Mehtap Honca

Prophylactic ketamine to prevent shivering in parturients undergoing Cesarean delivery during spinal anesthesia.

STUDY OBJECTIVE To compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery. DESIGN Prospective, randomized, double-blinded, placebo-controlled study. SETTING Operating rooms and postoperative recovery rooms. PATIENTS 120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia. MEASUREMENTS Patient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective. MAIN RESULTS The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia. CONCLUSIONS Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia.

Comparison of Effects of Dexmedetomidine-ketamine and Dexmedetomidine-midazolam Combinations in Transurethral Procedures

OBJECTIVE To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. METHODS Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. RESULTS Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P < .001 and P < .001, respectively), and Aldrete scores were greater in group K than group M. CONCLUSION Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination.

Efficacy of Prophylactic Ketamine in Preventing Postoperative Shivering

BACKGROUND Treatment with ketamine and pethidine is effective in postoperative shivering. The aim of this study was to compare the efficacy of low-dose prophylactic ketamine with that of pethidine or placebo in preventing postoperative shivering. METHODS A prospective randomized double-blind study involved 90 ASA I and II patients undergoing general anaesthesia. Patients were randomly allocated to receive normal saline (Group S, n=30), pethidine 20 mg (Group P, n=30) or ketamine 0.5 mg kg(-1) (Group K, n=30) intravenously 20 min before completion of surgery. The anaesthesia was induced with propofol 2 mg kg(-1), fentanyl 1 microg kg(-1) and vecuronium 0.1 mg kg(-1). It was maintained with sevoflurane 2-4% and nitrous oxide 60% in oxygen. Tympanic temperature was measured immediately after induction of anaesthesia, 30 min after induction and before administration of the study drug. An investigator, blinded to the treatment group, graded postoperative shivering using a four-point scale and postoperative pain using a visual analogue scale (VAS) ranging between 0 and 10. RESULTS The three groups did not differ significantly regarding patient characteristics. The number of patients shivering on arrival in the recovery room, and at 10 and 20 min after operation were significantly less in Groups P and K than in Group S. The time to first analgesic requirement in Group S was shorter than in either Group K or Group P (P<0.005). There was no difference between the three groups regarding VAS pain scores. CONCLUSION Prophylactic low-dose ketamine was found to be effective in preventing postoperative shivering.

In Vitro Effect of Dexmedetomidine on Platelet Aggregation

BACKGROUND AND OBJECTIVES Dexmedetomidine is a selective α2-agonist. There are 250-300 α2- adrenoceptor on the surface of each human platelet and ephedrine induces platelet aggregation by binding these receptors. This study was designed to study platelet function after incubation with therapeutic concentrations of dexmedetomidine. METHODS The study was carried out on 18 healthy, non-smoking males, ages ranging 25 to 35 years old. Because of the recommended therapeutic concentration range of dexmedetomidine obtained by intravenous infusion is 0.4-1.2 ng.mL(-1), dexmedetomidine solutions were prepared in three different concentrations. The calculated value of dexmedetomidine solution and diluent without dexmedetomidine as control were added to the blood sample. Thus, we obtained 0, 0.4, 0.8 and 1.2 ng.mL(-1) dexmedetomidine concentrations of plasma. Each concentration of dexmedetomidine was incubated with whole blood at 37°C during 15 minutes. Then blood samples were centrifugated to prepare platelet-rich plasma and platelet-poor plasma. The platelet-rich plasma was diluted with the platelet-poor plasma to yield test platelet-rich plasma with a final platelet count of 250 ± 50 X 10(9).L(-1). RESULTS The platelet aggregation amplitudes and slopes were statistically similar among all groups by the aggregation test, which were performed with ADP, collagen or epinephrine. CONCLUSION Therapeutic concentrations of dexmedetomidine had no effect on the platelet functions in healthy individuals in vitro.

Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery

BACKGROUND the aim of this study was to investigate the effects of spinal anesthesia using two different doses of fentanyl combined with low-dose levobupivacaine in anorectal surgery. METHODS in this prospective, double-blind study, 52 American Society of Anaesthesiologists I-II patients scheduled for elective anorectal surgery were randomized into two groups. The patients in group I received intrathecal 2.5mg hyperbaric levobupivacaine plus 12.5 μg fentanyl and in group II received intrathecal 2.5mg hyperbaric levobupivacaine plus 25 μg fentanyl. All the patients remained in the seated position for 5 min after completion of the spinal anesthesia. Sensory block was evaluated with pin-prick test and motor block was evaluated with a modified Bromage scale. RESULTS motor block was not observed in both of the groups. The sensory block was limited to the S2 level in group I, and S1 level in group II. None of the patients required additional analgesics during the operation. Time to two-segment regression was shorter in group I compared with group II (p<0.01). One patient in group I and 5 patients in group II had pruritus. Hemodynamic parameters were stable during the operation in both of the groups. CONCLUSION spinal saddle block using hyperbaric levobupivacaine with both 12.5 μg and 25 μg fentanyl provided good quality of anesthesia without motor block for anorectal surgery in the prone position.

