RESUMO
BACKGROUND: Anesthesia is performed in two major methods including regional and general.The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery. METHODS: In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital in 2013, were selected and divided into two groups based on anesthesia method. Lipid peroxide level and serum total antioxidant capacity (TAC) were measured before anesthesia induction and one hour after surgery. As the normal range, the findings obtained from 23 healthy volunteers were utilized. RESULTS: ean age was 54.9±11.21 and 52.4±11.23 years in the spinal anesthesia (SA) and the general anesthesia (GA) group, respectively (P=0.49). Serum TAC in GA group increased from 1.03±0.04 mM to 2.98±0.7 mM. In SA group, the increase of serum TAC from 1.22±0.11 mM to 3.42±0.5 mM was observed that indicated the increase of serum TAC in both groups was not significantly different (P=0.21). Serum Malondialdehyde (MDA) in GA and SA groups did not show a significant difference before surgery (31.14±3.9 mM vs. 29.06±2.49 mM in GA and SA groups, respectively) (P=0.31), while it was significantly different after surgery (23.14±2.6 mM and 19.24±2.7 mM in GA and SA groups, respectively) (P=0.03). CONCLUSION: lower limb amputation can help to control oxidative stress in diabetic patients; and considering serum MDA as a marker of oxidative stress, SA seems to be more effective to control this problem.
RESUMO
BACKGROUND: There is some evidence for the efficacy of antiplatelet therapies in increasing the vascular access patency duration or decreasing the thrombosis of arteriovenous grafts. OBJECTIVE: To determine the effect of low dose aspirin and dipyridamole on primary patency of arteriovenous grafts in hemodialysis patients. METHODS: This randomized, double-blind, placebo-controlled trial was done at Imam Reza Hospital in Mashhad, Iran from September 10, 2015 to July 05, 2016. Sixty hemodialysis patients, after the placement of a new arteriovenous graft, were divided into three study groups which including; Group 1, who received 80 mg aspirin tablet daily, Group 2 received 80 mg aspirin plus 75 mg dipyridamole daily and Group 3 received placebo daily. Primary unassisted patency was recorded in follow-up until 12 months and the outcomes were analysed using one-way ANOVA test. RESULTS: Primary patency time in Group 1 (Aspirin) was 324.75±147.00 day and for Group 2 (Aspirin + Dipyridamole) was 399.05±92.09 day and for Group 3 (Placebo) was 383.55±108.23 day. There were no significant differences between the 3 groups (p>0.05). Successful dialysis was done in 16.7% in Group 1, 37.5% in Group 2 and 45% in Group 3 from brachial arteriovenous grafts after 1-year follow-up (p=0.746). CONCLUSIONS: In treating dialysis patients, treatment with low dose aspirin and dipyridamole is not effective on increasing the synthetic grafts primary patency duration. TRIAL REGISTRATION: The trial was registered at the Thai Clinical Trials Registry (http://www.clinicaltrials.in.th) with the Trct id: TCTR20160920003. FUNDING: The authors received no financial support for the research, authorship, and/or publication of this article.