Angiotensin II and angiotensin II receptor 2 levels can predict shock and mortality in septic patients.

BACKGROUND: The aim of this study was to evaluate the place of angiotensin II and its receptors in the prognosis of septic patients. METHODS: Patients with sepsis and septic shock were included in the study group. The control group consisted of patients who were followed up in the ICU and had no sepsis/septic shock. Plasma angiotensin II, angiotensin receptor-1 and 2 (AT-1, AT-2) levels were evaluated first and third days. RESULTS: Angiotensin II levels were significantly lower in the septic shock and non-survivor. AT-1 levels were lower in all septic patients on the first day compared to the control. While AT-1 levels on the third day decreased in the septic shock group, it increased in the sepsis group. AT-2 levels were significantly higher in sepsis, and lower in septic shock compared to controls on the first day. Angiotensin II (95%, 82%) and AT-2 levels (100%, 87%) were observed to have high sensitivity and specificity in demonstrating the presence of shock in septic patients. Angiotensin II and AT-1/AT-2 ratios were observed to have high sensitivity and low specificity in the development of mortality. CONCLUSIONS: In septic patients, angiotensin II, AT-2 and AT-1/AT-2 levels can predict the probability of shock development and mortality.

Efficacy of Intravenous Ibuprofen and Intravenous Paracetamol in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy.

PURPOSE: Many different techniques, including multimodal analgesia, have been used for the management of postoperative pain after Percutaneous nephrolithotomy (PCNL). Ketorolac, intravenous (IV) paracetamol, rofecoxib, and IV ibuprofen have been used as a part of a multimodal analgesic approach in different surgical procedures. However, the efficacy of IV ibuprofen has not been well elucidated in adult patients undergoing elective PCNL. The aim of the study was to examine the efficacy of IV ibuprofen compared to IV paracetamol after elective PCNL. DESIGN: This was a prospective randomized clinic study. METHODS: The study was conducted with 50 patients scheduled for PNCL between the ages of 18 and 65. IV ibuprofen 800 mg infusion was used for Group I, and 1 g IV paracetamol infusion Group P. IV tramadol infusion was administered with a Patient Controlled Analgesia device for postoperative analgesia. The primary outcome was 24-hour tramadol consumption. Secondary outcomes were pain intensity and side effects of the drugs. All outcomes were recorded in the 30th minute in the PACU and in 2, 4, 6, 12, 24 hours postoperatively. FINDINGS: Total postoperative tramadol consumption was significantly lower in Group I compared with Group P (P = .031). There was also a significant decrease in the cumulative tramadol consumption between the two groups in the 2nd and 24th hours (P < .012). In all measurement periods, pain intensity, sedation score, nausea and vomiting, itching, additional analgesia, and satisfaction with pain management were similar between the two groups. CONCLUSION: IV ibuprofen, used as a part of multimodal tramadol-based analgesia reduced tramadol consumption compared with IV paracetamol in the first 24 hours postoperatively after elective PCNL. The IV ibuprofen-tramadol combination seems appeared superior to a paracetamol-tramadol combination.

Assessment of Psychological Responses and Related Factors of Discharged Patients Who Have Been Hospitalized with COVID-19.

BACKGROUND: COVID-19 is the biggest pandemic of the last century. While a large number of cases and mortality rates direct the research to the clinic and prognosis of the disease, the mental health of these patients has recently become a matter of concern. This study aims to predict psychiatric morbidity and possible associated markers in COVID-19 survivors. SUBJECTS AND METHODS: A total of 102 survivors with COVID-19 infection participated in this study. A questionnaire was applied to the participants to evaluate demographic variables, history of comorbid diseases, smoking, loss of a relative due to COVID-19, and environmental attitudes after the discharge. Length of hospitalization, lung findings, intensive care history and treatments were recorded. Psychiatric morbidities were evaluated with General Anxiety Disorder-7, Patient Health Questionnaire-9 and The National Stressful Events Survey PTSD Short Scale. RESULTS: Anxiety was found in 20.6%, depression in 13.7% based on moderate and above levels, 21.6% had significant PTSD. Female gender, history of psychiatric and comorbid diseases, smoking, perceived discrimination, and lack of long-lasting immunity posed a risk in terms of psychological response. There was a negative correlation between age and depression scores. No relation was found between the duration of hospitalization, presence of lung involvement, receiving intensive care treatment, losing a relative due to COVID-19 and psychological response. CONCLUSIONS: On patients treated for COVID-19 infection, psychological response continue after discharge. Mental health support and efforts to reduce stigma among infected subjects can reduce the psychological impact caused by the pandemic.

