Suprachoroidal drainage of aqueous humour with a novel implant: Suprajet

AIM: To evaluate the efficacy and safety of a new implant, Suprajet(VSY Biotechnology, Istanbul, Turkey), which is developed for supraciliary and suprachoroidal drainage of aqueous humour.METHODS: Five rabbits were included in the study. One Suprajet shunt was implanted in one eye of each rabbit. Implantation was performed by a superior clear corneal incision through the anterior chamber into the suprachoroidal space. Proximal end of the implant was placed in the iris root resting against the scleral spur, distal end was placed in the suprachoroidal space. Rabbits were followed for 4wk. Preoperative and postoperative intraocular pressure(IOP)levels were measured with Tonopen AVIA. At last follow-up visit animals were sacrificed and eyes were enucleated. Macroscopic and histopathologic evaluation of the eyes were made. RESULTS: Mean preoperative IOP was 18.6±6.1 mmHg. Mean postoperative IOP was 8.4±1.1 mmHg, at one week. At the 2nd week of the follow-up period one rabbit died. Thereafter, only 4 rabbits were followed. Mean postoperative IOP was 11.0±2.8 mmHg at the 2nd week, 9.50±3.1 mmHg at the 3rd week and 11.3 ±3.3 mmHg at 4th week after the operation. When mean preoperative IOP was compared with the postoperative IOP values, only the IOP at the first week was found as significantly lower(P=0.042). There was no statistically significant difference between mean preoperative IOP level and mean IOP level at 2, 3 and 4wk postoperatively(P=0.66, P=0.66 and P=0.102, respectively). As an intraoperative complication, minimal hyphema was noted in three eyes during the surgery. However, the next day hyphema cleared completely. Macroscopic evaluation of the enucleated material showed that in one eye the distal end of the implant was in the vitreous instead of suprachoroidal space, in the other 3 eyes the distal end of the implant was noted in the suprachoroidal space. In all eyes, proximal end of the implant was localized in the anterior chamber angle. Histopathologic evaluation of the enucleated eyes showed deposition of irregular collagen bundles and fibroplasia including numerous fibroblastic and histiocytic cells around the implant.CONCLUSION: This preliminary animal study showed that implantation of Suprajet in glaucoma is a promising procedure. Further studies are needed to evaluate its efficacy and safety profile

Effectiveness of sugammadex for cerebral ischemia/reperfusion injury

AbstractCerebral ischemia may cause permanent brain damage and behavioral dysfunction. The efficacy and mechanisms of pharmacological treatments administered immediately after cerebral damage are not fully known. Sugammadex is a licensed medication. As other cyclodextrins have not passed the necessary phase tests, trade preparations are not available, whereas sugammadex is frequently used in clinical anesthetic practice. Previous studies have not clearly described the effects of the cyclodextrin family on cerebral ischemia/reperfusion (I/R) damage. The aim of this study was to determine whether sugammadex had a neuroprotective effect against transient global cerebral ischemia. Animals were assigned to control, sham-operated, S 16 and S 100 groups. Transient global cerebral ischemia was induced by 10-minute occlusion of the bilateral common carotid artery, followed by 24-hour reperfusion. At the end of the experiment, neurological behavior scoring was performed on the rats, followed by evaluation of histomorphological and biochemical measurements. Sugammadex 16 mg/kg and 100 mg/kg improved neurological outcome, which was associated with reductions in both histological and neurological scores. The hippocampus TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and caspase results in the S 16 and S 100 treatment groups were significantly lower than those of the I/R group. Neurological scores in the treated groups were significantly higher than those of the I/R group. The study showed that treatment with 16 mg/kg and 100 mg/kg sugammadex had a neuroprotective effect in a transient global cerebral I/R rat model. However, 100 mg/kg sugammadex was more neuroprotective in rats

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Comparison of Effects of Extubation in Prone and Supine Positions in Patients Operated for Lumbar Disc Herniation.

