Mesut Erbas

Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score

PurposeFine-needle aspiration biopsy (FNAB) of the thyroid is generally a well-tolerated procedure associated with weak levels of pain. However, pain may be very intense in some patients. The cause for the pain in these patients has not been identified. The hypothesis of this study is that there is a likely relationship between pain level and nodule depth during FNAB.Materials and methodsIncluded in the study were 98 patients with euthyroid nodular goiter who underwent FNAB. When ultrasound guided thyroid fine-needle aspiration biopsy was performed findings such as the distance of the nodule to the skin, the size of the nodule, visual analogue scale (VAS) score values were recorded.FindingsThe distance of nodule to skin and nodule size was measured, respectively, as 10.7xa0±xa02.8xa0mm and 21.7xa0±xa08.6xa0mm. Mean VAS score was 36xa0±xa016. FNAB-related pain was correlated with the nodule depth (rxa0=xa00.43, pxa0<xa00.001). In the logistic regression analysis, we also found that high VAS score class was effected by only nodule depth (Bxa0=xa0−1.619; OR 1.287; CI 1.057–1.565, pxa0<xa00.05).ConclusionOur results show that pain increased significantly during FNAB in patients who had more deeply situated nodules. Local anesthetic methods may be recommended for these patients.

Comparação dos efeitos da perfusão de sevoflurano, desflurano e propofol sobre o sistema oxidante/antioxidante durante anestesia geral

BACKGROUND AND OBJECTIVESnDesflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy.nnnMETHODSn45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P, n=15), sevoflurane (group S, n=15) and desflurane (group D, n=15). All groups were given hypnotic 2mg/kg propofol IV, 1mcg/kg fentanyl IV and 0.1mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12mg/kg/h for the first 10minutes, 9mg/kg/h for the second 10minutes and 6mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants.nnnRESULTS AND CONCLUSIONSnThe 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation.

The investigation of airway management capacity of v-gel and cobra-PLA in anaesthetised rabbits

PURPOSEnTo evaluate the applicability and airway management capacity of v-gel® and Cobra PLA in rabbit anaesthesia during assisted (AV) or controlled ventilation (CV).nnnMETHODSnThis study was carried out in 44 adult New Zealand white rabbit. Baseline arterial pH, PaCO2 and PaO2 values were recorded. Anaesthesia was induced with 5 mg/kg xylasine and 35 mg/kg ketamine HCI combination. AV rabbits were assigned as; control (CG-AV; n=5), LMA (LMA-AV; n=5), cobra PLA (PLA-AV; n=5) and v-gel (v-gelAV; n=5). Rabbits have CV were also assigned as; ET (ET-CV; n=6), LMA (LMA-CV; n=6), cobraPLA (PLA-CV; n=6) and v-gel (v-gelCV; n=6). All measurements were repeated 1st, 5th, 15th and 30th mins during anaesthesia.nnnRESULTSnThe less insertion time, number of attempt and complications are recorded in v-gel applied rabbits compared to other apparatus. For arterial pH values significant differences are recorded in especially at 15th and 30th min between groups of CV (p<0.005 or p<0.001). All groups had similar results with each other during anaesthesia for PaCO2 except for LMA-CV group.nnnCONCLUSIONnThe v-gel may be used as airway device in rabbit anaesthesia undergoing AV or CV and also can be a suitable alternative to endotracheal tubes and laryngeal mask airway.

Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia

AbstractnIn this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30thxa0minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5thxa0minute mean arterial pressure values (pxa0<xa00.05). It was observed that QTc intervals at the 1st and 5thxa0minute in the ET group significantly increased when compared with the other groups (pxa0<xa00.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (pxa0<xa00.05). It was also observed that QTc interval of LMA Group at the 5thxa0minute after intubation significantly increased when compared with V-gel group (pxa0<xa00.05). It was observed that HR values of ETT group at the 1st, 5th and 15thxa0minutes after intubation increased with regards to PLA and V-gel groups (pxa0<xa00.05). It was determined that the 30thxa0minute hearth rate of ETT group was higher when compared to V-gel group (pxa0<xa00.05). Conclusion: In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.

