Effect of different litter materials on growth performance, the gait score and footpad dermatitis, carcass parameters, meat quality, and microbial load of litter in broiler chickens.

In the current study, the microbial load of litter materials, growth performance, the gait score and footpad dermatitis, carcass characteristics, and meat quality of broilers reared on different litter materials were investigated. After hatching and sex determination, the chicks were allocated to 3 different experimental groups with each having 8 replications. The chicks were reared on thick sawdust, fine sawdust, or rice hull litter materials. A total of 480 chicks were used with each replicate having 20 chicks (10 males, 10 females) of similar body weight. At the end of the experiment, a total of 96 chickens were slaughtered, 32 from each group with equal number of males and females. The effect of the experimental groups on body weight, mortality, and carcass characteristics were not significant; however, feed consumption and feed conversion ratio were significantly (P < 0.05) affected by the treatments in all weeks except the first 2 wk of the experiment. Different litter materials significantly (P < 0.05) influenced the foot health of the chickens as well as the microbial load of the litter. There was no significant difference between the treatment groups in terms of pH, color, and cutting resistance of raw meat however, the water loss during the cooking of the meat and the TPA analysis results such as hardness, springiness, and chewiness of the cooked meats were significantly (P < 0.05) affected by the type of litter material. It was concluded that the use of fine sawdust from trees such as pine and larch containing antimicrobial extracts would be more appropriate as a litter material in broiler production.

Amperometric glucose biosensing performance of a novel graphene nanoplatelets-iron phthalocyanine incorporated conducting hydrogel.

Herein, a novel one step synthesis of multicomponent three dimensional polyacrylic acid (PAA) based conducting hydrogel (CH) incorporated with iron phthalocyanine functionalised graphene nanoplatelets (GPL-FePc) is reported. An amperometric glucose biosensor was fabricated by the immobilization of glucose oxidase (GOx) onto the synthesised PAA-VS-PANI/GPL-FePc-CH (where VS-PANI is vinyl substituted polyaniline). Scanning electron microscopy reveals the presence of three dimensional microporous structure with estimated pore size of 19 µm. The 5-(trifluoromethyl)-2-mercaptopyridine substitution onto FePc enabled the solubility of FePc in water and controls the aggregation of GPL-FePc in the synthesised CH. A sharp peak around 699 nm in UV-visible spectra confirms the presence of incorporated GPL-FePc into CH. Cyclic voltammogram of the synthesised CH biosensor exhibited well defined redox peaks with a ΔEp value of 0.26 V in Fe(CN)63-/4- bench mark solution. The fabricated PAA-VS-PANI/GPL-FePc/GOx-CH amperometric biosensor resulted in remarkable detection sensitivity of 18.11 µA mM-1 cm-2 with an average response time of ∼1 s, linearity from 1 to 20 mM, and low detection limit of 6.4 µM for the determination of glucose.

Intralesional treatments for hypertrophic scars: comparison among corticosteroid, 5-fluorouracil and botulinum toxin in rabbit ear hypertrophic scar model.

OBJECTIVE: Different treatment modalities have been used either alone, or in combination to achieve an optimum improvement for hypertrophic scars. Intralesional injections of corticosteroids and 5-fluorouracil are among the most commonly used treatments. Recently, botulinum toxin is proposed as a new treatment option. In this study, it is aimed to compare the efficacies of intralesional triamcinolone acetonide, 5-fluorouracil and botulinum toxin-A for hypertrophic scars. In order to minimize the variables affecting scar formation, standardized wounds in rabbit ear hypertrophic scar model was used. MATERIALS AND METHODS: Four surgical wounds were created on both ears of eight rabbits. Injections to be compared (triamcinolone acetonide, 5-fluorouracil, botulinum toxin-A and control) are administered intralesionally to established scars on day 30. Scars were harvested on day 60 for morphometric analysis including hypertrophic index, fibroblast density, and relative collagen density. RESULTS: Triamcinolone acetonide and 5-fluorouracil injections decreased hypertrophic indexes significantly compared to botulinum toxin-A and control group. However, only 5-fluorouracil was effective to reduce fibroblast counts significantly. No statistically significant differences were found between the treatment groups in terms of collagen index. CONCLUSIONS: According to the results of our study, triamcinolone acetonide and 5-fluorouracil are comparatively effective as monotherapy, but botulinum toxin-A was not effective on established hypertrophic scars.

