Gonul Sagiroglu

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

BackgroundWe aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations.MethodsOne hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.ResultsThe VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group.ConclusionsTEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.

Protective effect of everolimus on renal ischemia reperfusion injury in rats.

The aim of this study was to determine the effect of everolimus and tacrolimus pretreatments on renal morphology and function in a rat ischemia reperfusion (I/R) model. Twenty-eight male Sprague-Dawley rats were randomly assigned to saline + sham operation, saline + I/R (IR), tacrolimus + I/R (TRL + I/R) and everolimus + I/R (ERL + I/R) groups. Saline and active treatments were administered intraperitoneally for seven consecutive days before the surgery. The suprarenal aorta was clamped to achieve warm ischemia, except in the sham group. Right nephrectomy was performed in all animals and histology was examined. Renal function was assessed on post-operative Day 7 by Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy, glomerular filtration rate (GFR) and serum biochemistry. Both everolimus and tacrolimus preserved serum creatinine and blood urea nitrogen levels, but only everolimus preserved GFR (0.74 ± 0.36, 1.20 ± 0.37 and 2.24 ± 0.32 mL/min for I/R, TRL + I/R and ERL + I/R, respectively, P < 0.001). %ID values for sham, I/R, TRL + I/R and ERL + I/R were 55 ± 3, 47 ± 4, 45 ± 6 and 62 ± 7 (P < 0.001). On histologic evaluation, ERL + I/R showed less tubular damage and necrosis than I/R, as well as TRL + I/R. Within the confines of this rat warm ischemia model, everolimus pre-treatment was useful in preserving renal function following I/R injury. The possibility of using everolimus as a pre-conditioning agent for I/R injury in kidney transplantation should be further explored.

Comparing early postoperative period analgesic effect of dexketoprofene trometamol and lornoxicam in mediastinoscopy cases.

OBJECTIVE In this study, we aimed comparing early postoperative period analgesic effectiveness and the effects on opioid consumption of intravenous dexketoprofen and lornoxicam that are given preemptively. MATERIALS AND METHODS Forty patients, planned elective mediastinoscopy, were included in this prospective randomized study. These patients were classified in two groups, group D for dexketoprofene trometamol and group L for lornoxicam, randomly. 20 minutes before the operation 50 mg dexketoprofene trometamol and 8 mg lornoxicam were injected intravenously for group D and group L respectively. In postoperative intensive care unit, pain scores, mean arterial pressures, heart rates and peripheric O2 saturations of patients were recorded at 0, 10, 20, 60, 90 and 120(th) minutes. RESULTS When we evaluate the VAS score of the groups, there was a significant decrease in group D in all measured timesstatistically compairing to group L (p<0.001). When both group were evaluated in itself according to 0 minute time, in group L there was a significant decrease at 10 minutes time (p<0.0001) but in group D there was not a significant decrease (p>0.05). CONCLUSION Since intravenous dexketoprofen, applied preemptively, has more potent analgesic effect and causing less opioid consumption in early postoperative period, is better than intravenous lornoxicam.

The effects of sildenafil and n-acetylcysteine on ischemia and reperfusion injury in gastrocnemius muscle and femoral artery endothelium.

Purpose We aimed to examine the effects of sildenafil and n-acetylcystein on ischemia/reperfusion injury in femoral artery endothelium and gastrocnemius muscle. Basic methods 32 rats of Sprague-Dawley breed were randomly divided into four groups (n = 8). Median laparotomy was performed, then a 120-minute ischemia was created by microvascular clamping of infrarenal aorta, followed by the release of clamping. In sildenafil group, 1 mg/kg of sildenafil infusion and in the n-acetylcystein group, 100 mg/kg of n-acetylcystein infusion was administered after release of clamps. Blood samples and tissue samples of femoral artery and gastrocnemius muscle were extracted for a histopathological evaluation. Principal findings Serum levels of malondialdehyde in ischemia/reperfusion group (6.16 ± 0.79) were higher compared to the control group (4.69 ± 0.33), whereas a significant decrease was detected in sildenafil (5.17 ± 0.50) and n-acetylcystein (4.96 ± 0.49) groups. Femoral artery tissue sections of the control group, mean tumor necrosis factor alpha and hypoxy-induced factor-1 alpha immunoreactivity were found to be negative. In the ischemia/reperfusion group, mean tumor necrosis factor α immunoreactivity was intense and mean hypoxy-induced factor-1 alpha immunoreactivity was 51–75%. In the ischemia/reperfusion + Sildenafil and ischemia/reperfusion + NAS groups, mean tumor necrosis factor α immunoreactivity was slight and mean hypoxy-induced factor-1 alpha immunoreactivity was 26–50%. Conclusions In conclusion, sildenafil and n-acetylcystein may reduce femoral artery endothelium and gastrocnemius muscle injury following lower extremity ischemia/reperfusion.

