Anesthesia management for ALS and WPW

WOS: 000435650500021Epidural anesthesia can provide anesthesia and analgesia for unilateral or bilateral lower extremity surgery and is associated with a low complication rate. We present our epidural anaesthetic management of a patient with both Amyotrophic lateral sclerosis (ALS) and Wolff-Parkinson-White (WPW) syndrome after intertrochanteric femur fracture surgery. It should be kept in mind that the choice of correct anaesthetic method in such patients with complicated neurological, pulmonary, and cardiac symptoms will significantly reduce postoperative mortality and morbidity

Polietilen glikol hidrojel dural bariyer nörotoksisitesinin değerlendirilmesi

AIm: Although polyethylene glycol (PEG) is a neutral, biocompatible hydrophilic polymer recognized for its lack of interaction with biological barrier, its neurotoxicity has not been clearly identified in neurosurgery. This study is constructed to evaluate the possible neurotoxicity of a PEG hydrogel dural sealant. Ma terIal and Methods: After a burrhole was opened in the left parietal bone of the twenty five Wistar albino rats, the dura mater and cerebral cortex were incised and the experimental material (activated polyethylene glycol and polyethylene imine) was sprayed into the burrhole. Then brain tissues were harvested for histopathological and biochemical studies at 72 hours to investigate the acute stage changes and on 15th day to evaluate the chronic stage changes. Results: There were statistically significant differences among the groups regarding the comparison of the values of the PMNL cell infiltration grades, gliosis and congestion in both acute and chronic stages. However, the values of the MNL cell infiltration grades, edema and fibrin formation, lipid peroxidation levels of harvested brain tissues were similar in all groups. ConclusIon: Although this study did not present the detailed histopathological and biochemical evaluation results, it indicated that the application of the PEG-based hydrogel sealant was not associated with neurotoxicity, delayed healing, or degenerative changes

Düşük doz metotreksatın ratlarda serebral iskemi reperfüzyon üzerine olan etkileri

Background: During cerebral ischemia reperfusion injury, oxidative stress leads to excitotoxicity, blood brain barrier dysfunction and inflammation. This study was designed to evaluate possible protective effects of low dose methotrexate on cerebral transient ischemia reperfusion injury in rat. Methods: Except CONTROL group, temporary aneurysm clips were performed to both common carotid arteries of rats for duration of 30 minutes. Four hours later, except CONTROL and SHAM groups, methotrexate (1.25 mg/kg/day) was administered intraperitoneally. Seventy two hours later, animals of CONTROL, MTX-A and SHAM-A group; and ten days later animals of MTX-C and SHAM-C group were sacrificed and hippocampal pyknotic neuronal cell count results and tissue lipid peroxidation (LPO) values were analyzed statistically. Results: Pyknotic cell count values of CONTROL group were lower than SHAM-A, SHAMC, MTX-A and MTX-C group values. Cell count values of SHAM-A and MTX-A group were higher than SHAM-C and MTX-C values, respectively. LPO values of CONTROL group were lower than SHAM-A and MTX-A values, but not different from MTX-C and SHAM-C values. LPO values of MTX-A group higher than MTX-C group values. Conclusion: Cell count values and LPO values demonstrated that low dose methotrexate could not prevent neuronal cells from destructive effects of transient ischemia reperfusion injury in rat.Amaç: Serebral iskemi reperfüzyon yaralanmalarında oluşan oksidatif stress eksitotoksisiteye, kan-beyin bariyerinde bozulmaya ve inflamasyon süreçlerinin oluşmasına neden olur. Bu çalışmada ratlarda oluşturulan hipoksi reperfüzyon yaralanmasında düşük doz metotreksatın olası koruyucu etkileri araştırılmıştır. Yöntem ve Gereç: Serebral iskemi reperfüzyon yaralanması oluşturmak amacıyla KONTROL grubu haricindeki tüm deney hayvanlarının (N=30) iki taraflı karotis arterlerine 30 dakika süreyle geçici anevrizma klibi konulmuştur. Yaralanmadan 4 saat sonra KONTROL ve SHAM grubu haricindeki hayvanlara intraperitoneal düşük doz metotreksat (1.25 mg/kg/gün) verilmiştir. Takiben 72 saatin sonunda KONTROL (N=6), MTX-A (N=8) ve SHAM-A (N=6) grubundaki hayvanlara ve 10 günün sonunda MTX-C (N=8) ve SHAM-C (N=8) grubundaki hayvanlara ötenazi uygulanıp beyin dokuları çıkarılmış; hipokampustaki dejenere (piknotik) nöron hücre sayıları ve dokulardaki lipid peroksidasyon (LPO) düzeyleri istatistiksel analize tabi tulmuştur. Bulgular: KONTROL grubunun piknotik nöron sayılarının SHAM-A, SHAM-C, MTX-A ve MTX-C gruplarınınkinden düşük olduğu saptanmıştır. Öte yandan SHAM-A ve MTX-A grubuna ait sayım değerlerinin sırası ile SHAM-C ve MTX-C gruplarının değerlerine göre belirgin yüksek olduğu tespit edilmiştir. KONTROL grubunun LPO düzeylerinin SHAM-A and MTX-A gruplarından düşük ancak MTX-C ve SHAM-C gruplarının düzeyleri ile aynı olduğu bulunmuştur. Ayrıca, MTX-A grubunun LPO değerlerinin MTX-C grubuna göre daha yüksek olduğu da görülmüştür. Sonuç: Araştırmanın sonunda, düşük doz metotreksat tedavisinin ratların nöronal hücelerini serebral iskemi reperfüzyon yaralanmasının yıkıcı etkilerinden koruyamadığı gözlenmiştir

