Orhan Tokgöz

The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in rats.

AIM To investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury. METHODS Forty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 μg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups. RESULTS According to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs. CONCLUSION This study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver.

Protective Effects of Beta Glucan and Gliclazide on Brain Tissue and Sciatic Nerve of Diabetic Rats Induced by Streptozosin

There have not been yet enough studies about effects of beta glucan and gliclazide on oxidative stress created by streptozotocin in the brain and sciatic nerve of diabetic rats. The aim of this paper was to investigate the antioxidant effects of gliclazide and beta glucan on oxidative stress and lipid peroxidation created by streptozotosin in brain and sciatic nerve. Total of 42 rats were divided into 6 groups including control, diabetic untreated (DM) (only STZ, diabetic), STZ (DM) + beta glucan, STZ (DM) + gliclazide, only beta glucan treated (no diabetic), and only gliclazide treated (no diabetic). The brain and sciatic nerve tissue samples were analyzed for malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase (PON-1) levels. We found a significant increase in MDA, TOS, and OSI along with a reduction in TAS level, catalase, and PON-1 activities in brain and sciatic nerve of streptozotocin-induced diabetic rats. Also, this study shows that in terms of these parameters both gliclazide and beta glucan have a neuroprotective effect on the brain and sciatic nerve of the streptozotocin-induced diabetic rat. Our conclusion was that gliclazide and beta glucan have antioxidant effects on the brain and sciatic nerve of the streptozotocin-induced diabetic rat.

Cooled radiofrequency application for treatment of sacroiliac joint pain

BackgroundThe unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation.MethodsPatients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients’ pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI).ResultsCooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7–9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1–4), 2 (1–3) and 3 (2–4). The baseline median ODI score (interquartile range) was 36 (32–38), while at the 1st, 3rd and 6th month, it was 16 (8–20), 12 (9–18) and 14 (10–20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores.ConclusionIt was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.

Thymoquinone treatment against acetaminophen-induced hepatotoxicity in rats

AIM In this study, we aimed to examine the efficacy of thymoquinone (TQ) treatment in acetaminophen-induced liver toxicity in rats. METHODS Forty Wistar Albino rats were used for the study (four groups, with 10 rats for each group). Animals in the control group were not given any medication. In the thymoquinone (TQ) group, animals were given three times 5 mg/kg oral thymoquinone for every six hours, which equals to a total dose of 15 mg/kg. In the acetaminophen (APAP) group, animals were given APAP at a single dose of 500 mg/kg orally. In the APAP + TQ group, animals were given 500 mg/kg APAP orally followed by three doses of TQ at a 15 mg/kg total dose in an 18-h time interval. All animals were sacrificed at the 24th hour. Alanine amino transferase (ALT), aspartat amino transferase (AST), superoxide dismutase (SOD), oxidized glutathione (GSSG), glutathione peroxides (GSH-Px), and malondialdehyde (MDA) activities were measured in rat blood. Histopathological examination was also performed. RESULTS Serum ALT, AST levels, GSSG, and SOD activity as well as the serum and tissue MDA levels were found to be higher in the APAP group than in the control group (p ≤ 0.001). Likewise, serum GSH-Px activity was found to be lower in the APAP group (p ≤ 0.001). In contrast, in the APAP + TQ group, serum ALT, AST levels, GSSG, SOD activity and the serum and tissue MDA levels were found to be lower compared to that of the APAP group. This difference was statistically significant (p ≤ 0.001). In the APAP + TQ group, the GSH-Px activity was found to be significantly higher compared to the APAP group (p < 0.05). In contrast to this finding, the GSH-Px activity in the APAP + TQ group was found to be lower than that of the control group (p ≤ 0.001). Histopathological analysis revealed significant liver necrosis and toxicity with a high dose of APAP where TQ treatment was related with significantly lower liver injury scores. CONCLUSION TQ treatment may have an important therapeuthic effect via the upregulation of antioxidant systems in the APAP-induced liver hepatotoxicity in rats.