Therapeutic and protective effects of montelukast against doxorubicin-induced acute kidney damage in rats.

OBJECTIVES: The current study was designed to investigate the therapeutic and protective effects of montelukast (ML) against doxorubicin (DOX)-induced acute kidney damage in rats. MATERIALS AND METHODS: Thirty-five Wistar albino female rats were randomly divided into 5 groups as follows: Group I: Control; Group II: Control+ML; Group III: DOX; Group IV: DOX+ML; Group V: ML+DOX. At the end of the experiment, the kidney tissues of rats were collected. Thiobarbituric acid reactive substance (TBARS), reduced glutathione, superoxide dismutase (SOD), and catalase levels were determined from the kidney tissues. In addition, the kidney tissues were examined histologically. RESULTS: DOX induced a significant increase in the kidney TBARS levels, whereas SOD contents significantly decreased when compared with the control group. On the other hand, ML administration before and after DOX injection caused significant decreases in TBARS production and also increases in SOD levels. Histologically, the most remarkable damage was glomerulosclerosis and tubular changes in the DOX group. Moreover, marked tubular necrosis and swelling in tubular epithelial cells were observed in this group. Contrarily, although glomerulosclerosis was recognized as alleviated also in both DOX+ML and ML+DOX groups, the lesions did not completely ameliorate. However, treatment with ML after DOX injection was more effective than treatment with ML before DOX injection with respect to the protection of tubular structures. CONCLUSION: It was determined that ML treatment after DOX injection caused therapeutic effects against DOX-induced kidney damage. Thence, ML treatment is of some clinical properties for oxidative stress damage in kidney tissues.

Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study.

BACKGROUND: This study were designed to investigate the usefulness of the videolaryngoscope-guided insertion technique compared with the standard digital technique for the insertion success rate and insertion conditions of the Proseal™ laryngeal mask airway (PLMA). METHODS: Prospective, one hundred and nineteen patients (ASA I-II, aged 18-65 yr) were randomly divided for PLMA insertion using the videolaryngoscope-guided technique or the standard digital technique. The PLMA was inserted according to the manufacturer's instructions in the standard digital technique group. The videolaryngoscope-guided technique was performed a C-MAC® videolaryngoscope with D-Blade, under gentle videolaryngoscope guidance, the epiglottis was lifted, and the PLMA was advanced until the tip of the distal cuff reached the oesophagus inlet. The number of insertion attempts, insertion time, oropharyngeal leak pressure, leak volume, fiberoptic bronchoscopic view, peak inspiratory pressure, ease of gastric tube placement, hemodynamic changes, visible blood on PLMA and postoperative airway morbidity were recorded. RESULTS: The first-attempt success rate (the primary outcome) was higher in the videolaryngoscope-guided technique than in the standard digital technique (p = 0.029). The effect size values with 95% confidence interval were 0.19 (0.01-0.36) for the first and second attempts, 0.09 (- 0.08-0.27) for the first and third attempts, and not computed for the second and third attempts by the groups, respectively. CONCLUSION: Videolaryngoscope-guided insertion technique can be a help in case of difficult positioning of a PLMA and can improve the PLMA performance in some conditions. We suggest that the videolaryngoscope-guided technique may be a useful technique if the digital technique fails. TRIAL REGISTRATION: ClinicalTrials.gov NCT03852589 date of registration: February 22th 2019.

Efeitos antimicrobianos de cetamina em combinação com propofol: um estudo in vitro / The antimicrobial effects of ketamine combined with propofol: an in vitro study / Efectos antimicrobianos de la cetamina en combinación con el propofol: un estudio in vitro

