Oxidative stress and DNA damage due to one-lung ventilation.

AIM: One-lung ventilation (OLV) is an anesthesia technique used to provide visualization in thoracoscopic lung surgeries and increase surgical site visibility during operation. In OLV, atelectasis occurs and blood from the lung participates in circulation without receiving oxygen. We designed a prospective study on patients we implemented surgery in order to research whether OLV leads to oxidative stress and DNA damage or not. METHODS: It was taken 5cc blood samples 4 times from these patients in the postoperative preparatory stage (T1), on the 60th minute after the start of OLV (T2), on the 60th minute after the termination of OLV (T3) and 24 hours after surgery (T4). Total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI) values were examined with regards to DNA damages in the blood samples taken. RESULTS: DNA damage was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05). TAC level was statistically decreased with OLV compared to baseline level and statistically increased in 24 hour (p<0.05 ). TOS level was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05 ). OSI level was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05 ). CONCLUSION: To the best of our knowledge this is the first study showing DNA damage in thoracic surgery which was operated with OLV. This DNA damage found to be decreased in first postoperative day and might be related to changes in oxidative status of this patient group. KEY WORDS: Oxidative stress, lung ventilation, DNA damage.

The airway device preference may affect the overlapping of the common carotid artery by the internal jugular vein.

BACKGROUND: Anatomical variation in the internal jugular vein (IJV), as well as its small size, tendency to collapse, and proximity to the common carotid artery (CCA) makes central venous cannulation via the IJV a technically challenging procedure, especially in pediatric patients. AIM: We evaluated the effects of laryngeal mask airway insertion and endotracheal intubation (ETT) on the anatomical relationship between the IJV and the CCA in neutral and 40° head away positions. METHOD: After parental consent 92 patients with ASA physical status I-II, aged 0-17, undergoing elective urological surgery were enrolled and divided into two groups according to the airway management device used for anesthesia: Group laryngeal mask airway (n = 63) and Group ETT (n = 29). An ultrasonographic evaluation was performed before and after airway instrumentation at neutral and 40° head rotation. The IJV position in relation to the CCA was noted, and the overlap percentage of the CCA was calculated as the ratio of the CCA length covering by the internal jugular vein to the transverse diameter of the CCA. RESULTS: With no airway device insertion, the position of the IJV was found to be anterolateral to the CCA in the majority of patients (48.8% vs 35.3%, right vs left IJV) in the neutral head position. While there was no significant change in the overlap percentages of the CCA after laryngeal mask airway insertion in the neutral head position [48.71% vs 57.30% for the right IJV (difference in median: -21.20; 95% confidence interval (CI) of difference: -56.92 to 14.52; P = 0.133); 52.54% vs 60.36% for the left IJV (difference in median: -10.3; 95% CI of difference: -41.49 to 20.89; P = 0.128)], it increased significantly in the 40° head away position on both sides [50.11% vs 64.83% for the right IJV (difference in median: -55; 95% CI of difference: -84 to -25.24; P = 0.01); 53.82% vs 71.20% for the left IJV (difference in median: -46; 95% CI of difference: -86.85 to -5.15; P = 0.004)]. However, the overlap percentages of CCA decreased significantly on the right side with patients in a neutral head position (31.23% vs 6.27%, difference in median: 19; 95% CI of difference: -5.68 to 43.68; P = 0.002) and on both sides in the 40° head away position [29.50% vs 16.19%, difference in median: 26; 95% CI of difference: 2.84 to 49.16; P = 0.03 and 47% vs 31.94%, difference in median: 9.50; 95% CI of difference: -40.87 to 59.87; P = 0.03 for the right and left sides, respectively] after ETT insertion. CONCLUSIONS: Laryngeal mask airway with 40° head rotation increases, whereas ETT decreases, the overlap percentage of CCA by IJV. Both head position and airway management methods have an influence on the overlap of the CCA by the IJV in pediatric patients.

Do we really need to panic in all acute vision loss in ICU? Acute angle-closure glaucoma.

