Mustafa Oğurlu

Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study.

AbstractBackground and objective: Predicting the haemodynamic changes that may result in myocardial ischaemia for patients undergoing laryngoscopy and tracheal intubation will help to avoid events that trigger ischaemia and allow immediate treatment. The objective of this study was to compare the effects of esmolol with those of lidocaine (lignocaine) and fentanyl on prevention of tachycardia and hypertension caused by endotracheal intubation. Methods: This was a prospective, randomised, double-blind study. The study was conducted at the Adnan Menderes University Hospital in Aydin, Turkey and involved 120 patients of American Society of Anesthesiologists physical status I or II aged 20–50 years. The patients were randomised into four equal groups. The control group (group C) received dextrose 5% 5mL, the esmolol group (group E) received esmolol 1.5 mg/kg, the fentanyl group (group F) received fentanyl 1 µg/kg and the lidocaine group (group L) received lidocaine 1.5 mg/kg 2 minutes before endotracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were recorded before and after induction of anaesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. Results: Compared with control, HR decreased significantly in group E after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). In group F there was an increase in MAP immediately after intubation, but the increase was less than in other groups. Compared with control, RPP decreased significantly in groups E and F after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). RPP was significantly lower in group E than in controls and group L 3 minutes after intubation (p < 0.0083), and it was significantly lower in group F than in controls 10 minutes after intubation (p < 0.0083). Conclusion: It can be concluded that administration of esmolol 1.5 mg/kg 2 minutes before intubation prevents tachycardia and an increase in RPP caused by laryngoscopy and tracheal intubation, and can be beneficial when administered before laryngoscopy and tracheal intubation in patients with tachycardia.

The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia

We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 μg NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 ± 1.1 versus 4.5 ± 1.2 min; P = 0.01 and 3.3 ± 1.6 versus 5.2 ± 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 ± 1.6 versus 3.1 ± 1.2 min P < 0.0001 and 7.3 ± 1.3 versus 3.6 ± 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 ± 74 min versus 39 ± 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.

Pressure-Controlled vs Volume-Controlled Ventilation During Laparoscopic Gynecologic Surgery

STUDY OBJECTIVE To quantify and compare the effects of conventional volume-controlled ventilation (VCV) with the alternative mode, pressure-controlled ventilation (PCV), on respiratory mechanics and noninvasive hemodynamic parameters in patients undergoing laparoscopic gynecologic surgery. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Respiratory mechanics and hemodynamic parameters were recorded for each patient at time T1, 10 minutes after induction, in the supine position; T2, 15 minutes after pneumoperitoneum, in the Trendelenburg position; and T3, 10 minutes after pneumoperitoneum withdrawal, in the supine position. PATIENTS Sixty women, aged 20 to 50 years, undergoing laparoscopic gynecologic surgery, with American Society of Anesthesiologists classes I and II disease. INTERVENTIONS Patients were randomly allocated to 1 of 2 groups. In the VCV group (n = 30), ventilation mode was maintained, whereas in the PCV group (n = 30), ventilation mode was changed to PVC. MEASUREMENTS AND MAIN RESULTS Both groups were comparable insofar as patient characteristics, operating time, pneumoperitoneum time, anesthesia time, and mean operative time. VCV was associated with a significant increase in peak airway pressure, plateau pressure, and airway resistance at T2 (p < .05). Compliance was significantly higher in the PCV group at T2 (p < .05). No other statistically significant differences were found between the groups. CONCLUSIONS Both VCV and PCV seem to be equally suited for use in patients undergoing laparoscopic gynecologic surgery. However, lower peak airway pressure, plateau pressure, and airway resistance, and higher compliance are observed with PCV in laparoscopic gynecologic surgery.