EXPERIÊNCIA E OBJETIVOS: Cetamina e propofol são os anestésicos gerais que também exibem efeitos antimicrobianos e promotores do crescimento microbiano, respectivamente. Embora esses agentes sejam frequentemente aplicados em combinação durante o uso clínico, não há dados sobre seu efeito total no crescimento microbiano na administração combinada. Nesse estudo, investigamos o crescimento de alguns microrganismos em uma mistura de cetamina e propofol. MÉTODO: Nesse estudo, utilizamos cepas padronizadas: Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa e Candida albicans. Realizamos uma análise de tempo-crescimento para avaliar as taxas de crescimento microbiano em propofol 1%. A atividade antimicrobiana de cetamina, isoladamente e em propofol, foi estudada pelo método de microdiluição. RESULTADOS: Em propofol, as cepas estudadas cresceram de concentrações de 10³-10(4) ufc/mL para > 10(5) ufc/mL, dentro de 8-16 horas, dependendo do tipo de microrganismo. Foram determinadas a concentração inibitória mínima (CIM) e a concentração bactericida mínima (CBM) (para Candida, concentração fungicida mínima) de cetamina, como se segue (CIM, CBM): E. coli 312,5, 312,5 µg/mL; S.aureus 19,5, 156 µg/mL; P. aeruginosa 312,5, 625 µg/mL; e C. albicans 156, 156 µg/mL. Na mistura cetamina + propofol, cetamina exibiu atividade antimicrobiana para E. coli, P. aeruginosa e C. albicans em CBMs a 1250, 625 e 625 µg/mL, respectivamente. O crescimento de S. aureus não foi inibido nessa mistura (concentração de cetamina = 1250 µg/mL). CONCLUSÃO: Cetamina preservou sua atividade antimicrobiana de maneira dose-dependente contra alguns microrganismos em propofol, que é robusta solução promotora de crescimento microbiano. O uso combinado de cetamina e propofol na aplicação clínica de rotina pode diminuir o risco de infecção causada por contaminação acidental. Entretanto, deve-se ter em mente que cetamina não pode reduzir todas as ameaças patogênicas na mistura com propofol.

BACKGROUND AND OBJECTIVES: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture. METHOD: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method. RESULTS: In propofol, studied strains grew from 10³-10(4) cfu/mL to >10(5) cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 µg/mL; S.aureus 19.5, 156 µg/mL; P.aeruginosa 312.5, 625 µg/mL; and C.albicans 156, 156 µg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 µg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 µg/mL). CONCLUSION: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture.

EXPERIENCIA Y OBJETIVOS: La Cetamina y el propofol son los anestésicos generales que también tienen efectos antimicrobianos y son los promotores del crecimiento microbiano, respectivamente. Aunque esos agentes sean frecuentemente aplicados en combinación durante el uso clínico, no hay datos sobre su efecto total en el crecimiento microbiano en la administración combinada. En ese estudio, investigamos el crecimiento de algunos microrganismos en una mezcla de cetamina y propofol. MÉTODO: En este estudio, utilizamos cepas estandarizadas: Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa y Candida albicans. Realizamos un análisis de tiempo-crecimiento para evaluar las tasas de crecimiento microbiano en el propofol al 1%. La actividad antimicrobiana de cetamina, aisladamente y en propofol, fue estudiada por el método de microdilución. RESULTADOS: En el propofol, las cepas estudiadas crecieron de concentraciones de 10³-10(4) ufc/mL para #> 10(5) ufc/mL, dentro de 8-16 horas, dependiendo del tipo de microrganismo. Fueron determinadas la concentración inhibitoria mínima (CIM) y la concentración bactericida mínima (CBM) (para Candida, concentración fungicida mínima) de cetamina, como vemos (CIM, CBM): E. coli 312,5, 312,5 µg/mL; S.aureus 19,5, 156 µg/mL; P. aeruginosa 312,5, 625 µg/mL; y C. albicans 156, 156 µg/ml. En la mezcla cetamina + propofol, la cetamina mostró una actividad antimicrobiana para E. coli, P. aeruginosa y C. albicans en CBMs a 1250, 625 y 625 µg/mL, respectivamente. El crecimiento de S. aureus no se inhibió en esa mezcla (concentración de cetamina = 1250 µg/mL). CONCLUSIONES: La cetamina preservó su actividad antimicrobiana de manera dosis-dependiente contra algunos microrganismos en propofol, que es una robusta solución que promueve el crecimiento microbiano. El uso combinado de cetamina y propofol en la aplicación clínica de rutina puede disminuir el riesgo de infección causada por la contaminación accidental. Sin embargo, debemos tener presente que la cetamina no puede reducir todas las amenazas patógenas en la mezcla con el propofol.

Protective effects of melatonin and ß-d-glucan against liver injury in rats - a comparative study.

