Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study.

BACKGROUND: Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions. OBJECTIVES: The objective of this study was to investigate whether preemptive oral administration of gabapentin 800 mg can reduce postoperative pain and modulate the inflammatory cytokine response in comparison to placebo in patients undergoing total knee arthroplasty under general anesthesia. MATERIAL AND METHODS: Fifty-two patients were randomly divided into 2 groups before surgery, either to receive peroral gabapentin 800 mg or placebo drug, 1 h before surgery. All patients had general anesthesia with endotracheal intubation, in a standardized fashion, by the same anesthetist. Thirty min before completion of surgery, intramuscular diclofenac sodium 75 mg was administered. Following extubation, visual analogue pain scale (VAS) scores and additional analgesic requirements were recorded at 15 min at post-anesthesia care unit (PACU), and at 4th and 24th h postoperatively. Plasma levels of interleukin 6 (IL-6), and tumor necrosis factor R (TNF-R) were measured at predetermined time points (T0 1 h before administration of gabapentin, T1 at postoperative the 4th h mark, and T2 at postoperative at the 24th h mark). RESULTS: The VAS scores at postoperative 4th h were significantly higher in placebo and gabapentin groups compared with VAS scores at PACU and at 24th h. The groups did not differ in terms of additional analgesic requirements. In gabapentin group, IL-6 levels at T1 and T2 were significantly lower in comparison to values measured in placebo group at the same time points. This difference was not significant in TNF-R levels between the groups. CONCLUSIONS: Though preemptive oral gabapentin administration did not reduce postoperative pain and analgesic requirements in total knee arthroplasty surgery, it attenuated IL-6 production on the first postoperative day.

Comparison between Colloid Preload and Coload in Bone Cement Implantation Syndrome under Spinal Anesthesia: A Randomized Controlled Trial.

BACKGROUND: Bone cement implantation syndrome (BCIS) is characterized by hypoxia hypotension cardiac arrest. There is not any research that investigated the hemodynamic effects of colloid use during and before cement implantation regarding BCIS development. AIMS: We aimed to compare the effects of colloid preloading before or coloading simultaneously at cement implantation on BCIS development and hemodynamic parameters in patients who underwent total knee arthroplasty. SETTINGS AND DESIGN: This is a prospective, randomized, clinical trial with the participation of 109 patients over 60 years of age and patients physical status American Society of Anesthesiologists Classes I and II to undergo knee surgery. The patients were administered spinal anesthesia, divided into three groups. SUBJECTS AND METHODS: The patients in Group I were infused 8 mL/kg hydroxyethyl starch (130/0.4) 20 min before the cement implantation, those in Group II were infused the same simultaneously during cement implantation. Group III was infused 8 mL/kg/h sodium chloride during the anesthesia management. Hemodynamic parameters of the patients were recorded at before and after cement implantation and once the tourniquet was removed. STATISTICAL ANALYSIS USED: The descriptive statistics were presented as the mean ± standard deviation for normally distributed variables, as the median for nonnormally distributed variables, and as the number of cases and (%) for nominal variables. Pearson's Chi-square test and Fisher's exact test were used in the analysis of categorical variables. RESULTS: Compared to the control group, Groups I and II were hemodynamically more stable. The development of moderate hypoxia during cement implantation was significantly different between the study groups (P < 0.05). CONCLUSIONS: We suggest that avoiding intravascular volume depletion by using the colloids, particularly in elderly patients, is important for preventing from the BCIS.

Can Sevoflurane Induce Micronuclei Formation in Nasal Epithelial Cells of Adult Patients?