AIM: To observe the effects of prone position extubation on respiratory side effects and hemodynamic parameters in patients who underwent lumbar spinal surgery. MATERIAL and METHODS: This prospective observational study included 60 patients extubated in either the prone (n=30) or supine (n=30) positions. Heart rate, noninvasive arterial blood pressure, peripheral oxygen saturation, train of four values, and bispectral index values were measured and recorded in all patients during operation and at the time of anesthetic agent discontinuation, before and after extubation. The Aldrete recovery score was recorded together with the severity of cough during emergence and recovery. Sore throat visual analog scale (VAS) score was recorded at the first and sixth hours after extubation. Incidents such as nausea, vomiting, respiratory failure, uncontrolled airway, and decreased saturation were also recorded. RESULTS: The number and severity of cough (p0.05). CONCLUSION: Extubation in the prone position after lumbar spinal surgery provides more comfortable emergence and recovery periods with less alteration of respiratory status and a better recovery profile

INVESTIGATING THE FREQUENCY AND CAUSES OF DIFFICULT MASK VENTILATION IN INTRAOPERATIVE IN GERIATRIC PATIENTS

Introduction: The sunken cheeks of edentulous elderly patients may cause mask ventilation to be ineffective or even impossible. The aim of this study was to identify the frequency and causes of difficult mask ventilation in geriatric patients

EFFECT OF LARYNGEAL MASK CUFF PRESSURE ON POSTOPERATIVE PHARYNGOLARYNGEAL MORBIDITY IN GERIATRIC PATIENTS

Introduction: In many of the world's developed regions, the geriatric population forms a rapidly increasing portion of the total population. Therefore the vast majority of daily operating schedule constitutes the elderly patients. Pharyngolaryngeal complications are indicators of quality geriatric patient care. This study compared postoperative pharyngolaryngeal morbidity in geriatric patients managed with manometers to limit the laryngeal mask intracuff pressure (60 cmH(2)O) with geriatric patients under routine care

Use of laryngeal mask airway in anesthesia for treatment of retinopathy of prematurity

Objectives: To review clinical experience of anesthesia management using laryngeal mask airway (LMA) during retinopathy of prematurity (ROP) photocoagulation

Effects of Propofol and Propofol-Remifentanil Combinations on Haemodynamics, Seizure Duration and Recovery during Electroconvulsive Therapy.

Objective: This study aimed to evaluate the effects of adding different doses of remifentanil to propofol treatment compared with propofol alone with regard to parameters, including the seizure duration, haemodynamic changes and recovery time, in patients undergoing electroconvulsive therapy (ECT)

The Effects of Two Different Doses of Dexmedetomidine in a Testicular Ischemia-Reperfusion Model in Rats

Objective: Dexmedetomidine is known to have anti-inflammatory activity in both ischemic and toxic inflammatory response models. In this study, the effects of two different doses of dexmedetomidine were investigated in a rat model of testicular ischemia-reperfusion. Material and Methods: Twenty eight rats weighing 300-350 g were divided into four groups. The left testis and spermatical cord were liberated by left inguinal incision in all groups. Sham group (Group 1) (n=7) did not receive any other procedure. One hour of torsion and four hours of detorsion were applied to the other groups. The rats in ischemia/reperfusion group (Group 2) (I/R, n=7), did not receive any drug. Dexmedetomidine 50 mu g/kg for Group 3 (I/R+50D, n=7) and 100 mu g/kg for Group 4 (I/R+100D, n=7) was injected intraperitoneally after 30 mins of testicular torsion. To grade the testicular reperfusion injury tissue malondialdehyde (MDA) and nitric oxide (NO) levels were measured and the germ cell damage was evaluated histopathologically using Cosentino Scale in the excised testis. Results: MDA levels in group I/R were significantly higher than in sham, I/R+50D and I/R+100D groups (p<0.001). MDA levels in I/R+50D and I/R+100D were also significantly different (p=0.01). NO levels were significantly higher in group I/R when compared to Sham, I/R+50D and I/R+100D groups (p=0.003). Hystopathological scores were higher in I/R group than in I/R+50D and I/R+100D groups (p=0.001). Conclusion: Deksmedetomidine treatment at a dose of 50 and 100 mu g/kg, attenuated reperfusion injury in a dose-dependent manner in this experimental testicular ischemia reperfusion model

Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications

Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8: 00 AM and 7: 59 PM, and as 'night-time' when induction was between 8: 00 PM and 7: 59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P = 0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P = 0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P = 0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P = 0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P = 0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events