Osman Nuri Aydin

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.

Patient-controlled analgesia and sedation with fentanyl in phacoemulsification under topical anesthesia

Purpose: To investigate the effects of intravenous (IV) patient‐controlled sedation/analgesia with fentanyl during phacoemulsification surgery under topical anesthesia. Setting: Adnan Menderes University Medical School, Departments of Ophthalmology and Anesthesiology and Reanimation, Aydin, Turkey. Methods: In this double‐blind randomized study, 68 patients were randomly allocated to 2 groups. In the fentanyl group comprising 34 patients, fentanyl was administered by patient‐controlled analgesia (PCA) equipment in 5 &mgr;g bolus doses with a lockout period of 5 minutes after an IV loading dose of 0.7 &mgr;g/kg in 2 mL balanced salt solution. In the control group comprising 34 patients, a balanced salt solution was given without an analgesic drug by PCA equipment. Verbal pain scale (VPS) and sedation scores were recorded preoperatively and 5, 10, 15, 20, and 30 minutes after the start of surgery. Patient comfort and surgeon satisfaction were assessed postoperatively. Results: The sedation score was higher in the fentanyl group than in the control group at 5 and 10 minutes (P = .006 and P = .012, respectively). The VPS scores were higher in the control group than in the fentanyl group at 15 and 20 minutes (P = .02 and P = .016, respectively). Patients pressed the button for additional analgesia 2.6 times ± 3.9 (SD) in the control group and 0.9 ± 1.6 times in the fentanyl group (P = .025). Patient and surgeon satisfaction were higher in the fentanyl group than the control group (P = .023 and P = .018, respectively). Conclusion: The results of this study suggest that IV PCA with fentanyl has supplemental effects on analgesia and sedation during cataract surgery under topical anesthesia and increases patient comfort and surgeon satisfaction.

Infantile Amyand's hernia.

The finding of an uninflamed appendix within an inguinal hernia is estimated to be found in approximately 1% of adult inguinal hernia repairs. 1,2 A normal appendix in an inguinal hernia sac is three times more likely to occur in infants than in adults. 3 Acute or perforated appendicitis occurring within an inguinal hernia is a rare event and is known as ‘Amyand’s Hernia’. 1,2,4,5 The first case was reported in 1735 by the surgeon Claudius Amyand. 5 Amyand’s hernia is almost never diagnosed prior to surgery. 1 We present an infant whose appendicitis was found within the inguinal hernia sac in operation, which was performed eight hours following manual reduction of his incarcerated inguinal hernia.

The antinociceptive effects of systemic administration of tramadol, gabapentin and their combination on mice model of acute pain.

OBJECTIVES The aim of the present study was to investigate the possible antinociceptive effects of systemic administration of tramadol and gabapentin either alone or in combination on acute pain models in mice. METHODS After obtaining the approval of Animal Ethics Committee; 96 BALB/c albino male mice were divided into 12 groups: (I) control without injection, (II) control treated with saline, (III)-(IV) mice treated with tramadol 10 mg/kg or 30 mg/kg, (V)-(VIII) mice treated with gabapentin; 30, 100, 200, 300 mg/kg respectively. In order to determine possible interactions between tramadol gabapentin and; mice received four different combinations of tramadol + gabapentin (30+30, 30+100, 30+200 and 30+300 mg/kg) (Groups IX-XII respectively). Mice received 0.1 ml solution for every 10 g of their weight. The drug was injected into peritonea. Thirty minutes after the drug injection, tail-flick and hot-plate tests were conducted. RESULTS Ten and 30 mg/kg tramadol produced dose dependent antinociceptive effect in tail-flick and hot plate tests. Gabapentin had no antinociceptive effect in the tail flick test except 300 mg/kg dose, and had dose dependent antinociceptive effect in hot-plate test. In both tests, various combinations of tramadol and gabapentin produced an antinociceptive effect that is greater than that produced by tramadol and gabapentin alone. But, just 30 mg/kg tramadol + 300 mg/kg gabapentin combination caused statistically significant increase in both tests (p<0.05). CONCLUSION When gabapentin and tramadol were used in combination, gabapentin had no additive antinociceptive effect except for 300 mg/kg in tail-flick and hot-plate tests. Tail-flick test showed that tramadol produced better antinociceptive effect than gabapentin.