Effects of two different techniques of postoperative analgesia management in liver transplant donors: a prospective, randomized, double-blind study.

The aim of this study was the compare the donor patients who received intravenous (IV) morphine with patient-controlled analgesia (PCA) or epidural morphine during the early postoperative period who underwent liver transplantation. Forty patients were included in the study and randomly divided into 2 groups in a double-blinded manner. They were given IV morphine 5 mg (Group C), or epidural anesthesia adding morphine (2 mg; Group E) by epidural anesthesia technique starting 15 minutes before the estimated time of completion of surgery. All of the patients received PCA with IV morphine (Group C; PCA device was set to deliver 1 mg morphine with a lockout of 15 minutes and a 4-hour limit of 20 mg, and no continuous infusion) or epidural morphine (Group E; patient-controlled epidural analgesia [PCEA] device was set to deliver 0.5 mg morphine with a lockout of 30 minutes and a 4-hour limit of 10 mg, and no continuous infusion) and were followed up for 24 hours, and pain scores were evaluated by study nurses who were blinded to the study protocol. The visual analogue scale (VAS) scores at rest and at movement and morphine consumption at 12 and 24 hours after operation evaluation time points were significantly higher in Group E than those in Group C (P < .05). Furthermore, total morphine consumption in Group C was significantly higher than that in Group E (P < .05). Epidural morphine via PCEA was associated with decreased postoperative VAS scores and morphine consumption. These findings may be beneficial for managing postoperative analgesia protocols in liver transplant donor patients.

Comparison of antioxidant effects of isoflurane and propofol in patients undergoing donor hepatectomy.

BACKGROUND: The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy. METHODS: A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study. The patients were randomly divided into 2 groups: propofol and isoflurane. Plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured before surgery (t0) and after surgery (t1). RESULTS: There were no statistically significant differences in demographic features, anesthesia, and times of surgery between the groups (P > .05). Plasma TAC levels at t0 and t1 were significantly lower in the propofol group than in the isoflurane group (P < .05). OSI at t1 was significantly higher in the propofol group than in the isoflurane group (P < .05). MDA levels were significantly higher in the propofol group than in the isoflurane group at t0 (P < .05). MDA levels level were significantly higher in the isoflurane group than in the propofol group at t1 (P < .05). CONCLUSIONS: Propofol may have protective effects against IR injury caused by the Pringle maneuver during donor hepatectomy in living-donor transplantations. However, the effectiveness of propofol for clinical use needs to be investigated further.

How fast can a naturopathic medicine cause skin burn? a case report of garlic burn.

This paper presents a case in which a chemical burn resulted from the use of garlic as a naturopathic medicine for knee pain.

Nous présentons une brûlure chimique causée par l'ail utilisé comme une médecine naturopathique antalgique du genou.

Indium-chlorine and gallium-chlorine tetrasubstituted phthalocyanines in a bulk system, Langmuir monolayers and Langmuir-Blodgett nanolayers--spectroscopic investigations.

The paper deals with spectroscopic characterization of metallic phthalocyanines (Pc's) (indium and gallium) complexed with chlorine and substituted with four benzyloxyphenoxy peripheral groups in bulk systems, 2D Langmuir monolayers and Langmuir-Blodgett nanolayers. An influence of the molecular structure of dyes (the presence of metal and of substitutes attached to the phthalocyanine macroring) on the in situ measurements of light absorption is reported. Molecular arrangement of the phthalocyanine molecular skeleton in the Langmuir monolayers on water substrate and in the Langmuir-Blodgett nanolayers is evaluated. A comparison of the light absorption spectra of the phthalocyanine monolayers with the spectra of the dyes in solution supports the existence of dye aggregates in the monolayer. It was shown that the type of dye aggregates (oblique and H types) depends markedly on the dye molecular structures. The NIR-IR, IR reflection-absorption and Raman spectra are also monitored for Langmuir-Blodgett nanolayers in non-polarized and polarized light. It was shown that the dye molecules in the Langmuir-Blodgett layers are oriented nearly vertically with respect to a gold substrate.

The effects of ephedrine on maternal hypothermia in caesarean sections: a double blind randomized clinical trial.