Correlation of ischemia-modified albumin levels and histopathologic findings in experimental ovarian torsion

Objectives Ischemia modified albumin (IMA) levels significantly increased and may be used as a diagnostic marker in ovarian torsion. The aim of this study is to investigate whether there was any correlation between IMA levels and histopathologic changes in experimental ovarian torsion. Material and methods Fourteen Sprague-Dawley rats, each weighing 220–250 g were divided randomly into 2 groups; in Group 1, the control group (n = 7), only laparotomy was performed and in Group 2, the experimental group (n = 7), ovarian torsion was performed. Ischemia was performed for 3 h; following the ischemia period, the torsion was relieved by detwisting the adnexa and then the ovarian I/R protocol was applied for 3 h. Blood samples were taken from all of the rats to measure the IMA levels and the ovaries were surgically removed for histologic examination. A blinded pathologist examined and scored the samples. Results The median (minimum–maximum) IMA values were 921.00 (870.00–966.00) ABSUs in the ovarian torsion group and 853.00 (782.00–869.00) ABSUs in the control group. The difference was statistically significant. In the correlation analysis, a significant and strong correlation was found between IMA levels and histopathologic changes (Spearmans rho = +0.987, p < 0.001). Conclusion Positive correlation was found between the IMA levels and the histopathologic severity of the disease. This finding is important for both diagnosis of the disease and patient follow-up. As a new marker in ovarian torsion, IMA may also indicate the severity of the ovarian histopathology.

Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos

BACKGROUND AND OBJECTIVESnTenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment.nnnMETHODSnThis study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria.nnnRESULTS AND CONCLUSIONSn22 of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment.

Effects of sugammadex on the prevention of postoperative peritoneal adhesions.

Many materials and techniques have been used to prevent and repair intra‐abdominal adhesions, but an effective solution has not been found. The aim of this study is to research the effect of sugammadex on intra‐abdominal adhesions in an experimentally induced intra‐abdominal adhesion model. Twenty‐four female Wistar albino rats were included in the study. The experimental animals were randomly divided into three groups: the sugammadex group (Group SX, nu2009=u20098), the control group (Group C, nu2009=u20098), and the sham group (Group S, nu2009=u20098). After starvation for 1 night, the rats were injected with a 50u2009mg/kg intramuscular dose of ketamine and a 5u2009mg/kg intramuscular dose of xylazine for anesthesia. The rats in the SX group were given 3u2009mL sugammadex into the peritoneal cavity, while rats in the control group were given 3u2009mL 0.9% sodium chloride. In the sham group, the peritoneal cavity was opened, but no chemicals were administered. All rats were sacrificed on the 10th postoperative day. The adhesions were staged as 0, 1, 2, and 3 according to Evans etu2009al.s model. Our evaluation of macroscopic adhesion intensity found statistically significant differences between the groups. The sugammadex group was observed to have fewer adhesions in a statistically significant manner compared with the control group (pu2009<u20090.05). In our experimental intra‐abdominal adhesion model in rats, we observed that sugammadex prevented postoperative intra‐abdominal adhesions.

Comparison of effects of sugammadex and neostigmine on QTc prolongation in rabbits under general anesthesia

