Comparing spinal blockade effectiveness and maternal hemodynamics using 25 gauge and 29 gauge spinal needles with the same volumetric flow rate in patients undergoing caesarean section

Spinal needles with different diameters can be used to prevent side effects in patients undergoing spinal anaesthesia. However, the velocity of local anaesthetic changes through the spinal needle depending on the diameter of it. Local anaesthetic injection velocity has been reported to be associated with the spinal block level. We aimed to compare spinal needles of different diameters with the same local anaesthetic volumetric flow rate in terms of spinal blockade and hemodynamics in obstetric patients. Eighty-four patients received spinal anaesthesia by either a 25G needle or 29G with the same volumetric flow rate. Block levels, adverse effects, ephedrine given and a success rate of spinal anaesthesia were significantly higher in 25G than in 29G (p < .05). Athough the use of 29G was associated with a low level of block, a sufficient block level was generated for caesarean section. Furthermore, in spite of the technical difficulty, use of 29G was accompanied by a decreased incidence of maternal hypotension, bradycardia and a lowered ephedrine administration.Impact statement Local spinal anaesthetic injections at faster flows cause turbulent flow leading to lower anaesthesia concentrations. The control of spinal anaesthesia levels has some difficulties due to anatomical repositioning, especially in pregnant patients. Also, it can cause frequent hemodynamic complications including hypotension and bradycardia, complications that may also have inadvertent effects on foetus. In this study, we showed that smaller diameter spinal needles provided safer spinal anaesthesia levels and a lower incidence of hemodynamic complications

Angiotensin-I-Converting Enzyme (ACE)-Inhibitory Peptides from Plants

Hypertension is an important factor in cardiovascular diseases. Angiotensin-I-converting enzyme (ACE) inhibitors like synthetic drugs are widely used to control hypertension. ACE-inhibitory peptides from food origins could be a good alternative to synthetic drugs. A number of plant-based peptides have been investigated for their potential ACE inhibitor activities by using in vitro and in vivo assays. These plant-based peptides can be obtained by solvent extraction, enzymatic hydrolysis with or without novel food processing methods, and fermentation. ACE-inhibitory activities of peptides can be affected by their structural characteristics such as chain length, composition and sequence. ACE-inhibitory peptides should have gastrointestinal stability and reach the cardiovascular system to show their bioactivity. This paper reviews the current literature on plant-derived ACE-inhibitory peptides including their sources, production and structure, as well as their activity by in vitro and in vivo studies and their bioavailability

The Levels and Duration of Sensory and Motor Blockades of Spinal Anesthesia in Obese Patients That Underwent Urological Operations in the Lithotomy Position

Obesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TUR-P) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI<25 kg/m2, Group N) or obese (BMI≥30 kg/m2, Group O) group. SB assessments were recorded afterthe LP. SB at 6 and 120 min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120 min SB levels were significantly higher for Group O (P<0.05). Blood pressure (BP) after the LP was significantly higher for Group N (P<0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients

Clinical Study The Levels and Duration of Sensory and Motor Blockades of Spinal Anesthesia in Obese Patients That Underwent Urological Operations in the Lithotomy Position

Obesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TUR-P) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI &lt; 25 kg/m 2 , Group N) or obese (BMI ≥ 30 kg/m 2 , Group O) group. SB assessments were recorded afterthe LP. SB at 6 and 120 min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120 min SB levels were significantly higher for Group O ( &lt; 0.05). Blood pressure (BP) after the LP was significantly higher for Group N ( &lt; 0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients

A Case Report of Tongue Edema due to Laryngeal Mask with Introducer

Airway management using a laryngeal mask is an especially preferred noninvasive technique because of its achievement of hemodynamic stability and ease of application in surgeries that have short surgery time and do not require specific positions such as the prone position. Although it is easily performed, serious complications may manifest rarely because of lack of experience and inappropriate choice of instrumentation. In this case report, clinical management and treatment options of tongue edema that developed because of the forgotten introducer in laryngeal mask application are presented

The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy

Introduction: Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. Materials and methods: In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I–II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. Results: Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p < 0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p > 0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p < 0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p > 0.05). Conclusion: All airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers. Resumo: Introdução: A broncofibroscopia flexível (BF) é uma valiosa intervenção para o manejo e avaliação de doenças respiratórias em pacientes tanto pediátricos quanto adultos. O objetivo deste estudo foi investigar a influência das manobras de apoio das vias aéreas sobre a visibilidade da glote durante a BF pediátrica. Material e método: Estudo cruzado, randômico e controlado, incluindo pacientes com idades entre 0-15 anos, ASA I-II, que foram submetidos à BF. Pacientes com risco de intubação difícil, entubados ou com traqueostomia e aqueles com mobilidade reduzida do pescoço ou que exigissem cuidados para a mobilidade do pescoço foram excluídos do estudo. Depois de obter a melhor visibilidade da glote na posição neutra, os pacientes foram posicionados com elevação da mandíbula e abertura da aberta (EMBA), com elevação da mandíbula e protrusão dos dentes (EMPD), com inclinação da cabeça elevação do queixo (ICEQ) e com a tripla manobra das vias aéreas (TMVA). Os melhores escores da glote foram registrados. Resultados: No total, 121 pacientes pediátricos foram incluídos no estudo: 57 pacientes do sexo feminino e 64 do sexo masculino. Ambos as manobras EMBA e EMPD melhoraram a visibilidade da glote em comparação com a posição neutra (p < 0,05), mas não observamos diferença entre as manobras EMBA e EMPD (p > 0,05). As manobras ICEQ e TMVA melhoraram a visibilidade da glote em comparação com as manobras EMBA e EMPD e a posição neutra (p < 0,05); porém, não encontramos diferenças entre a ICEQ e a TMVA (p > 0,05). Conclusão: Todas as manobras de acesso às vias aéreas melhoraram a visibilidade da glote durante a BF pediátrica; porém, a inclinação da cabeça e elevação do queixo e a tripla manobra das vias aéreas foram consideradas as manobras mais eficazes. Keywords: Fiberoptic bronchoscopy, Pediatrics, Airway maneuvers, Jaw trust, Glottis view, Palavras-chave: Fibrobroncoscopia, Pediatria, Manobras das vias aéreas, Elevação da mandíbula, Visibilidade da glot