Acute angle closure glaucoma is a sight-threatening situation characterized by a sudden and marked rise in intraocular pressure (IOP) due to obstruction of aqueous humour outflow. Many local (ocular drops, nasal and nebulized agents) and systemic drugs (e.g. atropine, adrenaline, ephedrine, some psychoactive and antiepileptic drugs) that are widely used in intensive care units have the potential to precipitate such an acute attack. In this case report, we describe progressive visual loss due to acute angle-closure glaucoma (AACG) in a 59 year old female patient followed in the ICU due to a massive pulmonary embolism.

Adding 75 mg pregabalin to analgesic regimen reduces pain scores and opioid consumption in adults following percutaneous nephrolithotomy / Adição de 75 mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea / La adición de 75 mg de pregabalina al régimen analgésico reduce puntuaciones de dolor y consumo de opiáceos en adultos después de la nefrolitotomía percutánea

Background and objectives: Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL). Methods: 60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour. Results: Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027). Conclusions: Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects. .

Justificativa e objetivos: A adição de novos medicamentos adjuvantes, como os gabapentinoides, ao regime analgésico multimodal pode ser razoável para diminuir os escores de dor no pós-operatório, o consumo total de opiáceos e os efeitos colaterais após nefrolitotomia percutânea. Nosso objetivo foi avaliar durante o período pós-operatório o efeito de pregabalina nos escores de dor, consumo de analgésicos e funções renais expressas por clearance de creatinina (ClCr) e níveis séricos de cistatina-C (Cis-C) e lipocalina associada à gelatinase de neutrófilos (LAGN) em pacientes submetidos à nefrolitotomia percutânea (NLPC). Métodos: Sessenta pacientes submetidos à NLPC eletiva foram incluídos no estudo. Os pacientes foram randomizados para receber pregabalina oral em dose única de 75 mg – grupo pregabalina e grupo controle. Os escores de dor medidos pela Escala Visual Analógica (EVA), o consumo de morfina intravenosa nas primeiras 24 horas de pós-operatório, LAGN sérico, níveis de Cis-C e clearance de creatinina (ClCr) foram mensurados no pré-operátorio e na segunda e 24a horas de pós-operatório. Resultados: Os escores EVA no pós-operatório foram significativamente menores no grupo pregabalina nos tempos de 30 min, 1 e 2 horas (p = 0,002, p = 0,001 e p = 0,027, respectivamente). A média do consumo de morfina no pós-operatório foi estatisticamente significante menor em todos os intervalos de tempo no grupo pregabalina (p = 0,002, p = 0,001, p = 0,001, p = 0,001, p < 0,001, respectivamente). Não houve diferença estatisticamente significante entre os dois grupos em relação ao ClCr ou Cis-C no pré-operatório e na segunda e 24a horas de pós-operatório. Os níveis de LAGN na 24a hora de pós-...

Justificación y objetivos: La adición de nuevos medicamentos adyuvantes, como los gabapentinoides, al régimen analgésico multimodal puede ser interesante para poder disminuir las puntuaciones de dolor en el postoperatorio, el consumo total de opiáceos y los efectos colaterales después de la nefrolitotomía percutánea. Nuestro objetivo fue evaluar, durante el período postoperatorio, el efecto de la pregabalina en las puntuaciones de dolor, consumo de analgésicos y funciones renales expresadas por aclaramiento de creatinina y niveles séricos de cistatina-C y lipocalina asociada con la gelatinasa de neutrófilos en pacientes sometidos a la nefrolitotomía percutánea. Métodos: Sesenta pacientes sometidos a nefrolitotomía percutánea electiva fueron incluidos en el estudio. Los pacientes fueron aleatorizados para recibir pregabalina oral en dosis única de 75 mg (grupo pregabalina) y grupo control. Las puntuaciones de dolor medidas por la escala visual analógica, el consumo de morfina intravenosa en las primeras 24 h de postoperatorio, nivel sérico de lipocalina asociada a la gelatinasa de neutrófilos, niveles de cistatina-C y aclaramiento de creatinina fueron medidos en el preoperatorio y en la 2.a y 24.a horas del postoperatorio. Resultados: Las puntuaciones de la escala visual analógica en el postoperatorio fueron significativamente menores en el grupo pregabalina a los 30 min, 1 y 2 h (p = 0,002; p = 0,001; y p = 0,027 respectivamente). El promedio del consumo de morfina en el postoperatorio fue estadísticamente significativo y menor en todos los intervalos de tiempo en el grupo pregabalina (p = 0,002; p = 0,001; p = 0,001; p = 0,001; p < 0,001 respectivamente). No hubo diferencia estadísticamente significativa entre los 2 grupos con relación al aclaramiento de creatinina o cistatina-C en el preoperatorio y en ...