Topical Heparin: A Promising Agent for the Prevention of Tracheal Stenosis in Airway Surgery

BACKGROUND The protective effects of topical mitomycin-C (MMC) have been well documented for tracheal stenosis; however, to the best of our knowledge, the use of heparin as an anti-inflammatory agent to support wound healing in upper airway surgery was not studied before. The aim of this study was to investigate the efficacy of topical heparin for healing of tracheal re-implants in a rabbits model and its resultant histological changes compared with that of MMC. METHODS In a rabbit model (n = 21), an elliptically shaped portion of the anterior tracheal wall was excised (3-4 tracheal cartilages) under anesthesia and immersed in an isotonic saline solution containing 0.4 mg/mL (0.04%) MMC (n = 7), heparin (liquemine) 5000 U/mL (n = 7), or none (n = 7) for 2 min and then re-implanted. The follow-up period was 2 wk for all animals and then both the larynx and the trachea were excised for histological evaluation. Hematoxylin-eosin (H and E) staining was applied to the excised tissues for microscopic evaluation. RESULTS Compared with controls, the granulation tissue formation score in MMC group (P = 0.03), and epithelial regeneration and inflammation scores in heparin group (P = 0.032 and P = 0.022, respectively) were more favorable. The fibrosis index and tracheal lumen ratio values were also more favorable in both MMC (P = 0.019 and P = 0.0028, respectively) and heparin (P = 0.023 and P = 0.0021, respectively) groups compared with controls on the 15th d. CONCLUSIONS Topical heparin application may have favorable effects on healing of tracheal autografts in a rabbit model. We suggest that heparin therapy should be further researched for the prevention of tracheal stenosis in airway surgery.

Effects of Sevoflurane on QT Dispersion and Heart Rate Variability

The purpose of this study was to use estimates of corrected QT dispersion (QTcd) and heart rate variability (HRV) to assess the effects of sevoflurane, an inhalation agent used frequently in clinical practice, on autonomic cardiac function. This study was conducted prospectively and in a blind manner on 20 women between 38 and 51 y of age who were classified as American Society of Anesthesiologists stage I–II and whose treatment required total abdominal hysterectomy. Electrocardiograms were recorded by 12-lead Holter monitor for 5 min before sevoflurane induction and again for 5 min at 10 min after tracheal intubation. Data on the first recording were considered as baseline; those on the second recording were viewed as final data. The study was terminated at this point, and surgery was allowed to proceed. QTcd and HRV values were assessed by a cardiologist, who was blinded to all data. All parameters were expressed as a mean value ± standard deviation. Wilcoxon’s test was used to compare baseline and final data. Statistical significance was considered asP< .05. No significant changes were observed between baseline and final QTcd values and between low and high-frequency components (LF and HF) of HRV; nor were changes seen in the LF/HF ratio. With the patient under sevoflurane/nitrous oxide anesthesia, no significant changes were detected in QTcd, LF, and HF values, and in the LF/HF ratio, whereas a significant increase (P=.001) was seen in standard deviation of the R-R interval, which was used as a measure of cardiac autonomic tone.

Ropivacaine versus lidocaine for deep‐topical, nerve‐block anaesthesia in cataract surgery: a double‐blind randomized clinical trial

Purpose:  To evaluate the safety and efficacy of ropivacaine versus lidocaine for deep‐topical, nerve‐block anaesthesia in cataract surgery.

Effect of headphones on sevoflurane requirement for MRI

BackgroundAcoustic noise may have adverse effects, even in patients under general anesthetic.ObjectiveWe aimed to determine the effect of headphones on sevoflurane requirements in children undergoing general anesthesia for an MRI scan.Materials and methodsChildren scheduled for MRI were enrolled in the study. Sevoflurane was used for general anesthesia in all children. Patients were randomly divided into two groups, one to wear headphones and the other none. After reaching a predetermined end-tidal concentration, the MRI scan was initiated, and the patient was evaluated by an observer blinded to the concentration of sevoflurane. Awakening was defined as eye opening, onset of continued purposeful movement or phonation. Using the Dixon up-and-down method, each target concentration was determined by the response of the previous child in the same group.ResultsThe study included 28 children undergoing MRI. There was a significant difference in ED50 between the two groups (0.92, 0.81–1.02, vs. 0.47, 0.42–0.63; P < 0.001). The times to spontaneous arm and leg movements, eye opening and discharge from the post-anesthesia care unit were significantly shorter in patients with headphones than in those without (P < 0.001). However, there was no difference in times to hospital discharge (P = 0.056).ConclusionNoise-concealing headphones decrease inhalational anesthetic requirements and facilitate recovery. We recommend the routine use of headphones in children undergoing an MRI scan.