OBJECTIVES: The aim of this study was to investigate the possible protective effects of melatonin and ß-d-glucan against ischemia-reperfusion (IR) injury in rats. MATERIAL AND METHODS: Forty rats were randomly divided into 5 groups, each consisting of 8 animals, as follows. Sham group [S], IR group [C], IR + ß-Glucan group [ß], IR + melatonin group [MLT], IR + melatonin + ß-Glucan group [MLT + ß]. The rats in the C, ß, MLT and MLT + ß groups were subjected to IR for 60 min each. Melatonin (10 mg∙kg⁻¹) was intraperitoneally injected for a single dose 30 min before IR. ß-Glucan (50 mg∙kg⁻¹âˆ™day⁻¹) was orally administered for 10 days to rats. All of the rats were killed on day 11, and histological changes in the liver and tissue levels of oxidants and antioxidants were evaluated. RESULTS: Malondialdehyde [MDA] level were significantly higher in the C group compared to the S group (p = 0.007). MDA level were significantly higher in the ß group compared to the MLT and MLT + ß groups (p =0.007). Tissue antioxidant markers (superoxide dismut ase [SOD], glutathione-peroxidase [GPx], and catalase [CAT]) were significantly lower in the C group than the S group (p < 0.05). SOD levels were simply not significant in the ß group compared to the MLT and MLT + ß groups. CAT and GPx activities were significantly higher in the ß group compared to the MLT and MLT + ß groups (p = 0.004).The histological damage ameliorated in ß, MLT and MLT + ß groups compared to C group.

The hemodynamic effects of dexmedetomidine and esmolol in electroconvulsive therapy: a retrospective comparison.

AIM: Acute hemodynamic responses, including transient hypertension and tachycardia, to electroconvulsive therapy (ECT) predispose vulnerable patients to significant cardiovascular complications. Many drugs have been used in an attempt to attenuate these responses. To date, no comparative study of the acute hemodynamic effects of dexmedetomidine and esmolol in ECT has been published. Hence, this retrospective study aimed to compare the effects of dexmedetomidine and esmolol on acute hemodynamic responses in patients undergoing ECT. MATERIALS AND METHODS: The anesthesia records for 66 patients who underwent a total of 198 ECT treatments performed between July 2009 and January 2010 were analyzed retrospectively. For each case, 1 seizure with 1-mg/kg propofol as control (group C), 1 seizure with 1-µg/kg dexmedetomidine combined with propofol (group D; total volume, 30 mL for 10 minutes), and 1 seizure with 1-mg/kg esmolol combined with propofol were compared (group E; total volume, 30 mL for 10 minutes). Anesthesia was induced with 1-mg/kg propofol, and then intravenous succinylcholine, 0.5-mg/kg, was administered. Heart rates and systolic and mean blood pressures were recorded at baseline (T0) and 1, 3, and 10 minutes after the seizure (T1, T2, and T3, respectively). The electroencephalographic (EEG) tracing motor seizure duration, and recovery times (spontaneous breathing, eye opening, and obeying commands) were recorded. RESULTS: The baseline hemodynamic measurements were similar between the groups. Heart rates at T1, T2, and T3 were lower in group D than those in groups E and C (P < 0.05). Systolic blood pressures at T1, T2, and T3 were lower in group D than those in groups C (P < 0.05). In addition, systolic blood pressure at T3 was lower in group D than that in group E (P < 0.05). The mean blood pressure at T3 was significantly lower in group D than those in groups E and C (P <0.05). The electroencephalographic tracing, motor seizure durations, and recovery times were similar between the groups. CONCLUSION: Dexmedetomidine administration before anesthesia induction reduced the acute hemodynamic response compared with esmolol administration in the early period of ECT. Therefore, dexmedetomidine may be effective in preventing acute hemodynamic responses to ECT.

Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam.