[Adding 75 mg pregabalin to analgesic regimen reduces pain scores and opioid consumption in adults following percutaneous nephrolithotomy]. / Adição de 75mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea.

BACKGROUND AND OBJECTIVES: Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: 60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour. RESULTS: Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027). CONCLUSIONS: Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects.

Forty-five degree wrist angulation is optimal for ultrasound guided long axis radial artery cannulation in patients over 60 years old: a randomized study.

Arterial cannulation is a common anaesthetic procedure that might be challenging and time-consuming in elderly patients. To establish an appropriate wrist joint position for arterial cannulation is crucial for ultrasound (US)-guided cannulation success. This study aimed to find out the optimal wrist joint angle for long axis in-plane (LA-IP) US-guided approach in radial artery cannulation in elderly patients. One hundred patients over 60 years old, who were assumed to require an arterial catheter for continuous blood pressure monitoring or frequent blood gas analysis in the intensive care unit or in the operating room were included in this prospective randomized study. Patients were randomized to five groups according to the wrist positions (0°, 15°, 30° 45° and 60° groups) for LA-IP approach for radial artery cannulation. Cannulation time (s), number of attempts, total success rate (%), first attempt success rate were recorded in all patients. Mean radial artery height was increased in 45° group compared to other groups (p < 0.05). Distance between skin and radial artery in 45° and 60° groups were statistically significantly decreased compared to 0° group (p < 0.05 for all comparisons). Mean cannulation time of 45° group was statistically decreased compared to other groups (p < 0.05). Number of attempts and total success rate were similar among groups, whereas first attempt success rate was significantly increased in 45° group compared to other groups (p < 0.05). Mean arterial height of the first attempt successful group was statistically increased compared to the first attempt failed group (p < 0.001) and mean cannulation time and mean number of attempts were also negatively correlated with arterial height (p < 0.001; for all comparisons). The 45° wrist angle increment might be advantageous in US-guided LA-IP radial artery cannulation in elderly patients in view of cannulation time and first attempt success rate.

[Complex regional pain syndrome type 1 after fracture of distal phalanx: case report]. / Distal falanks kirigi sonrasi kompleks bölgesel agri sendromu tip 1 gelisimi: olgu sunumu.

Complex Regional Pain Syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion, vasomotor instability and patchy bone demineralization in the extremities. In this case, we report a 46-year-old woman diagnosed with CRPS type 1, whose complaints, such as swelling in the left hand, pain, and limitation of movement, started 2 months after a fracture of the distal phalanx in the left 4th finger. Her complaints were reduced with treatment of calcitonin, gabapentin, calcium and vitamin D3, retrograde edema massage, contrast baths, conventional TENS, pulsed ultrasound, desensitization and exercise with range of joint motion. CRPS type 1 should be considered in the differential diagnosis of upper limb pains which start after a fracture of the distal phalanx.

