Zekine Begeç

Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron

Background:  The aim of the present study was to compare placebo, ketamine, granisetron and a combination of ketamine and granisetron in the prevention of shivering caused by regional anaesthesia.

Propofol and erythropoietin antioxidant properties in rat brain injured tissue

So far, several treatment modalities have been attempted to brain protection in cases such as brain trauma, stroke or brain hemorrhage. However, a treatment method that the effect begins immediately and definitely helpful has not been discovered yet. In this study, we aimed to compare the effects of propofol and erythropoietin (Epo) on brain injury caused by oxidative stress and antioxidant properties of these agents after closed head injury (CHI) in rats. For this study, female Wistar Albino rats were divided into five groups: non-traumatic control group, trauma performed group CHI, trauma with propofol (100 mg/kg) intraperitoneally (i.p.), trauma with Epo (5000 U/kg) i.p. and trauma with propofol and Epo performed study groups. Twenty-four hours after CHI, rats were sacrificed and the brains were removed. Superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) levels were measured in brain tissue. MDA and NO levels were decreased significantly in Groups Epo, Propofol and Epo+Propofol than Group CHI (p<0.01). XO activity was significantly lower in Group Epo than Group CHI (p<0.05). Epo and propofol decreased oxidative stress by decreasing MDA and NO level in brain tissue after CHI. However, combination of Epo and propofol has no significant beneficial advantage than Epo or propofol alone.

The effects of dexmedetomidine on liver ischemia–reperfusion injury in rats

BACKGROUND Ischemia-reperfusion (IR) injury of the liver may cause various types of damage to hepatic tissues. It can affect the prognosis of patients and the success of an operation. Dexmedetomidine is a selective α2 receptor agonist. We investigated whether dexmedetomidine provides protection against IR-induced liver injury in rats. METHODS Forty rats were divided equally into four groups. In group 1, the liver was manipulated after the laparotomy, and no occlusion of the vessels of the liver was performed. In group 2, once the abdomen was opened, 60 min of ischemia and 60 min of reperfusion were applied according to the segmental hepatic ischemia model. In group 3, 10 μg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. In group 4, 100 μg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. Further procedures in groups 3 and 4 were the same as those of group 2. After the experiment was completed, the rats were killed. Liver tissues were removed and stored until biochemical and histologic assessments were performed. RESULTS The malondialdehyde level in group 2 was higher than that of groups 1, 3, and 4 (P = 0.001, P = 0.000, and P = 0.000, respectively). Superoxide dismutase, catalase, and glutathione levels in group 2 were lower than those in group 1 (P = 0.001, P = 0.027, and P = 0.014, respectively). Superoxide dismutase and catalase levels in group 4 were higher than those in group 2 (P = 0.002 and P = 0.000, respectively). GSH levels in groups 3 and 4 were higher than those in group 2 (P = 0.049 and P = 0.006, respectively). A lower glutathione peroxidase level was detected in groups 2 and 3 than that in group 1 (P = 000). Group 4 demonstrated an increase in glutathione peroxidase levels compared with group 3 (P = 0.014). The histologic injury scores in groups 2-4 were higher than those in group 1 (P = 0.003, P = 0.002, and P = 0.001, respectively). However, the histologic injury scores were lower in groups 3 and 4 than those in group 2 (P = 0.003 and P = 0.002, respectively). CONCLUSIONS This study showed that dexmedetomidine may protect the liver against IR injury in rats.

The effect of esmolol on the QTc interval during induction of anaesthesia in patients with coronary artery disease.

The aim of this study was to evaluate whether esmolol has an effect on QT interval during induction of anaesthesia using etomidate and fentanyl in patients with known coronary artery disease. Sixty patients were prospectively randomised to either a control group or the esmolol group. Esmolol was administered as a bolus 1 mg.kg−1, followed by a continuous infusion at 250 μg.kg−1min−1. All patients received etomidate 0.3 mg.kg−1 and fentanyl 15 μg.kg−1. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 1 min following etomidate (T2), 3 min following vecuronium (T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. In the esmolol group, QTc interval was significantly shorter at T1, T2 and T4 compared to the control group (p < 0.05). In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. An infusion of Esmolol attenuated the QTc interval prolongation associated with tracheal intubation.

Ketamine or alfentanil administration prior to propofol anaesthesia: the effects on ProSeal™ laryngeal mask airway insertion conditions and haemodynamic changes in children

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway® (PLMA) insertion conditions in children. Eighty children, aged between 3–132 months, were randomly allocated to receive either alfentanil 20 μg.kg−1 (alfentanil group) or ketamine 0.5 mg.kg−1 (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg−1, a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg−1 with propofol 4 mg.kg−1 preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 μg.kg−1 during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil.

Dexmedetomidine blunts acute hyperdynamic responses to electroconvulsive therapy without altering seizure duration

Background: This study was designed to evaluate the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity and recovery times in patients undergoing electroconvulsive therapy (ECT).

