Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Cytokine release is a well-known response to surgery especially when it is linked to cancer. Paravertebral block [PVB] is the suitable regional anesthesia for breast surgery. We tested the effect of replacing general anesthesia [GA] with PVB on cytokine response during and after surgeries for cancer breast. Controlled randomized study. Forty cancer breast patients were divided in two groups; Group 1 received PVB and Group 2 received GA during performance of unilateral breast surgery without axillary clearance. Plasma concentrations of interleukin [IL]-6, IL-10, IL-12 and interferon-gamma [IFN-gamma] were measured and IL-10/IFN-gamma were estimated in the following points; before starting PVB in Group 1 or induction of GA in Group 2 [Sample A], before skin incision [Sample B], at the end of procedure before shifting out of operating room [Sample C], 4-h post-operatively [Sample D] and 24-h post-operatively [Sample E]. unpaired Student t-test. IL-6 increased progressively in both groups with statistically significant lower levels in samples C and D in Group 1. IL-10 levels showed progressive increasing in both groups without differences between groups. IL-12 showed progressive decrease in both groups with statistically significant higher levels in samples C and D in Group 1. IFN-levels showed significantly higher levels in samples C and D in Group 1. IL-10/IFN-gamma ratio was significantly lower in Group 2 in samples C and D. Replacing GA with PVB can attenuate cytokines response to cancer breast surgeries

Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly

Little is known about the relationship between sedative drugs used preoperatively and postoperative delirium. Melatonin is a drug used to sedate patients preoperatively and is hypothesized by recent works to have a curative effect on postoperative delirium. The incidence of postoperative delirium will be tested if affected by three different sedative drugs including melatonin. Controlled randomized double-blind study. Three-hundred patients aged>65 years scheduled for hip arthroplasty under spinal anesthesia were randomly distributed to one of the four groups. Group 1 [control] received nothing for sedation. Group 2 [melatonin] received 5 mg melatonin. Group 3 [midazolam] received 7.5 mg midazolam. Group 4 [clonidine] received 100 microg clonidine. These medications were given orally at sleep time at night of operation and another dose 90 min before operative time. Patients who developed postoperative delirium received 5 mg of melatonin 9 pm for three successive days in a trial to treat delirium. Statistical analysis was done using the SPSS Software [version 13]. Total of 222 patients completed the study. Percentage of postoperative delirium in the control group was 32.65% [16/49 patients]. The melatonin group showed a statistically significant decrease in the percentage of postoperative delirium to 9.43% [5/53 patients]. Melatonin was successful in treating 58.06% of patients suffered postoperative delirium [36/62 patients] with no difference between different groups. Postoperative delirium is affected with the drug used for preoperative sedation. Melatonin was successful in decreasing postoperative delirium when used preoperatively and in treating more than half of patients developed postoperative delirium when used for three postoperative nights

Safety and efficacy of pentastarch 6% versus albumin 5% for acute normovolemic hemodilution in patients undergoing major abdominal surgeries

Acute normovolemic hemodilution [ANH] has been used to decrease allogenic blood transfusion. ANH has different systemic effects that may include hemodynamic, oxygen transport variables, renal, hematological and acid base status. The effect of pentastarch [6% hydroxyethyl starch, MW: 200 kDa] versus human serum albumin [5%, MW: 69 kDa] as volume replacement solution after induction of anesthesia for major abdominnal surgery was assessed in this study. Eighty patients were divided into two groups; HES group [no = 40] received pentasarch and ALB group [no = 40] received albumin. Fifteen m1/kg of blood was removed and replaced simultaneously with the tested solutions to keep central venous pressure between 12-15 mmHg. Blood was reinfused before the end of operations. Total blood loss at 1st postoperative day was significantly higher in HES group [1198.5 +/- 354.3 vs. 1044.2 +/- 288.3 m1 in ALB group]. Significantly Higher amounts of the tested colloid [2084.7 +/- 408.6 in HES group vs. 1766.6 +/- 574.3 ml in ALB groups, 4 hrs postoperatively], crystalloids [5748.8 +/- 1165.3 in HES group vs. 5116.8 +/- 1309.8 ml in ALB group at 1 st postoperative day], FFP [243.6 +/- 29.7 in HES group vs. 123.5 +/- 25.3 ml in ALB group, at the end of surgery] and packed RBC [988.8 +/- 47.8 in HES group vs. 645.9 +/- 44.8 ml in ALB group, at the end of surgery] were used in HES group. HES group showed significantly higher cardiac index [3.9 +/- 0.9 in HES group vs. 3.4 +/- 1.0 1/min.m 2 in ALB group, at the completion of ANH], better preservation of SVRI [2052.3 +/- 251.5 in 5HES2 group vs. 1729.6 +/- 159.4 dyne.sec/cm5. m 2 in ALB group, at the completion of ANH]. Renal functions were better preserved in ALB group. Serum creatinine was significantly higher HES group [1.41 +/- 0.35 vs. 0.98 +/- 0.31 mg% in ALB group, at 3rd postoperative day]. Urinary N-acetyl-beta-glucosaminidase [beta-NAG] was significantly higher in HES group [1.38 +/- 0.52] compared with ALB group [0.97 +/- 0.52] u/mmol creatinine] at the 3rd posstoperative day. alpha-1-microglobulin was significantly higher in HES group [19.7 +/- 9.3] compared with ALB group [15.2 +/- 9.3 mg/1] at the 3rd postoperative day. Activated PTT was significantly higher in HES group [44.8 +/- 4.4] compared with ALB group [40.5 +/- 4.7 sec] 4 hrs postoperatively. D-dimer was significantly higher in HES group [2.4 +/- 0.2] compared with ALB group [3.0 +/- 0.6 ng/1] at the 1st postoperative day. Thrombin/antithrombin III [TAT] was statistically higher in HES group [2.2 +/- 0.7] compared with ALB group [1.9 +/- 0.6 micro g/1] at the 1st postperative day. There was a state of metabolic acidosis in both groups with a significant difference in base-excess results [-3.2 +/- 1.5 in HES group vs. -4.1 +/- 1.3 mmo1/1 in ALB group] at the completion of ANH. We can conclude that both solution were safe and effective for performing ANH before major abdominal operations with the superiority of albumin over pentastarch