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Effect of hydroxyethyl starch 130/0.4 on ischemia-reperfusion determinants in minor lower extremity surgery with tourniquet application

STUDY OBJECTIVE To investigate the effect of 6% hydroxyethyl starch (HES) (130/0.4) infusion on ischemia-reperfusion determinants in minor lower extremity operations with tourniquet application. DESIGN Prospective, randomized, clinical trial. SETTING University hospital operation room. PATIENTS American Society of Anesthesiologists I and II 40 patients between 18 and 65 years of age who were scheduled to undergo knee arthroscopy and below-knee minor orthopedic surgery. INTERVENTIONS Patients were randomized into 2 groups (normal saline [NS] group and HES group). Unilateral spinal anesthesia with 2-mL 0.5% hyperbaric bupivacaine after 10 mL/kg NS intravenous infusion to NS group and 10 mL/kg 6% HES intravenous infusions to HES group. MAIN OUTCOME MEASURES Blood samples were obtained from antecubital vein for malondialdehyde, xanthine oxidase, and hypoxanthine before tourniquet inflation and after 10 minutes of tourniquet deflation. RESULTS There was no significant difference between groups with respect of hemodynamic data. There were no significant differences between 2 groups in terms of malondialdehyde values before tourniquet inflation and after tourniquet deflation. In the HES group, xanthine oxidase levels after tourniquet deflation were significantly lower than xanthine oxidase levels before tourniquet inflation (P < .05). In the HES group, hypoxanthine levels after tourniquet deflation were similar with the basal levels; however, they were significantly higher than levels obtained before tourniquet inflation in the SF group (P < .05). CONCLUSION HES infusion may be beneficial for reduction of tourniquet-associated ischemia-reperfusion injury; however, further large-scale studies are needed to fully elucidate its mechanism.

Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy

ABSTRACT Purpose: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen. Methods: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. Results: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). Conclusion: Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Can neutrophil-lymphocyte ratio be a predictor of cerebral vasospasm in patients with subarachnoid hemorrhage?

This study aimed to investigate the relationship between neutrophil-lymphocyte ratio (NLR) and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods The study was performed by retrospectively analyzing the data of 170 aneurysmal SAH patients who admitted to the intensive care unit of our hospital between 2011 and 2017. We investigated the ability of NLR values calculated from the blood samples taken at the time of admission to predict for vasospasm. Results Thirty-five percent of the patients developed vasospasm. NLR values were associated with the development of vasospasm (OR 1.15; 95% confidence interval, 1.09-1.22; p

The effect of spinal versus general anesthesia on intraocular pressure in lumbar disc surgery in the prone position: A randomized, controlled clinical trial

OBJECTIVE To compare IOP changes between spinal anesthesia (SA) and general anesthesia (GA) in patients who underwent lumbar disc surgery in the prone position. DESIGN Prospective, randomized, controlled trial. SETTING Operating room. PATIENTS Forty ASA I-II patients scheduled for lumbar disc surgery in prone position. INTERVENTION Patients were randomly allocated to the SA or GA groups. MEASUREMENTS IOP was measured before anesthesia (IOP1), 10 min after spinal or general anesthesia in supine position (IOP2), 10 min after being placed in the prone position (IOP3), and at the end of the operation in the prone position (IOP4). MAIN RESULTS There was no significant difference between baseline IOP1 (group GA = 19.4 ± 3.2 mmHg; group SA = 18.6 ± 2.4 mmHg) and IOP2 values (group GA = 19.7 ± 4.1 mmHg; group SA = 18.4 ± 1.9 mmHg) between and within the groups. IOP values after prone positioning and group GA measurements (IOP3 = 21.6 ± 3.1 mmHg; IOP4 = 33.9 ± 3.1 mmHg) were significantly higher when compared with the SA group (IOP3 = 19.3 ± 2.7 mmHg, IOP4 = 26.9 ± 2.4 mmHg) (p = 0.018 and p < 0.001, respectively). Furthermore, IOP3 was significantly increased when compared with IOP2 in the GA group but not in the SA group (p = 0.019 and p = 0.525, respectively). In both groups, IOP4 values were significantly higher than the other three measurements (p < 0.001). CONCLUSION The results indicated that IOP increase is significantly less in patients who undergo lumbar disc surgery in the prone position under SA compared with GA.