Segmental epidural anesthesia for percutaneous kyphoplasty: comparison with general anesthesia

WOS: 000393331000032PubMed: 28081331Background/aim: This is a feasibility study evaluating whether segmental epidural anesthesia is an alternative anesthetic approach to general anesthesia for percutaneous kyphoplasty. Materials and methods: After ethics committee approval was obtained, 52 ASA class I-III patients scheduled for elective, single-level percutaneous kyphoplasty were recruited. The patients were divided into two equal groups. In Group E (Group Epidural) segmental epidural anesthesia was performed using the loss of resistance technique with saline. In Group G (Group Control) general anesthesia was performed. Hemodynamic parameters, intraoperative and postoperative analgesic requirements, visual analogue scale (VAS) scores, length of stay in the postanesthesia care unit (PACU), and complications were recorded. Results: Hemodynamics were similar between the two groups. Postoperative analgesic requirement was significantly higher in Group G than in Group E (P < 0.004). VAS scores were significantly lower in Group E than in Group G (P < 0.05). Time to first pain experience at the first postoperative 4 h was significantly longer and length of stay in the PACU was significantly shorter in Group E than in Group G (P < 0.001). Conclusion: Segmental epidural anesthesia is a safe anesthetic technique for percutaneous kyphoplasty. This technique offered advantages over general anesthesia in terms of postoperative analgesia, analgesic consumption, early recovery, and short PACU stay. Therefore, it should be considered a suitable anesthetic technique in patients undergoing single level percutaneous kyphoplasty

Effect of rapid ventricular pacing on cerebral oxygenation in transcatheter aortic valve implantation (Tavi): Role of routine near-infrared spectroscopy monitoring

Objective: Transcatheter aortic valve implantation has become an important treatment modality in patients with high risk comorbidities for surgical aortic valve replacement. The objective of this study is to evaluate the cerebral perfusion status using near infrared spectroscopy method especially during the rapid ventricular pacing phase of the transcatheter aortic valve implantation procedure. Methods: 20 consecutive patients undergoing trans-femoral aortic valve implantation procedure between May 2015 and March 2016 in our institute were retrospectively evaluated. The periprocedural cerebral oxygenation was measured with a near infrared spectroscopy sensor (INVOSTM-5100 C, Medtronic Inc., Minneapolis, MI, USA) located on the forehead of the patients. All hemodynamic data and cerebral near infrared spectroscopy values were recorded before, during and after the procedure with constant time intervals, especially at the time of rapid ventricular pacing and device deployment. Results: The mean age was 74.4 ± 9.2 years. Male female ratio was 1.8 to 1 (13 males, 7 females). Mean procedure time was 70.2 ± 14.3 minutes. The rapid ventricular pacing included two episodes with a total time for pacing of 22.6 ± 5.1 seconds. There was a statistically significant difference with regard to the heart rate and the cerebral near infrared spectroscopy values (p=0.006 and p=0.02; respectively) in all patients during the rapid ventricular pacing period. The cerebral near infrared spectroscopy values were statistically lower than baseline levels (p<0.001). Conclusion: This observational study presents the significant decrease of cerebral near infrared spectroscopy values during the rapid ventricular pacing phase of the transcatheter aortic valve implantation procedure. Further studies may reveal cut-off values both for near infrared spectroscopy values and rapid ventricular pacing duration in order to determine a critical cut-off level

