Dilek Okyay

Effects of acute carbon monoxide poisoning on the P-wave and QT interval dispersions

OBJECTIVE The aim of our study was to investigate atrial conduction and ventricular repolarization inhomogeneities using P-wave dispersion (Pwd) and QT dispersion (QTd) analyses in acute carbon monoxide (CO) poisoning. METHODS Sixty patients were retrospectively included in this case-controlled study. Thirty acute CO poisoning patients were assigned to the Group with acute CO poisoning (ACOP). Patients who did not have acute CO poisoning were assigned to the control group (Group C, n=30). Anthropometric measurement, body mass index, electrocardiogram (ECG) and serum electrolyte levels were recorded in all patients. Also, carboxyhemoglobin (COHb) levels were recorded in Group ACOP. Pwd, QT interval and QTd durations were measured. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett formula. Independent samples t and Chi-square tests were used for statistical analysis. RESULTS No statistically significant difference was found between the age, gender distribution, anthropometric measurement, serum electrolytes, PR and QT durations between the groups. The Pwd (56.33 ± 17.11 msec vs 28.33 ± 11.16 msec, p=0.001) and QTd (63.33 ± 26.69 msec vs 42.16 ± 7.84 msec, p=0.001) were significantly longer in Group ACOP than in Group C. In addition, QTc and QTcd durations of Group ACOP were also found to be significantly longer than in Group C (p=0.001). CONCLUSION In our study, we found in ECG analyses of patients with acute CO poisoning that the Pwd, QTc and QTcd durations were significantly prolonged when compared with control group. For this reason, patients with acute CO poisoning need close attention because of arrhythmias, which can be related to increased QTcd and Pwd durations.

Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study

BACKGROUND AND OBJECTIVES In our study we aimed to investigate the effect of esmolol, lidocaine and fentanyl on P-wave dispersion (Pwd), QT and corrected QT (QTc) durations and hemodynamic responses to endotracheal intubation during propofol induction. METHODS A total of eighty adult patients, American Society of Anesthesiologists (ASA) Physical Status I or II aged 18 to 60 years were included in this prospective, randomised, double-blind study. All patients had control electrocardiograms (ECGs) done before anesthesia induction. The patients were randomised into four equal groups. The control group (Group C) received saline 5mL, the esmolol group (Group E) received esmolol 0.5mg.kg(-1), the fentanyl group (Group F) received fentanyl 2μg.kg(-1) and the lidocaine group (Group L) received lidocaine 1.5mg.kg(-1) before anesthesia induction. Anesthesia was induced with intravenous propofol. ECGs for all patients were performed during the 1(st) and 3(rd) minutes of induction, 3minutes after administration of muscle relaxant, and at 5minutes and 10minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after induction of anesthesia, immediately after intubation, and 1, 3, 5, 7 and 10minutes after intubation. RESULTS Compared with control, HR significantly increased in Group C, Group L and Group F after intubation. However, in Group E, there was no significant difference in HR values between control and after intubation. Compared with control, MAP significantly increased in Group C and Group L after the intubation. However, in Group E and Group F, there was no significant difference in MAP values between control and after the intubation. Compared with control, Pwd significantly increased in Group C after intubation. In Group L, Group F and Group E, there was no significant difference in Pwd values between control and after the intubation. Compared with control, QTc duration significantly increased in Group C and L after the intubation. In Group F and Group E, there was no significant difference in QTc durations between control and after the intubation. CONCLUSION We concluded that administration of esmolol before intubation prevents tachycardia and an increase in MAP, Pwd and QTc duration caused by laryngoscopy and tracheal intubation.

The effect of gender on reversal of non-depolarizing block with Sugammadex -

Sugammadex is a rapid and selective aminosteroid agent that has entered use recently. We aimed to research the effect of gender on reversal of non-depolarizing block with sugammadex. We designed a prospective study. The research included a total of 100 cases who underwent rhinoplasty operation administered general anaesthesia. Cases were divided according to gender as male (Group M) and female (Group F). At the end of the operation for patients with TOF value 25%, patients were given 2 mg kg-1 iv sugammadex. Duration from the rocuronium administration until the TOF value was zero(TOF0), the time from sugammadex administration until TOF reached from 25% to 90% was recorded (TOF25-90). The time from TOF90 to extubation was named the extubation duration. From the time the patients entered the PCU until Aldrete score was ≥9 was named the recovery duration and recorded. The time for the groups to TOF25-90 was 123.84 ± 38.03 s in Group M and 122.06 ± 30.461 s in Group F (p > 0.05). The extubation duration was 189.68 ± 41.37 s in Group M and 206.50 ± 45.99 in Group F (p = 0.316). The recovery time was 8.26 ± 14 min in Group M and 8.48 ± 14.23 min in Group F (p = 0.328). After the administration of sugammadex, there was no difference observed between the groups in terms of the TOF25-90 duration, recovery and extubation duration. As a result, conclusion was reached that gender did not affect rocuronium reversal with sugammadex.

