THE EFFECT OF PREOPERATIVE ANXIETY ON FETAL CORD BLOOD TUMOR NECROSIS FACTOR-ALPHA, INTERLEUKIN-6, AND NEONATAL OUTCOMES IN PREGNANT WOMEN

Backgrounds: In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-alfa,IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood. Subjects and methods: Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-alfa,IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1st and 5th minutes after birth were recorded. Results: The mean preoperative maternal SAI and TAI scores were 46,6+-10,9 and 41,4+-7,8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-alfa,IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values. Conclusions: Our results show that an increase in the levels of TNF-alfa,IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn

THE EFFECT OF PREOPERATIVE ANXIETY ON FETAL CORD BLOOD TUMOR NECROSIS FACTOR-ALPHA, INTERLEUKIN-6, AND NEONATAL OUTCOMES IN PREGNANT WOMEN

Backgrounds: In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-alfa,IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood. Subjects and methods: Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-alfa,IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1st and 5th minutes after birth were recorded. Results: The mean preoperative maternal SAI and TAI scores were 46,6+-10,9 and 41,4+-7,8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-alfa,IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values. Conclusions: Our results show that an increase in the levels of TNF-alfa,IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn

Effects of the menstrual cycle on injection pain due to rocuronium

WOS: 000325732900009PubMed: 23965205Study Objective: To investigate the effect of the menstrual cycle on rocuronium injection pain. Design: Prospective, randomized, double-blinded study. Setting: Academic medical center. Patients: 80 ASA physical status 1 and 2 women scheduled for elective surgery with general anesthesia. Measurements: Patients were divided into two groups according to their time in the menstrual cycle. Forty patients at days 8 to 12 of the menstrual cycle were considered to be at the follicular phase (Group F), and 40 patients at days 20 to 24 of the menstrual cycle were considered to be at the luteal phase (Group L).Withdrawal movements were recorded. Main Results: Overall frequency of withdrawal movements was significantly higher in Group L than Group F (P < 0.001). The mean withdrawal movement score was 1.77 +/- 0.76 in Group L and 0.52 +/- 0.67 in Group F. Conclusion: Menstrual cycle phases affect the severity of rocuronium injection pain. Women exhibit greater pain sensitivity from rocuronium injection in the luteal phase than the follicular phase. (c) 2013 Elsevier Inc. All rights reserved

Efeito in vitro de dexmedetomidina na agregação plaquetária

JUSTIFICATIVA E OBJETIVOS: Dexmedetomidina é um &#945;2-agonista seletivo. Há 250-300 receptores &#945;2-adrenérgicos na superfície de cada uma das plaquetas humanas e a efedrina induz a agregação das plaquetas por ligação desses receptores. Este estudo foi desenvolvido para estudar a função plaquetária após incubação com concentrações terapêuticas de dexmedetomidina. MÉTODOS: O estudo foi conduzido com 18 homens saudáveis, não fumantes, com idades entre 25 e 35 anos. Porque o intervalo recomendado de concentração terapêutica de dexmedetomidina, obtido por infusão intravenosa, é de 0,4-1,2 ng.mL-1, as soluções de dexmedetomidina foram preparadas em três concentrações diferentes. Os valores calculados da solução de dexmedetomidina e do diluente sem dexmedetomidina (controle) foram adicionados a uma amostra de sangue. Assim, 0; 0,4; 0,8 e 1,2 ng.mL-1 de concentrações plasmáticas de dexmedetomidina foram obtidas. Cada concentração de dexmedetomidina foi incubada com sangue total a 37ºC durante 15 minutos. Em seguida, as amostras de sangue foram centrifugadas para preparar o plasma rico em plaquetas e o plasma pobre em plaquetas. O plasma rico em plaquetas foi diluído com o plasma pobre em plaquetas para gerar o teste de plasma rico em plaquetas com uma contagem final de plaquetas de 250 ± 50 x 10(9).L-1. RESULTADOS: As amplitudes e os declives da agregação plaquetária foram estatisticamente semelhantes entre todos os grupos nos testes de agregação feitos com ADP, colágeno ou adrenalina. CONCLUSÃO:As concentrações terapêuticas de dexmedetomidina não tiveram efeito in vitro nas funções plaquetárias de indivíduos saudáveis

In Vitro Effect of Dexmedetomidine on Platelet Aggregation

Background and objectives: : Dexmedetomidine is a selective α2-agonist. There are 250-300 α2- adrenoceptor on the surface of each human platelet and ephedrine induces platelet aggregation by binding these receptors. This study was designed to study platelet function after incubation with therapeutic concentrations of dexmedetomidine. Methods: The study was carried out on 18 healthy, non-smoking males, ages ranging 25 to 35 years old. Because of the recommended therapeutic concentration range of dexmedetomidine obtained by intravenous infusion is 0.4-1.2 ng.mL-1, dexmedetomidine solutions were prepared in three different concentrations. The calculated value of dexmedetomidine solution and diluent without dexmedetomidine as control were added to the blood sample. Thus, we obtained 0, 0.4, 0.8 and 1.2 ng.mL-1 dexmedetomidine concentrations of plasma. Each concentration of dexmedetomidine was incubated with whole blood at 37 °C during 15 minutes. Then blood samples were centrifugated to prepare platelet-rich plasma and platelet-poor plasma. The platelet-rich plasma was diluted with the platelet-poor plasma to yield test platelet-rich plasma with a final platelet count of 250 ± 50 X 109.L-1. Results: The platelet aggregation amplitudes and slopes were statistically similar among all groups by the aggregation test, which were performed with ADP, collagen or epinephrine. Conclusion: Therapeutic concentrations of dexmedetomidine had no effect on the platelet functions in healthy individuals in vitro. Keywords: Dexmedetomidine, In Vitro, Platelet aggregatio

Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery

BACKGROUND: the aim of this study was to investigate the effects of spinal anesthesia using two different doses of fentanyl combined with low-dose levobupivacaine in anorectal surgery. METHODS: in this prospective, double-blind study, 52 American Society of Anaesthesiologists I-II patients scheduled for elective anorectal surgery were randomized into two groups. The patients in group I received intrathecal 2.5 mg hyperbaric levobupivacaine plus 12.5 µg fentanyl and in group II received intrathecal 2.5 mg hyperbaric levobupivacaine plus 25 µg fentanyl. All the patients remained in the seated position for 5 min after completion of the spinal anesthesia. Sensory block was evaluated with pin-prick test and motor block was evaluated with a modified Bromage scale. RESULTS: motor block was not observed in both of the groups. The sensory block was limited to the S2 level in group I, and S1 level in group II. None of the patients required additional analgesics during the operation. Time to two-segment regression was shorter in group I compared with group II (p < 0.01). One patient in group I and 5 patients in group II had pruritus. Hemodynamic parameters were stable during the operation in both of the groups. CONCLUSION: spinal saddle block using hyperbaric levobupivacaine with both 12.5 µg and 25 µg fentanyl provided good quality of anesthesia without motor block for anorectal surgery in the prone position

Comparison of Effects of Dexmedetomidine-ketamine and Dexmedetomidine-midazolam Combinations in Transurethral Procedures

Batislam, Ertan/0000-0002-7493-4573WOS: 000304720600012PubMed: 22656405OBJECTIVE To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. METHODS Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. RESULTS Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P < .001 and P < .001, respectively), and Aldrete scores were greater in group K than group M. CONCLUSION Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination. UROLOGY 79: 1214-1219, 2012. (c) 2012 Elsevier Inc

Comparıson of the hemodynamıc parameters between preeclamptıc and healthy women undergoıng cesarean delıvery wıth spınal anesthesıa

Amaç: Preeklamptik ve sağlıklı gebelerde spinal bupivakain ve fentanil uygulanarak gerçekleştirilen nöroaksiyel anestezinin hemodinamik parametreler üzerine etkilerini retrospektif olarak karşılaştırmaktır. Metod: Ocak-Aralık 2012 arası, preeklampsi tanısı alan ve sağlıklı ASA I kadınlarda spinal anestezi altında sezaryen operasyonu geçirenlerin dahil edildiği retrospektif randomize bir çalışma planlanmıştır. Hastaların yaşı, vücut ağırlığı, gebelik haftası, operasyon süresi, anestezi süresi, intraoperatif dönemdeki hemodinamik parametreleri ( non invazif kan basıncı, kalp hızı, periferik oksijen satürasyonu), intraoperatif volüm tedavisi (kristaloid, kolloid), efedrin ihtiyacı, neonatal vücut ağırlıkları ve APGAR skorları kaydedilmiştir. Bulgular: Spinal anestezi altında sezaryen operasyonu yapılan, 223 preeklamptik hasta ve 221 sağlıklı gebeden oluşan toplam 444 olgu çalışmaya dahil edilmiştir. Preeklamptik hasta grubunda daha az hipotansiyon gözlenmiştir ve efedrin ihtiyacı daha az olmuştur. Preeklamptik hasta grubunda neonatal vücut ağırlıkları ve APGAR skorları daha düşük olarak bulunmuştur. Sonuç: Preeklamptik hastalarda spinal anestezi esnasında hipotansiyon ve efedrin ihtiyacı daha az olarak bulunmuş ve güvenli bir yöntem olduğu sonucuna varılmıştır.Objective: The aim of this study was to compare the hemodynamic parameters between preeclamptic and healthy women undergoing cesarean delivery with spinal bupivacaine and fentanyl retrospectively. Methods: A retrospective randomised study of women with severe preeclampsia and ASA I healty women requiring cesarean section with spinal anesthesia from January 2012 to December 2012 was carried out. Maternal age, weight, gestational age at delivery, duration of operation, duration of anesthesia, hemodynamic parameters during intraoperative period (non invasive blood pressure, heart rate, peripheral oxygen saturation), intraoperative volume replacement (colloidcrystalloid) , requirement of ephedrine, neonatal body weight and APGAR scores were recorded. Results: Consisting of 223 preeclamptic patients and 221 and healty women, a total of 444 patients were included in the study. The incidence of hypotension and ephedrine treatment were less in preeclamptic women. Neonatal body weight and APGAR scores were lower in the preeclamptic patient group. Conclusion: The incidence of hypotension and requirement of ephedrine were less in preeclamptic patients undergoing cesarean delivery with spinal anesthesia and it was concluded that this method was safe