The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury

BACKGROUND The purpose of this study is the investigation of the effects of intrathecally injected dexmedetomidine and methylprednisolone and their dominancy over one another in rats with generated Spinal Cord Injury (SCI). METHODS 40, female, adult Wistar Albino rats weighing 220-260 g were included in the study. The rats were fixed with Intrathecal catheter (IT) and divided into four groups. All subjects were applied T7-10 laminectomy after catheter. Group S (n:10) was injected with IT 10 μL isotonic saline; Group C (n:10) with IT 10 μL isotonic saline after SCI; Group D (n:10) with IT one doze 10 μL of dexmedetomidine after SCI; Group M (n:10) IT one dose 10 μL of methylprednisolone. The subjects were sacrificed 72 h after this operation. The damaged area was removed biochemically and histopathologically examined. RESULTS Antioxidant and inflammatory parameters searched for in all damages tissue were statistically different in all groups from group S. They were different in group M and group D than group C (p < 0.001). After the comparison of group D and group M, PON and IL6 values were higher in group D (p = 0.003, p = 0.035) while the other two biochemical parameters were similar in both groups (Table 1). After histopathologic trials, edemas, bleeding and necrosis were found less in group S while at the most in group C (p < 0.001). In group M and group D, however, they were higher than group S and lower than group C (p < 0.001). After the comparison of group D and group M, while there was no difference in terms of edema necrosis, the amount of bleeding was lower in group D (p < 0.001) (Table 2). CONCLUSIONS It has been discovered that intrathecal use of dexmedetomidine caused neuroprotective effects similar to methylprednisolone.

The effect of I-gel™ airway on intraocular pressure in pediatric patients who received sevoflurane or desflurane during strabismus surgery

Objectives:  The aim of this study was to investigate the effect of I‐gelTM laryngeal mask airway on intraocular pressure (IOP) in children with strabismus undergoing balanced anesthesia with sevoflurane or desflurane.

The effect of propofol lipuro with and without lidocaine on injection pain in children.

OBJECTIVE Despite advantages of propofol use such as providing a good anesthesia and rapid recovery; pain due to intravenous propofol injection continues to be a problem. The aim of this study was to compare the effects of generic propofol and propofol lipuro with and without lidocaine on injection pain in children. MATERIALS AND METHODS This study performed between 01 December 2009 and 16 May 2010. A total of 120 children, who planned to undergo elective surgery under general anesthesia, were included in four groups of 30 in a prospectively, randomized and double-blind study. Generic propofol was given to first and second groups and propofol lipuro was given to third and fourth groups. In addition to propofol, lidocaine was given to second and fourth groups. Injection pain was assessed using Ontario Childrens Hospital Pain Scale (mCHEOPS). RESULTS No differences were found in the mean age, weight and given dose of propofol administered between all groups (P>0.05). Double comparison of groups revealed no significant difference in pain scores between Group 1 and 2 (mean pain scores, 1.34 ± 1.42 vs. 1.22 ± 1.31 points, respectively; P>0.05). However, significant difference was found between propofol lipuro groups with or without lidocaine (3.20 ± 2.10 vs. 0.95 ± 1.21 points, respectively; P<0.001). CONCLUSION The highest pain scores were found in the propofol lipuro without lidocaine use while propofol lipuro plus lidocaine had the lowest pain scores. Because adding lidocaine to propofol lipuro decreased injection pain scores to minimum levels, this practice seems to be the most appropriate alternative in order to diminish propofol injection pain during anesthesia in children.

Inhalation Anesthesia with Sevoflurane during Intravitreal Bevacizumab Injection in Infants with Retinopathy of Prematurity

Bacground. To investigate the anesthetic management in premature infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) injections. Methods. A retrospective chart review was performed for the patients with ROP who had IVB injection. Clinical characteristics, demographic variables, anesthetic medications, operation techniques, time intervals, and complications were recorded. Results. Sixty-six eyes of 33 patients (23 males, 10 females) with type 1 ROP who were treated with IVB were included. A total of 66 anesthetic applications were performed. Mean gestational age at birth was 28.3 weeks (range 25–33). Mean birth weight was 1300 g (range 600–1850). Serious ocular and systemic complications were not observed in any infant. Conclusion. Inhalation anesthesia with sevoflurane during IVB treatment in premature infants with ROP may be appropriate for anesthetic management.

