Infusion and bolus administration of cisatracurium - effects on histamine release

The purpose of this study is to evaluate the usefulness of Cisatracurium Besilat [CB], and the method of its administration during laparotomies on adult patients, to determine whether CB caused cutaneous, systemic or chemical evidence of histamine release. This study was conducted as a randomized, double-blind clinical trial on 38 patients [ASA I-II]. After a standard anesthetic induction with fentanyl and propofol, patients received an i.v. bolus CB [0.15 mg/kg in Group A [n=20] or Group B [n=18]. In Group B, 0.18 mg/kg/h infusion was started. Following reaching stable muscle relaxations for intraabdominal operation and for recovery, Group A [Bolus group] and Group B [Infusion group] were compared. Train-of-four fade during recovery of block were recorded after administration of CB. The heart rate and arterial blood pressure were monitored noninvasively. There were no significant hemodynamic differences among the groups. 25%-75% spontaneous recoveries were [X +/- s] 12.75 +/- 4.52, 16.11 +/- 9.20 minutes for Group A, Group B. 70% TOF Ratios were [X +/- s] 1.07 +/- 0.13, 1.39 +/- 0.38 hours for the same groups. There was no consistent correlation between hemodynamic changes, cutaneous manifestations and histamine concentrations. - We conclude that CB does not cause systemic or cutaneous histamine release. The infusion method of cisatracurium has a stable level of curarization without side effect and there were no significant recovery time differences between the groups

effect of premedication on preoperative anxiety

The aim of this study was to evaluate the effect of premedication on anxiety, cortisol, residual gastric volume and gastric pH. Following the approval of the institutional Clinical Research Ethics Committee, 100 patients in ASA I-II scheduled for elective gynecologic surgery, were included into a double blind study. Patients were randomly allocated into two groups; the placebo and the premedicated. Oral 10 mg diazepam in the evening before surgery and 1.5 mg midazolam at least 15 min before surgery. The same anesthetic procedure was applied for both groups. Anxiety levels of patients were assessed by using Spiel Berger State- Trait Anxiety Inventory Scale [STAIs]. Blood samples for cortisol measurements were obtained at the preoperative visits, preanesthesia and intraoperative phases. Gastric contents were collected through an orally inserted gastric tube, acidity was measured by using Merck's pH paper. In placebo group, the pre anesthetic STAIs values were increased compared to the values obtained at preoperative visit [p<0.001]. The pre anesthetic STAIs values were decreased in premedicated group [p<0.001]. The changes of preanesthetic and preoperative visit values were statistically different [p<0.001]. The preanesthetic and intraoperative cortisol values were increased in both groups compared to values of preoperative visit. The augmentation was significantly higher in the placebo group [p<0.05]. Positive correlation was observed between basal state anxiety and basal cortisol values and preanesthetic STAIs and cortisol values in the placebo group [r=0.325, p<0.05]. These data support that preoperative sedation suppresses the preoperative anxiety and the cortisol augmentation resulting from surgery and stress

Effects of low and high intra-abdominal pressure on immune response in laparoscopic cholecystectomy

Immunosuppression is directly related to the degree of trauma. The aim of this study is to compare the effects of low and high intra-abdominal pressure on immune response in moderate surgical trauma. Twenty-two patients, scheduled for laparoscopic cholecystectomy, were randomly allocated to one of 2 groups according to intra-abdominal pressure: low and high intra-abdominal pressure. This study was conducted in the Hacettepe University Faculty of Medicine, Operation Room, Ankara, Turkey. Serum interleukin [IL]-2 and IL-6 levels were measured. Serum IL-2 showed a significant decrease before the incision in high intra-abdominal pressure group. The increase in serum IL-6 at the end of surgery and postoperatively was lower in low intra-abdominal pressure group. These results, can be interpreted as the immune system, are less depressed when there is lower intra-abdominal pressure. This may have clinical implications in immunocompromised patients