Turgay Öcal

The effects of sevoflurane and desflurane anesthesia on QTc interval and cardiac rhythm in children

Background:  Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life‐threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children.

Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels.

PurposeDespite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100ß protein and neuropsychological tests after coronary artery bypass grafting (CABG).MethodsTwenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group R Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100ß protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24th hr postoperatively (T5).ResultsPostoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P S-100ß protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05).ConclusionsDespite reports about the neuroprotective effects of propofol, S-100ß protein levels were significantly elevated in group R Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.RésuméObjectifMalgré les progrès de l’anesthésie, la circulation extracorporelle (CEC) et les techniques chirurgicales, les lésions cérébrales demeurent une importante source de morbidité postchirurgie cardiaque. Les effets neurologiques comparés de l’isoflurane et du propofol sont présentés par l’analyse des protéines sériques S-100ß et des test neuropsychologiques après un pontage aortocoronarien (PAC).MéthodeNotre étude préliminaire, prospective et contrôlée a porté sur 20 patients, répartis au hasard en deux groupes, qui devaient subir un PAC. L’isoflurane a été utilisé dans le groupe I et le propofol dans le groupe P L’examen neurologique et une batterie de tests neuropsychologiques, comprenant le mini-examen de l’état mental (MMSET pour mini mental state examination) et le test visuel et auditif de mémoire des chiffres (VADST pour visual aural digit span test), ont été réalisés avant l’opération et aux jours trois et six postopératoires. Les échantillons sanguins nécessaires à l’analyse des protéines S-100ß ont été prélevés avant l’anesthésie (T1), après l’héparinisation (T2), 15 min après le début de la CEC (T3), après la CEC (T4) et 24 h après l’opération (T5).RésultatsLes examens neurologiques postopératoires étaient normaux. La performance au VADST a décliné significativement au jour trois (P < 0,05) chez tous les patients. Il n’y a pas eu de différence intergroupe significative des scores de VADST et de MMSET. Dans le groupe P, les niveaux de protéines S-100ß ont augmenté à T3 et T4, comparés aux niveaux préopératoires et aux niveaux observés avec l’isoflurane (P < 0,05).ConclusionMalgré des études rapportant les effets neuroprotecteurs du propofol, les niveaux de protéines S-100ß ont été significativement élevés dans le groupe P de notre étude. Aucune détérioration neuropsychologiques n’a été observée, mais le propofol ne semble pas offrir d’avantage sur l’isoflurane pour la protection cérébrale pendant la CEC.

Excessive sac pressures: the pathogenesis and innocence of hydroceles in children

Objective To determine whether paediatric hydroceles result entirely from a small‐calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms.

Frequency and enzyme activity of the butyrylcholinesterase K-variant in a Turkish population

ObjectiveAmong variants of the butyrylcholinesterase gene (BChE), the K-variant causing Ala539Thr substitution is the most common one associated with about one-third reduction in the enzyme activity. This study aimed to detect the frequency of the K-variant allele in a Turkish population sample and also to evaluate how the plasma BChE activity was influenced by this variant.MethodsPatients administered for elective surgery (n=77) were examined for the presence of the K allele. The enzyme activity was determined in plasma.ResultsThe K-variant of BChE is a common allele with a frequency of 0.266 (CI95% 0.196–0.336) in our sample from a Turkish population. Mean enzyme activity in subjects homozygous for the K-variant was about 40% lower than other subjects.ConclusionThe frequency of the BChE K-variant was significantly higher in a Turkish population than those reported for other populations and it is associated with a diminished enzyme activity.

Propofol anaesthesia and metabolic acidosis in children.

Background: We aimed to investigate the effect of propofol infusion anaesthesia on acid–base status and liver and myocardial enzyme levels of children during short‐term anaesthesia.

Successful unilateral partial lung lavage in a child with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material accumulates within the alveoli. A 4-year-old child with autoimmune PAP, who was successfully treated with a series of unilateral partial bronchoalveolar lavages by selectively ventilating the other lung with a cuffed endotracheal tube, is presented.

Peroperative effects of fresh frozen plasma and antithrombin Iii on heparin sensitivity and coagulation during nitroglycerine infusion in coronary artery bypass surgery

Nitroglycerin (NTG) reduces the anticoagulant effects of heparin and may lead to heparin resistance. Fresh frozen plasma (FFP) and antithrombin III (ATIII) may be used for the treatment of heparin resistance. We aimed to compare the effects of FFP and ATIII on heparin requirement, coagulation parameters, and bleeding in patients undergoing coronary artery bypass graft surgery (CABGS) with moderate dose of intraoperative NTG infusion. Forty-eight patients undergoing CABGS with NTG infusion were randomly allocated to three groups. Group C served as control, whereas the patients in group P received FFP and those in group A received ATIII after anesthesia induction. ATIII activity and coagulation parameters were measured at five different times intraoperatively. Total heparin requirement, heparin consumption, and heparin sensitivity were calculated. ATIII activity and ACT were significantly higher and activated partial thromboplastin time and fibrinogen level were significantly lower during cardiopulmonary bypass in group A than in groups P and C. Heparin sensitivity was significantly higher and total heparin requirement and consumption were significantly lower in ATIII group than in other groups. ATIII administration increases heparin sensitivity and decreases heparin requirements compared with FFP in patients undergoing CABGS with peroperative NTG infusion. ATIII may be preferred to FFP in patients with heparin resistance due to NTG infusion undergoing CABGS.

