The effect of perioperative nutritional therapy on the cognitive functions and nutritional status in elderly patients with femoral neck fracture

Aim: Femoral neck fracture is a common condition in the elderly. The catabolic state due to the neurohumoral response and poor nutrition is a threat to the fitness, immune system and cognitive functions in this age group. This study investigated the effect of a pragmatic nutritional therapy on laboratory markers of nutritional status, cognitive functions and postoperative complications in elective geriatric patients with femoral neck fracture. Materials and Methods: A total of 47 patients were randomized into two groups: Study group was audited two times a day to ensure administration of 30 kcal/kg/day calorie and 1 kg/day protein. Control group received standard hospital care. Complete blood count and routine biochemistry tests, Mini mental test scores and triceps skinfold thickness were obtained at the day of admission to the study, before the day of surgery and on the 5th postoperative day. Blood products and postoperative complications were recorded. Results: Postoperative Mini mental test scores were lower in the study group (p<0.001, 95% confidence interval: -10.4 to -5.5). Serum hemoglobin, total protein and albumin concentrations were decreased in both groups during the preoperative period; but were significantly higher in the study group on the 5th postoperative day (p=0.010, 0.002, <0.001, respectively). Triceps skinfold thickness values were significantly higher in the Study group (2.51±0.24 vs 2.23±0.28 in the Control group, Wilcoxon test, p=0.001). Number of transfused blood products and postoperative complications were lower in the Study group. Conclusion: This study showed that perioperative nutritional therapy with daily audits may protect the cognitive functions and evaluated with pragmatic laboratory tests and a simple, bedside anthropometric measurement

Comparison of metoprolol and tramadol with remifentanil in endoscopic sinus surgery: a randomised controlled trial

Objective: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. Methods: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg?1 metoprolol and 1 mg kg?1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 ?g kg?1 remifentanil following anaesthesia induction, followed by 0.25-0.5 ?g kg?1 min?1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. Results: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). Conclusion: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases

Impact of leg wrapping in combination with leg elevation on postspinal hypotension in subjects undergoing elective cesarean section under spinal anesthesia

Aim: This study aimed to compare the efficacy of lower extremity wrapping with elastic bandages in conjunction with leg elevation to leg elevation alone in terms of maternal systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 in term mothers undergoing elective cesarean section (CS) with spinal anesthesia. Material and Methods: A series of 62 term mothers aged between 20 and 45 years who were scheduled for elective CS under spinal anesthesia were enrolled in the study. Using sealed envelopes, participants were allocated to one of two study groups: the wrapping group (n=30) or the control group (n=32). All subjects received volume administration of lactated Ringer's solution of 10 mL/kg over the 15 min prior to the administration of the spinal block. Subjects allocated to the wrapping group received lower extremity wrapping with 10-cm Esmarch elastic bandages applied from the ankle to the mid-thigh immediately before the administration of the subarachnoid block. Following intrathecal injection, lower limbs were elevated 20 degrees in subjects allocated to the wrapping group by tilting the foot-end of the operating table. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and SaO2 were monitored intraoperatively. Results: Systolic, diastolic, and mean blood pressures were significantly higher in the wrapping group compared to the control subjects beginning from the 2nd minute of the intrathecal injection to the 20th-30th minute of the intrathecal injection. The median ephedrine dose was significantly higher in the control group than the wrapping group [15 (0-40) mg vs. 5 (0-30) mg, p=0.007]. Vomiting was also more frequent in control subjects compared to those receiving lower extremity wrapping and leg elevation (18% vs. 0%, p=0.024). Discussion: Lower extremity wrapping in combination with leg elevation provides a better hemodynamic profile than volume administration alone in subjects undergoing elective CS under spinal anesthesia. Subjects receiving lower extremity wrapping and leg elevation require less vasopressors and experience less vomiting compared to subjects receiving only volume administration

Comparison of the effects of minimal and high-flow anaesthesia on cerebral perfusion during septorhinoplasty

