Comparison of the genotoxicity of propofol and desflurane using the comet assay in the lymphocytes of patients who underwent lumbar discectomy: A randomized trial.

OBJECTIVES: To compare the genotoxic effects of desflurane and propofol using comet assay in patients undergoing elective discectomy surgery. METHODS: This was a randomized controlled study. Patients who underwent elective lumbar discectomy under general anesthesia with propofol or desflurane were included in the study. Venous blood samples were obtained at 4 different time points: 5 minutes before anesthesia induction (T1), 2 hours after the start of anesthesia (T2), the first day after surgery (T3), and the fifth day following surgery (T4). Deoxyribonucleic acid damage in lymphocytes was assessed via the comet assay. RESULTS: A total of 30 patients, 15 in each group, were included in the analysis. The groups were similar in terms of age and gender distribution. There were no significant differences in demographics, duration of surgery, total remifentanil consumption, and total rocuronium bromide consumption. The comet assay revealed that head length, head intensity, tail intensity, tail moment at T1 were similar in the desflurane and propofol groups. Head length, tail length and tail moment measured in the desflurane group at T4 were significantly higher compared to the propofol group. Tail lengths of the desflurane group at T1, T2 and T3 were significantly higher than the corresponding values in the propofol group. CONCLUSION: Propofol and desflurane do not appear to induce DNA damage in lymphocytes. However, when the quantitative data were compared, it was determined that propofol had relatively lower genotoxic potential than desflurane.ClinicalTrials.gov Reg. No.: NCT05185167.

C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury.

BACKGROUND: Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI. METHODS: Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively. RESULTS: The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR. CONCLUSIONS: This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

APACHE II or INCNS to predict mortality in traumatic brain injury: A retrospective cohort study.

BACKGROUND: Some scoring systems, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), are used to predict mortality, but they are not specialized for traumatic brain injury. INCNS is a new scoring system for traumatic brain injury developed by Goa et al. INCNS score evaluates inflammation, nutrition, consciousness, neurological function and systemic condition. The present study aims to evaluate performances of Acute Physiology and Chronic Health Evaluation II (APACHE II) and INCNS to predict mortality in traumatic brain injuries. METHODS: In this study, 78 patients who were treated in anaesthesiology intensive care unit with the diagnosis of traumatic brain injury were included. Patients under the age of 18, foreigners, patients with incomplete data were excluded from this study. Medical records were examined retrospectively. APACHE II and INCNS scores in the first 24 hours were counted up. RESULTS: Of the 78 patients, 45 (57.7%) were males and 33 (42.3%) were females. The overall mortality was 34.6% (27/78). The mean APACHE II, INCNS score was 23.85±9.44 and 14.43±8.75, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.797 for the APACHE II and 0.847 for the INCNS. CONCLUSION: The INCNS scoring system had higher discriminatory power than the APACHE II in predicting the mortality of TBI in the ICU. INCNS can be considered as a usable prognostic model for Turkish people.