Muge Kosucu

Comparison of the effect of propofol and N-acetyl cysteine in preventing ischaemia-reperfusion injury

Background and objective The aim of this study was to compare the effects of propofol and N-acetyl cysteine (NAC) on tourniquet-induced ischaemia–reperfusion injury by determining malonyldialdehyde, ischaemia-modified albumin, lactate, blood gas and haemodynamic levels in arthroscopic knee surgery. Methods Sixty ASA I or II patients were randomized into three groups. Intrathecal anaesthesia was administered using 0.5% heavy bupivacaine in all patients. In group P, propofol was administered in a 0.2 mg kg−1 bolus, followed by infusion at a rate of 2 mg kg−1 h−1; in group NAC, NAC was administered as an infusion at a rate of 5 mg kg−1 h−1, and, in group C (the control group), an equal volume of isotonic saline was administered to patients until 30 min after reperfusion. Blood samplings were obtained immediately before intrathecal anaesthesia (t1), 1 min before tourniquet release (t2), 5 min after tourniquet release (t3) and 30 min after tourniquet release (t4). Results Plasma malonyldialdehyde, ischaemia-modified albumin and lactate levels increased significantly in group C at t3 and t4 compared with the baseline values. Plasma concentrations of malonyldialdehyde, ischaemia-modified albumin and lactate in groups P and NAC were significantly lower than those in group C at t3 and t4. In blood gas analyses, pH, HCO3 and base excess were found to be significantly lower at t3 and t4 compared with t1 and t2 in group C. Comparisons between groups P and NAC revealed no significant differences. Conclusion Small-dose infusions of both propofol and NAC appear to provide similar protection against ischaemia–reperfusion injury in arthroscopic knee surgery.

Interrupted aortic arch in a adult: diagnosis with MSCT

Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as a complete loss of luminal and anatomic continuity between ascending and descending aorta. It is important that we made a good diagnosis and accurate evaluation of their morphologic conditions before a heart operation. We presented an 18-year-old girl of interrupted IAA diagnosed by multi-slice computed tomography angiography.

Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapias syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2–t 9 and t 2–t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2–t 8 and t 2–t 9. IMA levels in Group T were significantly lower than those in Group S at t 2–t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

Peripheral nerve block to the lower extremity despite relative contraindication (two cases)

Abstract Peripheral nerve blocks can provide a number of advantages in high-risk patients and may sometimes be preferred despite relative contraindication. Our first case had relative contraindication due to being confused, with a

The Effect of Combination of Epidural Anaesthesia and General Anaesthesia on Ischemia-Reperfusion Injury in Vascular Surgery

Yöntemler: Çalışmaya, 60 hasta (ASA I-III) alındı. Revaskularizasyon uygulanacak 40 hasta iki gruba ayrılarak 20’sine “genel anestezi” (Grup G), 20’sine “genel+epidural anestezi” (Grup GE) uygulandı. Varisektomi yapılacak 20 hastadan oluşan kontrol grubuna (Grup K) ise “genel anestezi” uygulandı. Genel anestezi indüksiyonu; tiyopental sodyum (3-5 mg kg-1) ve fentanil (1-3 mcg kg-1), kas gevşekliği cisatrakuryum (0,15 mg kg-1), anestezi idamesi sevofluran (%2-3), oksijen içinde azot protoksit (%4060) ile sağlandı. Grup GE’de, anestezi indüksiyonu öncesi lomber epidural anestezi (%0,5 levobupivakain, 20 mL) uygulandı. İntraoperatif analjezi, epidural levobupivakain (%0.125, 10 mL saat-1) infüzyonu ile sağlandı. Serum MDA, IMA ölçümleri için; Grup G ve GE’de, indüksiyon öncesi (t1), aort klempini kaldırmadan hemen önce (t2), klempi kaldırdıktan 1 (t3), 2 saat sonra (t4), postoperatif 6. (t5), 24. (t6) saatlerde, Grup K’de, indüksiyon öncesi (t1), operasyon başladıktan 60 (t2), 120 (t3), 180 dakika sonra (t4), postoperatif 6. (t5), 24. (t6) saatlerde kan alındı. Preoperatif, postoperatif BKİ’leri ölçüldü.

Management of A Case of Severe Electrical Burn, With Multiple Vital Organ Injuries

Yirmi yasinda erkek hasta yuksek voltajli elektrik yaralanmasina (1000 V, 50 Hz ustu) bagli ventrikul fibrilasyonu, kalp ve solunum durmasi ile entube halde yogun bakim unitemize alindi. Pupilleri izokorik, isik refleksi cift tarafli mevcut, kalp atim hizi 135 atim.dk-1, kan basinci 120/80 mmHg olan hastanin her iki elde laserasyon tarzi yanik izi haric bulgusu yoktu. Elektrokardiyografisinde sinus tasikardisi, D1, AVL, V1-6 derivasyonlarinda ST yukselmesi vardi. Ekokardiyografisinde hafif on duvar akinezisi goruldu. Solunan O2 konsantrasyonu %50’den kucukken olculen ilk kan gazi degerleri normal, diger laboratuvar bulgulari glukoz: 280 mg dL-1, kan ure azotu: 19 mmol L-1, kreatinin: 1,3 mmol L-1, potasyum: 5,2, beyaz kure: 14,400, laktat dehidrogenaz: 1280 IU L-1, aspartat aminotransferaz: 135 IU L-1, kreatinin kinaz: 1977 IU L-1, kreatinin kinaz -MB: 389,5 IU L-1, ve miyoglobin: 2800 ng mL-1 olarak bulundu. Yapilan bilgisayarli beyin bilgisayarli tomografi goruntulemesinde, sol insula bolgesinde milimetrik lakuner infarkt odaklari gozlendi (Resim 1).