients who took levobupivacaine (P = 0.036 and P = 0.282, respectively). CONCLUSIONS In 50 patients with moderate COPD undergoing urologic surgery, hyperbaric bupivacaine caused a decrease in intraoperative PEFR compared with baseline because of higher level block; however, the effects of hyperbaric bupivacaine and isobaric levobupivacaine on pulmonary function in these patients showed equally effective potencies for spinal anesthesia.

742 A SUCCESFUL CONTINUOUS SPINAL ANESTHESIA IN A PATIENT WITH CONGESTIVE HEART FAILURE AND PULMONARY HYPERTENSION

Background: Assay sensitivity is key for successful analgesic studies, and can be difficult to achieve as such studies rely on self-reported measures of subjective states. Variability across centers in multi-site trials is often a confounder of this aim, as the potential for differences within and between sites increases, which can lead to substantive and statistical issues for data pooling. SCIREX has implemented initiatives designed to reduce such variability across its centers. One means by which the impact of these initiatives has been assessed is via analysis of data from a recent postorthopedic surgical pain trial. Methods: The study was performed at 3 SCIREX sites. The study investigated the analgesic efficacy of single oral doses of hydrocodone/acetaminophen 10mg/1000mg (HC/APAP) to placebo. The study was double-blind, randomized, single-dose and involved 119 patients. Research staff were previously trained, calibrated, and monitored using methodologies developed or adapted by SCIREX. Results: Results show each site demonstrated assay sensitivity with statistical separation between HC/APAP and placebo for analgesic outcomes: SPID 0−8 hrs (p< 0.0001); TOTPAR 0−8 hrs (p< 0.0002); VAS-SPID 0−8 hrs (p< 0.0001); and Patient Global Assessment (p< 0.0004). Comparability of clinical effect size across sites was tested by fitting interaction terms (site by treatment group) for each analgesic outcome (p-values from ANCOVA). No significant site interactions for SPID 0−8 hrs (p< 0.62); TOTPAR 0−8 hrs (p< 0.48); VAS-SPID 0−8 hrs (p< 0.91); Patient Global Assessment (p< 0.21); or time to rescue (p< 0.28) were found. Conclusion: Results demonstrate comparable assay sensitivity and no statistically significant differences between the centers.

The importance of pulmonary artery circulation during cardiopulmonary bypass

This study sought to determine changes in transpulmonary difference in blood cells and alveolar-arterial oxygen (A-aO2) gradient when pulmonary artery circulation was obstructed in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Eighteen patients were divided into group A (control group; X-clamp placed on aorta, n = 9) and group B (pulmonary ischaemia group; X-clamp placed on aorta and pulmonary artery, n = 9). Haematological parameters were compared before CPB and up to 90 min after declamping. A-aO2 gradient differences were compared before and 2 h and 6 h after declamping. A transpulmonary increase in leucocyte levels normalized after 60 min in group A but remained higher in group B. A transpulmonary increase in neutrophils normalized after 60 min in group A and 90 min in group B. Increased lymphocyte levels normalized after 30 min in group A and 90 min in group B. A-aO2 gradient was determined as: group A (294.8 ± 74.3) and group B (321.2 ± 73.3) before X-clamping; group A (132.7 ± 22.7) and group B (236.6 ± 41.5) 2 h after declamping; and group A (72.2 ± 22.7) and group B (189.4 ± 88.9) 6 h after declamping. When pulmonary artery circulation was obstructed during the X-clamping period, leucocyte, neutrophil and lymphocyte sequestration within both lungs increased, and an increased A-aO2 gradient was observed because of tissue damage. To prevent post-operative complications, precautions to maintain normal pulmonary artery circulation are recommended.