A year in review in Minerva Anestesiologica 2014

Year in revie

Antibacterial activity of remifentanil and mixtures of remifentanil and propofol

WOS: 000249799300005PubMed: 17869984Study Objective: To investigate the antibacterial activity of glycine, which is contained in remifentanil, when combined with propofol. Design: Prospective study. Setting: Departments of anesthesiology and microbiology of a university hospital. Measurements: Growth of the microorganisms Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans in propofol 1%; saline dilutions of remifentanil at one-, 10-, and 100-,mu g/mL concentrations; and 1:1 mixtures of propofol with remifentanil solutions was determined. Main Results: Remifentanil inhibits bacterial growth in a concentration-dependent manner. The antibacterial effects were more pronounced with Staphylococcus aureus and Pseudomonas aeruginosa at cultures obtained at the fifth hour. The inhibition of bacterial growth was less influenced with Escherichia coli and Candida albicans. Conclusions: Propofol and remifentanil mixtures decreased bacterial growth, and combinations may reduce the infectious complications from accidentally contaminated propofol. Crown Copyright (c) 2007 Published by Elsevier Inc. All rights reserved

The placebo controlled effect of ketorolac tromethamine with atropin-meperidine mixture on gynecologic day case surgery

Günlük jinekolojik girişimlerde İM ketorolak trometamin ile atropin - dolantin karışımının çift kör plasebo kontrollü etkinliği ve yan etkilerinin belirlenmesi amaçlandı. Devlet Hastanesi aile planlaması servisinde dilatasyon ve küretaj uygulanan ASA l ve II sınıfı toplam 64 hasta çalışma grubu olarak alındı. Çift kör plasebo kontrollü çalışmada 24 hastaya 60 mg İM ketorolak trometamin (K), 20 hastaya mg atropin- 100 mg dolantin (DA) ve 20 hastaya eşit volümde serum fizyolojik (P) girişimden 30-45 dakika önce İM olarak yapıldı. Hastaların girişim öncesi ve sırasında l saat süre ile vital bulguları 5 dakika ara ile izlendi. Ağrının belirlenmesinde forniksin tenakuluma olan duyarlılığı değerlendirildi. Reaksiyon 0 (hiç ağrı yok) ile 4 arasında derecelendirildi. Her üç gruptaki hastaların ağrı skorları arasında anlamlı bir fark bulunamadı. En büyük yan etki K grubunda gözlendi. DA ve P gruplarının postoperatif yan etki dağılımları benzer olmakla birlikte en düşük yan etki oram DA grubunda görüldü.Aim of this study is to establish pain scores on gynecologic day case surgery with IM ketorolac tromethamine (K), atropin-meperidine (MA) and placebo. 64 ASA class I and II patients who had received dilatation and curettage in family planning service in state hospital. 24 patients were received 60 mg ketorolac tromethamine, 20 patients were received atropin 1/2 mg and meperidine 100 mg and 20 patients received equal volume of saline solution IM 30-45 minutes before procedure with double blind randomised manner. Vital signs were determined during 1 hour period at 5 minutes interval. The reaction to attaching tenaculum to the cervix uteri was determined as pain reaction. Pain score was stepped 0 (null reaction) to 4 (curettage impossible). No outstanding difference was found between the pain scores of patient on K, MA and P groups. The most adverse effect was seen on K group. The adverse effect of P and MA groups were the same. The least adverse effect was seen on MA group

