Anesthesia for a child with Walker-Warburg syndrome.

BACKGROUND AND OBJECTIVES: Walker-Warburg Syndrome is a rare, autosomal recessive congenital muscular dystrophy manifested by central nervous system, eye malformations and possible multisystem involvement. The diagnosis is established by the presence of four criteria: congenital muscular dystrophy, type II lissencephaly, cerebellar malformation, and retinal malformation. Most of the syndromic children die in the first three years of life because of respiratory failure, pneumonia, seizures, hyperthermia and ventricular fibrillation. CASE REPORT: The anesthetic management of a two-months-old male child listed for elective ventriculo-peritoneal shunt operation was discussed. CONCLUSIONS: A careful anesthetic management is necessary due to the multisystem involvement. We reported anesthetic management of a two-months-old male child with Walker-Warburg Syndrome who was listed for elective ventriculo-peritoneal shunt operation.

Anestesia em criança com síndrome de Walker-Warburg / Anesthesia for a child with Walker-Warburg syndrome / Anestesia en niño con el síndrome de Walker-Warburg

Justificativa e objetivos: A síndrome de Walker-Warburg é uma distrofia muscular autossômica recessiva congênita rara, manifestada pelo sistema nervoso central com malformações oculares e possível envolvimento de vários sistemas. O diagnóstico é estabelecido pela presença de quatro critérios: distrofia muscular congênita, lisencefalia tipo II, malformação cerebelar e malformação da retina. A maioria das crianças com a síndrome morre nos primeiros três anos de vida por causa de insuficiência respiratória, pneumonia, convulsões, hipertermia e fibrilação ventricular. Relato de caso: É discutida a conduta anestésica em uma criança do sexo masculino, de dois meses, programada para cirurgia eletiva de derivação ventrículo-peritoneal. Conclusões: Uma abordagem anestésica cuidadosa é necessária por causa do envolvimento de vários sistemas. Relatamos a conduta anestésica em uma criança do sexo masculino de dois meses com síndrome de Walker-Warburg, que foi programada para cirurgia eletiva de derivação ventrículo-peritoneal. .

Background and objectives: Walker-Warburg Syndrome is a rare, autosomal recessive congenital muscular dystrophy manifested by central nervous system, eye malformations and possible multisystem involvement. The diagnosis is established by the presence of four criteria: congenital muscular dystrophy, type II lissencephaly, cerebellar malformation, and retinal malformation. Most of the syndromic children die in the first three years of life because of respiratory failure, pneumonia, seizures, hyperthermia and ventricular fibrillation. Case report: The anesthetic management of a two-months-old male child listed for elective ventriculo-peritoneal shunt operation was discussed. Conclusions: A careful anesthetic management is necessary due to the multisystem involvement. We reported anesthetic management of a two-months-old male child with Walker -Warburg Syndrome who was listed for elective ventriculo-peritoneal shunt operation. .

Justificativa y objetivos: el síndrome de Walker-Warburg es una distrofia muscular autosómica recesiva congénita rara, manifestada por el sistema nervioso central con malformaciones oculares y la posible participación de varios sistemas. El diagnóstico se establece por la presencia de 4 criterios: distrofia muscular congénita, lisencefalia tipo II, malformación cerebelar y malformación de la retina. La mayoría de los niños con el síndrome se muere a los primeros 3 años de vida debido a la insuficiencia respiratoria, neumonía, convulsiones, hipertermia y fibrilación ventricular. Relato de caso: se discute aquí la conducta anestésica en un niño del sexo masculino, de 2 meses de edad, programado para la cirugía electiva de derivación ventrículo-peritoneal. Conclusiones: un cuidadoso abordaje anestésico se hace necesario debido a la involucración de varios sistemas. Relatamos la conducta anestésica en un niño del sexo masculino de 2 meses de edad, con el síndrome de Walker-Warburg, que fue programado para la cirugía electiva de derivación ventrículo-peritoneal .

Effects of intracisternal and intravenous dexmedetomidine on ischemia-induced brain injury in rat: a comparative study.