PURPOSEnTo compare the effects of sugammadex and neostigmine, used to antagonize the effects of rocuronium, on the QTc interval.nnnMETHODSnThis study used 10 adult New Zealand white rabbits of 2.5-3.5 kg randomly divided into two groups: sugammadex group (Group S, n:5) and neostigmine group (Group N, n:5). For general anesthesia administering 2 mg/kg iv propofol and 1 mcg/kg iv fentanyl, 0.6 mg/kg iv rocuronium was given. Later to provide reliable airway for all experimental animals V-Gel Rabbit was inserted. The rabbits were manually ventilated by the same anesthetist. After the V-Gel Rabbit was inserted at 2, 5, 10, 20, 25, 27, 30 and 40 minutes measurements were repeated and recorded. At 25 minutes after induction Group N rabbits were given 0.05 mg/kg iv neostigmine + 0.01 mg/kg iv atropine. Group S were administered 2 mg/kg iv sugammadex.nnnRESULTSnComparing the QTc interval in the rabbits in Group S and Group N, in the 25th, 27th and 30th minute after muscle relaxant antagonist was administered the QTc interval in the neostigmine group rabbits was significantly increased (p<0.05).nnnCONCLUSIONnWhile sugammadex, administered to antagonize the effect of rocuronium, did not significantly affect the QTc interval, neostigmine+atropine proloned the QTc interval.

An experimental study of ascorbic acid effects in acute renal failure under general anesthesia

PURPOSEnTo evaluate the preventive effect of ascorbic acid on sevoflurane-induced acute renal failure in an experimental rat model.nnnMETHODSnTwenty-four adult male Wistar rats were randomly distributed into three groups. Subjects were allocated into 3 groups: Group I received sevoflurane only, whereas Groups II and III had moderate (150 mg/kg) and high (300 mg/kg) doses of AA in addition to sevoflurane, respectively. Rhabdomyolysis and myohemoglobinuric ARF was formed by intramuscular administration of glycerol on the upper hind limb on the 15th minute of inhalation anesthesia. Biochemical parameters consisted of serum levels of blood urea nitrogen, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), total antioxidant capacity (TAC), and protein carbonyl content. Histopathological variables were tubular necrosis, fibrin, and cast formation.nnnRESULTSnNGAL levels were significantly lower in Group III than Group II and Group I. On the other hand, TAC, PCO, urea and creatinine levels were notably higher in Group I compared with Groups II and III. There was a significant difference between 3 groups on frequencies of acute tubular necrosis (p=0.003), fibrin (p<0.001) and cast (p<0.001). Acute tubular necrosis and fibrin formation were more prominent in Group I. Casts were more common in Groups II and III.nnnCONCLUSIONSnThe ascorbic acid serve as a prophylactic agent against renal damage in patients receiving sevoflurane anesthesia and higher doses were associated with more apparent protective effects.

Prevention of intraocular pressure elevation with oleuropein rich diet in rabbits, during the general anaesthesia.

Background Oleuropein is known to have anti-oxidant and anti-inflammatory effects. An important aim of anesthetic management in ocular surgery is to keep the intraocular pressure under control. Studies have researched a variety of prophylactic materials used to prevent increases in intraocular pressure. We aimed to research the effects of oleuropein on intraocular pressure (IOP) during general anaesthesia.MethodsFourteen New Zealand rabbits were randomly divided into two groups of seven. The rabbits in Group O were given olive leaf extract (OLE) equivalent to a daily dose of 20xa0mg/kg oleuropein for 15xa0days. HPLC method used for oleuropein standardization. For anaesthesia induction 1xa0mg/kg rocuronium was given and after muscle relaxation all animals had a V-gel Rabbit inserted. Anesthetic maintenance was provided by 1 MAC isoflurane. Twenty minutes after rabbits were given 10xa0mg/kg ketamine, basal IOP values were measured. After the V-gel rabbit was inserted, in the 5th, 10th, 20th, 25th and 30th minutes measurements were repeated.ResultsIOP data variation of OLE group was compared with control group and the measured levels were lower in Group O during the anaesthesia. IOP was 33.8xa0±xa04xa0mmHg in Group C and 24.1xa0±xa08xa0mmHg in Group O in 25th minute and the difference between the two groups was statistically significant at this time.ConclusionWe observed that consumption of prophylactic OLE had a reducing effect on IOP in the period before waking in anaesthesia. We believe it is necessary to investigate the effects of OLE on IOP in broad participation patient groups.