The effects of combination of verapamil and MK-801 on rat neuropathic pain model

N-Metil-D-Aspartat reseptörü kalsiyum ile aktif hale gelmektedir. Kalsiyum antagonisti verapamil ve N-metil-D-aspartat antagonisti MK-801'in sıçanlarda kronik sinir hasarı modelinde termal nosisepsiyona olan etkileri bilinmektedir. Bu çalışmada her iki ilacın birlikte uygulanmasının analjezik etkinliğinin araştırılması amaçlandı. Çalışma, ağırlıkları 180-220 g arasında değişen Sprague Dawley cinsi 30 erkek sıçanda gerçekleştirildi. Barbitürat anestezisi altında sağ siyatik sinirleri bulunarak 4/0 kromik katgüt ile gevşek şekilde bağlandı. İlaçlara ameliyatı takiben başlandı ve beş gün süre ile uygulandı. Tedavi protokolünde: ilk dört gün intraperitoneal 10 mg kg-1 verapamil uygulandı; beşinci gün ise 20 dakikalık ara ile verapamil 1 mg kg-1 MK-801 ile kombine edildi. Nosiseptif testler 46.5°C'de Hot Plate Test ile 120 dakika boyunca her 30 dakikada bir ölçüm yapılarak gerçekleştirildi. Opere bacağın çekilme zamanı reaksiyon süresi olarak belirlenerek kaydedildi. Nöropatik ağrı modelinde kronik verapamil veya tek başına MK-801 uygulaması nosisepsiyonu belirgin ölçüde azalttı. İki ilacın kombinasyonu ile tek başına gözlenen antinosiseptif etkinin altında değerler elde edildi. Kalsiyum antagonisti ön tedavisi nöropatik ağrı mode-linde N-metil-D-aspartat reseptörüne olan duyarlılığı azaltmaktadır. N-metil-D-aspartat reseptöründe kalsiyum antagonistleri ve MK-801'in bağlanma bölgeleri birbirine yakın olabilir. Bu nedenle, birlikte uygulandıklarında reseptör duyarlılığını azaltarak ve/veya bağlanma düzeyinde etkileşerek antagonist etkinin görülmesine neden olduklarını düşünmekteyiz.N-methly-D-aspartate receptor is activated by calcium. The effects of a calcium antagonist verapamil and N-methly-D-aspartae receptor antagonist MK-801 on thermal nociception in rat model of chronic nerve injury was well known. We aimed to study the analgesic effects of combination of two drugs using the same model. The present study was constituted on 30 male Sprague Dawley rat weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic gut under anaesthesia with a barbiturate. The administration of drugs were started after the operation and continued through five days. According to the treatment protocol, verapamil 10 mg kg-1 was administered for four days and on the fifth day MK-801 1 mg kg-1 was combined. The drugs were given with 20 mi-nutes' intervals through intraperitoneal route. Nociceptive tests were performed by Hot Plate Test at 46.5°C throughout a 120 minutes' period at every 30 minutes. The time of withdrawal of the operated limb was accepted as reaction time. Chronic administration of verapamil or MK-801 admi-nistration as a sole drug was substantially reduced nociception on neuropathic pain model. The antinociceptive effects of the combination of drugs was found to be lower than values obtained from each drug individually. Pretreatment with a calcium antagonist reduced the sensitivity to N-methyl-D-aspartate receptor on neuropthic pain model. It was concluded that, the binding sites of calcium antagonists and MK-801 on N-methyl-D-aspartate receptors can be close to each other, therefore antagonism may be seen by reducing receptor sensitivity or a reaction during binding

Alçı içindeki cilt basıncı, kompartman basıncını yansıtabilirmi? Deneysel bir çalışma