BACKGROUND: The purpose of the study was to investigate the effect of bolus and the combination of bolus and infusion of ephedrine on maternal hypothermia which are used for treating maternal hypotension under spinal anaesthesia. PATIENTS AND METHODS: 110 ASA I-II patients who developed maternal hypotension were included into the study. Spinal anaesthesia was performed with 12.5 mg heavy bupivacaine + 15 µg fentanyl. Group I: Ephedrine bolus 5 mg plus ephedrine infusion, Group B: Ephedrine bolus 5 mg plus normal saline infusion. The systolic blood pressure was allowed to range between 20% from baseline values. Ephedrine solution infusion started after hypotension occurred (0.5 mg/minute). The body temperature under 35.5°C was accepted as hypothermia. The newborns' rectal temperature was measured. Moreover, the Apgar scores, umbilical vein-arterial blood gas and acid-base status were evaluated. RESULTS: In Group I, the body core temperatures which were measured at 9, 18, 33, and 39th minutes were significantly higher than Group B (p < 0.05). The prevalence of maternal hypothermia in Group I was significantly lower than the Group B, which were as 65.5% (36/55) and 85.5% (47/55), respectively (p < 0.05). In Group I, the newborn rectal temperatures and the total dose of ephedrine were significantly higher than Group B (p < 0.05). In Group I, the systolic and mean blood pressures were higher than Group B (p < 0.05). CONCLUSIONS: As a result, we found that combined bolus and infusion of ephedrine for treating maternal hypotension prevents maternal and neonatal hypothermia during caesarean section under spinal anaesthesia compared to bolus administrations alone.

Remifentanil without muscle relaxants for intubation in microlaryngoscopy: a double blind randomised clinical trial.

OBJECTIVES: We aimed to compare the effect of remifentanil without muscle relaxant with succinylcholine for intubation in microlaryngoscopy. PATIENTS AND METHODS: Eighty patients were randomly divided into two groups: Group R (n=40) and S (n=40) received remifentanil 4 µg/kg intravenously or 1 µg/kg respectively. Anesthesia was induced with 2 mg/kg propofol in both groups. Intubation was performed after bolus administration of 10 ml saline as a placebo or 1 mg/kg of succinylcholine in Group R and S respectively. Remifentanil infusion was initiated at 0.025 µg/kg in each groups. RESULTS: Intubation conditions were similar in both groups. The mean arterial pressure (MAP) values at post-induction period were significantly lower in the Group S than in the Group R (p = 0.001). The requirement for ephedrine in Group R was found to be significantly lower than Group S (p = 0.023). Recovery times were significantly shorter (p = 0.001) and recovery scores were significantly higher (p = 0.021) in Group R. Time to patient could respond to commands was significantly longer in the Group S (p = 0.001). The surgeon's satisfaction score was significantly higher in Group R (p = 0.001). CONCLUSIONS: It was concluded that remifentanil without muscle relaxants provides similar intubating conditions as that provided by succinylcholine, and remifentanil is superior to succinylcholine with regard to haemodynamic stability and recovery duration.

Effects of preoperative iron deficiency on transfusion requirements in liver transplantation recipients: a prospective observational study.

The aims of this study were to determine the frequency of preoperative iron deficiency in adult living donor liver transplantation patients and to investigate its relationship with the need for intraoperative transfusion. Between September 1, 2011, and June 1, 2012, 103 patients scheduled for liver transplantation were included in this prospective study. Patients were divided into 2 groups according to baseline iron status: an iron-deficient group and a non deficient (normal iron profile) group. Iron deficiency was assessed on the basis of several parameters, including transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein, and peripheral blood smear. Preoperative iron deficiency was diagnosed in 62 patients. Preoperative iron deficiency was associated with low preoperative hemoglobin levels (P = .01) and a high rate of intraoperative transfusion (P < .0001). Preoperative iron deficiency is prognostic factor for predicting intraoperative transfusion requirements. These findings have important implications for transfusion practices for liver transplant recipients.

Serum YKL-40 levels as a novel marker of inflammation and endothelial dysfunction in patients with pseudoexfoliation syndrome.