Oxigênio suplementar em cesariana eletiva sob raquianestesia: manejar um punhal com cuidado / Supplemental oxygen in elective cesarean section under spinal anesthesia: handle the sword with care / Oxígeno suplementario en cesárea electiva bajo raquianestesia: manejar el cuchillo de doble fi lo con cuidado

JUSTIFICATIVA E OBJETIVOS: Nosso objetivo foi investigar o efeito de 21% e 40% de oxigênio suplementar sobre o estresse oxidativo materno e neonatal em cesariana eletiva (CE) sob raquianestesia. MÉTODOS: Foram incluídas no estudo 80 parturientes com gestação a termo, submetidas à CE sob raquianestesia. As pacientes foram randomicamente alocadas em dois grupos para receberem 21% (grupo Ar) ou 40% (grupo oxigênio) de oxigênio a partir do momento da incisão até o fim da cirurgia. Amostras de sangue das parturientes e da artéria umbilical (AU) foram coletadas antes e depois da cirurgia. A capacidade antioxidante total (CAT), o estado oxidante total (EOT) e o índice de estresse oxidativo (IEO) foram medidos. RESULTADOS: Idade, peso, altura, paridade, semana de gestação, tempo de incisão espinhal, tempo de incisão cirúrgica para extrair o feto, tempo de extração do feto, tempo de cirurgia, escores de Apgar no primeiro e quinto minutos e peso ao nascer foram semelhantes entre os grupos (p > 0,05 em todas as comparações). Não houve diferença entre os grupos em relação aos níveis pré-operatórios de CAT, EOT e IEO (p > 0,05 em todas as comparações). Os níveis maternos pós-operatórios de CAT, EOT e IEO aumentaram significativamente no grupo oxigênio (p = 0,047; < 0,001 e 0,038, respectivamente). Nas artérias umbilicais, os níveis da CAT aumentaram significativamente no grupo oxigênio (p = 0,003) e os de EOT e IEO aumentaram significativamente no grupo Ar (p = 0,02 e < 0,001, respectivamente). CONCLUSÕES: A diferença em relação ao impacto sobre o estresse oxidativo materno e fetal da suplementação de 40% em comparação com a de 21% exige estudos adicionais em ampla escala que investiguem o papel da suplementação de oxigênio durante CE sob raquianestesia.

BACKGROUND AND OBJECTIVES: We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS: Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS: Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS: The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

JUSTIFICATIVA Y OBJETIVOS: Nuestro objetivo fue investigar el efecto de 21% y 40% de oxígeno suplementario sobre el estrés oxidativo materno y neonatal en la cesárea electiva (CE), bajo raquianestesia. MÉTODOS: Fueron incluidas en el estudio 80 parturientes con gestación a término sometidas a la CE bajo raquianestesia. Las pacientes fueron aleatoriamente ubicadas en dos grupos para recibir 21% (grupo Aire) y 40% (grupo Oxígeno) de oxígeno a partir del momento de la incisión hasta el final de la cirugía. Las muestras de sangre de las parturientes y de la arteria umbilical (AU) se recolectaron antes y después de la cirugía. La capacidad antioxidante total (CAT), el estado oxidante total (EOT) y el índice de estrés oxidativo (IEO) se midieron. RESULTADOS: La edad, el peso, altura, paridad, semana de gestación, el tiempo de incisión espinal, el tiempo de incisión quirúrgica para extraer el feto, el tiempo de extracción del feto, el tiempo de cirugía, las puntuaciones de Apgar al primero y quinto minutos y el peso al nascer, fueron similares entre los grupos (p > 0,05 en todas las comparaciones). No hubo diferencia entre los grupos con relación a los niveles preoperatorios de CAT, EOT y IEO (p > 0,05 en todas las comparaciones). Los niveles maternos postoperatorios de CAT, EOT y IEO aumentaron significativamente en el grupo oxígeno (p = 0,047 < 0,001 y 0,038, respectivamente). En las arterias umbilicales, los niveles de la CAT aumentaron significativamente en el grupo oxígeno (p = 0,003) y los de EOT y IEO aumentaron significativamente en el grupo aire (p = 0,02 y < 0,001, respectivamente). CONCLUSIONES: La diferencia con relación al impacto sobre el estrés oxidativo materno y fetal de la suplementación de 40% en comparación con la de 21%, exige estudios adicionales en amplia escala que investiguen el rol de la suplementación de oxígeno durante CE bajo raquianestesia.

Relationship between oxidative stress parameters and cystatin C levels in patients with severe preeclampsia.