ALÇI İÇİNDEKİ CİLT BASINCI, KOMPARTMAN BASINCINI YANSITABİLİRMİ? DENEYSEL BİR ÇALIŞMA Ekstremite travmaları nedeniyle alçı tedavisi gören hastalarda kompartman basıncın değerlendirilmesi çoğu zaman mümkün olamamaktadır. Bu çalışmanın amacı; alçı içindeki cilt basıncının, kompartman basıncını yansıtıp yansıtmayacağının, oluşturulan ön kol modelinde araştırılmasıdır. Volar ve dorsal kompartmanları olan bir ön kol modeli oluşturularak, alçı uygulandı. Alçı ve model arasından farklı bölgelerden alınan basınç değerleri, kompartman basıncı ile karşılaştırıldı. Yapılan ölçümler sonucu alçı içi cilt basıncı ile kompartman basıncı arasında tüm lokalizasyonlarda korelasyon saptandı. Ortalama korelasyon katsayısı .995 (P000), (Std dev: .002, Minimum .992, Maksimum .999) olarak saptandı. Alçı içi cilt basıncı, kompartman basıncının moniterizasyonunda kullanılabilecek bir seçenektir. Bu konuda yapılacak klinik çalışmalar sonucunda alçı içi cilt basıncı moniterizasyonunun, ileride günlük kullanıma girmesi, hekime ve alçı tedavisi gören hastalara takip konusunda yardımcı olması beklenebilir.Purpose: Although monitoring intracompartmental pressure under a cast is very important, it is not possible to measure it in every patient undergoing cast treatment. This study aims to answer the question, whether skin surface pressure under a cast can reveal intracompartmental pressure. Material and Methods: A plaster cast was applied to a sculpted inflatable forearm model with dorsal and volar compartments. Skin surface pressures under the cast were measured at five different localizations from both dorsal and volar sides of the model and compared to corresponding intracompartmental pressures. Results: All of the skin surface pressure measurements taken from the dorsal and volar side of the model correlated with intracompartmental pressure. Mean correlation coefficient of the measurements was .995 (P.000), (Std dev: .002, Minimum .992, Maksimum .999). Conclusion: Measuring the pressure between skin and cast can monitor intracompartmental pressure. Skin surface pressure monitoring can help the physician, patient or parents in the follow up of patients undergoing cast treatment

Single shot "3-in-1" femoral nerve blockade with 0.25% or 0.375% levobupivacaine provides similar postoperative analgesia for total knee replacement

WOS: 000275833900012Aim: To compare postoperative analgesia provided by single shot "3-in-1" femoral nerve blockade using 0.25% or 0.375% levobupivacaine in preceding with spinal anesthesia for unilateral total knee replacement surgery. Materials and methods: Forty consenting patients undergoing unilateral total knee arthroplasty were included in this prospective randomized study. Spinal anesthesia was achieved with 15 mg plain bupivacaine at the L3-4 or L4-5 interspace. After resolution of the spinal anesthesia, patients were randomized into 2 groups: "3-in-1" femoral nerve blocks were performed using 30 m L of 0.25% levobupivacaine (Group 1, n = 20) or 0.375% levobupivacaine (Group 2, n = 20). Pain was assessed by visual analogue scale (VAS). The total morphine consumption and the side effect profile were compared during the postoperative period. Results: There were no significant differences between the 2 study groups with respect to characteristics or intraoperative variables. Furthermore, sensory block periods and time to first pain sensation, VAS, and morphine consumption for 24 h (Group 1: 19.7 +/- 9.2, Group 2:20.6 +/- 12.1 mg) were similar. Pain scales and range of motion during rehabilitation period and side effects were also comparable. Conclusion: Our results indicate that the augmenting concentration did not influence the clinical outcome when single shot "3-in-1" femoral nerve block was performed with 0.25% or 0.375% levobupivacaine in total knee arthroplasty

Postoperatif analjezide % 0,25 veya % 0,375 levobupivakain ile tek doz 3’e 1 femoral sinir blokajı total diz protezi operasyonunda benzer analjezi sağlar