PURPOSE: To evaluate serum levels of YKL-40 in patients with pseudoexfoliation syndrome (PEX) in comparison with those of age- and sex-matched healthy subjects. METHODS: Forty patients with PEX (PEX group) and 40 age- and sex-matched control subjects (control group) were enrolled in the study. An enzyme immunoassay method using the commercially available test MicroVue YKL-40 was used to measure serum YKL-40 concentration. Systolic and diastolic blood pressures, serum levels of high sensitivity C-reactive protein (hsCRP), total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides were also examined. RESULTS: The mean age was 54.4±7.6 (ranging 41-65) years in each group. The mean serum YKL-40 level of the PEX group was significantly higher than that of the control group (P<0.001). In addition, the mean serum HsCRP, total cholesterol, LDL, and triglycerides levels were significantly higher, and mean serum HDL level was significantly lower in the PEX group than in the control group (all P<0.001, excluding both P=0.002 for triglycerides and HDL levels). Further, the mean systolic and diastolic blood pressures were significantly higher in the PEX group than in the control group (P1=0.001 and P2=0.01, respectively). CONCLUSION: We have shown a relationship between PEX and elevated serum levels of YKL-40. We imply that a better understanding of the role of YKL-40 in the pathogenesis of endothelial dysfunction and atherosclerosis is necessary to develop new therapies for preventing or treating PEX. Further studies are warranted to clarify the clinical relevance of these findings.

Effects of isoflurane and propofol on hepatic and renal functions and coagulation profile after right hepatectomy in living donors.

We compared postoperative hepatic and renal functions and coagulation profiles in living donors undergoing right hepatectomy under isoflurane (n = 40) versus propofol (n = 40) anesthesia. After induction, anesthesia was maintained with isoflurane/air-O2 (group I) or propofol/air-O2 (group P) in addition to remifentanil and atracurium infusion in both groups. Aspartate aminotransferase, alanine aminotransferase, international normalized ratio (INR), activated partial thromboplastin time (aPTT), albumin, total bilirubin, blood urea nitrogen, creatinine, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were measured in the preoperative period, after end of the operation, and on the first, third, fifth and seventh postoperative days (PODs). INR was significantly increased on POD 3 and aPTT on POD 5 in group I compared with group P (P < .05). Albumin level was significantly lower in Group I on POD 1 and 3 (P < .05). GFR was significantly lower on POD 1 in the group I compared with group P (P < .05). The postoperative coagulation, GFR, and albumin values were superior following administration of propofol than isoflurane in donors who underwent living hepatectomy; however, both approaches were clinically safe, with no significant clinical difference.

Effect of preoperative iron deficiency in liver transplant recipients on length of intensive care unit stay.

Liver transplant (LT) recipients often display iron deficiency preoperatively, which significantly increases the quantity of blood that needs to be transfused intraoperatively, A risk factor for a prolonged intensive care unit (ICU) stay. The aim of this retrospective study was to determine whether there was a clinically significant association between iron deficiency and the length of ICU stay, among 153 patients scheduled for OLT from September 2011 to June 2012. Patients were divided into 2 groups according to their baseline iron status: iron- deficient (ID) and non-ID (normal iron profile) cohorts. Iron deficiency was assessed on the basis of several parameters; transferrin saturation as well as serum iron, ferritin, soluble transferrin receptor, and C-reactive protein levels. We retrospectively analyzed the data regarding demographic and clinical features, preoperative laboratory values, intraoperative transfusions, and length of ICU stay. Patient demographic features and preoperative values were similar between the groups. Preoperative iron deficiency, which was diagnosed in 72 patients (58.6%), was associated with a greater intraoperative use of fresh frozen plasma and red blood cell transfusions (P = .0001). The median length of ICU stay after LT was longer among the ID versus the non-ID group (5 and 3 days per patient, respectively; P = .0001). Therefore, we have suggested that preoperative iron deficiency may be a prognostic factor for the length of ICU stay after LT.

Sevoflurane alone and propofol with or without remifentanil for electroconvulsive therapy-a randomised, crossover study.

We compared the effectiveness of three anaesthetic regimens (propofol alone, propofol with remifentanil and sevoflurane alone), with respect to seizure duration and seizure quality in patients undergoing electroconvulsive therapy. Thirty-nine patients underwent a total of 234 electroconvulsive therapy treatments in this prospective, observer blinded, crossover study. Each patient received either propofol 1 mg/kg alone (Group P), propofol 0.5 mg/kg and remifentanil 1 µg/kg (Group R), or sevoflurane alone 6% (Group S) for their initial electroconvulsive therapy session. The patients subsequently received an alternative regimen in their next session, such as from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 µg/kg, from propofol 0.5 mg/kg and remifentanil 1 µg/kg to sevoflurane alone 6%, or from sevoflurane alone 6% to a continuing alternation between drugs at each session, until their sixth session. Muscle paralysis was achieved with 1 mg/kg succinylcholine. Seizure duration, postictal suppression index, early and midictal amplitude were recorded. The mean motor and electroencephalogram seizure durations were significantly longer in Groups P and R compared to Group S (P <0.001). The postictal suppression index and early and midictal amplitude values were not significantly different among the groups. These findings indicate that the three anaesthetic regimens had similar effects on seizure quality parameters, although sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil.