BACKGROUND: The study aim was to compare the efficacy of dexmedetomidine vs midazolam for sedation during the early postoperative period in adolescents who underwent scoliosis surgery. METHODS: We performed a prospective, randomized trial in an intensive care unit (ICU) in a tertiary care center. In this study, 42 patients (American Society of Anesthesiology physical status I and II) who underwent scoliosis surgery were divided into two groups according to sedation protocols: group dexmedetomidine (DEX) (n = 22) and group midazolam (MDZ) (n = 20). Adolescents (12-18 years) requiring mechanical ventilation underwent a continuous infusion of either dexmedetomidine (group DEX; starting dose, 0.4 µg·kg(-1) ·h(-1)) or midazolam (group MDZ; starting dose, 0.1 mg·kg(-1) ·h(-1)) with intermittent fentanyl, as needed. The efficacy of sedation was assessed using the Richmond Agitation Sedation Scale (RASS). Quality of pain relief was measured using the Numeric Visual Analog Scale (NVAS). Delirium was determined in patients in the RASS range of -2 to +1 using the Confusion Assessment Method for the ICU (CAM-ICU). Fentanyl consumption, incidence of delirium, NVAS scores, and hemodynamics were recorded postoperatively at 2, 4, 6, and 24 h in the ICU. RESULTS: The NVAS pain scores and fentanyl consumption at all the evaluation time points were significantly higher in group MDZ than those in group DEX (P < 0.05). Further, total fentanyl consumption in group MDZ was significantly higher than that in group DEX (P < 0.05). Delirium was significantly higher in the group MDZ than that in group DEX (31.3% vs 12.5%) when analyzed as the endpoint of CAM-ICU (P < 0.05). The heart rate was significantly lower in group DEX compared with that in group MDZ at all the evaluation time points (P < 0.05). CONCLUSION: Dexmedetomidine was associated with the decreased postoperative fentanyl consumption, NVAS scores, and a decreased incidence of delirium. These findings may be beneficial for managing sedation protocols in adolescents who have undergone scoliosis surgery.

The effects of secondhand smoke on postoperative pain and fentanyl consumption.

BACKGROUND: Although the need for increased postoperative analgesia in smokers has been described, the effect of secondhand smoke on postoperative analgesia requirements has not been studied. We examined the effects of secondhand smoke on fentanyl consumption and postoperative pain. METHODS: In this study, 101 patients (American Society of Anesthesiology physical status I and II) who underwent abdominal hysterectomy were divided into 3 groups according to history of exposure to cigarette smoke as per medical records which was retrospectively confirmed by measurement of serum cotinine: smokers (n = 28), nonsmokers (n = 31), and secondhand smokers (n = 32). All patients received propofol-remifentanil total intravenous anesthesia and used fentanyl patient controlled analgesia for postoperative pain. The fentanyl consumption visual analogue scale-pain intensity (VAS-PI) score and side effects were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 h after surgery. RESULTS: Fentanyl consumption at all the evaluation time points was significantly higher in secondhand smokers than in nonsmokers (P < 0.05). However, fentanyl consumption in secondhand smokers was lower than that in smokers in the PACU and at 24 h (P < 0.05). VAS-PI scores during movement and at rest in the PACU and at 4, 6, and 24 h after surgery were higher in secondhand smokers than in nonsmokers (P < 0.05). There were no statistically significant differences between the groups with regard to side effects such as nausea, vomiting, and dizziness (P > 0.05). CONCLUSION: Secondhand smoking was associated with increased postoperative fentanyl consumption, and increased VAS-PI scores. These findings may be beneficial for managing postoperative pain in secondhand smokers.

The effects of dexmedetomidine on liver ischemia-reperfusion injury in rats.

BACKGROUND: Ischemia-reperfusion (IR) injury of the liver may cause various types of damage to hepatic tissues. It can affect the prognosis of patients and the success of an operation. Dexmedetomidine is a selective α2 receptor agonist. We investigated whether dexmedetomidine provides protection against IR-induced liver injury in rats. METHODS: Forty rats were divided equally into four groups. In group 1, the liver was manipulated after the laparotomy, and no occlusion of the vessels of the liver was performed. In group 2, once the abdomen was opened, 60 min of ischemia and 60 min of reperfusion were applied according to the segmental hepatic ischemia model. In group 3, 10 µg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. In group 4, 100 µg/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. Further procedures in groups 3 and 4 were the same as those of group 2. After the experiment was completed, the rats were killed. Liver tissues were removed and stored until biochemical and histologic assessments were performed. RESULTS: The malondialdehyde level in group 2 was higher than that of groups 1, 3, and 4 (P = 0.001, P = 0.000, and P = 0.000, respectively). Superoxide dismutase, catalase, and glutathione levels in group 2 were lower than those in group 1 (P = 0.001, P = 0.027, and P = 0.014, respectively). Superoxide dismutase and catalase levels in group 4 were higher than those in group 2 (P = 0.002 and P = 0.000, respectively). GSH levels in groups 3 and 4 were higher than those in group 2 (P = 0.049 and P = 0.006, respectively). A lower glutathione peroxidase level was detected in groups 2 and 3 than that in group 1 (P = 000). Group 4 demonstrated an increase in glutathione peroxidase levels compared with group 3 (P = 0.014). The histologic injury scores in groups 2-4 were higher than those in group 1 (P = 0.003, P = 0.002, and P = 0.001, respectively). However, the histologic injury scores were lower in groups 3 and 4 than those in group 2 (P = 0.003 and P = 0.002, respectively). CONCLUSIONS: This study showed that dexmedetomidine may protect the liver against IR injury in rats.

Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial.

PURPOSE: The objective of this study was to compare the effects of ketamine-propofol mixture (ketofol) and propofol on ProSeal laryngeal mask airway (PLMA) insertion conditions and hemodynamics in elderly patients. METHODS: Eighty elderly patients, American Society of Anesthesiologists (ASA) physical status I and II, were randomly divided into two groups to receive either propofol 0.15 ml/kg (n = 40), or ketofol (using a 1:1 single-syringe mixture of 5 mg/ml ketamine and 5 mg/ml propofol) (n = 40) before induction of anesthesia. Sixty seconds after induction, the PLMA was inserted. Heart rate and arterial blood pressure (systolic [S] BP) were recorded prior to the induction of anesthesia, immediately following induction, immediately after PLMA insertion, and 5 and 10 min after PLMA insertion. PLMA insertion conditions were scored according to mouth opening, swallowing, coughing, head and body motion, laryngospasm, and ease of PLMA insertion by the same experienced anesthesiologist, who did not know which agents were used. RESULTS: There were no differences in PLMA insertion conditions between the groups. The number of patients in need of ephedrine (P = 0.043) and the total dose of ephedrine (P = 0.022) were significantly lower, and apnea duration (P < 0.001) was significantly higher in the ketofol group compared with the propofol group. SBP was significantly higher in the ketofol group than in the propofol group immediately after PLMA insertion and 5 min after PLMA insertion. CONCLUSIONS: The same PLMA insertion conditions were found with ketofol and propofol. The number of patients in need of ephedrine and the total ephedrine dose were lower and apnea duration was increased in the ketofol group.

Effects of dexmedetomidine and midazolam on motor coordination and analgesia: a comparative analysis.

OBJECTIVE: We compared the effects of 2 sedative drugs, dexmedetomidine and midazolam, on motor performance and analgesic efficacy in a rat model. MATERIALS AND METHODS: Rats were randomly divided into the following 4 groups on the basis of the treatment received. The first group received 83 µg/kg/min midazolam; the second, 1 µg/kg/min dexmedetomidine; the third, 83 µg/kg/min morphine; and the fourth was a control group. The rats were measured motor coordination and pain reflexes by using rotarod, accelerod, hot plate, and tail flick tests. RESULTS: At all the tested speeds, the midazolam-injected rats remained on the rotarod longer than did the dexmedetomidine-injected rats. Furthermore, in the 10-minute accelerod test, the midazolam-injected rats remained for a longer duration than did the dexmedetomidine-injected rats. The latency time for the hot plate test was significantly higher at 10 minutes and 20 minutes in the dexmedetomidine group than in the midazolam group. Further, the latency time at 10 minutes for the tail flick test was greater in the dexmedetomidine group than in the midazolam group. CONCLUSIONS: In this rat model, midazolam results in faster recovery of motor coordination performance when compared with dexmedetomidine.

Effects of perineural administration of dexmedetomidine in combination with levobupivacaine in a rat sciatic nerve block.

OBJECTIVE: The aim of this study was to assess if perineural administration of dexmedetomidine combined with levobupivacaine increases the duration of the sensory and motor blockade of a sciatic peripheral nerve block in rats. METHODS: Forty male Sprague-Dawley rats were randomly divided into 5 experimental groups: Group 1, sham; Group 2, perineural levobupivacaine (0.2 mL of a 0.5% solution) and subcutaneous saline; Group 3, perineural levobupivacaine (0.2 mL of a 0.5% solution) plus dexmedetomidine (20 µg/kg dexmedetomidine) and subcutaneous saline; Group 4, perineural saline and subcutaneous dexmedetomidine; and Group 5, perineural saline and subcutaneous saline. Pain reflexes in response to a thermal stimulus were measured at 0 and 240 minutes after drug administration by using a hot-plate and tail-flick tests. Neurobehavioral status, including sensory and motor functions, was assessed by an investigator who was blinded to the experimental groups every 30 minutes until normal functioning resumed. RESULTS: The sensory and motor blockades of the rats did not increase in the treatment with dexmedetomidine plus levobupivacaine when compared with the treatment with levobupivacaine alone at all the time points (P > 0.05). Compared with rats in Group 2, those in Group 3 showed significantly higher latency times at 30 and 60 minutes in the hot plate test (P < 0.01). At 30 and 60 minutes, the latency times of the rats in Group 3 were longer than those in Group 2 in the tail-flick test (P < 0.01). Furthermore, the durations of the complete sensory and motor blockade were similar when treatment with levobupivacaine plus dexmedetomidine was compared with treatment with levobupivacaine alone. CONCLUSIONS: A 20µg/kg dose of dexmedetomidine added to levobupivacaine did not increase the duration of the sensory and motor blockades in rats. However, treatment with dexmedetomidine plus levobupivacaine increased the quality of analgesia in rats.