AIM: To compare the effect of dexmedetomidine administered by intracisternal route with by intravenous route on brain tissue of rat after incomplete cerebral ischemia. MATERIAL AND METHODS: Cerebral ischemia was produced by the combination of right common carotid artery occlusion and hemorrhagic hypotension during 30 minutes. Thirty minutes before the ischemia, 0.1 ml 0.9% NaCl (Group SIC, n=6) or 9 µg/kg dexmedetomidine (Group DIC, n=6) was administered into the cisterna magna. For the intravenous groups, 9 µg/kg dexmedetomidine (Group DIV, n=6) or 0.9% NaCl (Group CONTROL, n=6) 5 ml/kg/h was given in 2 hours. After 24 hours, the lipid peroxidation levels were measured in the brain tissue and plasma. Hippocampal formations were used for histopathological examination. RESULTS: Intravenous dexmedetomidine produced a decrease in baseline mean arterial blood pressure and plasma glucose concentrations. There was a significant difference between the DIV group and DIC, SIC, CONTROL groups regarding the brain lipid peroxidation levels (p < 0.001, p < 0.001, p=0.001, respectively), and regarding the picnotic neuronal cell count (p < 0.001, p=0.01, p=0.009, respectively). Mean plasma lipid peroxidation levels of the DIV group was different from the DIC group (p=0.003). CONCLUSION: Systemically administered dexmedetomidine had neuroprotective effect in ischemia-induced neuronal damage, but centrally administered dexmedetomidine did not.

Anesthetic risks associated with Antley-Bixler syndrome.

Antley-Bixler syndrome is an autosomal recessive disorder characterized by multiple bone and cartilaginous abnormalities. The main features of this syndrome include brachycephaly, midface hypoplasia, dysplasia of ears and nose, radiohumeral synostosis, choanal stenosis, or atresia. Distinctive features are based on craniofacial deformity and humeroradial synostosis. In this report, we describe the anesthesia management of a 20-year-old Antley-Bixler syndrome patient who underwent maxillary advancement via Le Fort I osteotomy. During surgical management of craniofacial syndrome patients, particularly Antley-Bixler syndrome, the whole surgical team should be aware of possible deformities involving the airway, which may be underestimated or nondetected prior to surgery. These deformities including choanal atresia/stenosis may lead to failure of nasotracheal intubation and mask ventilation, therefore jeopardizing the surgical procedure and/or patient safety. Accurate preoperative preparation and being aware of the components of this syndrome is vital to eliminate respiratory complications and enable uneventful anesthetic and surgical management.

Effects of intracisternal dexmedetomidine on cerebral neuronal cells in rat: a preliminary study.

AIM: The aim was to investigate whether dexmedetomidine had a toxic effect on cerebral neurons when it was administered centrally into the cerebrospinal fluid by the intracisternal route. MATERIAL AND METHODS: Eighteen rats were anesthetized and the right femoral artery was cannulated. Mean arterial pressures, heart rates, arterial carbon dioxide tension, arterial oxygen tension, and blood pH were recorded. When the free cerebrospinal fluid flow was seen, 0.1 ml normal saline (Group SIC, n=6) or 9 µg/kg diluted dexmedetomidine in 0.1 ml volume (Group DIC, n=6) was administered into the cisterna magna of rats. After 24 hours, the whole body blood was collected for measurement of plasma lipid peroxidation (LPO) levels. The hippocampal formations used for histopathological examination and measurement of tissue LPO levels. RESULTS: There was a statistically significant difference between the DIC/SIC groups and DIC/CONTROL groups regarding the brain LPO levels (p=0.002, p < 0.001, respectively). Plasma LPO levels were statistically different between the CONTROL/DIC groups, CONTROL/SIC groups, DIC/ SIC groups (p=0.002, p=0.047, p=0.025, respectively), The picnotic neuron counts were different between the CONTROL/SIC groups, CONTROL/ DIC groups, DIC/SIC groups (p < 0.001, p=0.001, p=0.024, respectively). CONCLUSION: In conclusion, dexmedetomidine had a toxic effect on cerebral neurons when it was administered centrally into the cerebrospinal fluid by the intracisternal route.

Comparison of effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations in transurethral procedures.

OBJECTIVE: To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. METHODS: Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. RESULTS: Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P < .001 and P < .001, respectively), and Aldrete scores were greater in group K than group M. CONCLUSION: Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination.

Neuroprotective effects of racemic ketamine and (S)-ketamine on spinal cord injury in rat.