Effects of oral ß- glucan on liver ischemia/reperfusion injury in rats.

AIM: Ischemia/reperfusion (IR) injury (IRI) in liver transplant patients may negatively affect graft function. Although ß-glucan protects kidneys against IRI, its effect on the liver is unknown. This study sought to investigate ß-glucan effects on oxidative damage to the liver after IRI in rats. MATERIALS AND METHODS: Thirty-two rats were randomly divided into 4 experimental groups n = 8 in each group: sham, IR, ß-glucan and IR + ß-glucan. ß-Glucan (50 mg.kg(-1) . day(-1)) was orally administered for 10 days to rats in the ß-glucan and IR + ß-glucan groups. The rats in the IR and IR + ß-glucan groups were subjected to ischemia and reperfusion (IR) for 60 minutes each. All rats were killed on day 11 to evaluate histological changes as well as tissue levels of oxidants and antioxidants. RESULTS: Malondialdehyde (MDA) levels were significantly higher in the IR than the sham group (P = .001). MDA level was significantly higher in the IR group than in the IR + ß-glucan group (P = .001). The levels of tissue antioxidant markers (superoxide dismutase [SOD], glutathione-peroxidase [GPx], and catalase [CAT]) were significantly lower in the IR group than in the sham group (P < .05). SOD and GPx levels did not differ significantly between the IR and IR + ß-glucan groups. CAT activity was significantly higher in the IR than the IR + ß-glucan group (P = .001). Histological tissue damage was reduced in the IR + ß-glucan than the IR group. CONCLUSION: Liver IRI is an inevitable problem during liver surgery. Our results suggested that ß-glucan pretreatment suppressed oxidative stress and increased antioxidant levels in an rat model of liver IRI.

Minimally invasive stabilization of vertebral compression fractures using balloon kyphoplasty.

AIM: Spinal trauma is a leading cause of destabilization of the vertebral column. Balloon kyphoplasty is one among several surgical treatment methods for restoring spinal stability. This series included 25 patients (10 [40%] males and 15 [60%] females) over the age of 50 years who had undergone balloon kyphoplasty for traumatic compression fracture and were retrospectively evaluated to determine the success of this technique in terms of restoration of spinal stabilization. METHODS: Preoperative and postoperative direct radiographic images were obtained in all cases. Vertebral body height in the anterior, middle and posterior coronal planes were estimated from the radiographs. RESULTS: The mean anterior vertebral body height in the coronal plane was 16.39±5.64 mm before and 23.17±5.93 mm after surgery. Compared with preoperative measurements, the restoration ratio was 43% in the anterior coronal plane, 35% in the mid-coronal plane, and 43% in the posterior coronal plane. CONCLUSION: The study results suggest that balloon kyphoplasty may be used in the surgical treatment of vertebral compression fractures in selected cases.

Assessment of cup-to-disc ratio with slit-lamp funduscopy, Heidelberg Retina Tomography II, and stereoscopic photos.

PURPOSE: To compare optic disc measurements achieved by slit-lamp funduscopy, Heidelberg Retina Tomography II (HRT II), and stereoscopic optic nerve photos (SONP) in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 176 eyes (glaucomatous [n=87], ocular hypertensive [n=40], and normal eyes [n=49]) of 90 participants were studied. Each participant underwent a full ophthalmic examination, including automated perimetry, slit-lamp funduscopy, HRT II, and SONP. To compare the three different methods being investigated, the following measurements were used: vertical cup to disc ratio (VCDR), horizontal cup to disc ratio (HCDR), and cup to disc area ratio (CDR). Slit-lamp funduscopy was evaluated only with respect to VCDR. HRT II and SONP were evaluated with all three measurements (VCDR, HCDR, and CDR). RESULTS: CDR measurements in ocular hypertensive eyes did not differ significantly according to the measurement methods used (p=0.4). CDR in the other groups of participants, as well as VCDR and HCDR, all differed significantly within each group according to the method used (p<0.05 for all). Mean VCDR measured with funduscopy was smaller than mean VCDR measured with either HRT II or SONP in the glaucoma and ocular hypertension groups (p=0.0001). However, overall, the three methods showed a strong correlation in terms of VCDR, HCDR, and CDR measurements. CONCLUSIONS: Despite the correlation among the three methods, the significant differences between their measurements of optic disc parameters may be too large for these methods to be used interchangeably in clinical situations.