The effects of apelin on mesenteric ischemia and reperfusion damage in an experimental rat model.

OBJECTIVE Intestinal ischemia-reperfusion (I/R) injury is associated with high morbidity and mortality rates. There is ongoing research to find an effective preventive or treatment agent. We aimed to evaluate the effects of apelin 13 (AP) on intestinal I/R injury in a rat model. MATERIAL AND METHODS Twenty-four male Sprague-Dawley rats aged 6-8 weeks and weighing 280±20 g were equally divided into three groups (control, I/R and I/R+AP). The control group underwent superior mesenteric artery (SMA) mobilization alone without any clamping. In the I/R and I/R+AP groups, an atraumatic microvascular bulldog clamp was placed across the SMA at its point of origin from the aorta. In the I/R+AP group, 2 μg/kg/d apelin was administered intraperitoneally. After 60 minutes of ischemia, relaparotomy was performed to remove the microvascular clamp on the SMA for 3 hours of reperfusion. After 3 hours, tissue samples were obtained for biochemical [malondialdehyde (MDA) and glutathione (GSH) levels] and histopathological analyses. RESULTS MDA levels were significantly higher in the I/R group compared to the control group. Although MDA levels were lower in the I/R+AP group compared tothe I/R group, the difference was not statistically significant. There was also no significant difference between the I/R+AP and I/R groups regarding GSH levels. The median histopathological grade was significantly lower in the I/R+AP group compared to the I/R group (p=0.001). CONCLUSION Apelin appeared to have a positive effect on oxidative injury; this did not reach statistical significance. Thus, the role of apelin and associated findings in the initial treatment of intestinal ischemia needs further large-scale animal studies before human use.

Comparison of Sirolimus and Colchicine Treatment on the Development of Peritoneal Fibrozis in Rats Having Peritoneal Dialysis

BACKGROUND Continuous ambulatory peritoneal dialysis is a successful treatment modality for patients with end-stage renal disease. Peritoneal fibrosis (PF) is the most critical complication of long-term peritoneal dialysis (PD). AIMS In our study, we aimed to compare the effects of colchicine and sirolimus on PF induced by hypertonic peritoneal dialysis solutions in rats. STUDY DESIGN Animal experiment. METHODS Twenty-four rats were randomly divided into three groups. The control group received an intraperitoneal injection (ip) of saline. The sirolimus group received the PD solution, plus 1.0 mg/kg/day Rapamune®. The colchicine group received the PD solution ip plus 1.0 mg/kg/day of colchicine. Blood samples were taken to measure the serum levels of VEGF, TGF-β, and TNF-α. Peritoneal tissue samples were taken for histopathological evaluation. RESULTS TGF-β and TNF-α values in the sirolimus group were found to be statistically significantly lower than in the control and colchicine groups, but the differences between the control and colchicine groups were not statistically significant. No statistically significant differences were found between the groups regarding the VEGF values. Vascular neogenesis and peritoneal thickness were compared; the values in the sirolimus group were statistically reduced compared to the values in the control group. Mild fibrosis developed in 75% of all animals in the sirolimus group; there was no moderate or severe fibrosis observed. Fibrosis developed to varying degrees in 100% of the animals in the control and colchicine groups. CONCLUSION The present study demonstrates that sirolimus might be beneficial for preventing or delaying the progression of PF and neoangiogenesis. These alterations in the peritoneal membrane may be connected with reduced TNF-α and TGF-β levels.

