Mustafa Kemal Bayar

Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass

OBJECTIVE The role of aprotinin in the prevention of lung reperfusion injury was investigated in the patients undergoing cardio-pulmonary bypass (CPB) for coronary artery bypass grafting (CABG) operations. METHODS The study was planned randomly and prospectively. Two hundred milliliters of physiological saline solution was added to the prime solution of patients in group I (n=10) whereas, 200 ml aprotinin (Trasylol, Bayer AG) was given to patients in group II (n=10). In order to measure lung tissue malondialdehyde (MDA) levels, glutathion peroxidase (GSH-Px) activity levels and polymorphonuclear leukocytes (PMNs) numbers, lung tissue samples were taken before CPB and 5 min after removing the cross clamp. In addition, alveolo-arterial oxygen difference (AaDO(2)) for tissue oxygenation was calculated by obtaining arterial blood gas samples. RESULTS MDA levels before CPB increased from 41.72+/-21.00 nmol/g tissue to 66.71+/-13.44 nmol/g tissue in group I and from 43.44+/-5.16 nmol MDA/g tissue to 53.22+/-10.95 nmol MDA/g tissue in group II after cross clamp removal (P=0.001 and P=0.021, respectively). The increase in group II was found to be significantly lower than group I (P=0.048). With the initiation of reperfusion, GSH-Px activity decreased in group I from 3.05+/-0.97 to 2.31+/-0.46 U/mg protein (P=0.015) whereas GSH-Px activity in group II decreased from 3.18+/-1.01 to 2.74+/-0.81 U/mg protein (P=0. 055). This decrease in the group II was less than group I (P=0.049). AaDO(2) significantly increased in the group I and II (P=0.012 and P=0.020, respectively), but elevation in the group I was significant than in the Group II (P=0.049). In histopathological examination, it was observed that neutrophil counts in the lung parenchyma rose significantly following removal of cross clamp in both groups (P=0. 001). The increase in group I was significantly larger than in group II (P=0.050). CONCLUSION Results represented in our study indicate that addition of aprotinin (2 million units) into the prime solution during CPB can reduce lung reperfusion injury.

Effect of sevoflurane anesthesia on the severity of renal histopathologic changes in rabbits pretreated with gentamicin: A controlled, investigator-blinded, experimental study

BACKGROUND Inorganic fluoride and compound A are potential nephrotoxic products of sevoflurane, a halogenated inhalational general-anesthetic drug. OBJECTIVE The aim of this study was to microscopically examine the effect of sevoflurane on the severity of renal histopathologic changes in rabbits pretreated with gentamicin. METHODS In this controlled, investigator-blinded, experimental study at the Firat University School of Medicine, Elazig, Turkey, male New Zealand white rabbits (age range, 6-8 months; weight range, 2600-3400 g) were randomly divided into 4 groups of equal size. The gentamicin group received IM gentamicin 10 mg/kg · d(-1) for 10 days. Rabbits in the sevoflurane group received pH-balanced saline solution at a volume of 10 mg/kg · d(-1) for 10 days, equivalent to the volume of gentamicin administered to the gentamicin group. On day 11, anesthesia was induced with 8% sevoflurane in 50% oxygen and air using a suitable facemask. When a sufficient depth of anesthesia (loss of eyelash reflex and tolerance to tail-clamp stimuli) was reached (without a muscle relaxant), the rabbits were intubated (3-mm ID) and allowed to breathe spontaneously. End-tidal or end expiratory concentration of sevoflurane was then decreased to 4% and the rabbits were anesthetized at a flow rate of 4 L/min for 4 hours. The rabbits in the gentamicin + sevoflurane group were treated with IM gentamicin at a dosage of 10 mg/kg · d(-1) for 10 days. On day 11, they were exposed to sevoflurane, as described for the sevoflurane group. The control group received IM pH-balanced saline solution for the duration of the study. Twenty-four hours after treatment completion, all rabbits were euthanized and kidney tissue samples were obtained. Histopathologic examinations were then carried out using light microscopy. Changes in renal histopathology were based on the percentage of acute tubular necrosis (ATN) and judged on a scale from none to severe. RESULTS Forty male New Zealand white rabbits (mean [SD] age, 7 [0.49] months; mean [SD] weight, 2900 [150] g) were divided into 4 groups of 10 rabbits each. Proximal renal tubule cell injury in the form of ATN (the mean score) was significantly greater in the 3 treatment groups than in the control group (all, P < 0.001), especially at the corticomedullary junction. In the 3 treatment groups, the most severe renal damage observed was rated as mild (10%-25%). More rabbits in the gentamicin + sevoflurane group had mild renal damage (7) than in the gentamicin group (4) or the sevoflurane group (4), but the between-group differences were not statistically significant. CONCLUSION In this experimental study of the effects of sevoflurane on the severity of renal histopathologic changes, a higher percentage of rabbits were observed to have greater renal damage in the gentamicin + sevoflurane group than the other groups. However, between-group differences did not reach statistical significance.