Energy transfer in zinc porphyrin-phthalocyanine heterotrimer and heterononamer studied by fluorescence resonance energy transfer (FRET).

Two or eight zinc triphenyl porphyrins were conjugated with Zn-phthalocyanine or H2-phthalocyanine to form ZnPc-(ZnTPP)2, ZnPc-(ZnTPP)8, H2Pc-(ZnTPP)2 and H2Pc-(ZnTPP)8. Energy transfers from the porphyrin moiety to phthalocyanine part were quantitatively studied with the modality of fluorescence resonance energy transfer (FRET). By measuring the fluorescence increment from the phthalocyanine moiety and the decrease from porphyrin part under selective excitation at the B band of the porphyrin part in those conjugated compounds and their equimolar mixture of compositions, energy transfer efficiencies were estimated to be 90% for H2Pc-(ZnTPP)8 and ZnPc-(ZnTPP)8, and 60%, 30% for ZnPc-(ZnTPP)2 and H2Pc-(ZnTPP)2, respectively.

The effects of single-dose tramadol on post-operative pain and morphine requirements after coronary artery bypass surgery.

AIM: To investigate the effects of a single dose of tramadol administered prior to extubation on post-operative pain and morphine consumption after coronary artery bypass surgery. METHODS: Patients were randomized post-operatively into two groups (group T, n= 30; group P, n= 30). The technique of anaesthesia was standardized for all patients. The patients in group T received intravenous tramadol, 1 mg/kg, and the patients in group P received 2 ml of saline 0.9%, both approximately 1 h before extubation. After extubation, all patients were allowed to use the morphine patient-controlled analgesia (PCA) device for 24 h post-operatively. Post-operative data were recorded in the cardiac intensive care unit at 30 min, 1 h, 2 h, 4 h, 12 h and 24 h after extubation by the same anaesthesiologist, who had no knowledge of the groups, and the side-effects were also evaluated. RESULTS: In group P, the visual analogue scale (VAS) scores were found to be higher 30 min (P < 0.01), 1 h (P < 0.01), 2 h (P < 0.01) and 4 h (P < 0.05) after extubation. The patient comfort scores were higher in group T 30 min (P < 0.01), 1 h (P < 0.05), 2 h (P < 0.01) and 4 h (P < 0.01) after extubation. The total morphine consumption was higher in group P at all evaluation times (P < 0.01), and the numbers of PCA demands and boluses were also higher in group P (P < 0.01). CONCLUSIONS: The study demonstrated that a single dose of tramadol administered prior to extubation following coronary artery bypass surgery is associated with a decrease of up to 25% in morphine consumption, a decrease in the VAS scores and an improvement in patient comfort within the first 4 h post-operatively.

Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of dexmedetomidine, an alpha(2)-adrenoceptor agonist, on intraoperative bleeding, anaesthetic drug requirement and postoperative pain. METHODS: Forty patients scheduled for elective tympanoplasty and septorhinoplasty operations under general anaesthesia were included in the study. The patients were randomly assigned to receive either a dexmedetomidine 1 microg kg(-1) bolus 10 min before induction of anaesthesia plus 0.5 microg kg(-1) h(-1) infusions during maintenance or placebo. Mean arterial pressure was maintained between 60 and 80 mmHg. Perioperative mean arterial pressure, heart rate, time to extubation and time to awakening were recorded. Bleeding during surgery was assessed by the surgeon, blinded to the study drugs, both intraoperatively and postoperatively as a final personal opinion about the whole surgical process. RESULTS: The heart rate and mean arterial pressure were significantly lower during induction, operation and extubation in the dexmedetomidine group (P < 0.05). Blood losses were lower in the dexmedetomidine group (P < 0.05). Propofol dose required for induction, and fentanyl and isoflurane consumption were significantly reduced in the dexmedetomidine group (P < 0.05). The total amounts of nitroglycerin and meperidine used were higher in the control group (P < 0.05). CONCLUSIONS: Dexmedetomidine decreased bleeding, postoperative analgesic requirements and intraoperative anaesthetic requirements and was associated with more stable haemodynamic responses to anaesthesia. We conclude that dexmedetomidine is a useful adjuvant to decrease bleeding when a bloodless surgical field is requested.