Sevoflurane as an alternative anaesthetic for electroconvulsive therapy.

Objectives: The aim of this study was to investigate the effects of sevoflurane and propofol used in electroconvulsive therapy (ECT) on hemodynamic variables and duration of seizure activity and recovery profiles. Methods: Sixteen patients who were not premedicated, with a mean age 27.1 years, were enrolled in this prospective open trial, receiving a total of 64 ECT treatments. Each patient was given the following 2 anesthetic regimens in random order: In group S, anesthesia was induced with 7% sevoflurane in 100% oxygen at 6 L min−1 fresh gas flow until the loss of consciousness and 1.5 mg kg−1 propofol in group P. Adequate muscle relaxation was achieved with suxamethonium, 1.0 - 1.2 mg kg−1. Noninvasive mean arterial pressure (MAP) and heart rate (HR) values, duration of motor seizure activity, and recovery times were recorded. Results: The mean motor seizure duration was significantly longer with sevoflurane (mean [SD]: 43.09 [16.6] s) than with propofol (28.91 [7.9] s; P < 0.05). The MAP 1 minute and 10 minutes after ECT (101.25 [7.5] mm Hg and 100.16 [11.0] mm Hg, respectively) was significantly increased compared with before ECT (94.56 [6.9] mm Hg) in sevoflurane group (P < 0.05). Time to spontaneous breathing, eye opening and obeying commands, and changes in MAP and HR during and after ECT were similar in both regimens. Conclusion: Induction with 7% sevoflurane allows prolonged duration of motor seizures in ECT. We concluded that induction of anesthesia with sevoflurane inhalation is a reasonable alternative for patients undergoing ECT.

Effects of Propofol or Etomidate on QT Interval During Electroconvulsive Therapy

Background: Because patients with major depression have an altered autonomic nervous system activity, the risk of arrhythmias and sudden cardiac death may be increased. In addition, electroconvulsive therapy (ECT) may cause an acute rise in QT dispersion, which may predispose to arrhythmias. In this study, we investigated the effects of propofol or etomidate on the corrected QT (QTc) interval during ECT in patients with major depression. Materials and Methods: Fourteen unpremedicated American Society of Anesthesiologists I patients, each scheduled for 6 ECT sessions for major depression, were included in a prospective, randomized crossover study. The patients randomly received either 1-mg/kg propofol (propofol group) or 0.2-mg/kg etomidate (etomidate group). The mean arterial pressure (MAP), heart rate (HR), and electrocardiogram were recorded before anesthetic induction, 0 and 1 minute after the seizure ended, and 3 and 10 minutes after the seizure ended (T3 and T4, respectively). Results: In the propofol group, the QTc interval was shorter than the baseline at 0 minute after the seizure ended. The QTc interval increased from the baseline at T3 and T4 in the etomidate group. In the etomidate group, the QTc interval was longer at T3 and T4 than that in the propofol group (P < 0.05). In the etomidate group, the HR increased at T3 and T4, but the MAP increased at all measurement times from the baseline value. The HR and the MAP were lower at T3 and T4 in the propofol group than in the etomidate group (P < 0.05). Conclusions: Propofol did not induce prolongation of the QT interval and controlled the hemodynamic response better than etomidate during ECT. Therefore, propofol may be more suitable than etomidate for ECT treatments.

Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus

PurposeIn this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section.MethodsOne hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 µg and hyperbaric bupivacaine 12 mg. Patients were randomly allocated to three groups, each with 36 participants. Immediately following delivery, patients received either lornoxicam 8 mg IV (group L; n = 36), ondansetron 8 mg IV (group O; n = 36), or normal saline 2 ml IV (group P; n = 36). Pruritus, pain, and nausea and vomiting scores were recorded during the initial 24 h postoperatively.ResultsThe incidence of pruritus was significantly lower in group O from 4 to 12 h postoperatively when compared to that in group L and group P. According to the pruritus grading system we used, the number of patients without pruritus was significantly higher in group O when compared to that in group L and group P. The number of patients experiencing moderate pruritus was significantly lower in group O when compared to that in group P.ConclusionWe observed that the administration of 8 mg IV lornoxicam failed to prevent intrathecal fentanyl-induced pruritus in parturients. Also, our data confirmed that ondansetron is likely to attenuate intrathecal fentanyl-induced pruritus.

Performance of Size 1 I-Gel Compared with Size 1 ProSeal Laryngeal Mask in Anesthetized Infants and Neonates

Purpose. The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA. Methods. Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications. Results. There were no significant differences in terms of airway leak pressure between the I-gel (27.44 ± 5.67) and ProSeal LMA (23.52 ± 8.15) (P = 0.054). The insertion time for the I-gel was shorter (12.6 ± 2.19 s) than for the ProSeal LMA (24.2 ± 6.059 s) (P = 0.0001). Insertion success and conditions were similar in groups. We encountered few complications. Conclusion. Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.gov NCT01704118.