Szymon Bialka

Comparison of Thiopental, Urethane, and Pentobarbital in the Study of Experimental Cardiology in Rats In Vivo

Background: Despite earlier research studying the influence of anesthetics in arrhythmia models, a lot of controversy remains. The aim was to compare the influence of three anesthetics (60 mg/kg thiopental, 1200 mg/kg urethane, 60 mg/kg pentobarbital intraperitoneally) on ventricular arrhythmias and to combine it with measured hemodynamic parameters to find the most suitable agent for such experiments. Method: In the model of ischemia- and reperfusion-induced arrhythmias in Sprague-Dawley rats, after left anterior descending coronary artery occlusion (7 minutes) and reperfusion (15 minutes), the following parameters have been measured or calculated: mortality index; ventricular fibrillation and tachycardia incidence and duration; systolic, diastolic, and mean arterial blood pressure; heart rate; myocardial index of oxygen consumption; and plasma creatine kinase concentration. Results: Evident depressive action of urethane on heart rate, blood pressures, and myocardial index of oxygen consumption should be reason enough to exclude it from use in such studies. Pentobarbital had no effect on arrhythmias, whereas thiopental was antiarrhythmic. Conclusions: Pentobarbital is the most suitable anesthetic offering stable hemodynamic values during arrhythmia studies. These hemodynamic values, which were similar to physiological values in awake rats, the long arrhythmia duration during reperfusion and approximately 50% mortality index are crucial parameters for evaluating antiarrhythmic drugs.

Beneficial effects of l-leucine and l-valine on arrhythmias, hemodynamics and myocardial morphology in rats.

Branched chain amino acids (BCAA) have been shown to have a general protective effect on the heart in different animal models as well as in humans. However, so far no attempt has been made to specifically elucidate their influence on arrhythmias. Our study was performed to evaluate whether an infusion of either l-leucine or l-valine in a dose of 1mgkg(-1)h(-1) 10min before a 7-min period of left anterior descending artery occlusion followed by 15min of reperfusion, had an effect on arrhythmias measured during the reperfusion phase in the ischemia- and reperfusion-induced arrhythmias model in rats in vivo. The effect of the infusion of these substances on mean arterial blood pressure was monitored throughout the experiment. Both of the tested amino acids exhibited significant antiarrhythmic properties. l-Leucine reduced the duration of ventricular fibrillation (P<0.05) and l-valine decreased the duration of ventricular fibrillation (P<0.001) and ventricular tachycardia (P<0.05). The two amino acids were generally hypotensive. l-Valine lowered blood pressure in all phases of the experiment (P<0.05) while l-leucine lowered this parameter mainly towards the end of occlusion and reperfusion (P<0.05). In addition, 30min infusion of the amino acids in the used dose did not produce any apparent adverse histological changes that were remarkably different from control. In summary, the results of our study suggest that l-leucine and l-valine in the dose that was used attenuates arrhythmias and are hypotensive in their influence. Our findings lend support to the many ongoing investigations into the benefit of the application of l-leucine and l-valine in cardiology like their addition to cardioplegic solutions.

Thyromental height test as a new method for prediction of difficult intubation with double lumen tube

Background Predicting difficult intubation is of high clinical interest. Methods 237 patients aged ≥18 years were included in the study. Preoperative airway evaluation included: Mallampati test, thyromental distance, sternomental distance and thyromental height test. During direct laryngoscopy Cormack & Lehane classification was graded. We calculated the ROC AUC, sensitivity and specificity for thyromental height test as a primary end point of our study. Results Only thyromental height test and Cormack-Lehane scale proved significant on occurrence of difficult intubation. The optimal sensitivity and specificity values of thyromental height test were met with a cut off value of 50 mm. With 1 mm increase in thyromental height test, risk of difficult intubation decreased by 7%. Conclusion Thyromental height test is a simple, easy to perform and non-invasive test to predict difficult intubation in patients scheduled for elective double lumen tube intubation during thoracic surgical procedures. With 1 mm above 50 mm increase in thyromental height test the risk of difficult intubation decreased by 7%. Trial registration Clinicaltrials.gov Identifier: NCT02988336.

