Sciatic nerve injury following analgesic drug injection in rats: a histopathological examination

OBJECTIVE: Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections. METHODS: We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema. RESULTS: All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve. CONCLUSION: Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed

IN VITRO INVESTIGATION OF ANTIBACTERIAL ACTIVITY OF DRUGS USED IN SEDATION IN INTENSIVE CARE UNIT

WOS: 000496261400099Introduction: Sepsis is a systemic inflammatory response to infection and is a life-threatening condition. Sedation is important such as these patients. Some drugs that used for sedation may have antimicrobial effects. the aim of this study was to investigate the antimicrobial activity of propofol, ketamine, thiopental, dexmedotomidine and midazolam, which are widely used in intensive care in the form of infusion for sedation. Materials and methods: in vitro antimicrobial activities of dexmedetomidine, midazolam, ketamine, propofol and thiopental sodyom drugs of different concentrations were investigated by using the agar well diffusion method. Ampicillin, streptomycin and fluconazole were used as standard antibacterial and antifungal drugs, respectively. While selecting the microorganisma, the agents which are unexpected to cause sepsis were included in the study in addition to the causative agents leading to sepsis, in order to understand the antimicrobial effect more clearly. All test microorganisms as follows: E. coli ATCC, Y. pseudotuberculosis ATCC, P. auroginosa ATCC, E. faecalis ATCC, S. aureus ATCC, B. cereus, M. smegmatis ATCC, C. albicans ATCC, C. tropicalis ATCC and S. cerevisiae ATCC. Results: Ketamine was found to have antimicrobial activity against all of the microorganisms tested, but the highest efficacy was determined against S. aureus. Bactericidal (and fungocidal) activity of ketamine was determined against all other microorganisms. Conclusion: We consider that it can be important to conduct the trial on the doses used in practice, and to demonstrate the usefulness of the antibacterial activity of these drugs in practice. in conclusion, in patients with sepsis followed in the intensive care unit, ketamine may be preferred for sedation. Thus, this can contribute to the patient's antibiotherapy. However, further clinical research is needed to evaluate the effectiveness of antimicrobial activity of ketamine in clinical practice and to assess the effectiveness of reducing the mortality in patients with sepsis

The use of sugammadex in a patient with myasthenia gravis

Miyastenia gravis, postsinaptik asetilkolin reseptörlerine karşı antikor gelişimiyle karakterize otoimmün bir hastalıktır. Hastalarda nondepolarizan kas gevşeticilere karşı duyarlılık artmıştır. Sugammadeks, roküronyum ve veküronyum gibi steroid yapılı nondepolarizan kas gevşeticileri seçici şekilde bağlayarak, etkilerini kaldırmak üzere tasarlanmış yeni bir ilaçtır. Bu makalede kas gevşetici olarak 0.6 mg kg-1 roküronyum kullanılan miyastenia gravisli bir olguda, kas gücünün geri dönüşünü sağlamada 4 mg kg-1 sugammadeks kullanımı sunulmuştur.Myasthenia gravis is an autoimmune disease characterized by antibody formation against postsynaptic acetylcholine receptors. Patients demonstrate increased sensitivity to nondepolarizing muscle relaxants. Sugammadex is a new selective nondepolarizing muscle relaxant-binding agent designed to reverse the effect of steroidal muscle relaxants like rocuronium and vecuronium. This article reports the use of 4 mg kg-1 Sugammadex to reverse neuromuscular blockade in a myasthenia gravis case, where 0.6 mg kg-1 rocuronium was used as a neuromuscular blocking agent

Histopathological effects of intramuscular metamizole sodium on rat sciatic nerve