OBJECTIVE: Volatile anaesthetics can inhibit the bronchociliary clearence in a dose- and time-dependend way. Moreover, they can have potential mutagenic/carcinogenic effects under chronic exposure. A genotoxicity test -micronuclei assay- was carried out in nasal epithelial cells to analyze the genotoxic effect of sevoflurane in adult patients undergoing general anesthesia. METHODS: In this study, micronucleus (MN) assay was conducted using nasal epithelial cells of 37 adult patients (age, 18-65 years) who underwent elective, minor, short surgical procedures under general anaesthesia with sevoflurane. Anaesthesia was induced and maintained using 8% sevoflurane (in 6 L min-1 of oxygen) and an inspired concentration of 2% in O2-air mixture, respectively. Nasal epithelial samples were collected at three time points: before anaesthesia induction (T1), after recovery from anaesthesia in the postanaesthesia care unit (T2) and on postoperative day 21 (T3). RESULTS: Sevoflurane significantly increased mean MN (‰) frequencies in nasal epithelial cells at T2 (6.97±2.33) and T3 (6.22±2.47) compared with those at T1 (3.84±1.89) (p<0.001). Similar result were observed for MN frequencies if the patients were analysed with regard to age (>40 or <40 years) or sex. CONCLUSION: Short-term administration of sevoflurane anaesthesia induces MN formation in nasal epithelial cells of this patient population. Further studies are required for evaluation of the results. The prolonged administration of volatile anaesthetics in various risk groups and surgical protocols should be conducted for evaluating their safety.

A Complication after Percutaneous Nephrolithotomy: Anesthesia Mumps.

Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female. Anesthesia mumps may occur in the immediate postoperative period with no suspicious predisposing factor. The reports of such cases would increase the awareness among anesthesiologists and postoperative caregivers regarding this benign complication.

Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara.

BACKGROUND: Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. METHODS: The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. RESULTS: There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. CONCLUSION: The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital.

Our Anaesthetic Experiences in Patients Undergoing Percutaneous Mitraclip Implantation.

OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68.5±10.2 years) were retrospectively investigated in terms of anaesthetic management. RESULTS: Of the 84 patients undergoing percutaneous mitraclip implantation under general anaesthesia, 84.5% had sodium thiopental and 75% had midazolam for anaesthesia induction. For the maintenance of anaesthesia, 57% of the patients were reported to have sevoflurane, whereas the rest had desflurane. The mean duration of the procedure and anaesthesia was 140.9±48.2 mins and 165.7±50.6 min, respectively. Seventy seven patients were transported to the intensive care unit and intubated after the procedure. The median extubation time was 3 h. Length of stay in the intensive care unit was 2 days, whereas it was 4 days for hospital stay. One patient died during the procedure and six patients died after the procedure. CONCLUSION: Percutaneous mitraclip implantation procedure is quite difficult for anaesthesiologists because of the procedure itself and the population on which the procedure is performed. The primary aim of anaesthesia management is to provide haemodynamic stability. The preoperative preparation and anaesthesia methods should be the same as for patients undergoing cardiac surgery. It is reported that as the experience regarding this subject increases, success of the procedure increases, with better protected haemodynamic stability, less inotropic and vasopressor requirement and shorter length of hospital stay.

Is an 87-Year-Old Grandfather Too Marginal for Being a Kidney Donor? The View of Anesthesiologists.

Living kidney donation has been accepted increasingly as a result of growth in the number of end-stage renal disease patients awaiting organ. In this aspect using grafts from marginal donors such as with advanced age is increasing in worldwide practice and also in Turkey. Therefore, anesthetic management of donors is particularly important. We herein report the anesthetic management of an 87-year-old grandfather donating his kidney to her granddaughter and review the current anesthetic strategies in a geriatric patient.

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy in aortic stenosis patients with high operative risk. Advances in experiences have shifted the choice of anesthesia from general to local anesthesia and sedation for these patients. We compared our anesthetic experiences in our institute in a period of 2.5 years. MATERIALS AND METHODS: A total of 151 (86 females, 65 males, mean age 76 years) symptomatic aortic stenosis patients undergoing transfemoral TAVI under general anesthesia (GA) (n = 79) and local anesthesia and sedation (LAS) (n = 72) were evaluated retrospectively in regards to anesthetic issues. RESULTS: The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) values of patients in the GA and LAS groups were 17 and 12, respectively. The anesthesia duration was significantly shorter in the LAS group (P < 0.001) and 16.7% of the patients in the LAS group were switched to general anesthesia. Length of stay in the intensive care unit was similar in the two groups. CONCLUSION: TAVI, applied in high-risk populations, has many challenges for anesthesiologists. With technological advances, it is possible to perform these procedures under sedation with variable advantages. Thus, future studies in regard to anesthesia are required for the success of the procedure and patient safety.

