Effects of low dose propofol on inflammatory responses to lipopolysaccharide-induced shock in conscious rats

Acute kidney injury [AKI] is a major culprit of mortality in endotoxemia. Propofol has been commonly used in critically ill patients for sedation. This experiment attempted to elucidate the effects and possible mechanisms of propofol on AKI induced by endotoxin shock. Expermentations were carried out wing anesthetized, ventilated rats and isolated perfused kidneys. Endotoxemia was induced by intraperetoneal [i.p] injection of lipopolysaccharide [LPS, 15 mg kg-1]. Subhypnotic dosage of propofol [40 mg/kg] was injected by i.p. route to study its action on LPS induced-endotoxemia in rats. The rats were randomly assigned into five groups of 8 rats each [FIG: 1]. Kidney pathology was evaluated to quantify the kidney injury score. Plasma tumor necrosis factor alpha, [TNF alpha] and interleukin-10[IL-10] were examined. Post treatment of propofol at low or high dose attenuated or prevented the extent of Am. It also reduced the plasma level of TNF alpha, and IL-10. Our results suggest that propofol exerts protective effect on the endotoxin-induced AKI. In addition, propofol abrogates the microvascular leakage of water and protein in the kidneys. The results imply that the use of propofol in critically ill is not only for sedation, but also useful for the prevention of inflammatory progression and organ damage

preemptive value of oral clonidine and gabapentin on morphine consumption by patient controlled analgesia after conservative breast surgery

This randomized, double-blinded placebo-controlled study was designed to assess the effect of oral clonidine and oral gabapentin on the postoperative patient controlled analgesia by intravenous morphine concerning dose, duration of analgesia, hemodynamic changes and side effects. Sixty female patients were undergoing elective conservative breast surgery under general anaethesia. The patients were randomized to three groups: Clonidine group received oral 5ug/kg, Gabapentin group received oral 300 mg and control group received placebo tab. The medications were given 90 min before surgery. The following parameter were measured:, heart rate, mean arterial pressure, oxygen saturation, pain intensity, the total dose of morphine consumption, nausea and vomiting was recorded. In the clonidine group, there was significant reduction of morphine consumption versus gabapentin and control groups [15.9 +/- 4.6], [25.3 +/- 2.2] and [32.2 +/- 3.5] respectively [P<0.005]. The VAS pain score was significantly lower in clonidine group in comparison to gabapentin and control group throughout the all periods of the study [P<0.005]. There was decrease in HR and MABP in the three studied groups all over the period of the study and this reduction is not significant but in between the three studied groups and between clonidine and gabapentin and between clonidine and control groups there was significant difference in mean arterial blood pressure at 6 hours only [P<0.005]. As regard to the incidence of nausea and vomiting there was insignificant difference in between the three studied groups but there was significant difference between the control group and other two groups. Preemptive oral clonidine was better than oral gabapentin as regard to postoperative morphine consumption, the quality of analgesia and hemodynamic effects. On the other hand, oral gabapentin drug was less of value in management of acute pain

Effect of haemodilution by intravenous crystalloids on coagulation system in surgical breast cancer patients

Aside from the efficacy of a specific solution, possible side-effects have become an increasing concern. One of the most important issues for assessing the optimal intravascular volume replacement strategy is the influence on the haemostatic process and subsequent influence on bleeding or the development of thrombosis. The aim of our study is an assessment of the effects of intravenous fluid administration especially crystalloids during operation in a progressive manners [progressive haemodilution] on coagulation system in cancer patients [breast cancer]. 36 female patients scheduled for breast cancer surgery above 18 years, weight ranged from 50-70 kg, ASA physical state I or II were included in the study and exclude all anaemic patients, patients with abnormal preoperative coagulation data. Patients were divided into 3 groups according to degree of haemodilution depending upon their haemodynamic stability: Group A [12 patients]: volume infused to them up to 500 ml saline 0.9%, Group B[12 patients]: received 1000 ml and Group C[12 patients]: received 1500 ml. All patients received general anaesthesia and continuously monitored with ECG, central venous pressure [CVP], non invasive blood pressure and pulse oximetry in each group during the period of surgery and the first 24hours postoperatively. Blood samples taken before surgery, after induction of anaesthesia, after the end of fluid infusion, after surgery, 5 hours, 12 hours and 24 hours postoperatively and the following parameter was measured complete blood picture, prothrombin time, prothrombin concentration, International normalized ratio [INK], activated partial thrompolastin time [a PTT], fibrinogen, fibrin degradation product [FDP], factor VIII, antithrombin III [AT III] and thrombin antithrombin complex [TAT]. The present study demonstrate no significant difference in white blood cell count, haematocrite value or platelet count apart from slight reduction in platelet count in between group A and B, while there is a steady decrease in red blood cell count [RBCs] and haemoglobin concentration [Hb] in the same group and in between the three groups. There was significant increase in prothrombin time, activated partial thromboplastin time and international normalized ratio [INR] in group A, while in groups E and C shows increase in prothrombin time and INK Prothrombin concentration was significantly decreased in the three groups. Fibrinogen concentration was significantly deceased in the same group and in between groups. Factor VIII concentration shows no significant difference in the same group and in between groups. Also, in AT III concentration shows slight reduction in it but no significant difference in the same group and in between groups. Fibrin degradation product [FDP] show no significant difference in the same group and in between groups, while the concentration of thrombin antithrombin complex [TAT] in our study shows significant increase in group A and C but in between groups there were no significant changes. The relationship between haemodilution thrombosis and haemostasis is probably more complicated than we used to believe. We found limited crystalloids administration with slow rate of infusion during surgery is beneficial for patient postoperative coagulation. Intravenous fluid administration, while being routine therapy for patients in operating rooms, may be harmful used in rapid fluid loading

effect of intraoperative use of esmolol and nicardipine on splanchnic perfusion in functional endoscopic sinus surgery