The antimicrobial effects of ketamine combined with propofol: An in vitro study.

BACKGROUND AND OBJECTIVES: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture. METHOD: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method. RESULTS: In propofol, studied strains grew from 10(3)-10(4) cfu/mL to ≥10(5) cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 µg/mL; S.aureus 19.5, 156 µg/mL; P.aeruginosa 312.5, 625 µg/mL; and C.albicans 156, 156 µg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 µg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 µg/mL). CONCLUSION: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture.

Effects of propofol and dexmedetomidine on motor coordination and analgesia: a comparative analysis.

OBJECTIVE: The objective of this study was to compare the effects of two drugs on motor performance and analgesic efficacy in a rat model. MATERIAL AND METHODS: Rats were randomly divided into four groups as follows: propofol (600 µg/kg/min), dexmedetomidine (1 µg/kg/min), morphine (83 µg/kg/min) and control. The rats were placed on a rotating rod and tested at the slowest speed (5 rpm) and then at increasing increments from 5, 10, 15, 20, 25, 30, 35 to 40 rpm. The speed was set up again from 1 to 79 rpm within 4 and 10 min for the accelerod test, respectively. Pain reflexes in response to a thermal stimulus were measured at 0, 10, 20 and 60 min after the drug injection using the hot-plate test. RESULTS: Dexmedetomidine injected rats showed an increased length of time compared to the propofol group at 20 rpm, 25 rpm, 35 rpm and 40 rpm speeds during the rotarod test. The latency times for the hot-plate test increased significantly for the propofol, at 0, 10 and 20 min compared to the control. At 10 min the latency times of the propofol group were longer than the dexmedetomidine group. CONCLUSIONS: For long-term analgesic benefit propofol treatment seems to be better than the dexmedetomidine group. Dexmedetomidine may be preferable in day-case surgery and sedation applications in intensive care units as it provided a faster onset of recovery of motor coordination performance.

Effects of 2 different doses of pregabalin on morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind clinical trial.

BACKGROUND: Pregabalin has a similar pharmacologic profile to that of its developmental predecessor gabapentin but has shown greater analgesic activity in rodent models of neuropathic pain. OBJECTIVE: The objective of the study was to compare the effects of 2 different doses of pregabalin and placebo on postoperative pain and morphine consumption. METHODS: Ninety patients who underwent abdominal hysterectomy were included in the study and randomly divided into 3 groups in a doubled-blinded manner. They were given 150 mg of pregabalin (group P300, n = 30), 300 mg of pregabalin (group P600, n = 30), or placebo capsules (group C, n = 30) 4 hours before the induction of anesthesia; they received a second dose of the drug 12 hours postoperatively. Morphine consumption, nausea, and vomiting, visual analogue scale-pain intensity (VAS-PI), sedation scores, and dissatisfaction scores were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 hours after operation. RESULTS: Morphine consumption at 24 hours was 40.80 (3.42) mg, 33.79 (5.77) mg, and 46.97 (6.67) mg in groups P300, P600, and C, respectively (P < 0.001). VAS-PI scores at movement and at rest in the PACU and at 2, 4, and 6 hours decreased in group P600 (P < 0.01). In the PACU and at 2, 4, and 6 hours, the sedation scores were increased in group P600 compared with the scores in group C (P < 0.001, P < 0.001, P = 0.01, P = 0.006, respectively). Patient satisfaction was higher in group P600 than in group C for all time points (P < 0.001, P < 0.001, P < 0.001, P = 0.001, P < 0.001, respectively). There were no statistically significant differences between the groups for side effects such as nausea, vomiting, and dizziness (P = 0.58). CONCLUSIONS: Pregabalin at a total dose of 600 mg, administered before operation and at 12 hours postoperatively after abdominal hysterectomy, reduced morphine consumption and pain intensity and increased patient satisfaction. No significant differences in side effects were observed between the study groups.