Amaç: Bu çalışmada tek taraflı total diz protezi cerrahisinde spinal anesteziyi takiben % 0,25 veya % 0,375 levobupivakain kullanılarak yapılan 3 e 1 femoral sinir bloğunun etkinliğinin karşılaştırılması amaçlandı. Yöntem ve gereç: Çalışmaya tek taraflı elektif diz cerrahisi geçirmesi planlanan onamı alınmış kırk hasta dahil edildi. Spinal anestezi 15 mg düz bupivakain kullanılarak L3-4 veya L4-5 seviyesinden gerçekleştirildi. Spinal anestezinin ortadan kalkmasından sonra hastalar randomize olarak iki gruba ayrıldı: 3 e 1 femoral blok 30 mL % 0,25 levobupivakain (Grup 1, n = 20) veya % 0,375 levobupivakain (Grup 2, n = 20) kullanılarak gerçekleştirildi. Ağrı Vizüel Analog Skala (VAS) ile değerlendirildi. Postoperatif dönemde total morfin tüketimi ve yan etkiler belirlendi. Bulgular:Her iki grup arasında hasta özellikleri veya intraoperatif değişimler açısından belirgin bir farklılık saptanmadı. Bundan öte, duyu bloğu süresi, ilk ağrı duyumu, VAS ve ilk 24 saatlik morfin tüketimi (Grup 1: 19,7 ± 9,2, Grup 2: 20,6 ± 12,1 mg) benzerdi. Ağrı skalaları, rehabilitasyon sırasındaki hareket genişliği ve yan etkiler benzerdi. Sonuç: Bulgularımız % 0,25 veya % 0,375 levobupivakain kullanılarak yapılan tek doz 3 ü 1 yerde femoral sinir blokajında konsantrasyon artışının klinik sonucu etkilemediğini gösterdi.Aim: To compare postoperative analgesia provided by single shot “3-in-1” femoral nerve blockade using 0.25% or 0.375% levobupivacaine in preceding with spinal anesthesia for unilateral total knee replacement surgery. Materials and methods: Forty consenting patients undergoing unilateral total knee arthroplasty were included in this prospective randomized study. Spinal anesthesia was achieved with 15 mg plain bupivacaine at the L3-4 or L4-5 interspace. After resolution of the spinal anesthesia, patients were randomized into 2 groups: “3-in-1” femoral nerve blocks were performed using 30 mL of 0.25% levobupivacaine (Group 1, n = 20) or 0.375% levobupivacaine (Group 2, n = 20). Pain was assessed by visual analogue scale (VAS). The total morphine consumption and the side effect profile were compared during the postoperative period. Results: There were no significant differences between the 2 study groups with respect to characteristics or intraoperative variables. Furthermore, sensory block periods and time to first pain sensation, VAS, and morphine consumption for 24 h (Group 1: 19.7 ± 9.2, Group 2: 20.6 ± 12.1 mg) were similar. Pain scales and range of motion during rehabilitation period and side effects were also comparable. Conclusion: Our results indicate that the augmenting concentration did not influence the clinical outcome when single shot “3-in-1” femoral nerve block was performed with 0.25% or 0.375% levobupivacaine in total knee arthroplasty

The effects of lactated ringer and HES solutions in differing combinations to prevent hypotension due to spinal anesthesia

Amaç: Bu çalışmada, spinal anesteziye bağlı hipotansiyonu önlenmek için kullanılan kristaloid ve kolloid sıvılar ile, bu sıvıların farklı uygulama zamanlarının etkinliğinin araştırılması amaçlandı. Yöntem: Çalışmaya alınan ASA I-II grubu 100 hasta, beş gruba ayrıldı. Grup I'e spinal anesteziden önceki 30 dk içinde 1000 mL Ringer laktat (RL), Grup II'ye 500 mL %6 HES, Grup III'e spinal anesteziden önceki 15 dk içinde 500 mL RL ve spinal anesteziden sonraki ilk 15 dk içinde 250 mL %6 HES, Grup IV'e ve Grup Ve aynı periyodlarda sırası ile 500'mLRL + 500 mL RL, ve 250 mL %6 HES + 250 mL %6 HES uygulandı. İlk 20 dakika boyunca her dakika, daha sonra 5 dakikada bir sistolik, diyastolik, ortalama arter basınçları ve kalp atım hızları kaydedildi. Spinal uygulamadan sonraki 5., 10. ve 15. dakikalardaki duyusal blok seviyeleri tesbit edildi. Bulgular: Grup III ve IV ile grup IVveVarasında 2., 3. ve 5. dakikalardaki diyastolik arter basınçları dışında arter basınçları ve kalp atım hızları açısından fark gözlenmedi. Sonuç: Spinal anestezi sonrası hipotansiyon oluşumunda blok seviyesinin önemli olduğu, spinal anestezi öncesi kullanılan sıvıların niteliği, miktarı ve uygulama zamanı açısından bir fark olmadığı sonucuna varıldı.Objective: The aim of this study was to assess the effectiveness of preloading with crystalloid and colloid fluids on hypotension following spinal anaesthesia. Method: One hundred ASA Class I-II patients were randomly assigned to the study and divided into five groups. Group I: Lactated Ringer (LR) 1000 mL 30 minutes before spinal anaesthesia, Group II: HES %6 500 mL solution before the procedure, Group III: 500 mL RL before and HES %6 250 mL within 15 minutes after the procedure. Group IV and Group V received RL 500 mL + 500 RL mL, and HES %6 250 mL + HES %6 250 mL respectively, using the same timing protocol. Systolic, diastolic and mean arterial pressures and heart rates were measured at 1 minute intervals in the first 20 minutes and then every 5 minutes. Results: With the exception of the differences in diastolic blood pressures at the 2nd, 3rd, and 5th minutes, there was no difference in arterial blood pressures and heart rates between Group HI and IV or Group TV and V. Conclusion: While significant correlation was found between spinal block level and the incidence of spinal hypotension, no difference was observed regarding the type, dosage, and timing of loading solutions before spinal anaesthesia