TURP syndrome and severe hyponatremia under general anaesthesia

Transurethral resection of prostate (TURP) syndrome is a complication characterised by symptoms changing from an asymptomatic hyponatremic state to convulsions, coma and death due to absorption of irrigation fluid during TURP. The syndrome appears to be related to the amount of fluid that enters the circulation via the blood vessels in the resection area. The first step in the course of action for therapy is to control bleeding and suspend the operation. In the case presented, we aimed to emphasise the importance of an early diagnosis and treatment of TURP syndrome in a patient that developed hyponatremia (90 mmol/l) while under general anaesthesia during a TURP procedure. In addition, multiple cystoscopic applications in the same session may facilitate development of the TURP syndrome.

Effects of ondansetron and granisetron on postoperative nausea and vomiting in adult patients undergoing laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%. OBJECTIVE The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery. METHODS Patients classified by the American Society of Anesthesiologists physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours. RESULTS Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01). CONCLUSIONS Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.

The Effects of Two Different Anaesthesia Techniques on Bispectral Index Values and Awareness During Off-Pump Coronary Artery Bypass Grafting

Objective. The aim of this study was to evaluate Bispectral Index values and awareness during two different anaesthesia regimens (fentanyl-propofol and fentanyl-midazolam) in patients undergoing off-pump CABG surgery. Methods. Fifty patients were included in the study. Patients were premedicated with midazolam and were randomly divided into two groups. Anaesthesia was induced with fentanyl (7–15 μg/kg), with either propofol (2–2.5 mg/kg, Group I) or midazolam (0.1–0.3 mg/kg, Group II) and vecuronium (0.1 mg/kg). Anaesthesia was maintained with fentanyl (15 μg/kg/h) together with either propofol (6 mg/kg/h) or midazolam (0.1 mg/kg/h). Depth of anaesthesia was adjusted according to clinical signs and haemodynamic responses. The level of sedation was monitored with Bispectral index continuously, but these levels were not shown to the attending anaesthetist. Bispectral index values were recorded for nine phases. Twenty-four hours after the operation, the patients were interviewed to determine intraoperative awareness and recall. Results. In all patients, Bispectral index values were found to decrease after induction (in Group I, p = 0.005, in Group II, p = 0.008) with the mean values remaining below 60 for all phases. The differences between the groups were not statistically significant in inter-group comparison. No patients were noted to recall the sounds presented during the operation and the preoperative events. Conclusions. BIS monitoring with clinical signs may be used to assess the adequacy of both types of anaesthesia techniques as well as to detect awareness during off-pump CABG surgery.

Anesthesia and Intensive Care Management in a Pregnant Woman with PRES: A Case Report

Posterior reversible encephalopathy syndrome (PRES) is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed.

Comparison of anaesthetic cost in open and laparoscopic appendectomy.

CONTEXT Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia. AIMS This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopic appendectomy under general anesthesia. SETTINGS AND DESIGN The design is retrospective and records of 379 patients who underwent open or laparoscopic appendectomy under general anesthesia, falling under the category of I-III risk group according to the American Society of Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77. SUBJECTS AND METHODS Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesia were evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluated the anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar

Effects of preoperative oral carbohydrate solution intake on thermoregulation

) of anesthetic agents used (induction, maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspiration probe), and intravenously administered fluids were evaluated. STATISTICAL ANALYSIS USED We used Statistical Package for the Social Sciences software (SPSS version 17.0) for statistical analysis. RESULTS Of the patients, 237 were males (62.53%) and 142 were females (37.47%). Anesthesia time limits were established as 70.30 ± 30.23 minute in Group I and 74.92 ± 31.83 minute in Group II. Mean anesthesia administration cost per patient was found to be 78.79 ± 30.01₺ (39.16 ± 14.15

Comparison of patient‐controlled analgesia versus continuous infusion of tramadol in post‐cesarean section pain management

) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34

Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery

) in Group II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158). CONCLUSIONS Although a statistical difference was not established in this study in terms of time and costs in appendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditions of drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update and revise cost analyses from time to time.