Effects of lidocaine oropharyngeal spray applied before endotracheal intubation on qt dispersion in patients undergoing coronary artery bypass grafting: a prospective randomized controlled study

Abstract Objective: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. Results: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. Conclusion: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. Trial Registration: NCT03304431

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: randomized clinical study / Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado / Comparación de los efectos de sulfato de magnesio y dexmedetomidina sobre la calidad de la visibilidad en cirugía endoscópica sinusal: estudio clínico aleatorizado

Background and objectives: Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. Method: 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50 mg kg−1 over 10 min and maintained at 15 mg kg−1 h−1; in Group D, dexmedetomidine was given at 1 mcg kg−1 10 min before induction and maintained at 0.6 mcg kg−1 h−1. Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. Results: Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. Conclusions: Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium. .

Justificativa e objetivo: Uma quantidade, mesmo pequena, de sangramento durante a cirurgia endoscópica pode alterar o campo endoscópico e dificultar o procedimento. Várias técnicas, incluindo hipotensão induzida, podem minimizar o sangramento durante a cirurgia endoscópica. O objetivo deste estudo foi comparar a qualidade da visibilidade cirúrgica, os parâmetros hemodinâmicos, a dor no período pós-operatório e outros efeitos do sulfato de magnésio, um agente hipotensor, com os da dexmedetomidina, inicialmente desenvolvida para sedação em curto prazo em unidade de terapia intensiva, mas que também é um sedativo agonista alfa-2. Métodos: Foram alocados 60 pacientes entre 18 e 45 anos em dois grupos: Grupo M (magnésio) e Grupo D (dexmedetomidina). No Grupo M, sulfato de magnésio foi administrado pré-indução a uma dose de carga de 50 mg kg−1 por 10 minutos e mantida com 15 mg kg−1 h−1; no Grupo D, dexmedetomidina foi administrada a uma dose de 1 mcg kg−1 10 minutos antes da indução e mantida com 0,6 mcg kg−1 h−1. No período intraoperatório, foram registrados os parâmetros hemodinâmicos e respiratórios e a avaliação do campo cirúrgico com uma escala de seis pontos. Durante o período pós-operatório foram registrados os valores da escala numérica de 11 pontos para avaliar a dor, a escala de sedação de Ramsay, a escala de avaliação de náusea/vômito, o perfil dos efeitos adversos e pruridos. Resultados: O Grupo D apresentou redução significativa da frequência cardíaca e do escore na escala de avaliação do campo cirúrgico intraoperatório. A média do tempo cirúrgico foi de 50 minutos e o Grupo M apresentou um número maior de cirurgias prolongadas. ...

Introducción y objetivo: Una cantidad, aunque sea pequeña, de sangrado durante la cirugía endoscópica puede alterar el campo endoscópico y dificultar el procedimiento. Varias técnicas que incluyen hipotensión inducida pueden minimizar el sangrado durante la cirugía endoscópica. El objetivo de este estudio fue comparar la calidad de la visibilidad quirúrgica, los parámetros hemodinámicos, el dolor en el período postoperatorio y otros efectos del sulfato de magnesio, que es un agente hipotensor, con los de la dexmedetomidina, inicialmente desarrollada para la sedación a corto plazo en la unidad de cuidados intensivos, pero que también es un sedante agonista alfa-2. Método: 60 pacientes con edades entre 18 y 45 años se dividieron en 2 grupos: grupo M (magnesio) y grupo D (dexmedetomidina). En el grupo M, el sulfato de magnesio fue administrado antes de la inducción en dosis de carga de 50 mg kg−1 por 10 min y se mantuvo con 15 mg kg−1 h−1; en el grupo D, la dexmedetomidina fue administrada con una dosis de 1 µg kg−1 durante 10 min antes de la inducción y se mantuvo con 0,6 µg kg−1 h−1. En el período intraoperatorio se registraron los parámetros hemodinámicos y respiratorios y la evaluación del campo quirúrgico con una escala de 6 puntos. Durante el postoperatorio también se registraron la escala numérica de 11 puntos para evaluar el dolor, la escala de sedación de Ramsay, la escala de evaluación de náuseas/vómito, el perfil de los efectos adversos y los pruritos. Resultados: El grupo D tuvo una reducción significativa de la frecuencia cardíaca y de la puntuación en la escala de evaluación del campo quirúrgico intraoperatorio. La media del tiempo quirúrgico fue de 50 min, y el grupo M tuvo un número mayor de ...

Severe Pulmonary Edema due to Hyponatremia after Hysteroscopy; Rapid and Full Recovery.

Hysteroscopy is an important diagnostic and therapeutic procedure that can cause serious complications, including uterine perforation and dilutional hyponatremia. Hyponatremia itself may cause central pontine myelinolysis, and pulmonary edema, which could be dangerous. We report a patient who developed near fatal pulmonary edema, and hyponatremia during hysteroscopy. A total of 12 L irrigation fluid was given in 45 minutes and eight litres were collected. At the end of the procedure, the patient was suddenly being desaturated (Saturation O2 < %50) and huge amount of frothy fluid had come out of laryngeal mask airway, pulmonary edema was considered. The supportive treatment, mechanical ventilation and 3% hypertonic saline solution were used in the ICU. Initial sodium levels were below the value of 100mEq/L but after 12 hours it was reached 135mEq/L. At the 17th hour she was extubated and day after she healed completely. This case report emphasizes the importance of rapid correction of hyponatremia and pulmonary edema caused by excessive fluid overload during hysteroscopic surgery.

Sugammadex associate persistant bradycardia.

Sugammadex is a safe selective relaxant binding agent, composed of modified cyclodextrin molecules. It especially has a selectivity for neuromuscular blocking agents (NMBAs) of steroid composition, such as rocuronium and vecuronium. In this paper, we present a case where intravenous (iv) sugammadex has been applied and subsequently persistent bradycardia has developed. A 56-year-old male patient (weight 77 kg, height 163 cm) was scheduled for ureterorenoscopy because of a stone in the upper part of ureter. Preoperative examination showed possible difficult intubation (mallampati 3). There are no known heart diseases and no history of any drug use. The electrocardiography was in normal sinus rhythm, and the blood biochemistry was normal. (WBC: 8.47 K/mm3; Hb: 14.3 g/dL; Na: 135 mEq/L; K: 3.9 mEq/L; BUN: 41 mg/dL; Creatin: 0.69 mg/dL).When the operation ended, We monitored neuromuscular block level with a neuromuscular monitoring device (TOF- Watch S). At the end of the operation, 200 mg sugammadex (Bridion 200 mg/2 mL, MSD) was administered to the patient through iv injection. Approximately 2 minutes following the administration, the patient developed sinusoidal bradycardia (pulse 35 beats/min). We believe that cardiac side effects may be observed following sugammadex administration and that atropine-resistant bradycardia may also develop.

Sudden death due to voluntary lighter fluid inhalation: A case report.

The abuse of hydrocarbon by inhalation in adolescent ages has increased in last year due to the euphoric effect it provokes. Butane, which is a kind of hydrocarbon compound, may be abused by inhalation and thus lead to addiction. Inhaling lighter fluid containing butane can cause lung toxicity, brain damage, myocardial effects, and neurologic problems. We reported, in parallel to literature, a 19-year-old patient who inhaled lighter fluid and who presented with lung haemorrhage, hypoxia and acute coronary syndrome.