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine.

BACKGROUND: The goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperative analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery. METHODS: Sixty patients undergoing arthroscopic shoulder surgery were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine 0.25 % (group B) 40 ml or levobupivacaine 0.25 % (group L) 40 ml. BIS scores or respiratory and hemodynamic parameters during the operation, recovery characteristics, consumed doses of desflurane and pain intensities were evaluated. RESULTS: The eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p < 0.05). Group B and group L saved 36 % and 25 % desflurane per unit time respectively when compared with group C (p < 0.001and p < 0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p < 0.05). CONCLUSIONS: Because of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, general anaesthesia in combination with interscalene block may be preferred in arthroscopic shoulder surgery. TRIAL REGISTRATION: The trial registration number is ACTRN12613000381785.

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience.

BACKGROUND/AIM: To describe the anesthetic management and early results of transcatheter aortic valve implantation (TAVI) in a single center in Turkey. MATERIALS AND METHODS: We evaluated 79 (54 females, 25 males; mean age: 76 ± 9 years) consecutive symptomatic patients with severe aortic stenosis who underwent TAVI under general anesthesia between July 2011 and September 2012. We preferred a transfemoral approach as the first option. RESULTS: The duration of anesthesia was 149 ± 49 min. Thirty-eight percent of the patients were extubated in the cardiac catheterization laboratory. Three patients required a permanent pacemaker, while 8 patients required inotropic support in the postoperative period. Mortality rate was 9% within 30 days. Fifteen patients had vascular complications, of which 53% were treated surgically. CONCLUSION: Today, as a result of developments in technology, TAVI can be considered as a beneficial alternative treatment option for inoperable aortic stenosis patients. Thus, anesthesiologists will be confronted with a number of TAVI cases, and so they should be prepared to face issues related to the patient's safety both during the administration of anesthesia and in the postoperative period in the near future.

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery.

The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥ 4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.

The impact of OGG1, MTH1 and MnSOD gene polymorphisms on 8-hydroxy-2'-deoxyguanosine and cellular superoxide dismutase activity in myocardial ischemia-reperfusion.

Ischemia-reperfusion (I/R) injury, by inducing oxidative DNA damage, is one of the leading causes of increased patient morbidity and mortality in coronary artery by-pass grafting (CABG) surgery. 8-Hydroxyguanine (8-OHG) is an important oxidative base lesion. The 8-oxoguanine glycosylase (hOGG1) and hMTH1, which have several polymorphisms, remove 8-OHdG from the nucleotide pool. We investigated whether there are any correlations the biomarkers of oxidative stress (superoxide dismutase; SOD and 8-OHdG in serum) with genotype for two DNA repair genes (OGG1 and MTH1) and an antioxidant enzyme gene (manganese superoxide dismutase; MnSOD). Therefore, we measured DNA damage (8-hydroxy-2-deoxyguanosine; 8-OHdG) and endogenous antioxidant activity (SOD) at five different time points (T1, before anesthesia; T2, after anesthesia; T3, after ischemia; T4, after reperfusion and T5, after surgery). and also, MnSOD and MutT homolog 1 (MTH1) genes polymorphisms were genotyped by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) in patients undergoing coronary artery by-pass grafting (CABG) surgery. No statistically significant differences were detected in the levels of 8-OHdG and SOD in serum in terms of OGG1 Ser326Cys, MTH1 Val83Met and MnSOD Ala16Val genetic polymorphisms. Our results suggest that OGG1, MTH1 and MnSOD gene polymorphisms are not genetic risk factors for I/R injury.

Comparison of efficacy of dexketoprofen versus paracetamol on postoperative pain and morphine consumption in laminectomy patients.

