The effects of intra-articular levobupivacain versus levobupivacain plus magnesium sulfate on postoperative analgesia in patients undergoing arthroscopic meniscectomy: A prospective randomized controlled study

Objective: The aim of this study was to compared the effectiveness of intraarticular levobupivacain with levobupivacain and magnesium sulfate. Methods: In this prospective randomized double blinded study, 96 patients (67 male, 29 female; age range: 18–65 years) with ASA (American Society of Anesthesiologist) score I and II, who had undergone arthroscopic meniscectomy operation, were divided to 3 groups that had postoperative analgesia with intra-articular saline injection (control group), levobupivacain injection (L group) or levobupivacain and magnesium sulfate injection (LM group). Patients were compared with postoperative VAS (Visual Analog Score) score during rest and activity, opioid analgesic need, non-opioid analgesic need and other medication needs. Results: Postoperative VAS scores during rest and activation at early postoperative period were significantly lower at LM group when compared with L group and lower than control group at all time periods. Opioid analgesic need, non-opioid analgesic need and other medication needs for non-pain symptoms were lower at LM group when compared with L and control groups at all time periods. Conclusion: Intraarticular magnesium sulfate plus Levobupivacain injection is a safe and effective method for post operative pain management after arthroscopic meniscectomy.Keywords: Intra-articular injection, Magnesium sulfate, Levobupivacain, Postoperative analgesia, Chondrocyte apoptosis, Pain management, Arthroscopic menisectomy Level of Evidence: Level I, Therapeutic study Keywords: Intra-articular injection, Magnesium sulfate, Levobupivacain, Postoperative analgesia, Chondrocyte apoptosis, Pain management, Arthroscopic menisectom

Remifentanil improves left ventricular diastolic parameters in patients with impaired diastolic function: a prospective clinical study

Abstract Background Left ventricular diastolic dysfunction has a significant impact on perioperative morbidity and mortality, and its incidence is high in elderly individuals. Anesthetic agents may impair diastolic function, which may increase the incidence of perioperative complications. The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle (LV) diastolic function in patients with diastolic dysfunction. The study was performed on 30 spontaneously breathing subjects (aged 60–80 years) with diastolic dysfunction. Methods Thirty patients (aged 60–80 years) with diastolic dysfunction scheduled for surgery were recruited between November 2019 and March 2023. Left ventricle function was evaluated once the intravenous remifentanil infusion reached a target-controlled concentration of 2 ng/ml with transthoracic echocardiography. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm), whereas diastolic function focused on changes in transmitral peak flow (E), E/A, mitral septal and lateral e’ waves, E/e’ ratios and left atrial volume index following remifentanil infusion. Results Diastolic function measures of LV (mitral E/e’, septal and lateral e’ waves) statistically significantly improved (E/e’ from 10.6 ± 2.9 cm.sn− 1 to 9.5 ± 2.2 cm.sn− 1; p = 0.006) following remifentanil infusion. Left atrial volume index decreased following remifentanil infusion without statistical significance (from 55 ± 14.4 ml.cm− 2 to 51.6 ± 13.3 ml.cm− 2; p = 0.1). Systolic function (ejection fraction and Sm) did not change following remifentanil infusion. Conclusions Remifentanil improves left ventricular diastolic parameters in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a plasma concentration of 2 ng.ml− 1 might be used safely in patients with left ventricular diastolic dysfunction

Plörotomi yap›lmaks›z›n internal torasik arter grefti haz›rlanmas›n›n solunum fonksiyonlar› ve erken dönem iyileflme periyodu üzerine etkileri

İstanbul Bilim Üniversitesi, Tıp Fakültesi.OBJECTIVE: Postoperative respiratory functions, arterial blood gases, blood loss and clinical outcome following coronary artery bypass surgery (CABG) were assessed in a prospective randomized single-blind (patient- blind) clinical study comparing two different techniques of internal thoracic artery (ITA) harvesting. METHODS: Fifty-four patients admitted for CABG were allocated into two groups according to 'random numbers' technique. In a Group 1 (n=26) ITA was prepared keeping the pleura intact and in a Group 2 (n=28) pleura was opened. Both groups were compared in terms of postoperative respiratoryfunctions, arterial blood gases, bleeding and clinical outcomes using ANOVA for repeated measurements analysis. RESULTS: Analysis of spirometric and partial oxygen pressure data showed that postoperative reductions in forced expiratory volume (0.17+/-0.18 lt vs. 0.28+/-0.14 lt, p=0.016), forced vital capacity (0.18+/-0.19 lt vs. 0.28+/-0.13 lt, p=0.037) and arterial oxygen measurements (-0.03+/-0.22 mmHg vs. 0.15+/-0.4 mmHg, p=0.023) were less pronounced in patients of Group 1 as compared with patients of Group 2. The increase in intrapulmonary shunts (Qs/Qt ratio) after the operation was more pronounced in Group 2 patients than in Group 1 patients (p<0.01) and the mean values of Qs/Qt ratio 24 hours after the operation were higher in group 2 as compared to Group 1 patients(0.100+/-0.063 vs. 0.054+/-0.048, p=0.001). Radiological evaluation revealed that costophrenic angle obliteration after operation more often occurred in Group 2 (14/28 patients) than in Group 1 (0/26 patients) (p<0.0001). Cardiothoracic index increased significantly after operation only in group 2 patients (p=0.001). Postoperative blood loss within 24 hours was significantly lower in Group 1 compared to Group 2 (656+/-179 ml vs. 907+/-257 ml, p=0.001). There was no significant difference between groups in the ICU stay duration (p=0.186), whereas the hospital stay was significantly longer in group 2 patients than in Group 1 patients (8.8+/-2.0 days vs. 7.6+/-2.0 days, p=0.039). CONCLUSION: According to our results, preserving pleural integrity has positive effects on the respiratory functions and patients' clinical outcomesfollowing CABG operations

Comparing Effects of Intraventricular Hypertonic Saline and Magnesium Sulfate Application on Diffuse Brain Injury in Rats

Objective: Diffuse brain injury is one of the most common issues encountered in, patients with trauma and it leads to morbidity and mortality via increased intracranial pressure. The aim of the study was to compare the effects of magnesium sulfate and hypertonic saline on diffuse brain injury in rats. Materials and Methods: In this study 18 male Sprague-Dawley rats weighing 250-300 g were used. The rats were randomly divided into trauma (control), trauma+magnesium, and trauma+hypertonic saline groups. Traumatic brain injury was induced by modified Feeney head trauma model. A single dose of 10 µL isotonic saline, magnesium sulphate and hypertonic saline were applied intraventricularly to the control, magnesium, and hypertonic saline groups, respectively. Rats were decapitated 24 hours after the head trauma. Their brains were dissected immediately and stored with dry ice at -80 °C for histopathological experiments. Results: The number of damaged neurons were significantly higher in both control and hypertonic saline groups (p=0.001, p=0.008). However, the number of damaged neurons did not show significant difference between hypertonic saline and control groups, it was significantly lower in magnesium group (p<0.05). Conclusion: In this study, intraventricular magnesium application is found effective in reducing the number of the damaged neurons in rat traumatic brain injury model. These results suggest that magnesium usage may be evaluated for the treatment of patients with traumatic brain injury in further prospective studies