WOS: 000389136100004PubMed: 27746863Objective(s): We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. Materials and Methods: This study was performed using 48 adult male Wistar albino rats. Ten groups were constituted with 6 rats in each group. MS injection into the sciatic nerve (group 1), MS injection into the muscle [group 3 (50 mg/kg, 0.4 ml) and group 5 (50 mg/kg, 0.8 ml)], MS injection into the muscle cavity in the vicinity of the sciatic nerve [group 2 (50 mg/kg, 0.4 ml) and group 4 (50 mg/kg, 0.8 ml)], normal saline injection into the muscle in the vicinity of the sciatic nerve [group 6A (0.4 ml) and 6B (0.8 ml)], subjected to injury by drilling the entire layer of nerve without injecting any drug, normal saline injection in the sciatic nerve, and control group. Nerve and muscle samples were taken 7 days after administrations. Tissue sections were stained using a hematoxylin and eosin-Luxol (R) fast blue stain, assessed by a histologist. Results: the levels of axonal degeneration of the rats in groups 1, 2, 3, 4, 5, 6A, and 8 were found to be significantly higher compared to the levels of the rats in the control group (P< 0.05). Myelin degeneration of the rats in all groups was found to be significantly higher compared to myelin degeneration of the rats in the control group (P< 0.05). Conclusion: It was observed that MS could lead to injury in the sciatic nerve with a toxic effect due to diffusion

Adli tıp kurumunda değerlendirilen havayolu yönetimi sırasında ortaya çıkan istenmeyen durumlar

Objective: Unsuccessful airway management at anesthesia practice can result with death or permanent brain damage. In this study we investigate the cases which are in dispute by the accusation of problematic airway control during anesthesia and that sent to Council of Forensic Medicine for expertise by court. Method: We retrospectively analyzed 37 case files between the years of 2006-2012 which were in dispute by the accusation of problematic airway control during anesthesia and that were evaluated by Council of Forensic Medicine.Result: 27 (72.98%) of the cases were female, 10 (27.02%) of the cases were male. The distrubution of cases were as follows:16 of cases (43.23%) were from Obstetrics and Gynecology, 7 of cases (18.91%) were from ENT, 6 of cases (16.21%) were from general surgery. The airway management in 27 cases (72.97%) were planned intervention, and 10 of the cases (27.03%) were urgent. While the preoperative preparations in 20 cases were adequately completed, the preparations in 17 cases were inadequtely completed. The number of cases that the anesthesia was performed by anesthesiologist or by anesthesia technicians with anesthesiologist supervision seems to higher than the cases that the anesthesia was performed. by anesthesia technicians with surgeon supervision. It was found that most frequent adverse outcome was the difficult intubation with difficult ventilation (37.83%). Tracheal injuries ( 18.91 %) and esophageal injuries ( 10.81 %) followed this respectively. Patients who underwent tracheostomy because of difficult intubation was 16.21% of all cases. Conclusion: It is necessary to be prepared for difficult airway possibility even if difficult intubation criteria aren't detected. We suggest that training program on the recognization and management of difficult intubation and must be generalized. We predict that, with this generalized training program, the adverse outcomes and lawsuits might decrease.Amaç: Ülkemizde, genel anestezi uygulamaları esnasında oluşan hava yolu yönetimi ile ilgili sorunları adli yönden inceleyen bir çalışma bulunmamaktadır. Bu çalışmada hava yolu yönrtimi sırasında istenmeyen durumların yaşandığı iddiası ile dava konusu olan ve bilirkişi incelemesi için Adli Tıp Kurumu'na gönderilen olgular incelenmiştir.Yöntem: Adli Tıp Kurumu'nda 2006-2012 yıllarına ait hava yolu yönrtimi sırasında istenmeyen durumların yaşandığı iddiası ile dava konusu olan ve görüş bildirilen 37 dosya retrospektif olarak incelendi.Bulgular: Olguların 27'si (% 72.98) kadın, 10'u (% 27.02) erkekti. Klinik branşlara dağılımı incelendiğinde; 16 olgu Kadın Hastalıkları ve Doğum (% 43.23), 7 olgu Kulak Burun Bogaz (%18.91), 6 olgu Genel Cerrahi (% 16.21) 'yi ilgilendiriyordu. Olguların 27'sinde (% 72.97) müdahale planlı, 10'unda (% 27.03) acil idi. Olguların 20'sinde preoperatif hazırlığın tam olarak yapıldığı, 17 olguda da bu hazırlıkta eksiklikler olduğu saptandı. Anestezi uzmanı veya anestezi uzmanı ile birlikte anestezi teknisyeninin anestezi uyguladığı olguların (% 75,67) oranının cerrahın kontrolünde anestezi uygulayan anestezi teknisyeninkilere göre daha fazla olduğu görülmektedir. Zor entübasyon ile birlikte zor ventilasyon (% 37.83) en sık karşılaşılan istenmeyen durum olarak bulundu. Bunu trakeal yaralanmalar (% 18.91) ve özefagus yaralanmaları (% 10.81) takip etti. Zor entübasyon nedeniyle entübe edilemeyen ve trakeostomi açılan olgular tüm olguların %16.21' ini oluşturmaktadır. Sonuç: Zor entübasyon kriterleri saptanmasa bile zor hava yolu gelişme riski göz önünde bulundurularak gerekli hazırlıklar yapılmalıdır. Ayrıca zor havayolunun tanınması ve yönetilmesine yönelik eğitimin yaygınlaştırılması gerektiğini düşünüyoruz