OBJECTIVES: The aim of this prospective randomized, double-blind study was to evaluate the analgesic efficacy and opioid-sparing effects of preemptive single dose of dexketoprofen trometamol in comparison with that of paracetamol or placebo for elective lumbar disc surgery, over a 24-hour (h) investigation period. METHODS: After institutional approval and informed consent had been obtained, 75 patients scheduled for single level lumbar disc surgery were randomly allocated into three equal groups. Patients received oral dexketoprofen 25 mg (Group D), 500 mg paracetamol (Group P) or placebo tablets (Group C) 30 minutes (min) before induction of standard anesthesia. Patient-controlled analgesia was supplied postoperatively using morphine. Hemodynamics, visual analogue scale (VAS), sedation score, morphine consumption, and side effects were recorded every 15 min in the first hour and at 2, 6 and 24 h after surgery. RESULTS: The mean pain scores were similar among groups (p>0.05). The cumulative (SD) 24-h morphine consumption was 28.1 mg, 40.6 mg, and 43.6 mg for Groups D, P and C, respectively. The amount of morphine use at 2, 6 and 24 h was significantly lower in Group D (p<0.006). Hemodynamic parameters, sedation scores and side effects did not differ among the groups (p>0.05). CONCLUSION: The study demonstrated that preemptive dexketoprofen trometamol 25 mg is associated with a decrease of up to 35% in morphine consumption compared with placebo over the first 24 h following lumbar disc surgery; however, paracetamol 500 mg did not show the expected opioid-sparing effect comparatively.

Comet assay in evaluating DNA damage associated with ischaemia-reperfusion injury in patients undergoing coronary surgery.

Ischaemia-reperfusion (I/R) injury is responsible for a number of conditions such as coronary bypass and myocardial infarction, and deaths. Oxygen-free radicals formed during I/R have been proposed as the leading causes of tissue injury, and they play an important role in I/R injury. I/R induces oxidative DNA damage (such as purinic and pyrimidinic base lesions). Comet assay is a suitable and sensitive method for early detection of low-level DNA damage. We used modified alkaline comet assay in peripheral blood lymphocytes and evaluated I/R-induced DNA damage in patients undergoing coronary artery bypass graft (CABG) operation (in vivo model for I/R). No statistically significant difference in DNA damage levels was found before surgery, after anaesthesia, ischemia, reperfusion, and surgery. However, blood lactate levels (assessed in parallel with the comet assay) increased after I/R and did not return to the baseline level. Our findings showed that I/R injury did not induce DNA damage, but increased the lactate levels. This finding suggests that there might be reversible and uncommon necrosis that did not reflect on overall DNA base damage. Further studies are needed using this approach.

[Comparison of the effects of lidocaine, lidocaine plus tramadol and lidocaine plus morphine for intravenous regional anesthesia]. / Intravenöz rejyonal anestezide kullanilan lidokain, lidokain-tramadol ve lidokain-morfinin etkinliklerinin karsilastirilmasi.

OBJECTIVES: The aim of this study was to compare the effects of lidocaine alone and those of morphine or tramadol when added to lidocaine for intravenous regional anesthesia (IVRA) on tourniquet pain, the onset and regression time of motor and sensory block, the level and duration of analgesia, and analgesic consumption. METHODS: After institutional approval and informed consent, 90 patients scheduled for forearm or hand surgery were enrolled and randomly assigned to one of three groups for administration of either 0.5% lidocaine (Group L), 0.5% lidocaine with 1.5 mg.kg(-1) tramadol (Group LT), or 0.5% lidocaine with 0.1 mg.kg(-1) morphine (Group LM) in a volume of 40 ml. The onset and duration of sensory and motor blocks, duration of analgesia and proximal and distal tourniquet, time to first pain medication, visual analog scale (VAS) scores, analgesic requirements in 24 hours, vital signs, and side effects were recorded. RESULTS: Sensory block onset time was significantly shorter in Group LM compared with the other groups and also in Group LT compared to Group L. In addition, sensory block regression time was significantly shorter in Group L than in Group LM (p<0.05). There was a significant increase in VAS scores at the postoperative 4th and 5th hr in Group L (p<0.05). Mean arterial blood pressure was significantly reduced in Group LM at the time of tourniquet deflation (p<0.05). CONCLUSION: IVRA with lidocaine and morphine or tramadol improves postoperative analgesia and sensory block. However, these combinations provide no advantage on tourniquet pain, motor block quality, analgesia duration or analgesic consumption.