COMPARISON OF EPIDURAL AND COMBINED SPINAL-EPIDURAL ANALGESIA IN PARTURIENTS RECEIVING PATIENT CONTROLLED EPIDURAL ANALGESIA DURING LABOR

Amaç: Doğum ağrılarının giderilmesinde Kombine Spinal - Epidural Analjezi (KSEA), Epidural Analjeziye (EA) bir alternatif olarak sunulmaktadır. Bu çalışmada, doğum eyleminin birinci evresinde KSEA veya EA uygulanan gebelerde analjezik yöntemin, doğum eylemi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve yöntem: Fakülte Etik Kurul onayı alındıktan sonra, ASA I-II'ye uyan 130 nullipar gebe kombine spinal-epidural (n=65) veya epidural (n=65) analjezi uygulanmak üzere çalışmaya alındı. KSEA grubunda, intratekal aralığa 20 μg fentanil + 1 ml %0,25 bupivakain uygulandı; epidural kateter yerleştirildi. Epidural grupta %0,125 bupivakain + 50μg fentanil (toplam 10 ml) epidural aralığa enjekte edilerek analjezi sağlandı. Her iki grupta analjezi idamesinde Hasta Kontrollü Epidural Analjezi (HKEA) (%0,125 bupivakain + 2 μg/ml fentanil-10 ml bolus + 30 dk. kilit süresi) uygulandı. Serviksin dilatasyon ve efasman derecesi, fetus başının seviyesi, oksitosin infüzyon hızı, doğumun I ve II evre süreleri, yeni doğanın Apgar skoru, doğum şekli ve anne memnuniyeti; ayrıca hemodinamik parametreler, ağrı skorları, motor blok ve yan etkiler kaydedildi. Veriler istatistiksel olarak değerlendirildi. Bulgular: Oksitosin infüzyon hızının Grup EA'da 3-8. saatlerde daha yüksek olduğu (p<0,05), serviks dilatasyonunun KSEA grubunda daha hızlı ilerlediği, efasman dereceleri arasında fark olmadığı saptandı. KSEA grubunda fetus başının daha hızlı iniş yaptığı belirlendi (p<0,05). Motor blok görülme oranı, doğum şekli, Apgar Skorları, anne memnuniyeti gruplar arasında farklı değildi. Sonuç: Geleneksel EA ile kıyaslandığında, KSE analjezi uygulanan nullipar gebelerde, serviks dilatasyonu ve fetus başının seviyesinin daha hızlı indiği ve bu yöntemin geleneksel epidural analjeziye bir alternatif olabileceği kanaatına varıldı. Objective: Combined spinal-epidural analgesia (CSEA) technique is proposed as an alternative to conventional epidural analgesia (EA) for pain of labor. In this study we aimed to compare the effects of CSEA with those of epidural analgesia on the progress of labor during the first stage of labor. Material and method: After approval by the local ethics committee, one hundredthirty nulliparous parturients were randomly allocated to receive either CSEA (n=65) combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 20 μg fentanyl were injected into the subarachnoid space and the epidural catheter was inserted. The initial dose consisted of 0.125 % bupivacaine+50μg fentanyl in 10 ml of saline in the epidural group. Both groups received epidural top-ups of 10 ml 0.125 % bupivacaine+2μg/ml fentanyl via Patient Controlled Epidural Analgesia (PCEA) pump. Data were collected on cervical dilation, effacement, station, oxytocin infusion rates, length of 1st and 2nd stage of labor, Apgar scores, mode of delivery, mother satisfaction, hemodynamic parameters, side effects, pain and degree of motor block. Results: The mean cervical dilation rates and progress of station were significantly faster in patients receiving CSEA. Oxytocin infusion rates were higher in patients receiving EA. Progress of effacement, the incidence of side effects, and mode of delivery and Apgar scores were similar between groups. Parturients in both groups were equally satisfied. Conclusion: In nulliparous parturients, CSEA is associated with rapid progress of cervical dilation and station when compared to conventional EA; and can be an alternative to EA in our opinion

Effect of Hemodynamic Monitoring Systems on Short-Term Outcomes after Living Donor Liver Transplantation

Background and Objectives: To evaluate the effects of the pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method hemodynamic monitoring systems on short-term graft and patient outcomes during living donor liver transplantation in adult patients. Materials and Methods: Overall, 163 adult patients who underwent living donor liver transplantation between January 2018 and March 2022 and met the study inclusion criteria were divided into two groups based on the hemodynamic monitoring systems used during surgery: the MostCare Pressure Recording Analytical Method group (n = 73) and the pulse index continuous cardiac output group (n = 90). The groups were compared with respect to preoperative clinicodemographic features (age, sex, body mass index, graft-to-recipient weight ratio, and Model for End-stage Liver Disease score), intraoperative clinical characteristics, and postoperative biochemical parameters (aspartate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, prothrombin time, international normalized ratio, and platelet count). Results: There were no significant between-group differences with respect to recipient age, sex, body mass index, graft-to-recipient weight ratio, Child, Model for End-stage Liver Disease score, ejection fraction, systolic pulmonary artery pressure, surgery time, anhepatic phase, cold ischemia time, warm ischemia time, erythrocyte suspension use, human albumin use, crystalloid use, urine output, hospital stay, and intensive care unit stay. However, there was a significant difference in fresh frozen plasma use (p p = 0.037). Conclusions: The clinical and biochemical outcomes are not significantly different between pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method as hemodynamic monitoring systems in living donor liver transplantation. However, the MostCare Pressure Recording Analytical Method is more economical and minimally invasive

Ischaemic preconditioning attenuates haemodynamic response and lipid peroxidation in lower-extremity surgery with unilateral pneumatic tourniquet application: A clinical pilot study

Introduction: The harmful effects of ischaemia-reperfusion on skeletal muscle during extremity surgery can be diminished by using medications or ischaemic preconditioning

Proteomic Analysis of Kidney Preservation Solutions Prior to Renal Transplantation

One of the main issues in kidney transplantation is the optimal functional preservation of the organ until its transplantation into the appropriate recipient. Despite intensive efforts, the functional preservation period remains limited to hours. During this time, as a result of cellular injury, various proteins, peptides, and other molecules are released by the organ into the preservation medium. In this study, we used proteomic techniques to analyze the protein profiles of preservation solutions in which organs had been preserved prior to their transplantation. Samples were obtained from the preservation solutions of 25 deceased donor kidneys scheduled for transplantation. The protein profiles of the solutions were analyzed using 2D gel electrophoresis/MALDI-TOF and LC-MS/MS. We identified and quantified 206 proteins and peptides belonging to 139 different groups. Of these, 111 proteins groups were belonging to kidney tissues. This study used proteomic techniques to analyze the protein profiles of organ preservation solutions. These findings will contribute to the development of improved preservation solutions to effectively protect organs for transplantation

Protein spots of kidney preservation solution identified by 2D gel electrophoresis.

<p>Protein spots of kidney preservation solution identified by 2D gel electrophoresis.</p

List of proteins and peptides that were isolated from kidney preservation solution which showed a statistically significant correlation with donors’ age (DA), cold ischemia time (CIT), creatinine (Cr) and blood urea nitrogen (BUN).

<p>List of proteins and peptides that were isolated from kidney preservation solution which showed a statistically significant correlation with donors’ age (DA), cold ischemia time (CIT), creatinine (Cr) and blood urea nitrogen (BUN).</p

Proteins and peptides belonging to kidney tissues detected from preservation solution using LC-MS/MS (n:18).

<p>Proteins and peptides belonging to kidney tissues detected from preservation solution using LC-MS/MS (n:18).</p