A randomized, placebo-controlled, double-blind study that evaluates efficacy of intravenous ibuprofen and acetaminophen for postoperative pain treatment following laparoscopic cholecystectomy surgery

Background: Ibuprofen is a NSAID that has anti-inflammatory, antipyretic, and analgesic effects. The oral form of the drug has been used safely for a long time and is one of the most preferred NSAIDs. It has been shown that ibuprofen is effective in the treatment of postoperative pain; however, there have not been sufficient studies on ibuprofen. We evaluated and compared the influence of IV forms of ibuprofen and acetaminophen on pain management and opioid consumption on patients undergoing laparoscopic cholecystectomy surgery. Methods: Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen; group A (group acetaminophen, n = 30) was administered 1000 mg of IV acetaminophen; and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively. Results: Pain scores in group I and group A at all time periods were lower than those in group C (p < 0.05). Group I had significantly lower VAS scores than those in group A at all time periods postoperatively (p < 0.05). Those in group C had significantly higher opioid consumption than the other groups (p < 0.05). Opioid consumption in group I at all time periods postoperatively was significantly lower than those in group A (p < 0.05). Group I had statistically lower rescue medication than the other groups at all time periods. Conclusion: Our study suggested that IV ibuprofen resulted in lower pain scores and reduced opioid use compared with acetaminophen postoperatively in the first 24 h in patients undergoing laparoscopic cholecystectomy surgery

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter

84th IEEE Vehicular Technology Conference, VTC Fall 2016 -- 18 September 2016 through 21 September 2016 -- 126901BACKGROUND: Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver. OBJECTIVE: Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique. DESIGN: Prospective clinical study. SETTING: University hospital. SUBJECTS AND METHODS: Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated. MAIN OUTCOME MEASURE(S): Hemodynamic measurements and RIJV dimensions. RESULTS: In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P<.001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and <.001 for cross-sectional area and diameter, respectively). CONCLUSION: Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position. LIMITATIONS: No catheterization and study limited to healthy volunteers

The effects of dexmedetomidine on renal injury induced by intra-abdominal hypertension in rats

Introduction: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are potentially life-threatening conditions in critically ill patients. Laparascopic surgery is the gold standard and has been widely performed for many procedures since its inception in the early 1980s. Pneumoperitoneum is essential for laparascopic surgery. Dexmedetomidine is a potent and highly selective ?-2 adrenoceptor agonist with sympatholytic, sedative, amnestic and analgesic properties without respiratory depression. There is increasing evidence of its organ protective effects against ischemic and hypoxic injury, including neuroprotection, cardioprotection and renoprotection. The aim of this experimental study was to investigate the effects of the ?-2 adrenoceptor agonist, dexmedetomidine on IAH induced by renal injury. Materials and methods: A total of 24 male Wistar-albino rats were randomly separated into 4 groups as the control group (CG, n=6), sham group (SG, n=6), low-dose group (DXLD, n=6) and high-dose group (DXHD, n=6). In CG, no intervention was made. IAH was obtained by insufflating atmospheric air with percutaneous intraperitoneal needle using a manual insufflator of manometer up to 15 mmHg. At the 60th min, in SG, 1.5 ml/100 gr/hr saline was infused. In DXLD, 0.5 µg/kg/hr, and in DXHD, 1 µg/kg/hr dexmedetomidine (Precedex, 100 µg/ml; Abbott, Istanbul, Turkey) was infused intravenously. At the 90th min, a midline incision was made and the left kidney was harvested by median laparatomy for the measurement of tissue nitric oxide (NO), malondialdehyde (MDA) level and histopathological examination for proximal tubule injury by light microscopy. Results: No significant difference was determined between the groups either biochemically or histopathologically (p>0.05). Conclusion: Dexmedetomidine may not provide renoprotective effects within the clinical infusion doses of 0.5 µg/kg/hr, and 1 µg/kg/hr