BACKGROUND AND OBJECTIVE: Oxidative stress is believed to play a role in the development of preeclampsia (PE). It is known that an increased cystatin C level is also associated with PE. The aim of this study was to investigate the relationship between oxidative stress parameters and cystatin C levels in patients with severe PE. MATERIAL AND METHODS: Forty-four patients with severe PE and 40 healthy pregnant women were recruited for the study. All study subjects were divided into 2 groups: group 1 (n=44) consisted of patients with severe PE, and group 2 (n=40) included healthy pregnant subjects. Blood samples were obtained from all subjects in order to measure the cystatin C level, total antioxidant status, and total oxidant status. The oxidative stress index was calculated. RESULTS: The group 1 had significantly higher cystatin C, total oxidant status, oxidative stress index levels and lower total antioxidant status level as compared with the group 2 (P=0.001, P<0.001, P<0.001, P=0.036, respectively). The serum cystatin C level was significantly correlated with the oxidative stress index (r=0.609, P<0.001). CONCLUSIONS: The present study demonstrated that both oxidative stress and cystatin C levels were increased in patients with PE, and the increased cystatin C levels seem to be a consequence of oxidative stress.

Effects of sevoflurane and desflurane on oxidative stress during general anesthesia for elective cesarean section.

BACKGROUND: Anesthetic agents might considerably influence maternal-fetal oxidative stress and antioxidants during cesarean section (CS). The aim of this study was to investigate the effects of desflurane and sevoflurane on oxidative stress parameters both in mothers and newborns undergoing elective CS. MATERIALS AND METHODS: Eighty ASA physical status I-II, term parturients undergoing elective CS under general anesthesia were randomized to desflurane (Group D) and sevoflurane (Group S) groups. Blood samples were collected from mothers before operation and postoperatively and umbilical artery samples were obtained at delivery. Total oxidant status (TOS), total antioxidant capacity (TAC) status, lipid hydroperoxide (LOOH), and free sulfhydryl (-SH) levels were measured and oxidative stress index was calculated. Secondary outcomes included maternal hemodynamics. RESULTS: Preoperative LOOH, TOS, OSI, TAC, and -SH levels were similar among groups. Postoperative maternal serum LOOH, TOS, and OSI levels were significantly increased in Group D compared to Group S (p = 0.003, p = 0.005, p = 0.04; respectively). Postoperative umbilical artery LOOH, TOS, OSI levels were also significantly increased in Group D compared to Group S (p = 0.04, p = 0.02, p = 0.01; respectively). Postoperative TOS (p = 0.001, < 0.001 respectively) and OSI (p = 0.003, < 0.001 respectively) levels in both Group D and Group S were statistically significantly decreased compared to preoperative levels. Postoperative LOOH and -SH levels in Group S (p = 0.04, 0.029 respectively) were statistically significantly decreased compared to preoperative levels. There were no significant differences in TAC and -SH levels among groups (p = nonsignificant [n.s.]). Maternal perioperative mean blood pressure and heart rate were similar among groups (p = n.s.). CONCLUSION: Oxidative stress indices might be modified with preferred anesthetic agent and sevoflurane showed more favorable effects than desflurane in view of oxidative stress.

Efficacy of a single preoperative dose of pregabalin for postoperative pain after septoplasty.

We aimed to investigate the role of preoperative single dose of pregabalin for attenuating postoperative pain and analgesic consumption in patients undergoing septoplasty. One hundred forty-three patients with ASA physical status I who underwent elective septoplasty were included in this prospective, randomized, and controlled study. Subjects were randomized to receive pregabalin 75 mg, pregabalin 150 mg, and control group. All the medications were administered orally 1 hour before surgery. A standard septoplasty technique was used for all patients. Postoperative pain intensity was evaluated by a 0- to 100-mm horizontal visual analog scale (VAS) (0, no pain; 100, worst imaginable pain). Total analgesic consumption 1 to 24 h after operation was also recorded.Visual analog scale scores in the 1st, 2nd, 4th, 6th, 12th, and 24th hour were significantly decreased in 75 and 150 mg pregabalin group compared with the control group, and VAS scores in the 12th and 24th hour were significantly decreased in pregabalin 150 mg compared with 75 mg. The 24th total analgesic consumption was significantly decreased in pregabalin 75 mg and 150 mg groups compared with the control group.In conclusion, a single preoperative oral dose pregabalin 75 or 150 mg is an effective method for reducing postoperative pain and total analgesic consumption in patients undergoing septoplasty.

