Sibel Ozcan

Effects of levobupivacaine and bupivacaine on intracellular calcium signaling in cultured rat dorsal root ganglion neurons

Bupivacaine and levobupivacaine have been shown to be effective in the treatment of pain as local anesthetics, although the mechanisms mediating their antinociceptive actions are still not well understood. The aim of this study was to investigate the effects of bupivacaine and levobupivacaine on intracellular calcium ([Ca2+]i) signaling in cultured rat dorsal root ganglion (DRG) neurons. DRG neuronal cultures loaded with 5 μM Fura-2/AM and [Ca2+]i transients for stimulation with 30 mM KCl (Hi K+) were assessed by using fluorescent ratiometry. DRGs were excited at 340 and 380 nm, emission was recorded at 510 nm, and responses were determined from the change in the 340/380 ratio (basal-peak) for individual DRG neurons. Data were analyzed by using Student’s t-test. Levobupivacaine and bupivacaine attenuated the KCl-evoked [Ca2+]i transients in a reversible manner. [Ca2+]i increase evoked by Hi K+ was significantly reduced to 99.9 ± 5.1% (n = 18) and 62.5 ± 4.2% (n = 15, P < 0.05) after the application of 5 and 50 µM levobupivacaine, respectively. Bupivacaine also inhibited Hi K+-induced [Ca2+]i responses, reduced to 98.7 ± 4.8% (n = 10) and 69.5 ± 4.5% (n = 9, P < 0.05) inhibition of fluorescence ratio values of Hi K+-induced responses at 5 and 50 μM, respectively. Our results indicate that bupivacaine and levobupivacaine, with no significant differences between both agents, attenuated KCl-evoked calcium transients in a reversible manner. The inhibition of calcium signals in DRG neurons by levobupivacaine and bupivacaine might contribute to the antinociceptive effects of these local anesthetics.

Administration of general anaesthesia to a paediatric patient with osteopetrosis.

Osteopetrosis is a rare clinical syndrome characterised by the failure of bone resorption and remodelling, which causes multiple anatomical and physiological impairments. Pathological fractures can occur, in addition to, haemathological and metabolic impairments. Our patient was a 9-year-old girl diagnosed with osteopetrosis in the neonatal period. She had severe anaemia, thrombocytopaenia, hypocalcaemia, as well as growth and development delays. In this case report, the administration of general anaesthesia to the patient for a biopsy of the scalp and skull and a partial maxillectomy is presented.

Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy.

BACKGROUND Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro-immuno-endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions. OBJECTIVE The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy. STUDY DESIGN Prospective, randomized clinical comparative study. MATERIALS AND METHODS Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision. RESULTS There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin-6 (IL-6), IL-8, and IL-10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline-administered group compared to other groups (P < 0.05). CONCLUSION Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.

Agomelatine pretreatment prevents development of hyperglycemia and hypoinsulinemia in streptozotocin-induced diabetes in mice

The main objective of this study was to investigate potential effectiveness of agomelatine pretreatment in the prevention of diabetes itself and encephalopathy, with a focus on brain tissue oxidative stress and inflammatory processes in streptozotocin (STZ)‐induced diabetic mice. Interleukine‐1β (IL‐1β) and TACR1 (NK1), which is a tachykinine receptor, were used for the investigation of inflammation in the brain regions including raphe nucleus, periaqueductal gyrus (PAG), amygdala, and nucleus accumbens. The effects of agomelatine on total antioxidant capacity were also evaluated. In the in vitro part of the study, the effects of agomelatine on cell viability were investigated in dorsal root ganglion (DRG) neurons. Fasting blood glucose levels were measured 72 h after STZ injection to determine the diabetic condition. Agomelatine pretreatment prevented both hyperglycemia and hypoinsulinemia in STZ‐treated mice. When STZ was injected to induce diabetes in mice, neither hyperglycemia nor hypoinsulinemia was developed in agomelatine pretreated mice and 6 weeks after development of diabetes, agomelatine treatment significantly decreased levels of IL‐1β mRNA in raphe nucleus and nucleus accumbens. TACR1 mRNA levels were lower in raphe nucleus, PAG, and amygdala of agomelatine‐treated diabetic mice. The increase in total antioxidant capacity after agomelatine administration may responsible for its beneficial effect in the prevention of diabetes. We showed that agomelatine reversed high glucose–induced cell viability decreases in DRG neurons. Both the antihyperglycemic and antioxidant effects of agomelatine might have contributed to the DRG neuron viability improvement. In conclusion, agomelatine seems to both prevent development of diabetes and reverse the encephalopathic changes caused by diabetes.

Anesthetic Neurotoxicity in Pediatric Patients

In recent years, an increasing number of publications have shown the negative effects of anesthetics on the developing brain and have made inquiries about anesthesia for pediatric patients in practice. Anesthesia is applied to millions of children for surgery, imaging, and other invasive procedures; the issue is very serious and concerns. In this chapter, experimental and clinical studies about the issue have been summarized. As a result, anesthetic drugs except alpha-2 adrenergic agonist anesthetic (NMDA antagonist or a GABA agonist) used in pediatric patients (especially if there is no painful situation) have potential neurotoxicity. Particularly, if anesthesia exposure was applied in the fragile period (the first 4 years) and if used at higher concentrations or repeated anesthesia application, adverse effects of anesthesia exposure on the developing brain have been claimed. But, the issue is not fully clarified yet.

Effects on QTc Interval of 2 Different Doses of Spinal Anesthesia in Inguinal Hernia Operations

Background Cardiac arrhythmia is a significant cause of morbidity and mortality. In this study, through examination of the effects on the QTc interval of different doses of hyperbaric bupivacaine, we investigated the relationship with arrhythmia. Material/Methods A total of 60 patients were separated into 2 groups: spinal block was applied with 10 mg bupivacaine to Group S1 and with 15 mg to Group S2. The mean arterial pressure (MAP) and heart rate (HR) values were recorded before the spinal block and at 5 and 30 min after the block and at 60 min postoperatively. By recording the time of the spinal sensory block to reach T10 dermatome (Anaesth T) and the duration of the surgical procedure (Surg T.), the QTc intervals were calculated. Results The demographic data were similar in both groups. A statistically significant difference was determined between the S1 and S2 groups between the baseline and the 30 mins after spinal block QTc intervals (p=0.001). No statistically significant difference in HR values was determined between the groups at baseline, 5 min after spinal block, and 1 h after surgery (all p>0.05), but at 30 min after spinal block value there was a statistically significant difference (p=0.010). No statistically significant difference was determined in MAP values between the groups at baseline and 1 h after surgery (p>0.05). Conclusions The QTc interval lengthened in a dose-dependent manner after spinal anesthesia was applied with different doses of bupivacaine, but the doses used did not cause any severe arrhythmia.

A rare cause of peritonitis; jejunal diverticulitis: case report -

Jejunoileal diverticulosis is a rare disorder and frequently has asymptomatic progression. It is rarely presented with acute complications. In this case report we are presenting a 26 year old man administered to emergency department with acute abdomen symptoms who had diverticular perforation history for two times and diverticulitis finding in abdominal exploration.