Apendektomi operasyonlarında iki farklı intratekal levobupivakain dozunun etkinliğinin karşılaştırılması

Objectives: Spinal anesthesia, especially in the presence of coexisting diseases is preferred to reduce morbidity and mortality in many surgical practices. In this study, we aimed to compare the motor and sensory block characteristics, hemodynamic parameters, side effects and surgical and patient comfort, whom underwent appendectomy with spinal anesthesia in two different doses of levobupivacaine. Material and methods: After Minister of Health ethical committee approval and written consent of the patients who underwent open appendectomy were obtained, fifhty patients between the ages of 18-40 with ASA I-II were enrolled in this study. The patients were randomly allocated to two groups; Group I received 15 mg levobupivacaine 0.5% (total 3 ml) and Group II received 20 mg levobupivacaine 0.5% (total 4 ml Hemodynamic data, surgical and patient comfort and side effects were also recorded. Results: There were statistically significant differences between the two groups for two segment regression time of sensory block. Two-segment regression time was longer the Group II than Group I. In Group II motor block regression time (Group I 120 ± 40 min, Group II 158 ± 54 min) was significantly longer (p= p<0.05). There were statistically significant difference in numbers of side ef fects (hypotension, bradicardia) in Group II than Group I (p<0.05). Conclusions: This study showed that 15 mg levobupivacaine dose provides safe and effective anesthesia for appendectomy surgery. J Clin Exp Invest 2012; 3(1): 33-37 OZET

Evaluation of retrograde intubation in patients with limited mouth opening

To the Editor: Tracheal intubation may be difficult due to limited mouth opening or other anatomical abnormalities. Fiberoptic-assisted nasotracheal intubation is the technique of choice in such cases, but a fiberoptic bronchoscope is not always available, especially in hospitals situated in rural areas. We retrospectively investigated the advantages/disadvantages of retrograde intubation in patients with limited mouth opening by evaluating the hospital records of 28 consecutive patients who had undergone retrograde intubation. The success rate, procedure time, number of attempts, and frequency of complications were recorded. A signed consent form was obtained from each patient for all surgical and anesthesia applications. The institutional ethics committee approved the study. In our study, retrograde intubation was performed as described previously [1] in 28 patients (17 male and 11 female, mean age 27 ± 5 years). The mean body mass index was 24 ± 4. Twenty-one patients had temporomandibular joint ankylosis, and seven patients had maxillamandibular fracture. Mean time for retrograde intubation was 3.9 min. Overall success rate was 100 % and success rate of the first attempt was 67.9 %. In three patients, we performed tracheal puncture with a needle on the second attempt. If the guidewire was placed intraorally, it was withdrawn to the oropharanx position and then repositioned to the nasopharanx. In 11 (39.3 %) and 12 (42.9 %) patients, the guidewire was grasped successfully on the first and second attempt, respectively. An endotracheal tube was placed into the trachea on the first attempt in 19 (67.9 %) patients; a second attempt was performed in seven patients. The total procedure time was\5 min in 25 (82.1 %) patients. There was no episode of hypoxemia (pulse oxygen saturation \93 %) during intubation. We found no other evidence of esophagus or airway trauma, nor of serious epistaxis. Minimal bleeding into the trachea was observed in three patients. Additionally, sore throat was present in seven patients on the second-day control after the operation. No other complications were observed during and after the procedures. Retrograde tracheal intubation is a simple and quick procedure when performed by experienced practitioners and may be reliably used in patients with limited mouth opening, including facial trauma and temporomandibular joint ankylosis. Compared to fiberoptic bronchoscope-guided intubation, retrograde tracheal intubation has its advantages and disadvantages. It is a slightly invasive procedure with a number of potential complications, such as tracheoesophageal fistula, vocal cord damage, and bleeding [2]. The advantages of retrograde intubation over fiberoptic bronchoscope-guided intubation include its possible applicability when blood or secretions are present in the upper airway and in patients with an immobilized neck, shorter procedural duration, and a lower risk of subglottic edema and stenosis [3]. In the absence of fiberoptic bronchoscope, blind nasal intubation is another method for endotracheal intubation, but in patients with severe flexion A. Tufek (&) O. Tokgoz F. Celik Department of Anesthesiology, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey e-mail: adnantufek@hotmail.com