Perioperative anesthesia-related complications

WOS: 000209832000720

Sıçanlarda İskemiy le İndüklenen Bey in Hasarı Üzerine İntravenöz ve İntrasisternal Deksmedetomidinin Etkileri: Karşılaştırmalı Bir Çalışma

AMAÇ: Sıçanlarda inkomplet serebral iskemisi üzerine intrasisternal yolla verilen deksmedetomidinin etkilerinin intravenöz yolla verilen deksmedetomidinin etkileriyle karşılaştırılması amaçlandı. YÖNTEM ve GEREÇLER: Ortak sağ karotid arter oklüzyonu ve hemoraj ik hipotansiyon ile 30 dakika süreyle serebral iskemi oluşturuldu. İntrasisternal gruplarda, iskemiden 30 dakika önce sisterna magna içine 0,1 ml % 0.9 NaCl (Grup SIC, n6) veya 9 µg/kg deksmedetomidin (Grup DIC, n6) verildi.İntravenöz gruplarda ise 9 µg/kg deksmedetomidin (Grup DIV, n6) veya % 0,9 NaCl (Grup CONTROL, n6) 5 ml/kg/h hızla 2 saat süreyle infüze edildi. Yirmi dört saat sonra beyin dokusunda ve plazmada lipid peroksidasyon seviyeleri ölçüldü. Histopatoloj ik incelemeler için hipokampal yapı kullanıldı. BULGULAR: İntravenöz deksmedetomidin ortalama arteriyel basınç ve plazma glukoz seviyelerinde bazale göre bir düşüşe neden oldu. Grup DIV ile Grup DIC, Grup SIC ve CONTROL grupları arasında beyin dokusu lipid peroksidasyon seviyeleri ve piknotik hücre sayıları bakımından anlamlı farklılık vardı (sırasıyla; p0,001, p0,001, p0,001 ve p0,001, p0,01, p0,009). Grup DIV için ortalama plazma lipid peroksidasyon seviyeleri Grup DICınkinden farklı bulundu (p0,003). SONUÇ: İskeminin indüklediği nöronal hasarda sistemik yolla verilen deksmedetomidinin nöroprotektif etkisi varken santral yolla verilen deksmedetomidinin nöroprotektif etkisi yoktur.AIM: To compare the effect of dexmedetomidine administered by intracisternal route with by intravenous route on brain tissue of rat after incomplete cerebral ischemia. MATERIAL and METHODS: Cerebral ischemia was produced by the combination of right common carotid artery occlusion and hemorrhagic hypotension during 30 minutes. Thirty minutes before the ischemia, 0.1 ml 0.9% NaCl (Group SIC, n6) or 9 µg/kg dexmedetomidine (Group DIC, n6) was administered into the cisterna magna. For the intravenous groups, 9 µg/kg dexmedetomidine (Group DIV, n6) or 0.9% NaCl (Group CONTROL, n6) 5 ml/kg/h was given in 2 hours. After 24 hours, the lipid peroxidation levels were measured in the brain tissue and plasma. Hippocampal formations were used for histopathological examination. results: Intravenous dexmedetomidine produced a decrease in baseline mean arterial blood pressure and plasma glucose concentrations. There was a significant difference between the DIV group and DIC, SIC, CONTROL groups regarding the brain lipid peroxidation levels (p<0.001, p<0.001, p0.001, respectively), and regarding the picnotic neuronal cell count (p<0.001, p0.01, p0.009, respectively). Mean plasma lipid peroxidation levels of the DIV group was different from the DIC group (p0.003). CONCLUSION: Systemically administered dexmedetomidine had neuroprotective effect in ischemia-induced neuronal damage, but centrally administered dexmedetomidine did not