Choosing the optimal method of anesthesia in anterior resection of the rectum procedures – the assessment of the stress reaction based on selected hormonal parameters

INTRODUCTION The aim of this study was to compare hormonal stress responses (changes in adrenaline, noradrenaline, and cortisol concentrations) to surgical injury during total intravenous propofol anaesthesia and volatile anaesthesia with sevoflurane in patients subjected to anterior resection of the rectum. MATERIAL AND METHODS The prospective randomised study included 61 patients qualified for anterior resection of the rectum. The subjects were randomised into two groups, based on the type of anaesthesia: 1) Group I (TIVA, n = 31), administered total intravenous propofol anaesthesia, and 2) Group II (VIMA, n = 30), administered volatile induction and maintenance sevoflurane anaesthesia. Serum concentra-tions of adrenaline, noradrenaline, and cortisol were determined prior to surgery, during assessment of abdominal cavity, after resection of the rectum, and 30 min and one day post-surgery. RESULTS The two groups did not differ significantly in terms of their haemodynamic parameters: heart rate and arterial blood pressure. Compared to individuals subjected to TIVA, patients from the VIMA group presented with significantly higher concentrations of adrenaline during evaluation of the abdominal organs. No significant intergroup differences were found in terms of intra- and postoperative serum concentrations of noradrenaline and cortisol. CONCLUSIONS TIVA and VIMA induce similar hormonal stress responses during anterior resection of the rectum. The increase in serum adrenaline concentration during evaluation of the abdominal organs in the VIMA group implies that the dose of sevoflurane should be escalated at this time point.

Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial

BACKGROUND Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN A randomised, open label study. SETTING A single university hospital. Study conducted from August 2013 to February 2014. PARTICIPANTS In total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery). INTERVENTIONS Preoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h. MAIN OUTCOME MEASURES Total dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction. RESULTS A total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01) throughout the first 24 h. Group PVB patients also experienced fewer opioid-related adverse events and were less sedated during the first 12 postoperative hours. Patients in the PVB group had higher satisfaction scores at 48 h compared with the control group. There were no serious adverse events. CONCLUSION In our study, preoperative ThPVB was an effective part of a multimodal analgesia regimen for reducing opioid consumption and pain intensity. Methods and drugs used in both groups were well tolerated with no serious adverse events. Compared with the control group, patients in the ThPVB group reported increased satisfaction. TRIAL REGISTRATION Clinical Trials NCT02840526.

Familiarity with first-aid rules by attendees at rock-music festivals in Poland.

European countries, including Poland, follow the European esuscitation Council (ERC) Guidelines that were put into effect in 010 and that govern the rules of basic life support (BLS) activities.1 espite the guidelines, national laws also impact the use of firstid skills.2 In Poland, Clause 162 of the Criminal Code imposes the bligation to render first aid to victims of accidents by all the citiens, and failure to undertake first-aid measures to injured persons nder circumstances of direct hazard to lives is prosecuted by the enalty of imprisonment up to 3 years. We surveyed attendees at two rock music festivals held in oland in 2009. This group of individuals is frequently associated ith overuse of alcohol and recreational drugs. This can lead to incients that require first-aid interventions during concerts. Of 1129 uestionnaires, 1110 were correctly completed (98.5%). Eightyine percent of respondents said they would provide first aid ithout hesitation even if it were not mandatory by law. This high ate of respondents willing to help compares very favourably with revious studies by other groups.3 Polish laws requiring individuals o help in an emergency may contribute to this high response. Of the responders, who declared that they can correctly check hether the victim keeps breathing correctly or not (94.78% of the nterrogated people), 83.2% demonstrated correct knowledge on ow to clean the upper respiratory tract. Almost two-thirds (65.5%, = 729) of respondents said they had the ability to give first aid but nly 48.3% correctly answered questions on first aid. Among those ho believed they had the ability to give first aid, 44.2% thought that heir knowledge of first-aid topics was sufficient, whilst only 7.3% of hose without first-aid abilities believed so (Table 1). The difference etween an individual’s declared and actual knowledge may result rom lack of awareness of how the relevant guidelines vary. One eason is that the Polish Resuscitation Council guidelines are based