BACKGROUND: The aim of this study was to investigate and to compare the potential neuroprotective effects of racemic ketamine, (S)-ketamine and methylprednisolone after an experimental spinal cord injury model in rats. METHODS: Fifty-nine Wistar albino rats were divided into three main groups as acute stage (A), subacute stage (SA) and sham groups and then acute and subacute stage groups were divided into four groups regarding the used drug as control (CONT), racemic ketamine (RK), (S)-ketamine (SK) and methylprednisolone (MP) groups. A dorsal laminectomy was performed; and spinal cord injury was induced by using a temporary aneurysm clip. Four hours later from the clip compression, except those of the sham and control groups, the drugs (60 mg/kg racemic ketamine, 60 mg/kg (S)-ketamine or 30 mg/kg methylprednisolone) were administered intraperitoneally. At 72th h and 7th days of the study, the spinal cords of rats were removed from T8 level to the conus medullaris level. The specimens were and evaluated histopathologically, tissue lipid peroxidation (LPO) and myeloperoxidation (MPO) levels were measured and biochemically. RESULTS: The histopathological results were similar both in the acute and in the subacute stage groups. There was a statistically significant difference among all groups regarding the tissue LPO levels (p<0.001). There was a statistically significant difference between the CONT-A group and the MP-A, RK-A and SK-A groups (p=0.004, p<0.001 and p=0.007, respectively) in acute stage and between the CONT-SA group and SK-SA group (p=0.002) in subacute stage. There was a statistically significant difference among all groups regarding the tissue MPO levels (p=0.001). The median MPO levels were similar among acute stage groups (p=0.057), but there was a statistical difference among subacute stage groups (p=0.046). CONCLUSION: (S)-ketamine is more effective than methylprednisolone and racemic ketamine to reduce the LPO levels in subacute stage of spinal cord injury in rats. And, it is as effective as methylprednisolone in preventing secondary spinal cord injury histopathologically.

A novel approach for anterior sciatic nerve block: cadaveric feasibility study.

BACKGROUND: Sciatic nerve block is a commonly used technique for providing anesthesia and analgesia to the lower extremity. It is classically performed through posterior or lateral approaches. However, an anterior approach should be considered in certain conditions where patient positioning would be complicated. The success rate of the sciatic nerve block with previously defined approaches has been reported to be low, however, the complication rate with such approaches has been found to be high. Therefore, we aimed to conduct an anatomical study defining a new anterior approach to block the sciatic nerve and also to examine if the femoral nerve can be blocked via the same approach. METHODS: Initially, various landmarks and practical measurements were examined on 11 lower extremities. Eight of the lower extremities were used for defining the best approach to the sciatic nerve anteriorly. Once defined, Indian ink was injected into two cadaveric extremities with an anesthetic needle through such an approach. The route of the needle was evaluated via dissection and we observed whether the ink stained the sciatic nerve or injured regional neurovascular structures. The remaining extremity was cut axially to observe the route of the needle after injection. RESULTS: The ideal site of needle insertion was found to be 4-5 cm distal to the inguinal crease and 1-2 cm lateral to the femoral artery. On average, this point corresponded to a point located 8.0 ± 0.7 cm distal to a perpendicular line drawn midway through the straight line connecting the anterior superior iliac spine (ASIS) and the pubic tubercle (PT). The distance of this point to the straight line drawn between the ASIS and PT was approximately equal to half the distance of this line. CONCLUSION: The technique described herein appears anatomically safe with a lower risk of damage to major neurovascular structures. Additionally, the femoral nerve can be blocked simultaneously to obtain a larger area of anesthesia of the lower limb.

Effects of GSM-like radiofrequency on distortion product otoacoustic emissions of rabbits: comparison of infants versus adults.