Objective: The aim of this study was to analyse the effects of minimal-and high-flow anaesthesia on cerebral oxygenation during septorhinoplasty with controlled hypotension using near-infrared spectroscopy. Methods: Eighty patients scheduled for septorhinoplasty under general anaesthesia with controlled hypotension were randomised into two groups: minimal-flow (MF) or high-flow (HF). Both groups received desflurane anaesthesia to maintain bispectral index values at 40%-50% and 0.25-0.5 µg kg?1 min?1 i.v. remifentanyl infusion to maintain mean arterial blood pressure between 55 and 65 mmHg. The MF group received 5 L min?1 of fresh gas flow for the first 10 mins then the gas flow was reduced 0.4 L min?1. The HF group received 2 L min?1 of fresh gas flow throughout. Haemodynamic parameters and cerebral oxygen saturation were measured. Results: There were no statistical differences in demographic variables, duration of anaesthesia and surgery, time to extubation and proceeding to an Aldrete score of 9. There were no statistical differences in haemodynamic parameters, end-tidal CO2 and cerebral oxygen saturation. The amount of desflurane used in the MF group was significantly lower than that used in the HF group (30.5±9.8 mL vs. 48.5±12.1 mL; p<0.05). Conclusion: MF and HF anaesthesia did not lead to any difference in cerebral oxygen saturation in patients undergoing septorhinoplasty with controlled hypotension. MF anaesthesia may thus be used as safely as HF anaesthesia is

Evaluation of tissue oxygenation in cesarean cases under spinal anesthesia: A prospective observational study

Objective: Hypotension is common in cesarean section due to the sympathetic blockage induced by spinal anesthesia. We aimed to investigate the effect of vasoactive drugs and fluids, and uterotonic drugs on tissue oxygenation. Methodology: Patients scheduled for elective cesarean section were included in this study. Routine monitoring values, thenar oxygen saturation and hemoglobin (Hb) indices were recorded preoperatively at the operating table (T1), at 3rd minute after spinal block (T2) and after the administration of uterotonic drugs (T3). Results: Data of 61 patients were analyzed. In 24 cases (39%), Hb values were < 11 g/dl. The incidence of hypotension following spinal anesthesia was 34.4%. The mean amount of ephedrine administered before the baby removal was similar in all patients (214 mg). Baseline StO2 values of anemic patients were similar to that of non-anemic patients; tissue hemoglobin index values of the former were significantly lower (p = 0.017). T3 systolic arterial blood pressures of patients with intraoperative hypotension were significantly lower (p = 0.001); tissue oxygen saturation and Hb indices were similar (p = 0.301). Conclusion: Tissue oxygenation may be influenced by the presence of anemia, hypovolemia, and hypotension. Its measurement may be influenced by pregnancy-dependent factors like edema and adipose tissue thickness in the monitoring site. We found that maintaining systolic blood pressure above 100 mmHg in this patient cohort was sufficient to preserve tissue oxygenation despite presence of anemia; and tissue oxygen saturation and hemoglobin indices were reliable

Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

Objective We aimed to investigate the effects of hypotensive anaesthesia on oxidative stress with serum thiol/disulphide balance in patients undergoing elective septoplasty procedures under general anaesthesia. Methods Seventy-two patients between the ages of 18-60, with a physical condition I -II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anaesthesia, patients were divided into the groups as Hypotensive Anaesthesia (n = 40) and Normotensive Anaesthesia (n = 32). Serum thiol/disulphide levels were measured by the method developed by Erel & Neselioglu. Results The native thiol and total thiol values of both groups measured at the 60th min intraoperatively were significantly lower than the preoperative values (both P 40 years and female gender were found to have a significant effect on dynamic oxidative stress (P = .002 and .001, respectively). Conclusion This pilot study has found that hypotensive anaesthesia had no adverse effect on dynamic thiol/disulphide balance in elective surgeries

Influence of infliximab pretreatment on ischemia/reperfusion injury in rat intestine