Inadvertent placement of pulmonary artery catheter into right carotid artery

Purpose: To report a case of misplacement of a pulmonary artery catheter (PAC) into the carotid artery after open heart surgery.Clinical features: A 20-mo-old boy underwent open heart surgery (VSD repair). On the first day postoperatively, he had severe pulmonary hypertension and a PAC was inserted via the left internal jugular approach without complication. Two hours later, chest radiography showed the PAC in the right internal carotid artery which it had reached via the right and left ventrides and aorta. The PAC was withdrawn and a new PAC was inserted and its position was confirmed by chest radiography. Two years later echocardiography failed to demonstrate the second VSD or a residual leak through the patch although a PAC could be passed from the right ventride to the left ventride and subsequently into the aorta and right carotid artery.Conclusion: Correct placement of a PAC should be confirmed by chest radiography or other techniques to prevent complication.RésuméObjectif: Rapporter le cas d’un cathéter artériel pulmonaire (CAP) déplacé dans l’artère carotide après une intervention à coeur ouvert.Éléments cliniques: Un garçon de 20 mois a subi une opération à coeur ouvert (réparation d’une CIV). Le jour suivant l’opération, il a présenté une hypertension pulmonaire sévère et on a inséré un CAP, sans complication, en passant par la veine jugulaire interne gauche. Deux heures plus tard, une radiographie pulmonaire a révélé la présence du CAP dans l’artère carotide interne droite, position atteinte par les ventricules droit et gauche et l’aorte. On a retiré le CAP et inséré un nouveau cathéter. On a vérifié sa position par une radiographie pulmonaire. Deux ans plus tard, l’échocardiographie n’a pu démontrer une seconde CIV ou une fuite résiduelle provenant de la réparation, bien qu’un CAP puisse passer du ventricule droit au ventricule gauche et ensuite dans l’aorte et l’artère carotide droite.Conclusion: La mise en place correcte d’un CAP doit être confirmée par une radiographie pulmonaire ou d’autres techniques afin de prévenir toute complication.

Comparison of endtidal CO2 and arterial blood gas analysis in paediatric patients undergoing controlled ventilation with a laryngeal mask or a face mask

Endtidal CO2 (PeCO2) and arterial blood gas tensions were compared between laryngeal mask (LMA) and face mask (FM) ventilation in paediatric outpatients. Following premedication with midazolam, anaesthesia was induced with either thiopentone or isoflurane and atracurium. Anaesthesia was maintained with N2O, O2 and isoflurane. Manually controlled ventilation was applied with a nonrebreathing system. Both PeCO2 and arterial blood gas tensions were measured at 5 and 15 min after skin incision. The mean PaCO2 values in the LMA group were 36.6±7.4 and 37.5±6.4 mmHg and PaCO2–PeCO2 were 1.8±2.4 and 2.5±3.3 mmHg, respectively. The mean PaCO2 values in the FM group were 41.3±8.1 and 43.4±8.9 mmHg; and PaCO2–PeCO2 were 5.3±3.6 and 8.8±7.0 mmHg, respectively. These values were lower in the LMA group (P< 0.05). We have concluded that monitoring of PeCO2 is more reliable for estimating blood gas values during controlled ventilation with a LMA than a face mask.Endtidal CO2 (PECO2) and arterial blood gas tensions were compared between laryngeal mask (LMA) and face mask (FM) ventilation in paediatric outpatients. Following premedication with midazolam, anaesthesia was induced with either thiopentone or isoflurane and atracurium. Anaesthesia was maintained with N2O, O2 and isoflurane. Manually controlled ventilation was applied with a nonrebreathing system. Both PECO2 and arterial blood gas tensions were measured at 5 and 15 min after skin incision. The mean PaCO2 values in the LMA group were 36.6+/-7.4 and 37.5+/-6.4 mmHg and PaCO2 -PECO2 were 1. 8+/-2.4 and 2.5+/-3.3 mmHg, respectively. The mean PaCO2 values in the FM group were 41.3+/-8.1 and 43.4+/-8.9 mmHg; and PaCO2 -PECO2 were 5.3+/-3.6 and 8.8+/-7.0 mmHg, respectively. These values were lower in the LMA group (P< 0.05). We have concluded that monitoring of PECO2 is more reliable for estimating blood gas values during controlled ventilation with a LMA than a face mask.