Efeito in vitro de dexmedetomidina na agregação plaquetária

BACKGROUND AND OBJECTIVES Dexmedetomidine is a selective α(2)-agonist. There are 250-300 α(2)-adrenoceptor on the surface of each human platelet and ephedrine induces platelet aggregation by binding these receptors. This study was designed to study platelet function after incubation with therapeutic concentrations of dexmedetomidine. METHODS The study was carried out on 18 healthy, non-smoking males, ages ranging 25 to 35 years old. Because of the recommended therapeutic concentration range of dexmedetomidine obtained by intravenous infusion is 0.4-1.2 ng.mL(-1), dexmedetomidine solutions were prepared in three different concentrations. The calculated value of dexmedetomidine solution and diluent without dexmedetomidine as control were added to the blood sample. Thus, we obtained 0, 0.4, 0.8 and 1.2 ng.mL(-1) dexmedetomidine concentrations of plasma. Each concentration of dexmedetomidine was incubated with whole blood at 37°C during 15 minutes. Then blood samples were centrifugated to prepare platelet-rich plasma and platelet-poor plasma. The platelet-rich plasma was diluted with the platelet-poor plasma to yield test platelet-rich plasma with a fi nal platelet count of 250 ± 50 X 10(9).L(-1). RESULTS The platelet aggregation amplitudes and slopes were statistically similar among all groups by the aggregation test, which were performed with ADP, collagen or epinephrine. CONCLUSION Therapeutic concentrations of dexmedetomidine had no effect on the platelet functions in healthy individuals in vitro.

The evaluation of point-of-care testing for determining hemoglobin levels in geriatric intensive care patients

Abstract Background The aim of the present study was to compare hemoglobin (Hb) levels determined by point-of-care testing (POCT) HemoCue® and arterial blood gas analyzer using an automated hematology analyzer in critically ill geriatric patients. Methods Forty geriatric patients requiring intensive care treatment were included in the study. Arterial blood sample was analyzed using HemoCue® (HemoCue®; Hb 201+, Angelholm, Sweden) (HbHemoCueArterial), blood gas analyzer (Techno Medica, Gastat1800 series, Japan) (HbBGA) and an automated hematology analyzer (Cell Dyne 3700 System, Abbott Laboratories, USA) (HbLab) as a reference method. Capillary blood measurements were performed (HbHemoCueCapillary) using HemoCue® at bedside. Bland-Altman analysis was applied to the results. Results We found a positive correlation between the Hb measurements of HemoCueCapillary, HemoCueArterial and automated hematology analyzer (r-values were 0.799 and 0.922, respectively) and p<0.001. There was also a positive correlation between the Hb measurements of blood gas analyzer and automated hematology analyzer (r = 0.878) and p<0.001. The bias and limits of agreement were 0.32 and −2.5±3.14 g/dL for the HbHemoCueCapillary, 0.64 and −1.03±2.31 g/dL for the HbHemoCueArterial and −1.2 and −4.45±2.05 g/dL for the HbBGA. Inotropic agent administration did not affect the Hb values in all groups. Conclusions Both HemoCueCapillary and HemoCueArterial are sufficiently accurate and correlated with automated hematology analyzer in geriatric critically ill patients if used correctly. In terms of Hb levels, arterial and capillary blood sample measurements with HemoCue® provided more clinically acceptable accuracy than blood gas analysis system.

Plasma Indolamine 2,3 dioxygenase and serum neopterin levels in patients with first episode major depressive disorder and recurrent major depressive disorder

Objective: The aims of this study were to determine whether the plasma Indolamine 2,3 dioxygenase and neopterin levels in patients with major depression differ from a healthy control group and to investigate the relationship between previous major depression episodes and plasma indolamine 2,3 dioxygenase and serum neopterin levels. Methods: Thirty eight first episode major depression patients, sixty four recurrent major depression patients and forty one healthy control participant included the study. Plasma indolamine 2,3 dioxygenase and serum neopterin levels compared in these three groups. Results: Plasma indolamine 2,3 dioxygenase and serum neopterin levels in recurrent major depression group were statistically higher than first episode major depression and healthy control group. There was a positive correlation between plasma IDO levels and number of depressive episodes in major depression group (rho=0.36, p<0.001). Conclusion: According to these findings previous major depression episodes can promote response of the immune system associated with proinflamatuar cytokine activity. This sensitizing effect of previous depressive episodes may increase the recurrence risk of depression.

Antipsikotik ve Antiparkinson İlaçlarla Oluşan Antikolinerjik Zehirlenme

Anticholinergic poisoning with antipsychotic and antiparkinson drugs: case report. Tricyclic antidepressants, antipsychotics, antiparkinsonian and antihistamines are the drugs capable of producing anticholinergic toxicity. Anticholinergic poisoning causes tachycardia, hypertension, hyperthermia, mydriasis and altered mental status. Also life threatening complications such as ventricular arrythmias, rhabdomyolysis and seizures can occur. It can be difficult to distinquish from the sympathomimetic syndrome. Paliperidone or 9 hydroxy risperidone, is one of the newest atypical antipsychotics on the market and acts as a serotonin and dopamine antagonist. Biperidene is an anticholinergic drug and it is used to improve extrapyramidal side effects induced by neuroleptic agents. After an overdose it causes toxic effects of rapid onset to several organ systems. In this case report, we aimed to present anticholinergic toxicity resulting from the overdose ingestion of biperidene and paliperidone and physostigmine therapy in a patient with schizophrenia.