Ankilozan spondilite bağlı ağır solunum yetmezliği ve zor entübasyon vakasında sugammadex kullanımı

Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır restriktif akciğer hastalığı ve zor entübasyon bulguları gösteren 50 yaşında erkek hastanın anestezi yönetimi tartışıldı. Torakal deformite nedeniyle hastanın baş ekstansiyonu kısıtlı, supin pozisyonda uyuma ve nefes almada zorluk çekiyor. Ağız açıklığında ve baş ekstansiyonundaki kısıtlılık nedeniyle hasta larengeal maske kullanılarak entübe edildi. Bronşiyal sekresyonlarda artış ve bronkospazmı önlemek, solunum kaslarının fonksiyonunu optimum düzeyde geri döndürmek için sugammadex uygulamasını takiben ekstübe edildi.We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm

Avaliação in vitro das propriedades antimicrobianas de vasopressores

Justificativa e objetivo: os medicamentos administrados como perfus&#227;o intravenosa podem ser contaminados durante as v&#225;rias etapas de produ&#231;&#227;o ou prepara&#231;&#227;o. No entanto, estudos sobre os efeitos antibacterianos de vasopressores s&#227;o muito raros. Este estudo investiga a atividade antimicrobiana in vitro das formas de vasopressores usados clinicamente. Materiais e m&#233;todos: atividades antimicrobianas in vitro de subst&#226;ncias vasopressoras de diferentes concentra&#231;&#245;es foram investigadas com o uso da t&#233;cnica de microdilui&#231;&#227;o. Os microrganismos empregados no teste foram: Escherichia coli ATCC 25922, Yersinia pseudotuberculosis ATCC 911, Pseudomonas aeruginosa ATCC 10145, Listeria monocytogenes ATCC 43251, Enterococcus faecalis ATCC 29212, Staphylococcus aureus ATCC 25923, Bacillus cereus 702 Roma, Mycobacterium smegmatis ATCC607, Candida albicans ATCC 60193 e Saccharomyces cerevisiae RSKK 251. Os ensaios antibacterianos foram feitos em caldo de cultura Mueller-Hinton (pH 7,3) e os ensaios antif&#250;ngicos em solu&#231;&#227;o tamp&#227;o de base nitrogenada para levedura (pH 7,0). Resultados: duas prepara&#231;&#245;es diferentes de dopamina mostraram atividade antimicrobiana. Nenhuma outra subst&#226;ncia do estudo mostrou qualquer atividade antimicrobiana. Conclus&#245;es: em nossa opini&#227;o, os efeitos antibacterianos da dopamina podem ser vantajosos para inibir a propaga&#231;&#227;o de contamina&#231;&#227;o bacteriana durante a prepara&#231;&#227;o das solu&#231;&#245;es para perfus&#227;o. Contudo, salientamos a import&#226;ncia do seguimento rigoroso das diretrizes de esteriliza&#231;&#227;o dos equipamentos e de assepsia durante todos os procedimentos feitos em unidades de terapia intensiva