OBJECTIVES: The aim of this study is to investigate the potential hazardous effects of 1800 MHz Global System for Mobile Communications-like (GSM-like) Radiofrequency (RF) exposure on the cochlear functions of female infant and adult rabbits by measuring Distortion Product Otoacoustic Emission (DPOAE) response amplitudes. METHODS: Eighteen each one-month-old New Zealand White female rabbits and eighteen each 13-month-old adult rabbits were included into the study. They were randomly divided into four groups. Nine infant rabbits (Group 1) were not exposed to 1800 MHz GSM-like RF (Infant Control, C-In). Nine infant rabbits (Group 2) were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days after they reached one-month of age (Infant RF, RF-In). Nine adult rabbits were not exposed to 1800 MHz GSM-like RF, 15 min daily for 7 (Adult Control, C-Ad). Nine adult rabbits were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days (Adult RF, RF-Ad). Cochlear functions were assessed by DPOAEs at 1.0-8.0 kHz. RESULTS: At 1.0-2.0 and 6.0 kHz, the mean DPOAE values of Group 2 were significantly higher than that of Group 1. At 3.0-8.0 kHz, the mean DPOAE values of Group 4 were significantly lower than that of Group 1. At 6.0-8.0 kHz, the mean DPOAE values of Group 2 were significantly higher than that of Group 3. At 1.0-8.0 kHz, the mean DPOAE values of Group 4 were significantly lower than that of Group 2. At 1.0-8.0 kHz, the mean DPOAE values of Group 4 were significantly lower than that of Group 3. CONCLUSION: Harmful effects of GSM-like 1800 MHz RF exposure was detected more in the adult female rabbits than infant female rabbits by DPOAE measurement. Prolonged exposure and hyperthermia related to the power density of applied RFR, increasing the temperature in the ear canal, may decrease the DPOAE amplitudes. Water containing medium in the middle ear of infant rabbits may play the protective role **from the RF damage.

Effects of GSM-like radiofrequency on distortion product otoacoustic emissions in pregnant adult rabbits.

OBJECTIVES: To determine the effects of 1800 MHz GSM-like Radiofrequency (RFR) on the cochlear functions of pregnant adult rabbits by Distortion Product Otoacoustic Emissions (DPOAEs). METHODS: Eighteen 13-month-old pregnant and eighteen 13-month-old non-pregnant New Zealand White rabbits were studied. They were randomly divided into four groups. Nine pregnant rabbits (Group 2) and nine non-pregnant rabbits (Group 4) were exposed to 1800 MHz GSM-like RFR 15 min daily for 7 days. Nine pregnant (Group 1) and nine non-pregnant rabbits (Group 3) were not exposed to GSM like RFR. Cochlear functions were assessed by DPOAEs at 1.0-8.0 kHz. RESULTS: In all pregnant groups except 2.0 kHz, DPOAE amplitudes were not different in Group 2 and Group1. In Group 4, DPOAE amplitudes at 1.0-4.0 kHz (-1.68 dB SPL at 1.0 kHz, 3.05 dB SPL at 1.5 kHz, 2.96 dB SPL at 2.0 kHz, 1.30 dB SPL at 3.0 kHz and 12.22 dB SPL at 4.0 kHz) were lower than Group 3 (8.67 dB SPL at 1.0 kHz, 17.67 dB SPL at 1.5 kHz, 26.10 dB SPL at 2.0 kHz, 18.10 dB SPL at 3.0 kHz and 35.13 dB SPL at 4.0 kHz) (P < 0.0125). In the pregnant group, harmful effects of GSM-like RFR were less than in the non-pregnant group. CONCLUSION: GSM-like RFR caused decreases in DPOAE amplitudes mainly in non-pregnant adult rabbits. Prolonged exposure may affect the DPOAE amplitude. Recommendations are given to prevent the potential hazardous effects of RF in humans.

Effects of extremely low frequency electromagnetic fields on transient evoked otoacoustic emissions in rabbits.

OBJECTIVE: Humans are continuously exposed to an extremely low frequency (ELF) of electromagnetic fields (EMF), transmitted from the common sources like power stations, electric transmission lines, communication and radio-television signal transmission units. The present study aimed to assess the effects of 5.068 kV/m and 10.182 kV/m electric fields, which refer to the lower and upper intensity limits beyond which hazardous effects can be observed, on the auditory functions of rabbits via transient evoked otoacoustic emission (TEOAE) recordings. METHODS: The study was performed on 20 healthy adult female New Zealand White rabbits randomly divided into two groups and applied either 5.068 kV/m (Group 1) or 10.182 kV/m (Group 2) of electric field for 3h/day for 14 days. TEOAE responses were recorded on day 0 before the exposure (0-BE) and on the 6th (6th-AE) and 14th (14th-AE) days after the exposure (AE). Emission amplitudes at 1.0-4.0 kHz were analyzed. RESULTS: In Groups 1 and 2, the amplitudes separately recorded on the 6th-AE day were not different from the amplitudes recorded on day 0-BE. On the 6th-AE day, the only significant difference was detected in the right ear recordings of Group 1 at the frequency of 1.5 kHz (p=0.007). In Group 1, at 1.5 kHz, the median 6th day AE value (3.8 dB SPL) for the right ear was significantly lower than the median BE value. No significant difference in terms of amplitudes was detected in the comparison of 14th day AE with day 0-BE recordings. In the comparison of the groups for the recordings obtained at all the time points, no statistically significant differences were found. CONCLUSION: It was concluded that the TEOAE decrease at 1.5 kHz of the right ears of Group 1 on the 6th day AE was transient; and on the 14th day AE, no significant decrease was determined in the TEOAEs of both groups. Our results showed that the ELF EMFs have no significant effects on the hearing sensation of rabbits, the cochlear functions of whose were evaluated using TEOAE recordings.