AWAKE VIDEOTHORACOSCOPIC RESECTION WITH THE HELP OF THORACAL PARAVERTEBRAL BLOCK: TWO CASE REPORT AND REVIEW OF LITERATURE.

Thoracic paravertebral block (TPB) can be administered for VATS (video-assisted thoracic surgery) method and often used for analgesic purposes and provides good results. Awake VATS (AVATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. AVATS had been reported local anesthesia and sedation, intercostal blocks or TEA was used in terms of regional anesthesia in many studies. We present our experience with the two cases undergoing AVATS accompanied by TPB due to such cases are rarely seen in the literature. Specially, our second case of spontaneous pneumothorax surgery using AVATS with TPB anesthesia has not been reported previously in the literature.

Anaesthesia Management of a Child with West Syndrome

West syndrome (WS) is an epileptic encephalopathy usually occurring during the first year of life and is characterized by severe electroencephalography (EEG) derangement. Most of these patients may develop cerebral palsy, facial malformations, and skeletal deformities. The anaesthesiologist should make the preoperative assessment carefully due to epileptic seizures and should consider the possibility of difficult intubation because of coexisting anatomic malformations during the anaesthesia management of patients with WS. This report presents a case of general anaesthesia management in a left femoral fixation operation in an 11-year-old, 18 kg male patient.

The Comparison of Intravenous Patient Controlled Analgesia with Meperidine or Morphine for Pain Management after Thoracotomy

Yöntemler: Yüz kırk hasta (ASA I-III) prospektif çalışmada randomize olarak meperidin (Grup 1) ve morfin (Grup 2) gruplarına ayrıldı. Postoperatif ilk 24 saatteki İHKA kullanımı; Grup 1’de, 50 mg yükleme dozu, 7 mg sa-1 bazal infüzyon, 5 mg bolus dozunda Grup 2’de ise, 5 mg yükleme dozu, 0,5 mg sa-1 bazal infüzyon, 0,5 mg bolus dozunda uygulanırken, kilit zamanı 15’er dakikaydı. Toplanan veriler; sistolik, diastolik ve ortalama kan basınçları, kalp atım hızı, nabız oksimetresi satürasyonu, vizüel analog skala (VAS) ve Ramsey sedasyon skala değerleri, total ve ek analjezikler ile yan etkilerdi.

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

Introduction: The definition of pain focuses mainly on tissue damage and provides information regarding pathophysiological changes in the human being [1]. Patients experience pain as a response to this tissue damage after surgery and the pain intensity after thoracotomies is known to be severe [2]. Aim of the study: Our goal was to investigate the efficacy and adverse effects of thoracic epidural and paravertebral blocks for post-thoracotomy pain management. Material and methods: In a prospective, randomized double blinded study, patients were divided into thoracic epidural (EPI group, n = 30) and paravertebral (PVB group, n = 30) groups. A bolus dose of 10 ml of 0.25% bupivacaine was followed by a continuous infusion of 0.1 ml kg –1 h –1 for a total of 24 hours. A visual analog scale (VAS) was used to evaluate pain at rest (VAS-R) and after coughing (VAS-C) at baseline (after extubation), 2, 4, 12 and 24 hours after surgery. The duration of catheter insertion, morphine consumption, complications and side effects were collected. Results: In comparison of EPI and PVB groups, VAS-R and VASC scores were similar at baseline and at 2, 4, 12 and 24 hours after surgery (p > 0.05). The incidence of hypotension was higher and the duration of catheter insertion was longer in the EPI group in comparison to the PVB group (p = 0.038, p < 0.0001, respectively). Conclusions: For post-thoracotomy pain, both thoracic epidural analgesia and paravertebral block techniques provide sufficient pain relief. As paravertebral block is an easier and quicker technique with lower incidence of hypotension, it should be considered as a good alternative to thoracic epidural technique to establish postoperative analgesia.