Handan Birbicer

Effects of levosimendan on myocardial ischaemia-reperfusion injury

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening KATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty‐one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs‐Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n = 7) received no further treatment. In Group 2 (non‐treated; n = 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n = 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan‐treated group than in the non‐treated group (P = 0.019). The tissue Na+‐K+ ATPase activity was significantly decreased in the non‐treated group than in the levosimendan‐treated group (P = 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non‐treated group than in the levosimendan‐treated group (P = 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non‐treated and levosimendan‐treated groups. The severity of these findings was more extensive in the non‐treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

Manufacturing defect in an endotracheal tube connector: risk of foreign body aspiration

To the editor: Routine inspection and testing of endotracheal tubes (ETTs) prior to use may fail to identify certain manufacturing defects [1]. We would like to discuss the potential morbid complication of foreign body aspiration associated with a manufacturing defect in the tip of an ETT connector. A 28-year-old woman was scheduled for laparoscopic ovarian cystectomy. Induction of anesthesia was performed with 2 mg·kg propofol, 0.1 mg fentanil, and 0.1 mg·kg vecuronium bromide i.v. Tracheal intubation was achieved with a size 7.5-mm ETT (Well Lead Medical Instruments, Jinhu Industrial Estate Hualong, Panyu Guangzhou, P. R. China). Chest auscultation revealed clear, bilaterally equal breath sounds. The lungs were ventilated at 6 l·min and 17-mmHg peak airway pressure. While we were fi xing the ETT with tape, a moving particle was noticed in the lumen of the ETT. The ETT was immediately disconnected from the ventilator, and a tiny particle was noted in the distal part of the tube connector (Fig. 1). The connector was changed immediately and ventilation was maintained with no problem during the operation. Inspection of the connector revealed that the presence of the particle was caused by a manufacturing defect. Neither atelectasis nor a foreign body was seen on chest radiograph taken at the end of the operation. The postoperative course was uneventful. Problems associated with an ETT defect, if not corrected immediately, would lead to failure in ventilating the lungs, hypoxemia, and serious complications [2,3]. It is recommended that the use of transparent tubes and a pre-use check might allow visualization of the lumen and hence prevent problems [3]. However, some problems may still occur even with high-quality, pre-packed single-use transparent plastic ETTs [3]. In our patient, the foreign body moved with ventilation, and then it could be seen only in the lumen of the tube. If it had not been noticed, a possible problem would have been the inward migration of the particle, possibly leading to serious complications. There has been no previous report of this type of structural defect in an ETT. We suggest that an internal visual check of the lumen should be performed routinely, because the opaque nature of the connector makes visual Fig. 1. A Tiny particle in the distal part of an endotracheal tube connector. B The foreign body moved with ventilation, and then it could be seen in the lumen of the tube

Bispectral Index Monitoring in Confirmation of Brain Death in Children

Although the guidelines for the diagnosis of brain death in children are well established, the diagnosis is still under debate, and further confirmatory tests are required. Performing these confirmatory tests presents some drawbacks, such as high costs, the need for specialized personnel and technology, transportation of patients out of the intensive care unit, and the use of contrast media. Bispectral index monitoring can provide real-time, objective, continuous monitoring of the consciousness level in critically ill children. The aim of this prospective study was to define the role of bispectral index monitoring in the confirmation and diagnosis of brain death. Eight children who had fulfilled the diagnostic criteria of brain death were included in the study. The age of patients ranged from 3 months to 15 years. All patients had electrocerebral silence on their electroencephalographic recordings. After the diagnosis of brain death, at least 2-hour monitoring was performed, and all patients expressed a score of 0, indicating brain death. According to our study, the decrease in bispectral index score to 0 in patients with suspected brain death can support and confirm brain death diagnosis in children and can enable scheduling of expensive tests, such as cerebral angiography, in the appropriate time. Nevertheless, further studies are needed to determine the role of the bispectral index in the diagnosis and confirmation of brain death in children. In this article, we review clinical utility, application time, and interpretation of bispectral index monitoring in confirmation of brain death diagnosis in children. (J Child Neurol 2006;21:799—801; DOI 10.2310/7010.2006.00131).

Reversal of profound neuromuscular blockade with sugammadex in an infant after bronchial foreign body removal

Sugammadex is a selective chemical agent that can reverse neuromuscular blockade induced by vecuronium and rocuronium. The aim of this report is to discuss the effectiveness of sugammadex in the reversal of neuromuscular blockade in children younger than 2 years. A 16-month-old boy, weighing 10 kg, was admitted to the pediatric emergency department due to choking, cyanosis, and severe respiratory distress that occurred while he was eating peanuts. In the emergency department, the patients condition deteriorated, and he went into respiratory arrest. He was immediately intubated and taken to the operating room. A rigid bronchoscopy was performed under general anesthesia, with administration of intravenous pentothal (5 mg/kg), rocuronium (0.6 mg/kg), and fentanyl (0.5 μg/kg) in the operating room. The foreign body was removed within 6 minutes, and the profound neuromuscular blockade was reversed with a dose of 2 mg/kg sugammadex. He was extubated successfully after obtaining the spontaneous respiratory activity, and adequate breathing was restored. Clinical use of sugammadex in children younger than 2 years is not recommended because of the lack of clinical studies. In this case report, the profound neuromuscular blockade was successfully reversed with a dose of 2 mg/kg sugammadex in a 16-month-old boy. However, more prospective clinical studies are required for the safe use of this agent in children.

Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization.