Effects of intrauterine and extrauterine exposure to GSM-like radiofrequency on distortion product otoacoustic emissions in infant male rabbits.

OBJECTIVES: The aim of this study was to investigate the potential hazardous effects of intrauterine (IU) and/or extrauterine (EU) exposure to 1800 MHz Global System for Mobile Communications-like (GSM-like) radiofrequency (RF) on the cochlear functions of infant rabbits by measuring distortion product otoacoustic emission (DPOAE) response amplitudes. METHODS: Thirty-six white infant male New Zealand rabbits each 1-month-old were included in the study. The animals were randomly divided into four groups. Nine infant rabbits (Group 1) were not exposed to 1800 MHz GSM-like RF (Control-C). Nine infant rabbits (Group 2) were exposed to 1800 MHz GSM-like RF, 15 min daily for 14 days after they reached 1-month of age (extrauterine-EU). Nine infant rabbits (Group 3) were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days in the intrauterine period (between 15th and 22nd days of the gestational period) (intrauterine-IU). Nine infant rabbits (Group 4) were exposed to 1800 MHz GSM-like RF, 15 min daily for 7 days in the intrauterine period (between 15th and 22nd days of the gestational period) and 15 min daily for 14 days after they reached to 1-month of age (IU+EU). The cochlear functions were assessed by DPOAEs at 1.0-8.0 kHz. RESULTS: At 1.5 kHz, the mean DPOAE amplitude of Group 3 was higher than that of the controls and Group 2; and the mean DPOAE value of Group 4 was higher than that of the controls and Group 2. At 2.0 kHz, the mean DPOAE amplitude of Group 4 was higher than that of Group 2. At 3.0 kHz, the mean DPOAE amplitude of Group 4 was higher than that of the controls and Group 2. At 4.0 kHz, the mean DPOAE amplitude of Group 2 was lower than that of the controls, while the mean value of Group 4 was higher than the mean value of the controls and Group 2. At 6.0 kHz, the mean DPOAE amplitude of Group 2 was lower than that of the control group; however, the mean value of Group 4 was higher than that of Group 2. At 1.0 and 8.0 kHz, no significant differences were found among the four groups. CONCLUSION: Prolonged exposure and hyperthermia related to the power density of applied RF, increasing the temperature in the ear canal, may affect DPOAE amplitudes. Harmful effects of RF are mainly observed as a decrease in DPOAE amplitudes at 4.0-6.0 kHz during extrauterine exposure in infancy. During the intrauterine period, the water content of the middle and inner ear and amnion fluid may play a protective role. Therefore, children must be protected from RF exposure. The use of mobile phones at short distances from the ear of the infants should be avoided because of the lower thickness of the anatomical structure in infancy.

Effects of extremely low frequency electromagnetic fields on distortion product otoacoustic emissions in rabbits.