The effect of dexmedetomidine on middle ear pressure.

OBJECTIVE: Dexmedetomidine is a preferred anesthetic agent in otological surgery because it provides controlled hypotension and good surgical field visibility. The aim of this study was to evaluate the influence of this novel agent on middle ear pressure. STUDY DESIGN AND SETTING: This prospective clinical trial was performed in 60 patients who were scheduled for elective surgery. They received dexmedetomidine or saline infusion for 20 minutes before induction of anesthesia. Tympanometric measurements were recorded for both ears at preoperative, intraoperative, and postoperative states. RESULTS: Mean difference of tympanometric peak pressure from baseline was statistically significant between dexmedetomidine and control group at the 30th minute of operation (24.8 daPa, P = 0.003 for right ear; 20.5 daPa, P = 0.02 for left ear) and at the end of the operation (25.8 daPa, P = 0.01 for right ear; 28.1 daPa, P = 0.004 for left ear). CONCLUSIONS: Dexmedetomidine anesthesia raises the tympanometric parameters, but they never exceed the limits of normal.

Instillation of skin, nephrostomy tract, and renal puncture site with ropivacaine decreases pain and improves ventilatory function after percutaneous nephrolithotomy.

BACKGROUND AND PURPOSE: Pain after percutaneous nephrolithotomy (PCNL) is well investigated, but no optimal management strategy has yet been defined. Ventilatory changes after uncomplicated PCNL remain obscure. We investigated whether pain can be managed with a combination of a parenteral non-narcotic drug and instillation of a local anesthetic into the operative field. We also measured ventilatory changes early after PCNL to determine whether this analgesic modality improves ventilatory status. PATIENTS AND METHODS: In a randomized blinded study, 34 well-matched patients underwent PCNL with single subcostal access. At the end of the operation, 30 mL of either 0.02% ropivacaine or saline was instilled into the renal puncture site, nephrostomy tract, and skin. Postoperatively, patients received parenteral metamizol (dipyrone) (500 mg/dose) on demand. Pain visual analog score (VAS), peak expiratory flow rate (PEF), and blood-gas analysis were performed at 2, 6, and 24 hours postoperatively. The number of analgesic doses required was recorded. RESULTS: The VAS at 6 hours, time to first analgesic demand, and total analgesic need were significantly lower (P=0.001, 0.008, and 0.001, respectively) in the ropivacaine group, whereas the PEF at 2 and 6 hours was significantly higher (P=0.001 for each). Analgesic use in the first 12 and 24 hours was lower in this group. Blood-gas analysis was within the normal range in both groups. Time of surgery and hemoglobin decrease were not significantly different. CONCLUSIONS: A decrease in PEF indicating restricted ventilation appears early after PCNL. Because these patients were chosen carefully to have normal function preoperatively, this decrease was attributed to nociception. A combination of ropivacaine instillation with metamizol decreases pain and analgesic use and improves PEF more than use of metamizol alone. Such a multimodal pain-management strategy is effective in minimizing postoperative opioid use with proper pain management, resulting in better ventilation.

A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging.

We compared the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging procedures. Sixty children were randomly distributed into two groups: The dexmedetomidine (D) group received 1 microg/kg initial dose followed by continuous infusion of 0.5 microg.kg(-1).h(-1) and a propofol group (P) received 3 mg/kg initial dose followed by a continuous infusion of 100 microg.kg(-1).min(-1). Inadequate sedation was defined as difficulty in completing the procedure because of the child's movement during magnetic resonance imaging. Mean arterial pressure (MAP), heart rate, peripheral oxygen saturation, and respiratory rate (RR) were recorded during the study. The onset of sedation, recovery, and discharge time were significantly shorter in group P than in group D. MAP, heart rate, and RR decreased during sedation from the baseline values in both groups. MAP and RR were significantly lower in group P than in group D during sedation. Desaturation was observed in four children of group P. Dexmedetomidine and propofol provided adequate sedation in most of the children. We conclude that although propofol provided faster anesthetic induction and recovery times, it caused hypotension and desaturation. Thus, dexmedetomidine could be an alternative reliable sedative drug to propofol in selected patients.