Efeitos da manutenção de várias anestesias sobre os níveis séricos de selênio, cobre, zinco e ferro e a capacidade antioxidante

BACKGROUND AND OBJECTIVES In this study, we aimed to investigate the effects of sevoflurane, desflurane and propofol maintenances on serum levels of selenium, copper, zinc, iron, malondialdehyde, and glutathion peroxidase measurements, and antioxidant capacity. METHODS 60 patients scheduled for unilateral lower extremity surgery which would be performed with tourniquet under general anesthesia were divided into three groups. Blood samples were collected to determine the baseline serum levels of selenium, copper, zinc, iron, malondialdehyde and glutathion peroxidase. Anesthesia was induced using 2-2.5mgkg(-1) propofol, 1mgkg(-1) lidocaine and 0.6mgkg(-1) rocuronium. In the maintenance of anesthesia, under carrier gas of 50:50% O2:N2O 4Lmin(-1), 1 MAC sevoflorane was administered to Group S and 1 MAC desflurane to Group D; and under carrier gas of 50:50% O2:air 4Lmin(-1) 6mgkgh(-1) propofol and 1μgkgh(-1) fentanyl infusion were administered to Group P. At postoperative blood specimens were collected again. RESULTS It was observed that only in Group S and P, levels of MDA decreased at postoperative 48th hour; levels of glutathion peroxidase increased in comparison to the baseline values. Selenium levels decreased in Group S and Group P, zinc levels decreased in Group P, and iron levels decreased in all three groups, and copper levels did not change in any groups in the postoperative period. CONCLUSION According to the markers of malondialdehyde and glutathion peroxidase, it was concluded that maintenance of general anesthesia using propofol and sevoflurane activated the antioxidant system against oxidative stress and using desflurane had no effects on oxidative stress and antioxidant system.

Efeito de levobupivacaína e bupivacaína nas dispersões da onda P, QT e QT corrigido (QTc) em cesariana

OBJETIVOS Y JUSTIFICATIVA: Nuestro estudio tuvo como objetivo investigar el efecto de la bupivacaina y la levobupivacaina en la duracion de las dispersiones del QT, QT corregido (QTc) y de la onda P durante la raquianestesia en cesarea. METODOS: Sesenta parturientes programadas para cesarea electiva en grupos de riesgo ASA I-II fueron incluidas en el estudio. Los examenes electrocardiograficos (ECG) se hicieron despues de la entrada de las pacientes al quirofano. Se registraron la frecuencia cardiaca (FC), presion arterial no invasiva (PANI), saturacion periferica de oxigeno (SpO2) y frecuencia respiratoria (RR). Para el acceso venoso, se uso una canula de calibre 18. La precarga de liquidos fue hecha con una solucion de Ringer con lactato (10 mL.kg-1). Despues de la precarga de liquidos, un segundo examen electrocardiografico se hizo y las pacientes fueron designadas aleatoriamente para dos grupos. El Grupo B (n = 30) recibio 10 mg de bupivacaina y el Grupo L (n = 30) recibio 10 mg de levobupivacaina para la raquianestesia. Los examenes ECG se repitieron en los minutos 1, 5 y 10 despues de la anestesia. FC, PANI, SpO2, FR y los niveles de bloqueo sensorial tambien fueron registrados en los mismos intervalos de tiempo. En intervalos de tiempo predeterminados de raquianestesia, las duraciones de la dispersion de la onda P (OPd), QT (QTd) y QTc (QTcd) fueron medidas a partir de los registros del ECG. Las duraciones de QT y QTc fueron calculadas con la formula de Bazzett. RESULTADOS: No hubo diferencia entre los dos grupos en cuanto a los niveles de bloqueo, parametros hemodinamicos, OPd, QTd, QTc y QTcd. CONCLUSIONES: La levobupivacaina y la bupivacaina pueden ser los anestesicos de eleccion para la raquianestesia en las embarazadas con dispersiones prolongadas de la OPd y QTcd en el periodo preoperatorio.

Efeitos de esmolol, lidocaína e fentanil nos intervalos dispersão da onda P, QT, QTc e respostas hemodinâmicas à intubação endotraqueal durante indução com propofol: um estudo comparativo

JUSTIFICATIVA E OBJETIVOS: Investigar o efeito de esmolol, lidocaina e fentanil na dispersao da onda P (DP), duracoes dos intervalos QT e QT corrigido (QTc) e as respostas hemodinâmicas a intubacao endotraqueal durante a inducao com propofol. METODOS: Foram incluidos 80 pacientes adultos, estado fisico ASA I ou II, idade entre 18 e 60 anos, neste estudo prospectivo, randomico e duplo-cego. Todos os pacientes foram submetidos a exame eletrocardiografico (ECG) antes da inducao da anestesia. Os pacientes foram randomicamente alocados em quatro grupos iguais. O grupo controle (Grupo C) recebeu 5 mL de solucao salina; o grupo esmolol (Grupo E) recebeu 0,5 mg.kg-1 de esmolol; o grupo fentanil (Grupo F) recebeu 2 µg.kg-1 de fentanil e o grupo lidocaina (Grupo L) recebeu 1,5 mg.kg-1 de lidocaina antes da inducao anestesica. A anestesia foi induzida com propofol. ECG foi feito em todos os pacientes durante o primeiro e o terceiro minutos de inducao, 3 minutos apos a administracao de relaxante muscular e 5 e 10 minutos apos intubacao. A DP e intervalos QT foram medidos em todos os ECGs. Os intervalos QTc foram determinados com o uso da formula de Bazett. Frequencia cardiaca (FC) e pressao arterial media (PAM) foram registradas antes e depois da inducao anestesica, imediatamente apos a intubacao e em 1, 3, 5, 7 e 10 minutos apos a intubacao. RESULTADOS: Apos a intubacao, a FC aumentou significativamente nos Grupos C, L e F em comparacao com o grupo controle. Porem, nao houve diferenca significativa nos valores da FC apos a intubacao entre os grupos E e controle. Nos Grupos C e L, a PAM aumentou significativamente apos a intubacao em comparacao com o grupo controle. No entanto, nos Grupos L, F e E nao houve diferenca significativa entre os valores da PAM apos a intubacao em comparacao com o grupo controle. A DP foi significativamente mais longa no Grupo C apos a intubacao em comparacao com o grupo controle. Porem, nos grupos L, F e E nao houve diferenca significativa entre os valores de DP apos a intubacao em comparacao com o grupo controle. A duracao do intervalo QTc foi significativamente maior nos grupos C e L apos a intubacao em comparacao com o grupo controle. Porem, nao houve diferenca significativa na duracao do QTc nos grupos F e E apos a intubacao em comparacao com o grupo controle. CONCLUSAO: Concluimos que a administracao de esmolol antes da intubacao previne a taquicardia, o aumento da PAM e as duracoes da onda P e intervalo QTc causados pela laringoscopia e intubacao traqueal.

Scientific articleThe Effect of Levobupivacaine and Bupivacaine on QT, Corrected QT (Qtc), and P Wave Dispersions in Cesarean Section☆

BACKGROUND AND OBJECTIVES In our study we aimed to investigate the effect of bupivacaine and levobupivacaine on QT, corrected QT (QTc), and P wave dispersion durations during spinal anesthesia in cesarean section. METHODS Sixty parturients scheduled for elective cesarean section in ASA I-II risk groups were included in the study. Baseline electrocardiographic (ECG) records of the patients were obtained in the operation room. Heart rate (HR), non-invasive blood pressure (NIBP), peripheral oxygen saturation (SpO2) and respiration rates (RR) were recorded. Venous cannulation was performed with 18G cannula and fluid preload made with 10 mL.kg(-1). Lactated Ringer solution. After fluid preload, second ECG recordings were taken and the patients were randomly separated into two groups. Group B (n = 30) received 10mg of bupivacaine and Group L (n = 30) received 10mg of levobupivacaine for spinal anesthesia. ECG recordings were repeated at 1, 5 and 10 minutes after spinal block. HR, NIBP, SpO2, RR and sensory block levels were also recorded at the same time intervals. At predetermined time intervals of spinal anesthesia, P wave dispersion (Pwd), QT dispersion (QTd), and QTc dispersion (QTcd) durations were measured from ECG records. QT and QTc durations are calculated with Bazzett formula. RESULTS There was no difference between two groups according to block levels, hemodynamic parameters, Pwd, QTd, QTc and QTcd durations. CONCLUSION Bupivacaine and levobupivacaine may be preferred in spinal anesthesia in pregnant patients who have extended Pwd and QTcd preoperatively.

The Effect of Levobupivacaine and Bupivacaine on QT, Corrected QT (Qtc), and P Wave Dispersions in Cesarean Section

BACKGROUND AND OBJECTIVES In our study we aimed to investigate the effect of bupivacaine and levobupivacaine on QT, corrected QT (QTc), and P wave dispersion durations during spinal anesthesia in cesarean section. METHODS Sixty parturients scheduled for elective cesarean section in ASA I-II risk groups were included in the study. Baseline electrocardiographic (ECG) records of the patients were obtained in the operation room. Heart rate (HR), non-invasive blood pressure (NIBP), peripheral oxygen saturation (SpO2) and respiration rates (RR) were recorded. Venous cannulation was performed with 18G cannula and fl uid preload made with 10mL.kg(-1). Lactated Ringer solution. After fl uid preload, second ECG recordings were taken and the patients were randomly separated into two groups. Group B (n=30) received 10mg of bupivacaine and Group L (n=30) received 10mg of levobupivacaine for spinal anesthesia. ECG recordings were repeated at 1, 5 and 10minutes after spinal block. HR, NIBP, SpO2 , RR and sensory block levels were also recorded at the same time intervals. At predetermined time intervals of spinal anesthesia, P wave dispersion (Pwd), QT dispersion (QTd), and QTc dispersion (QTcd) durations were measured from ECG records. QT and QTc durations are calculated with Bazzett formula.