OBJECTIVE: Humans are continuously exposed to extremely low frequency (ELF), electromagnetic fields (EMF), transmitted from the common sources like power stations, electric transmission lines, communication and radio-television signal transmission units. The present study aimed to assess the effects of 50 Hz ELF-EMF of 5.068 and 10.182 kV/m electric fields, which refer to the lower and upper intensity limits beyond which hazardous effects can be observed, on the auditory functions of rabbits via Distortion Product Otoacoustic Emission (DPOAE) recordings. METHODS: The study was performed on 20 healthy adult female New Zealand White rabbits randomly divided into two groups and applied 50 Hz ELF-EMF with either 5.068 kV/m (Group 1) or 10.182 kV/m (Group 2) of electric field for 3h/day during 14 days. DPOAE responses recorded on the 0th day before exposure (B-EMF) and on the 6th (A-EMF-6th) and 14th (A-EMF-14th) days after exposure (AE). Mean stimulus intensity and emission amplitudes at 1.0-8.0 kHz were analyzed. RESULTS: In Group 2 rabbits, on 6th and 14th days, the DPOAE amplitudes were observed as increased at 1.5-4.0 kHz (at 2.0 and 4.0 kHz significantly) than B-EMF values. At 6.0 kHz, A-EMF-14th amplitudes were significantly lower than A-EMF values. CONCLUSION: These results suggest that ELF EMFs might affect hearing functions by frequency dependent manner. Higher ELF EMFs exposure caused increase of cochlear activity. Ototoxic effect of 10.182 kV/m ELF EMFs may begin at the basal turn of the cochlea by reducing DPOAEs at high frequencies.

The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters.

STUDY OBJECTIVES: To investigate the hemodynamic, cardiovascular, and recovery effects of dexmedetomidine used as a single preanesthetic dose. DESIGN: Randomized, prospective, double-blind study. SETTING: University Hospital of Kirikkale, Kirikkale, Turkey. PATIENTS: 40 ASA physical status I and II patients, aged 20 to 60 years, who were scheduled for elective cholecystectomy. INTERVENTIONS: Patients were randomly divided into two groups to receive 0.5 microg kg(-1) dexmedetomidine (group D, n = 20) or saline solution (group C, n = 20). Anesthesia was induced with thiopental sodium and vecuronium, and anesthesia was maintained with 4% to 6% desflurane. MEASUREMENTS: Mean arterial pressure (MAP), heart rate (HR), ejection fraction (EF), end-diastolic index (EDI), cardiac index (CI), and stroke volume index (SVI) were recorded at 10-minute intervals. The times for patients to "open eyes on verbal command" and postoperative Aldrete recovery scores were also recorded. MAIN RESULTS: In group C, an increase in HR and MAP occurred after endotracheal intubation. In group D, HR significantly decreased after dexmedetomidine was given. The EDI, CI, SVI, and EF values were similar in groups D and C. The modified Aldrete recovery scores of patients in the recovery room were similar in groups C and D at the 15th minute. CONCLUSIONS: A single dose of dexmedetomidine given before induction of anesthesia decreased thiopental requirements without serious hemodynamic effects or any effect on recovery time.

Topotecan treatment and its toxic effects on hematologic parameters and trace elements.

The aim of this study was to investigate the effects of topotecan, a topoisomerase I-inhibiting anticancer agent, on hematologic parameters and serum levels of trace elements. The study was conducted on three groups consisting of 16 and 18 rabbits in the study groups and 15 rabbits in the control group. Rabbits in group I (n = 16) received high-dose topotecan intravenously (i.v.; 0.5 mg/kg once daily), while rabbits in group II (n = 18) received low-dose topotecan i.v. (0.25 mg/kg once daily) for 3 days. The 15 rabbits comprising the control group did not receive topotecan. Serum samples were collected from each rabbit on the first day, before the treatment, and on the 15th day of treatment. Erythrocytes, hemoglobin, white blood cell count, thrombocyte count, and trace elements such as selenium, copper, lead, zinc, and cobalt were analyzed. Hemoglobin levels and erythrocyte counts were lower in both study groups than in the control group. However, thrombocyte and leukocyte counts were similar in all three groups (p > 0.005). Serum trace element levels (copper, lead, zinc, and cobalt) did not differ significantly between groups. However, serum selenium levels were significantly lower in both study groups than the control group (p < 0.001). The results revealed that topotecan treatment causes a decrease in erythrocyte counts and hemoglobin levels due to bone marrow suppression, and these effects must be taken into account during treatment. In addition, selenium supplementation might be helpful in cancer patients receiving topotecan to increase the effect of the chemotherapeutic agent.

Risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery.

OBJECTIVE: This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS). METHODS: The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients (10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times. RESULTS: There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA-4h), oxygen saturation value of the study group was lower than that of the control group. CONCLUSION: We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4h and AS-4h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory parameters and to give enriched oxygen by an oral catheter.

Antibacterial activity of remifentanil and mixtures of remifentanil and propofol.

