Seval Izdes

The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy.

We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to determine whether there is a role of inflammation in the analgesic efficacy of intraarticular piroxicam. Standardized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxicam 20 mg. After microscopic examination of the synovial materials, the patients were divided into two subgroups, inflammation positive (I+) and inflammation negative (I−). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and postoperative analgesic consumption were recorded. Analgesic duration was significantly longer in the I+ subgroup than the I− subgroup of Group 3 (P < 0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I− subgroup of Group 3 (P < 0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of intraarticular piroxicam.

Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients.

OBJECTIVES The aim of this prospective randomized, double-blind study was to evaluate the analgesic efficacy and opioid-sparing effects of preemptive single dose of dexketoprofen trometamol in comparison with that of paracetamol or placebo for elective lumbar disc surgery, over a 24-hour (h) investigation period. METHODS After institutional approval and informed consent had been obtained, 75 patients scheduled for single level lumbar disc surgery were randomly allocated into three equal groups. Patients received oral dexketoprofen 25 mg (Group D), 500 mg paracetamol (Group P) or placebo tablets (Group C) 30 minutes (min) before induction of standard anesthesia. Patient-controlled analgesia was supplied postoperatively using morphine. Hemodynamics, visual analogue scale (VAS), sedation score, morphine consumption, and side effects were recorded every 15 min in the first hour and at 2, 6 and 24 h after surgery. RESULTS The mean pain scores were similar among groups (p>0.05). The cumulative (SD) 24-h morphine consumption was 28.1 mg, 40.6 mg, and 43.6 mg for Groups D, P and C, respectively. The amount of morphine use at 2, 6 and 24 h was significantly lower in Group D (p<0.006). Hemodynamic parameters, sedation scores and side effects did not differ among the groups (p>0.05). CONCLUSION The study demonstrated that preemptive dexketoprofen trometamol 25 mg is associated with a decrease of up to 35% in morphine consumption compared with placebo over the first 24 h following lumbar disc surgery; however, paracetamol 500 mg did not show the expected opioid-sparing effect comparatively.

Response to Delayed Fluid Therapy in Crush Syndrome

Background: Although early treatment is valuable in the prognosis of crush syndrome, the diagnosis and treatment of many victims are inevitably delayed in major disasters. Patients and Methods: Among the 38 victims of the Marmara earthquake with crush injury, 27 were diagnosed as crush syndrome on the basis of findings of acute renal failure. Intensive intravenous fluid treatment was started in all patients on admission. Of these 27 patients, 10 required dialysis treatment while 17 did not. The laboratory data on admission were evaluated and compared between the two groups. Results: The mean admission time of 27 patients was 46.5 ± (SE) 3.08 h. There was no significant difference between the dialysis and the nondialysis groups with regard to patient’s age, trapped time or admission time. A significantly higher number of patients had crush injury in more than one extremity in the dialysis group. The dialysis group had significantly lower systolic blood pressure, central venous pressure but a higher heart rate together with higher levels of serum urea nitrogen, creatinine, creatinine kinase, C-reactive protein, fibrinogen on admission compared to the nondialysis group. Conclusion: Our results suggest that even delayed application of aggressive specific fluid treatment under close monitoring may prevent the development of established acute renal failure.

Comparison of the Effects of Bupivacaine and Levobupivacaine Used in Spinal Anesthesia on Propofol Requirement in BIS Guided Sedation

Objective: This study was designed to compare the effects of equivalent doses of bupivacaine and levobupivacaine on propofol requirement in BIS guided sedation under spinal anesthesia. Material and Methods: Spinal anesthesia was performed on seventy patients scheduled for elective lower limb surgery with 3 mL’s of either isobaric bupivacaine (Group B) or plain levobupivacaine (Group L). Five minutes after induction of spinal anesthesia, propofol infusion was started at 100 μg/kg/min and titrated to maintain bispectral index (BIS) score in the range of 65-75. Onset (to reach BIS ≤ 75) and recovery (the time from cessation of propofol infusion until BIS=90) time for sedation, and total propofol consumption during this time interval were recorded as well as time to recovery from sensory and motor block, length of stay (LOS) and sedation scores (OAA/S) in the postanesthesia care unit (PACU). Data were analyzed with One way ANOVA, Mann Whitney-U, Student’s t and x tests. Results: BIS was significantly decreased in Group B compared to Group L at 10 and 15 min after spinal anesthesia (p<0.01). The maximum sensory block level was higher, while time to reach maximum motor block level was shorter in Group B (p<0.05, p<0.001 respectively). Offset time of sensory and motor block, recovery time and LOS in PACU were significantly increased in Group L (p<0.05). Conclusion: Plain bupivacaine provides higher sensory block with faster onset of motor block, independent of propofol requirement as assessed by BIS monitorization.