Complication belong to stellate ganglion blockade after cervical trauma

Stellate ganglion block (SGB) is one of the most often used sympathetic blockade procedure. Despite performed by experienced physicians some complications may occur. The right brachial plexus injury was diagnosed in the patient who admitted to orthopedia clinic, with weakness in the right arm, and pain after motor vehicle accident. There was no response to medical treatment of fortyfour-years-old female patient and there was loosing of sensation from dis the right elbow joint to fingers on the radial and median nerve tracing. In the electromyelography; C5-T1 root avulsion, and MRI; Patient was evaluated as CPRS I (Complex regional pain syndrome) phase 1. In spite of medical treatment, SGB was performed. Respiratory arrest occurred 4-5 minutes after injection. Patient was breated with mechanical ventilator during 2 hours, and discharged 24 hours later with normal vital functions. One year later, the patient admitted the algology polyclinic with strong pain in the same area. Stellate ganglion Radyofreguency (RF) was planned. The first RF cannula was placed under fluoroscopy. Cerebrospinal fluid was seen in the second canula, and canula was withdrawn. Third cannula was placed in another region, and conventional RF was performed through two canuls. For anatomical structure defect, we planned cervical MR myelography. In the cervical MR myelography, traumatic pseudomeningocele was observed at the level of C6-T1 on the brachial plexus. Intraspinal block was thought to develop during blockade of stellate ganglion due to this.

Effect of statin use on pain relief by transforaminal epidural steroid injection

Aim To investigate the impact of statin use on response to fluoroscopy-assisted transforaminal anterior epidural steroid injection (TAESI). Methods Patients undergoing TAESI for low back pain were recruited and stratified according to statin use. Pain was evaluated with a visual analogue scale (VAS) before and at 1, 3, and 6 months after TAESI. Health-related quality-of-life was evaluated using the Short Form 36 (SF-36) questionnaire 6 months after TAESI. Results There were no significant differences in VAS scores after TAESI between statin users (n = 40) and statin nonusers (n = 253). The SF-36 subgroup: role limitations due to emotional problems score was significantly lower in statin users than statin nonusers. There were no significant between-group differences in any other SF-36 parameter. Conclusion Statin use had no effect on pain scores after TAESI.

Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection?

To compare the efficacy of intra‐articular injection and radiofrequency (RF) neurotomy of genicular nerves in patients with chronic knee osteoarthritis (OA) pain.

397 THE EFFECTS OF GABAPENTIN COMBINED WITH NITROGLYCERINE TO THE LIVER, KIDNEY, AND NERVE REGENERATION OF RATS

395 SIMILAR NERVE INJURY MODELS MAY DISPLAY DIFFERENT BEHAVIORAL CHANGES IN RATS N. Sasaki *, S. Konno, K. Olmarker. Orthopaedic Surgery, Minamisouma City General Hospital, Minamisouma, Japan; Department Orthopaedic Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan; Department of Medical chemistry and Cellbiology, Inst Biomedicine, University of Gothenburg, Gothenburg, Sweden

A influência do ciclo menstrual na dor aguda e persistente após colecistectomia laparoscópica

BACKGROUND AND OBJECTIVES Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. METHODS 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4h in the first 24h. Adverse effects were questioned every 4h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. RESULTS There was no difference in acute pain scores and analgesic consumption through the 24h period, Visual Analog Scale at 24h was 1.5±1.5cm for follicular group 1.4±1.7cm for luteal group (p=0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6±0.7cm and 1.8±0.8cm for follicular group and 2.7±1.3cm and 2.9±1.7cm in the luteal group (p=0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p=0.01) and oral feeding time was shorter in follicular phase (5.9±0.9h) than in luteal phase (6.8±1.9h, p=0.02). CONCLUSIONS Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.

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.