Erdivanli, Basar/0000-0002-3955-8242;WOS: 000335969500004PubMed: 24802959The Pringle maneuver is used in hepatic surgery to prevent blood loss but is associated with ischemia-reperfusion injury. To investigate the effect of infliximab on inflammation and apoptosis in rat intestinal mucosa during ischemia-reperfusion (IR) injury. A total of 30 male Wistar albino rats were equally divided into three groups to be subjected to (i) sham operation (sham), (ii) IR injury via Pringle maneuver (pringle) or (iii) infliximab (IFX) group (IFX was given at a dose 3 mg/kg for 3 days before IR injury). Following reperfusion period of 60 min., intestinal tissue and blood samples were taken and processed by standard histological methods. the Pringle maneuver and following reperfusion caused significant histopathological changes, increased serum transaminases' activity and the levels of oxidative stress markers and decreased glutathione peroxidase activity. IFX pretreatment partially prevented these changes. Infliximab pretreatment may protect intestinal mucosa against ischemia-reperfusion injury. Further studies are needed to investigate mechanism and evaluate safety and optimal dosing of IFX in humans exposed to the possible tissue damage by ischemia-reperfusion

Ağır Akciğer hastalığının Eşlik Ettiği Abdominal Aorta Anevrizması Olgusunda Epidural Anesteziyle Endovasküler Tedavi

Endovasküler cerrahi, abdominal aort anevrizmalarının tedavisini kolaylaştırmaktadır. Bunun sonucunda, ek hastalıkları olan pek çok hasta ameliyat edilmektedir. Bu tür hastaların anestezileri, kendilerine özgü sorunlara yönelik planlanmalıdır. Endovasküler abdominal aortik anevrizma onarımı planlanan, ağır obstrüktif akciğer hastalığı olan bir olguda anestezi yönetimimizi sunmayı amaçladık.Endovascular surgery simplifies repair of abdominal aortic aneurysms. As a result, many patients with comorbidities are being operated. Anaesthetic plan of such patients should be planned according to their specific conditions. We aimed to describe the anesthetic management of a patient with severe obstructive pulmonary disease scheduled for endovascular abdominal aortic aneurysm repair

Steroidal nondepolarizing neuromuscular blocker induced allergic reactions and role of sugammadex in treatment

Genel anestezi sırasında gelişen anafilaktik ve anafilaktoid reaksiyonların yarıdan fazlası kas gevşetici ajanlar nedeniyle oluşur. Teşhis ve uygun tedavide gecikme nedeniyle yüksek mortalite ve morbiditeyle sonuçlanan bu tür reaksiyonların önlenmesinde geleneksel destek tedavisi esastır. Fakat dolaşımdaki allerjenin hızla vücuttan uzaklaştırılması resüs itasyona büyük katkı sağlayabilir. Sugammadeks, ? -siklodekstrin yapısında bir ilaçtır. Steroid yapılı nondepolarizan nöromüsküler blokerleri selektif olarak bağlayarak, böbrek yoluyla vücuttan uzaklaştırmak üzere tasarlanmıştır. Literatürde, roküronyuma bağlı geliştiği saptanan, fakat rutin anafilaksi tedavisine yanıt vermeyen durumlarda, sugamm adeks ile etkin düzelme sağlandığını bildiren vaka sunumları vardır. Nondepolarizan nöromusküler blokerlere bağlı gel işen anafilaksinin geleneksel tedavisinde, dolaşımdaki alle rjeni elimine etmeye yönelik sugammadeksten faydalanılab ileceği kanaatindeyiz.More than half of the anaphylactic and anaphylactoid rea ctions during general anesthesia occur due to neuromuscular blocking agents. Traditional resuscitation is the mainstay therapy in these reactions, which have a high morbidity and mortality due to delay in diagnosis and specific treatment. However, prompt removal of the offending agent from circulation may greatly improve the outcome. Sugammadeks is a drug that is the structure of ? -cyclodextrin. It's designed specifically to encapsuate steroidal nondepolarizing neuromuscular blockers and facilitate their excretion through kidneys. There are case reports in the literature suggesting that anaphylactic reactions due to rocuronium, unrespo nsive to rutin anaphylactic therapy, respond promptly to sugammadex. In our opinion traditonal anaphylaxis trea tment may benefit from sugammadex in removal of the offending agent from circulation