Comparison of intrathecal low-dose levobupivacaine with levobupivacaine-fentanyl and levobupivacaine-sufentanil combinations for cesarean section

WOS: 000488219400010Objectives: To compare the effectiveness and side effects of intrathecal low-dose levobupivacaine with levobupivacaine plus fentanyl or sufentanil in cesarean section Design: Prospective study Setting: Training and Research Hospital, Ankara, Turkey Subjects: A total of 45 pregnant women were enrolled to study. Interventions: Using combined spinal epidural technique, 2 ml of 0.5% levobupivacaine was added to 1 ml of saline in group I, 1 ml of 15 mu cg of fentanyl in group II and 1 ml of 1.5 mu cg sufentanil in group III by intrathecal administration. Main outcome measures: Hemodynamic parameters, sensory and motor blockade levels, intraoperative and postoperative visual analogue scale (VAS) pain scores, the time to the first analgesic requirement and adverse effects were recorded. Results: The sensory block levels were lower in group I when compared to groups II and III (p < 0.05). Intraoperative and postoperative VAS scores were higher in group I than groups II and III (p < 0.05). The time to first analgesic requirement in the postoperative period (VAS = 3) and the time to the application of first analgesic dose by epidural catheter was significantly shorter in group I than in groups II and III (p < 0.05). Nausea (n: 0,9,8), vomiting (n: 0,2,0), bradycardia (n: 0,1,2), and hypotension (n: 5,10,9) were the adverse effects found in groups I, II and III respectively. Conclusion: Intrathecal levobupivacaine 10 mg in 3 ml solution does not provide adequate anesthesia during elective cesarean section. We found that the major adverse effect of adding fentanyl or sufentanil to levobupivacaine is the increase in nausea

A novel approach for brachial plexus block

WOS: 000272499100001Aim: The line from the midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered the surface projection of the brachial plexus in the supraclavicular region in a previous report using radiological and anatomic techniques. The needle insertion site was the point between the clavicular one-third and cervical two-thirds of this line. The aim of the present study was to determine the clinical efficacy of these suggested landmarks. Materials and methods: Brachial plexus block was performed in 60 healthy adult patients undergoing elective Surgery on an upper extremity using the above-mentioned new surface landmarks. Results: The characteristics of the block resemble those in the interscalene technique. Brachial plexus block was performed with a high success rate (98.5%) and minor complications including phrenic nerve palsy (45%), Horner syndrome (15%), and recurrent nerve block (1.6%). No major complication such as pneumothorax or accidental intravascular insertion was observed. Conclusion: The new landmarks were not dependent on patients' physical features or deeper anatomic structures. The surface landmarks based on bony prominences were defined easily. Brachial plexus block was performed with a high success rate and is considered a safe alternative to the classically described techniques