Comparing the administration of fentanyl 1 µg kg−1 and fentanyl 0.5 µg kg−1 in dilation and curettage procedures

Purpose: This study was carried out to compare fentanyl 0.5 µg kg−1−propofol as opposed to fentanyl 1 µg kg−1−propofol in terms of providing adequate analgesia, and a comparable recovery profile in dilation and curettage (D&C) procedures. Methods: Verbal Pain Scale (VPS) scores, modified Aldrete scores, and hemodynamic parameters were recorded during and after the surgical procedure. In addition, a record was also kept of adverse events, and patients and surgeons were questioned about their satisfaction with the anesthesia. Results: No difference was found between the two groups in terms of hemodynamic parameters, the VPS scores, or patient and surgeon satisfaction. The fentanyl 0.5 µg group displayed significantly higher modified Aldrete scores at both 5- and 10-min postoperative. Adverse events in both groups were considerably few. The incidence of postoperative nausea and vomiting (PONV) in the fentanyl 0.5 µg group was lower eventhough it did not reach the statistically significance level. In addition, faster recovery times were recorded with the administration of fentanyl 0.5 µg kg−1. Conclusion: Fentanyl 0.5 µg kg−1 appears to be as reliable as that of fentanyl 1 µg kg−1 with faster recovery times when used in D&C procedures.

The Efficacy of Tramadol Combined with A Donor of NO, Glyceryl Trinitrate (GTN) Mixture on Cytokines, NF-KB Expression and Oxidative Stress Marker in the Rat Model of Formalin Induced Inflammation

In addition to well-known analgesic action of tramadol, its potential antinflammatory effects have not been thoroughly evaluated. On the other hand, effectiveness of antioxidants is also reported against inflammation. It is known that glyceryl trinitrate, as a Research Article British Journal of Medicine & Medical Research, 3(4): 1988-1998, 2013 1989 nitric oxide donor, enhance the antioxidative and anti-inflammatory effects. In the present study, the efficacy of the tramadol mixtue with glyceryl trinitrate on cytokines, NF-kappa B expression and oxidative stress marker was examined on the formalin-induced inflammation in rats (Tramadol 5, 10 and 30 mg/kg + nitroglycerine 1 mg/kg). Cytokines (TNF-, IL-6 and IL-10) and oxidative/anti-oxidative stress markers (MDA, GSH) were measured in blood samples. NF-kappa B expression was assessed immunohistochemically in spleen and thymus. The results show that tramadol 30 mg/kg has both anti-inflammatory and anti-oxidative effects. Additionally, it was evidenced that glyceryl trinitrate improves the antiinflammatory and anti-oxidative effects of Tramadol (30 mg/kg) on the formalin-induced inflammation in rats. In this framework, the present study provides a unique approach for the analysis of the efficacy of tramadol and additive effects of glyceryl trinitrate on the acute inflammations in rats.

366 THE EFFECTS OF TRAMADOL AND COMBINATION OF NITRIC OXIDE WITH TRAMADOL ON ACUTE INFLAMMATORY PAIN IN RATS

plantar hindpaw to determine a withdrawal force threshold. COX expression in spinal cord was compared among groups of mice using reverse transcriptase polymerase chain reaction (RT-PCR). Results: Before carrageenan injection, there was no difference in withdrawal to von Frey filaments among the 5 mice groups. After injection, mechanical hyperalgesia was greatest (p < 0.05) in COX-2 (−/−) mice compared to any other group, while wild mice had the least mechanical hyperalgesia of any group. RT-PCR analysis of spinal cords did not reveal any compensatory expression of the COX genes. Conclusions: Mechanical withdrawal thresholds following carrageenan injection is decreased in COX-1 or -2 deficient mice compared with control wild mice. This may be due to factors other than reciprocal COX compensation in the spinal cord.