The Efficacy of Ultrasound-guided Type-I and Type-II Pectoral Nerve Blocks for Postoperative Analgesia after Breast Augmentation: A Prospective, Randomised Study

PURPOSE The present study was planned to evaluate the efficacy and safety of ultrasound-guided Pecs I and II blocks for postoperative analgesia after sub-pectoral breast augmentation. METHODS Fifty-four adult female patients undergoing breast augmentation were randomly divided into two groups: the control group (Group C, n=27) who were not subjected to block treatment and Pecs group (Group P, n=27) who received Pecs I (bupivacain 0.25%, 10mL) and Pecs II (bupivacain 0.25%, 20mL) block. Patient-controlled fentanyl analgesia was used for postoperative pain relief in both groups, and the patients were observed for the presence of any block-related complications. RESULTS The 24-h fentanyl consumption was smaller in Group P [mean±SD, 378.7±54.0μg and 115.7±98.1μg, respectively; P<0.001]. VAS scores in Group P were significantly lower at the time of admission to the post-anaesthetic care unit and at 1, 2, 4, 8, 12, and 24h (P<0.001). The rates of nausea and vomiting were higher in Group C than in Group P (9 vs 2, P=0.018). Hospital stay duration was shorter in Group P than in Group C (24.4±1.2h vs 27.0±3.1h, P<0.001). No block-related complications were recorded. CONCLUSIONS Combine used of Pecs I and II blocks provide superior postoperative analgesia in patients undergoing breast augmentation and shortens hospital stay.

Effects of Addition of Preoperative Intravenous Ibuprofen to Pregabalin on Postoperative Pain in Posterior Lumbar Interbody Fusion Surgery

Objective Ibuprofen and pregabalin both have independent positive effects on postoperative pain. The aim of the study is researching effect of 800 mg i.v. ibuprofen in addition to preoperative single dose pregabalin on postoperative analgesia and morphine consumption in posterior lumbar interbody fusion surgery. Materials and Methods 42 adult ASA I-II physical status patients received 150 mg oral pregabalin 1 hour before surgery. Patients received either 250 ml saline with 800 mg i.v. ibuprofen or saline without ibuprofen 30 minutes prior to the surgery. Postoperative analgesia was obtained by morphine patient controlled analgesia (PCA) and 1 g i.v. paracetamol every six hours. PCA morphine consumption was recorded and postoperative pain was evaluated by Visual Analog Scale (VAS) in postoperative recovery room, at the 1st, 2nd, 4th, 8th, 12th, 24th, 36th, and 48th hours. Results Postoperative pain was significantly lower in ibuprofen group in recovery room, at the 1st, 2nd, 36th, and 48th hours. Total morphine consumption was lower in ibuprofen group at the 2nd, 4th, 8th, 12th, and 48th hours. Conclusions Multimodal analgesia with preoperative ibuprofen added to preoperative pregabalin safely decreases postoperative pain and total morphine consumption in patients having posterior lumbar interbody fusion surgery, without increasing incidences of bleeding or other side effects.

High Prolactin Level as a Predictor of Vasospasm in Aneurysmal Subarachnoidal Hemorrhage

Background Aneurysmal subarachnoid hemorrhage (aSAH) is a destructive syndrome with a mortality rate of 50%. Recent studies have also suggested a high pervasiveness of hypothalamic-pituitary insufficiency in up to 45% of patients after aSAH. Prolactin has been associated with the pathogenesis of hypertensive irregularities that are linked to pregnancy. Material/Methods We identified a group of 141 patients with spontaneous SAH due to a ruptured cerebral aneurysm; these patients were operated on at our institution’s Neurosurgery and Interventional Radiology Department between 2011 and June 2015. All of the data were obtained retrospectively from medical records. Results The hormonal abnormalities observed in the initial 24 h after ictus in subjects with subarachnoid SAH were caused by stressful stimulation aggravated by intracranial bleeding. Conclusions The elevated prolactin levels that occur in patients with aSAH can be used in conjunction with other auxiliary factors that we believe may be beneficial to vasospasm.

Can ondansetron be used in the treatment of subdural block

Caudal epidural block is an adjunct to general anesthesia to provide postoperative analgesia particularly in pediatric patients undergoing infraumbilical, perineal and lower extremity surgery [1]. As with other neuroaxial techniques, subdural block can also occur associated with caudal anesthesia. However, there are no clear guidelines in the treatment of subdural block [2]. This report presents a pediatric case with subdural block that showed rapid recovery after IV ondansetron administration.