There are many techniques for reduction of mean arterial blood pressure [MAP] and heart rate [HR] during anesthesia. We designed this prospective, randomized, double-blinded study to test the effect of this technique for maintaining hemodynamic stability during general anesthesia and their influences on splanchnic perfusion. Sixty healthy consenting patients undergoing functional endoscopic sinus surgery [FESS] were randomly assigned to 1 of 3 treatment groups: Group I [control n = 20] received normal saline 5 mL and 1 mL, followed by a saline infusion at a rate of 0.005 mL kg[-1] min[1]; Group 2 [n = 20] received esmolol 50 mg and saline 1.mL, followed by an esmolol infusion 5 micro g kg[-1] min[-1]; and Group 3 [n = 20] received esmolol 50 mg and nicardipine 1 mg, followed by an esmolol infusion 5 micro g kg[-1] min[-1]. The study drugs were administered after the induction of anesthesia with fentanyl 1.5 micro g/kg, and propofol 2 mg/kg IV. Tracheal intubation was facilitated with vecuronium 0.12 mg/kg IV. Anesthesia was initially maintained with sevoflurane 2% end-tidal and N[2]O 50% In oxygen in all 3 groups. After induction of anesthesia a gastric tonometer [TRIP] NGS Catheter and a radial catheter were inserted. Baseline values of gastric intramucosal pH [pHi] were determined before induction of hypotension. The [pHi] values were calculated every 30 min until hypotension was discontinued .The CO2 -gap [i.e., the difference between arterial and gastric Pco2] was registered. Arterial blood lactate levels also were measured. During surgery, the mean arterial blood pressure [MAP] was maintained within +/- 15% of the baseline value by varying the study drug infusion rate and the inspired concentration of sevoflurane. In addition to MAP and heart-rate values, were recorded throughout the perioperative period. Recovery times and postoperative side effects were assessed. None of the [pHi] values calculated was less than 7.35 in the three studied groups. Arterial blood lactate levels did not increase in any of the patients. Compared with the control group, adjunctive use of esmolol and nicardipine attenuated the increase in heart rate [in Group 2] and MAP [in Group 3]. after tracheal intubation. Furthermore, the use of an esmolol infusion as an adjunct to sevoflurane to control the acute autonomic responses during the maintenance period significantly decreased emergence times [4 +/- 2 versus 7 +/- 4 min], decreased the need for postoperative opioid analgesics [35% versus 60%], and reduced the time before discharge [209 +/- 89 versus 269 +/- 100 min]. We conclude that the adjunctive use of esmolol alone or in combination with nicardipine during the induction of anesthesia reduced the hemodynamic response to tracheal intubation. It did not compromise splanchnic tissue oxygen balance in healthy patients nor increased blood lactate. Furthermore, use of an esmolol infusion as an adjuvant to sevoflurane- N[2] O anesthesia for controlling the acute hemodynamic responses during the maintenance period improved the recovery profile after functional endoscopic sinus surgery

Elevation of liver enzymes after laparoscopic cholecystectomy versus open cholecystectomy

Laparoscopic cholecystectomy [LC] has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gall bladder diseases. However, it has been noticed that following LC, the serum level of certain liver enzymes rises markedly, in patients who had preoperatively normal liver enzyme value. We measured serum values of hepatic alcohol dehydrogenase [AD] and glutathione S-transferase [GST] alanine aminotransferase [ALT] and aspertase aminotransferase [AST], in 80 patients who underwent open cholecystectomy or laparoscopic cholecystectomy, they were divided randomly into two groups. Group 1[40 patients] underwent laparoscopic cholecystectomy [LC]. Group 11[40 patients] underwent open cholecystectomy [OC]. To assess the liver function, serum liver enzymes of AD, GST, ALT, and AST were measured before operations and at 1, 3, 7, and 10 days postoperative. Pre operative AD, GST, ALT, and AST were insignificantly different between the two groups. Twenty four hours after the procedure. AD, GST, ALT and AST increased significantly in the LC group [AD 8.1 +/- 2.2 U/L, GST 82.2 +/- 19.1 U/L, ALT 87.1 +/- 24.2 U/L, and AST 95.1 +/- 7.7 U/L but in [OC] group these enzymes were [AD 4.8 +/- 1.9 U/L, GST 35.3 +/- 3.9 U/L, ALT 27.8 +/- 11.9 U/L, and AST 5.3 +/- 0.9 U/L]. A further increase in serum AD, GST, ALT and AST value in LC group at the 3 [rd] day after the operation [AD 9.3 +/- 1.5 U/L, GST 103.5 +/- 21.6 U/L, ALT 99.3 +/- 19.4 U/L, and AST 120.9 +/- 10.4 U/L] but in [OC] group these enzymes were [AD 5.6 +/- 3.4 U/L, GST 47.9 +/- 1.4 U/L, ALT 38.6 +/- 3.4 U/L, and AST 17.9 +/- 1.4 U/L]. Slow return to normality occurred 7-10 days after the procedure in the LC group. Alterations in hepatic function occur after LC and appear to be clinically insignificant. These alterations in hepatic function return to normal levels within ten days. CO2 pneumoperitoneum seems to be the main reason for these changes but other factors may also contribute