Different remifentanil doses in rapid sequence anesthesia induction: BIS monitoring and intubation conditions.

OBJECTIVES: The aim of this prospective, randomized, double blind trial was to investigate the effects of two different doses of remifentanil on bispectral index (BIS) values and intubation conditions in a simulated model of rapid sequence anesthesia induction (RSAI). MATERIAL AND METHODS: 54 ASA I-II adult patients undergoing elective surgery were randomly allocated to two groups. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 300 head-up position. Group I (n=26) and Group II (n=28) received a 1 µg/kg or 0.5 µg/kg bolus of remifentanil, respectively, over 30 seconds. Propofol was the induction agent. 1 mg/kg of rocuronium was used in all patients. Patients were intubated 60 s after administration of the muscle relaxant. Hemodynamic data and BIS scores were obtained before induction (baseline), after induction, at intubation and at 1, 3, 5 and 10 minutes following intubation. Intubation conditions were scored with a standard scoring system. RESULTS: The hemodynamic variables at all the measurement intervals and the area under the hemodynamic variable-time curves were similar among the groups. There was no difference among the groups for BIS measurements. Moreover, the mean area under the BIS-time curve for Group I (300±45cm2) was comparable to Group II (315±49cm2) (p=0.432). The mean total intubation condition score (maximum 14 points) in Group I (12.6±1.67) was higher than Group II (10.3±4.79) (p=0.030). CONCLUSIONS: 1 µg/kg of remifentanil compared to 0.5 µg/kg of remifentanil provides similar hemodynamic profiles and BIS scores, but 1 µg/kg of remifentanil was associated with superior endotracheal intubation conditions. According to this study design and medications used, a relation between BIS scores and intubation conditions couldn't be demonstrated.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES: We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS: Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS: Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS: The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Ketofol in electroconvulsive therapy anesthesia: two stones for one bird.

PURPOSE: Propofol and ketamine have become progressively popular in electroconvulsive therapy (ECT) anesthesia, although propofol shortened seizure duration and ketamine might cause cardiotoxicity, psychotic episodes, and delayed recovery. Ketofol is a combination of ketamine and propofol, and the current study was designed to evaluate the effect of ketamine, propofol, and ketofol on hemodynamic profile, duration of seizure activity, and recovery times in patients undergoing ECT. METHODS: Ninety patients (44 women, mean age 27.8 ± 7.2 years) in one ECT session were enrolled and randomized to the propofol, ketamine, or ketofol group. Hemodynamic profile duration of seizure activity and recovery times were recorded. RESULTS: Motor seizure duration in the propofol group was significantly decreased compared to other groups (p < 0.001), whereas spontaneous breathing time in the ketamine group statistically increased compared to the propofol group (p = 0.001), and also eye-opening time (p < 0.001) and obeying-command time (p < 0.001) was significantly increased in the ketamine group compared to other groups. Heart rate (HR) at induction (ketamine 91.2 ± 13.6 vs. propofol 77 ± 13.4 and ketofol 79.9 ± 15.6; p < 0.013; p < 0.08, respectively) was statistically significantly increased in the ketamine group compared to other groups, and HR at the third minute (ketamine 92 ± 12.9 vs. propofol 79.4 ± 9.3 and ketofol 81.5 ± 14.2; p < 0.012, p < 0.048) was also statistically significantly increased in ketamine group compared to other groups. CONCLUSION: The ketofol 1:1 mixture is associated with longer mean seizure time than propofol, and shorter mean recovery times than ketamine, with better hemodynamic stability, without any important side effects in ECT anesthesia.

Axillary brachial plexus blockade in moyamoya disease?

Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.