Introduction: Nowadays, assessment of brain oxygen saturation, which is simply appliable and noninvasive method, can provide the anesthesia plans to be optimized according to the needs of the brain, which is the main target organ. Brain may be exposed to hypoxia due to supply-demand imbalance of oxygen not only in general anesthesia procedures but also in sedation practices. The aim of the study is to compare the effects of dexmedetomidine and propofol which are widely used agents for pediatric catheterization procedures on brain oxygen saturation using Fore-Sight. Material and Methods: A total of 44 patients undergoing diagnostic cardiac catheterization between 1 and 18 years old were included in the study. All patients, who were randomly divided into two groups, had ASA physical status I-II. In Group Propofol (Group P, n = 22),induction of sedation was made by midazolam (0.5 mg,iv) + propofol (1m/kg,iv), and in Group Dexmedetomidine (Group D, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) +dexmedetomidine (1mcg/kg, iv). Throughout the sedation, cerebral tissue oxygen saturation (SctO 2 ) was recorded by Fore-Sight in addition to routine monitoring. Results: There were no statistically significant differences between the groups in terms of demographic data, hemodynamic data and sedation scores. On other hand, statistically significant decreases in cerebral tissue oxygen saturation were detected especially at 5th and 10th minutes, in Group D, while cerebral oxygenation level did not decrease in Group P. Though, statistically significant difference was determined between two groups in terms of cerebral oxygen saturation, the obtained data was not interpreted as cerebral desaturation. Conclusion: As a conclusion, there was a statistically significant but clinically insignificant decrease in cerebral tissue oxygen saturation in dexmedetomidine group compared to propofol group. Although it does not seem to be important in hemodynamic stabilization, we assume that may cause problems for clinically unstable patients.

Patients', who applied to the anesthesia clinic, perceptions and knowledge about anesthesia in Türkiye.

Background: Pre-operative evaluation includes determining the patients physiological and psychological situation, taking information about pharmacological and therapeutic history, laboratory examinations, and identifying the anesthesia risks. The aim of this study is to learn the patients’, who planned for elective surgery, knowledge and perception about anesthesia, to determine the causes of fears, to investigate whether age, gender, education level, and history of operation affect the outcome of the survey. Methods: A questionnaire consisting of 21 questions was asked to fill by the patients who applied to the anesthesia clinic. In our study, totally 250 patients, aged between 16 and 75 were included. The questionnaire consists of two parts: The first part includes demographic data such as age, gender, education level, occupation; the second part includes the questions about anesthesia experience and knowledge. Results: Of the 250 patients studied, 59% were females and 41% were males. Of these patients, 37.6% had secondary education. As occupation, the highest percentage was belonging to the housewives (33.6%). In the second part of the questionnaire, it was showed that having an anesthesia experience and high education status statistically significantly affect the level of information about anesthesia (P=0.001; P=0.001). Conclusion: In this study, it was showed that there is an important relationship between education and past anesthesia experience and having information about anesthesia and anesthetists. But, generally it was also showed that the patients not having adequate information about anesthesia and anesthetists and to provide the public more informed about anesthesia, with hospital policies and studies of increasing education level, the individual attempts of anesthetists and continuous studies for anesthesia displaying are needed.

Chest wall rigidity due to high dose sugammadex

because I am submitting this paper as Letter to the Editor. http://dx.doi.org/10.1016/j.jclinane.2017.08.027 0952-8180/© 2017 Published by Elsevier Inc. suggested in children is 2 mg/kg but we applied 4.5 mg/kg and due to this, we experienced chest wall rigidity. We did not ascribe this event to anaphylaxis, because no skin symptom, changes in blood pressure or heart rate promoted the anaphylaxis were observed. No data about isolated chest wall rigidity due to sugammadex was found in the literature but in a case report includes three cases about anaphylaxis after sugammadex, determining chest wall rigidity that corrupts the mask ventilation in one of the cases was reported [4]. The reactions dependant to this drug occurred after the patient is extubated and at the transferring stage where the patient is less monitored. Another issue that needs to be focused on is after the reversal of neuromuscular blockade with sugammadex, 24 h must be waited to apply the rocuronium again. This period is based on the 95 ml/kg clearance of sugammadex [5]. Despite this, we applied rocuronium within minutes after sugammadex and provided neuromuscular blockade in the case. With this case, we observed complications like thorax rigidity after sugammadex injection can occur and after the reversal of neuromuscular blockade of rocuronium with sugammadex, if necessary, rocuronium can be applied without waiting for 24 h.

The effects of caudal magnesium administration on anaesthesia depth and analgesia requirement: A-613

Background and Goal of Study: Recently most studies reported that magnesium was a N-methyl-D-aspartate (NMDA)-receptor antagonist and its analgesic and perioperative anesthesic effects were discussed with central desentisation pathway. We aimed to study effects of caudal ropivacaine plus magnesium o

Postpartum paradoxical cerebral embolism through an unknown patent foramen ovale

Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presen...

The usage of remifentanil and alfentanil in alleviating pain and anxiety during bone marrow aspiration in pediatric patients

Abstract Aims: To investigate the efficacy and safety of remifentanil and alfentanil compared with local anesthesia in providing analgesia and sedation during bone marrow aspiration procedures. Methods: Seventy-four children who underwent a diagnostic bone marrow aspiration were included in this study. Patients were assigned to one of 3 treatment groups (remifentanil, alfentanil and local anesthesia). Vital signs, sedation, pain scores, and somatic responses were recorded during and after bone marrow aspiration procedure. Results: There were no statistical differences between pain scores of the remifentanil group and the alfentanil group. Pain scores were significantly higher in the local anesthesia group compared with the other groups. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Conclusions: Remifentanil and alfentanil are effective in children and can be used safely in bone marrow aspiration procedure.