Effect of hypotensive anesthesia on cognitive functions. A comparison ofesmolol and remifentanil during tympanoplasty

To compare the effects of esmolol and remifentanil, used as adjuncts for induced hypotension on surgical conditions and short-term cognitive functions, during tympanoplasty. The study was conducted in Hacettepe University, School of Medicine, Ankara, Turkey between January 2005 and December 2006 following Institutional Ethical Committee approval, 40 ASA I-II patients, between 18 and 60 years of age were included in this study. With the induction of anesthesia, for group E, an esmolol infusion of 50-250 microg.kg[-1].min[-1] was titrated, following a bolus of 0.5 mg.kg[-1]; for group R, a remifentanil infusion of 0.2-0.5 microg.kg[-1].min[-1] was titrated; to achieve a mean blood pressure [BP] of 55-65 mm Hg. Arterial BP were recorded continuously throughout the operation. Mini Mental State Test [MMS] was performed at the preoperative 30th minute [MMS[60], postoperative 30th minute [MMS[30]], 60th minute [MMS[60]] and 24th hour [MMS[24]]. Surgical field was evaluated by the blinded surgeon, using a 6 point category scale. Patient demographics were similar in both groups. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Surgical field scores were lower in group R [P<0.05], although the scores were

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

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