STUDY OBJECTIVE: To investigate the antibacterial activity of glycine, which is contained in remifentanil, when combined with propofol. DESIGN: Prospective study. SETTING: Departments of anesthesiology and microbiology of a university hospital. MEASUREMENTS: Growth of the microorganisms Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans in propofol 1%; saline dilutions of remifentanil at one-, 10-, and 100-microg/mL concentrations; and 1:1 mixtures of propofol with remifentanil solutions was determined. MAIN RESULTS: Remifentanil inhibits bacterial growth in a concentration-dependent manner. The antibacterial effects were more pronounced with Staphylococcus aureus and Pseudomonas aeruginosa at cultures obtained at the fifth hour. The inhibition of bacterial growth was less influenced with Escherichia coli and Candida albicans. CONCLUSIONS: Propofol and remifentanil mixtures decreased bacterial growth, and combinations may reduce the infectious complications from accidentally contaminated propofol.

Use of the NMDA antagonist magnesium sulfate during monitored anesthesia care for shockwave lithotripsy.

PURPOSE: To assess whether intravenous magnesium sulfate infusion affects analgesic requirements during monitored anesthesia care (MAC) for shockwave lithotripsy (SWL). PATIENTS AND METHODS: Fifty patients in ASA class I or II undergoing SWL with MAC were randomized into two groups. Induction of MAC was produced by bolus doses of midazolam 0.03 mg/kg(-1) and fentanyl 0.5 microg/kg(-1) followed by intravenous infusion of midazolam 0.015 to 0.06 mg/kg(-1)/hr(-1) with fentanyl supplementation 0.2 microg/kg(-1). In addition, group I patients received magnesium sulfate 30 mg/kg(-1) intravenously as a bolus dose followed by a continuous infusion of 10 mg/kg(-1) /hr(-1) beginning 15 minutes before induction of sedation. The midazolam infusion rate and additional fentanyl doses were adjusted by verbal analog scale (VAS) measurements, observer assessment sedation score (OAA/S), and achieving a target bispectral index (BIS) in a range of 70 to 90. At the end of SWL, the total midazolam and total fentanyl consumptions were recorded, and the serum magnesium concentration was measured. RESULTS: Magnesium caused significant decreases in the total consumption of midazolam (P = 0.001) and fentanyl (P = 0.001). The VAS values at the 15th, 20th, and 25th minute in group I were significantly lower than in group II. In group I, hemodynamic and arterial oxygen parameters were better than in group II. CONCLUSION: A magnesium bolus and infusion can be utilized to reduce analgesic requirements under MAC during SWL.

A new approach for pudendal nerve exposure and its clinical significance.

Analgesia of the pudendal nerve is used in patients undergoing gynecologic, obstetric and penile surgery. Stimulation techniques are used to determine the functions of the nerve. In these interventions, different landmarks are used to describe the localization of this nerve. Although some authors use perineal approaches, others prefer a transvaginal (rectal in males) approach. Knowledge regarding the anatomy of the pudendal nerve and its blockade allows an easy approach to the clinical problems like perineal neuralgia, neurogenic bladder dysfunction and penile implant operations. However, in the descriptions of these different approaches, there is no clear information regarding the depth of the nerve and the branches of the pudendal nerve that are blocked. The aim of the present study was to determine the depth and location of the pudendal nerve and, thus, describe certain and easily identified surface landmarks for clinical use. According to our examinations, the distance between the ischial tuberosity and the coccyx (the base of a triangle defined by the ischial tuberosity, coccyx and ischial spine) was 8.62 +/- 0.92 cm (range 6.74-9.77 cm). The distance between the ischial tuberosity and the ischial spine was 5.23 +/- 0.33 cm (range 4.76-5.81 cm) and the distance from the ischial spine to the coccyx was 5.42 +/- 0.52 cm (range 4.02-6.32 cm). Because the pudendal nerve intersected the distance between the posterior superior iliac spine and the ischial tuberosity, the distance between these two landmarks was also measured and found to be 13.31 +/- 0.91 cm (range 10.58-15.13 cm); the depth of the nerve was 4.14 +/- 0.83 cm (range 3.13-5.25 cm).

Efficacy of topotecan treatment on antioxidant enzymes and TBA-RS levels in submandibular glands of rabbits: an experimental study.

OBJECTIVE: The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits. STUDY DESIGN AND SETTING: The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, submandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the submandibular glands of the rabbits were examined. RESULTS: SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05). CONCLUSION: It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits.