Erkan Yavuz Akçaboy

Can ephedrine pretreatment be effective in alleviating rocuronium injection pain

Objective: The aim of this randomized, double-blind, placebo-controlled study was to evaluate the effect of ephedrine pretreatment on the intensity of rocuronium injection pain when rocuronium was applied by timing principle and also to compare this effect with lidocaine and placebo. Subjects and Methods: 120 American Society of Anesthesiology risk score I–II patients scheduled for elective surgery under general anesthesia were randomized into three groups to receive either 70 µg/kg ephedrine (ephedrine group, n = 40) or 0.5 mg/kg lidocaine (lidocaine group, n = 40) or 5 ml NaCl 0.9% (placebo group, n = 40) as pretreatment. Thirty seconds after pretreatment drugs, rocuronium 0.6 mg/kg was administered by the timing principle and rocuronium injection pain scores were recorded. Twenty seconds after rocuronium administration, anesthesia was induced with thiopental and the patient’s trachea was intubated. Hemodynamic parameters and adverse effects were recorded. Results: The overall frequency of having pain was 82.5, 52.5 and 22.5% in placebo, ephedrine and lidocaine groups, respectively. Although the frequency of mild and moderate pain scores was higher in the ephedrine group than in the lidocaine group, this difference was not statistically significant (p = 0.032 and p = 0.001, respectively). Conclusion: Although not as effective as lidocaine 0.5 mg/kg, 70 µg/kg ephedrine pretreatment was able to alleviate rocuronium injection pain when rocuronium was applied by timing principle.

Spinal anesthesia with low-dose bupivacaine-fentanyl combination: a good alternative for day case transurethral resection of prostrate surgery in geriatric patients

BACKGROUND AND OBJECTIVE We evaluated the effectiveness, block duration, postanesthesia care unit stay and adverse effects of using intrathecal low dose bupivacaine and fentanyl combination and compared with conventional dose prilocaine and fentanyl combination for day case transurethral resection of prostate surgery in geriatric patient population. MATERIALS AND METHODS Sixty patients were randomized into two groups with Group B receiving 4 mg bupivacine 0.5%+25 μg fentanyl and Group P receiving 50 mg prilocaine 2%+25 μg fentanyl intrathecal. Block quality and duration, postanesthesia care unit stay and adverse effects were compared. RESULTS Block durations and postanesthesia care unit stay were shorter in Group B than in Group P (p<0.001 in both). Hypotension and bradycardia were not seen in Group B which was significantly different than in Group P (p=0.024 and p=0.011 respectively). CONCLUSION Intrathecal 4 mg bupivacaine + 25 μg fentanyl provided adequate spinal anesthesia with shorter block duration and postanesthesia care unit stay with stable hemodynamic profile than intrathecal 50 mg prilocaine + 25 μg fentanyl for day case transurethral resection of prostate surgery in geriatric patients.

Comparison of tramadol and lornoxicam in intravenous regional anesthesia: a randomized controlled trial

BACKGROUND AND OBJECTIVES Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n = 17) received 3mg/kg 0.5% prilocaine; group PT (n = 17) 3mg/kg 0.5% prilocaine + 2 mL (100mg) tramadol and group PL (n = 17) 3mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.

The Effect of Dexmedetomidine and Propofol on Oxidative Stress and Antioxidizing System Studied on Liver Ischemia-reperfusion Model on Rats

Purpose: The presence or absence of protective or preventive role of dexmedetomidine and propofol against ischemia/reperfusion (I/R) injury at tissue level on liver I/R model was demonstrated. Materials and methods: 24 rats were randomly divided into four groups. Following anesthesia laparotomy was done and hepatoduodenal ligament was explorated. Tissue samples were taken for both biochemical (MDA, SOD, GPx) and histological study. Results: MDA level was hisghest in Group II and was significantly lower in Group III and Group IV. GPx level was lowest in Group II, the level of GPx was higher in Group III and Group IV with respect to Group II. SOD level was lowest in Group II and was highest in Group IV. SOD levels in Group II and Group III did not show statistical significance. In the histopathological study, in Group I the liver parenchyme and membrane integrity was protected; in Group II the hepatocyte cellular membrane integrity was distorted, microvesicule number increased and the liver sinusoids were shrunken; in Group III the hepatocyte membrane and nucleus was near normal and well protected; and in Group IV the cellular component structures were protected, hepatocyte cell membrane was protected in normal thickness. Discussion: The results show that dexmedetomidine and propofol decrease the level of MDA in similarly; the effect of dexmedetomidine on GPx level was slightly lower than propofol and its effect on SOD level was lower than propofol. As a result, we believe that either propofol or dexmedetomidine can be effective in protecting hepatocytes from I/R injury especially in log term procedures but the former drug having dominance in this protective role.

Raquianestesia com dose baixa da combinação de bupivacaína e fentanil: uma boa alternativa para a cirurgia de ressecção transuretral de próstata em pacientes idosos em regime ambulatorial

JUSTIFICATIVA Y OBJETIVOS: Evaluar la eficacia, la duracion del bloqueo, la permanencia en la sala de recuperacion postanestesica y los efectos adversos del uso por via intratecal de dosis bajas de bupivacaina en combinacion con el Fentanilo, y compararlos con la dosis convencional de prilocaina y Fentanilo en cirugia de reseccion transuretral de prostata en pacientes ancianos en regimen ambulatorial. MATERIALES Y METODOS: Fueron designados aleatoriamente 60 pacientes para dos grupos: el Grupo B que recibio 4 mg de bupivacaina al 0,5% + 25 µg de Fentanilo y el Grupo P que recibio 50 mg de prilocaina al 2% + 25 µg de Fentanilo intratecal. Se compararon la calidad y la duracion de los bloqueos, el tiempo de permanencia en la sala de recuperacion postanestesica y los efectos adversos. RESULTADOS: La duracion del bloqueo y el tiempo de permanencia en la sala de recuperacion postanestesia fueron menores en el Grupo B que en el Grupo P (p < 0,001 para ambos). La hipotension y la bradicardia no se observaron en el Grupo B, que fue significativamente diferente del Grupo P (p = 0,024, p = 0,011, respectivamente). CONCLUSIONES: La administracion intratecal de 4 mg de bupivacaina + 25 µg de Fentanilo produjo una raquianestesia adecuada con menos tiempo de duracion del bloqueo y permanencia en la sala de recuperacion postanestesica, con el perfil hemodinamico estable que la administracion intratecal de 50 mg de prilocaina + 25 µg de Fentanilo para la cirugia de reseccion transuretral de prostata en pacientes ancianos en regimen ambulatorial.