Ferruh Bilgin

Topical cannabinoid antinociception: synergy with spinal sites

Analgesic effects of cannabimimetic compounds have been known to be related to their central effects. Cannabinoid receptors also exist in the periphery but their role in pain perception has been remained to be clarified. Therefore, we assessed topical antinociceptive effects of WIN 55, 212‐2, a mixed CB1 and CB2 receptors agonist, in mice using tail‐flick test. Immersion of the tail of mouse into the WIN 55, 212‐2 solution produced dose‐dependent antinociception. This antinociceptive activity was limited to the portion of the tail exposed to WIN 55, 212‐2. The antinociceptive response was dependent on duration of exposure to WIN 55, 212‐2 solution. The topical antinociceptive effects of WIN 55, 212‐2 were dose dependently blocked by topical pretreatment of CB1 receptor‐selective antagonist, AM 251. Thus, topical antinociceptive action of WIN 55, 212‐2 involve CB1 receptors. Intrathecal (i.th.) administration of WIN 55, 212‐2 produced a dose‐dependent antinociceptive effect. Interestingly, ineffective i.th. doses of WIN 55, 212‐2 produced a marked antinociception when combined with topical application of WIN 55, 212‐2 and topical antinociceptive effect was potentiated. The dose–response curve of i.th. WIN 55, 212‐2 was shifted to the left 15‐fold by topical WIN 55, 212‐2. This finding suggests that there is an antinociceptive synergy between peripheral and spinal sites of cannabinoid action and it also implicates that local activaton of cannabinoid system may regulate pain initiation in cutaneous tissue. Our findings support that cannabinoid system participates in buffering the emerging pain signals at the peripheral sites in addition to their spinal and supraspinal sites of action. In addition, an antinociceptive synergy between topical and spinal cannabinoid actions exists. These results also indicate that topically administered cannabinoid agonists may reduce pain without the dysphoric side effects and abuse potential of centrally acting cannabimimetic drugs.

Pain relief during dressing changes of major adult burns: Ideal analgesic combination with ketamine

Pain management during burn dressing changes is a critical part of treatment in acute burn injuries. Although several treatment options have been suggested, it is still a challenge in a clinical setting. This study is aimed at finding out an ideal analgesic, sedative and/or anxiolytic combination that would minimise the unwanted effects of ketamine. A total of 24 patients, with burns up to 20-50% of total body surface area (TBSA), were included in the study and randomly divided into three groups. In group I, 2 mg kg(-1) ketamine was administered. In group II, 1 mg kg(-1) tramadol was administered and 30 min later, 1 microg kg(-1) dexmedetomidine and 2 mg kg(-1) ketamine was administered. In group III, 1 mg kg(-1) tramadol was applied and 30 min later, 0.05 mg kg(-1) midazolam and 2 mg kg(-1) ketamine was administered. The evaluation was performed with cardiopulmonary monitoring, sedation and visual analogue pain scores and overall patient satisfaction. Any adverse effects of ketamine were recorded. The results showed that group II had better outcomes with respect to pain management during dressing changes. As a conclusion, the use of the combination of ketamine, tramadol and dexmedetomidine was found to be a good treatment option for the prevention of the procedural pain suffered by adult patients during dressing changes.

Pressure-Controlled vs Volume-Controlled Ventilation During Laparoscopic Gynecologic Surgery

STUDY OBJECTIVE To quantify and compare the effects of conventional volume-controlled ventilation (VCV) with the alternative mode, pressure-controlled ventilation (PCV), on respiratory mechanics and noninvasive hemodynamic parameters in patients undergoing laparoscopic gynecologic surgery. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Respiratory mechanics and hemodynamic parameters were recorded for each patient at time T1, 10 minutes after induction, in the supine position; T2, 15 minutes after pneumoperitoneum, in the Trendelenburg position; and T3, 10 minutes after pneumoperitoneum withdrawal, in the supine position. PATIENTS Sixty women, aged 20 to 50 years, undergoing laparoscopic gynecologic surgery, with American Society of Anesthesiologists classes I and II disease. INTERVENTIONS Patients were randomly allocated to 1 of 2 groups. In the VCV group (n = 30), ventilation mode was maintained, whereas in the PCV group (n = 30), ventilation mode was changed to PVC. MEASUREMENTS AND MAIN RESULTS Both groups were comparable insofar as patient characteristics, operating time, pneumoperitoneum time, anesthesia time, and mean operative time. VCV was associated with a significant increase in peak airway pressure, plateau pressure, and airway resistance at T2 (p < .05). Compliance was significantly higher in the PCV group at T2 (p < .05). No other statistically significant differences were found between the groups. CONCLUSIONS Both VCV and PCV seem to be equally suited for use in patients undergoing laparoscopic gynecologic surgery. However, lower peak airway pressure, plateau pressure, and airway resistance, and higher compliance are observed with PCV in laparoscopic gynecologic surgery.

Major surgery and anesthetic technique in epidermolysis bullosa

Epidermolysis bullosa is a hereditary rare condition characterized with local and generalized lesions and autosomal dominant trait with variable penetrance. It was decided to amputate the left leg under the knee of a female patient with epidermolysis bullosa with squamous cell carcinoma. The smallest trauma may cause formation of serious bullous in the skin in epidermolysis bullosa. Surgeons, dermatologists, and anesthesiologists must evaluate the cases. During preoperative, intraoperative, and postoperative periods, all interventions that may cause interruption in circulation of the tissues cause irritation, or delay healing of the wounds must be avoided.

Efficacy of different concentrations of sevoflurane administered through a face mask for magnetic resonance imaging in children

Background:  The main aim of this study was to use a non‐invasive method such as a face mask to maintain anesthesia in children during magnetic resonance imaging (MRI). The secondary aim was to ascertain hemodynamic‐respiration parameters, recovery time and complications of anesthesia with the administration of different concentrations of sevoflurane.

Respiratory and Cranial Complications during Anaesthesia in PfeifferSyndrome

Pfeiffer syndrome (PS) is rarely encountered, even at major craniofacial centers. Published reports indicate high mortality rates (25-85%) for severely affected subtypes. PS is characterized by bilateral coronal craniosynostosis, midface hypoplasia, beaked nasal tip, broad and medially deviated thumbs and great toes. We present a case of a 12-monthsold male infant with PS type 2 who underwent a craniosynostosis and advancing a supraorbital bar operations during general anesthesia. For simple procedures, a safe anesthetic plan can be formulated if the anatomic factors affecting the airway are carefully considered. More extensive and prolonged patient diagnosed to have PS require more monitoring and include all the problems associated with difficult intubation, hazardous airway management, massive blood loss and fluid shift, shunt-dependent hydrocephalus, and long anesthetic times. This case is presented since anaesthesiologists should be aware of the high incidence of respiratory and cranial complications in PS.