Insecticide contamination as a cause of food related illness

2. Spiller HA, Udicious TM, & Muir S: Angiotensin converting enzyme inhibitor ingestion in children. J Toxicol Clin Toxicol 1989; 27:345–353. 3. Lau CP: Attempted suicide with enalapril. N Engl J Med 1986; 315:197. 4. Lechleitner P, Dzien A, & Haring C: Uneventful self poisoning with a very high dose of captopril. Toxicology 1990; 64:325–329. 5. Stanton A, Jensen C, Nussberger J, Obrien E. Blood Pressure lowering in Essential Hypertension with an Oral Renin Inhibitor, Aliskiren. Hypertension 2003; 42:1137–1143. 6. Framme J, Dangardt F, Marild S, Osika W, Wahrborg P, Friberg P. 24-H systolic blood pressure and heart rate recordings in lean and obese adolescents. Clin Physiol Funct Imaging 2006; 26:235–239. 7. Harshfield GA, Wilson ME, Treiber FA, Alpert BS. A comparison of ambulatory blood pressure patterns across populations. Blood Press Monit 2002; 7:265–269. 8. Harshfield GA, Treiber FA, Wilson, Kapulu, Davis HC. A longitudinal study of ethnic deferences in ambulatory blood pressure patterns in youth. Amer J Hypertens 2002; 15:525–530.

Can Sevoflurane Induce Micronuclei Formation in Nasal Epithelial Cells of Adult Patients

Objective Volatile anaesthetics can inhibit the bronchociliary clearence in a dose- and time-dependend way. Moreover, they can have potential mutagenic/carcinogenic effects under chronic exposure. A genotoxicity test -micronuclei assay- was carried out in nasal epithelial cells to analyze the genotoxic effect of sevoflurane in adult patients undergoing general anesthesia. Methods In this study, micronucleus (MN) assay was conducted using nasal epithelial cells of 37 adult patients (age, 18-65 years) who underwent elective, minor, short surgical procedures under general anaesthesia with sevoflurane. Anaesthesia was induced and maintained using 8% sevoflurane (in 6 L min-1 of oxygen) and an inspired concentration of 2% in O2-air mixture, respectively. Nasal epithelial samples were collected at three time points: before anaesthesia induction (T1), after recovery from anaesthesia in the postanaesthesia care unit (T2) and on postoperative day 21 (T3). Results Sevoflurane significantly increased mean MN (‰) frequencies in nasal epithelial cells at T2 (6.97±2.33) and T3 (6.22±2.47) compared with those at T1 (3.84±1.89) (p<0.001). Similar result were observed for MN frequencies if the patients were analysed with regard to age (>40 or <40 years) or sex. Conclusion Short-term administration of sevoflurane anaesthesia induces MN formation in nasal epithelial cells of this patient population. Further studies are required for evaluation of the results. The prolonged administration of volatile anaesthetics in various risk groups and surgical protocols should be conducted for evaluating their safety.

Comet Assay in Evaluating DNA Damage Associated With Ischaemia-Reperfusion Injury in Patients Undergoing Coronary Surgery

Comet Assay in Evaluating DNA Damage Associated With Ischaemia-Reperfusion Injury in Patients Undergoing Coronary Surgery Ischaemia-reperfusion (I/R) injury is responsible for a number of conditions such as coronary bypass and myocardial infarction, and deaths. Oxygen-free radicals formed during I/R have been proposed as the leading causes of tissue injury, and they play an important role in I/R injury. I/R induces oxidative DNA damage (such as purinic and pyrimidinic base lesions). Comet assay is a suitable and sensitive method for early detection of low-level DNA damage. We used modified alkaline comet assay in peripheral blood lymphocytes and evaluated I/R-induced DNA damage in patients undergoing coronary artery bypass graft (CABG) operation (in vivo model for I/R). No statistically significant difference in DNA damage levels was found before surgery, after anaesthesia, ischemia, reperfusion, and surgery. However, blood lactate levels (assessed in parallel with the comet assay) increased after I/R and did not return to the baseline level. Our findings showed that I/R injury did not induce DNA damage, but increased the lactate levels. This finding suggests that there might be reversible and uncommon necrosis that did not reflect on overall DNA base damage. Further studies are needed using this approach. Primjena kometnog testa u procjeni oštećenja DNA nastalih zbog ishemijsko-reperfuzijskih ozljeda u bolesnika podvrgnutih kirurškim zahvatima na koronarnim žilama Ishemijsko-reperfuzijska (I/R) ozljeda čest je uzročnik pobola i smrtnosti u slučajevima kao što su ugradnja koronarnih premosnica, infarkt miokarda i sl. Slobodni kisikovi radikali koji nastaju tijekom procesa ishemije i reperfuzije smatraju se jednim od glavnih uzročnika oštećenja tkiva i imaju važnu ulogu u I/R ozljedama. I/R ozljede izazivaju oksidativna oštećenja u DNA (primjerice oštećenja purinskih i pirimidinskih baza). Kometni test osjetljiva je metoda koja omogućuje utvrđivanje niskih razina primarnih oštećenja u molekuli DNA. U ovom smo istraživanju primjenom kometnog testa na bijelim krvnim stanicama procjenjivali razine oštećenja u DNA nastale zbog I/R ozljeda u bolesnika podvrgnutih ugradnji premosnice koronarne arterije (in vivo model za I/R). Rezultati istraživanja upućuju na to da nema značajnih razlika u razinama oštećenja DNA izmjerenim u uzorcima krvi uzimanima prije kirurškog zahvata, nakon anestezije te tijekom ishemije, reperfuzije i zahvata. Međutim, uočeno je da su nakon I/R ozljede porasle razine laktata u serumu koje se više nisu vratile na početne vrijednosti. Takve vrijednosti laktata u serumu upućuju na to da tijekom I/R nastupa neobična i reverzibilna nekroza koja se, međutim, ne odražava na stupanj oštećenja DNA. Za objašnjenje ovih zapažanja potrebna su daljnja istraživanja.