Cardioprotective effect of intravenous lipid emulsion in bupivacaine- induced experimental cardiac toxicity

The intravenous lipid emulsion (ILE) therapy is known to alleviate clinical symptoms in cases of bupivacaine-induced cardiac toxicity. However, there is insufficient information regarding histopathological damage. This study aimed to investigate whether the use of ILE therapy in rats with experimentally induced bupivacaine-related cardiac toxicity can ameliorate histopathological damage. 28 Wistar albino rats were divided into four groups: control (A), lipid (B), bupivacaine (C), and bupivacaine + lipid (D). After providing monitoring in all groups, group B received 1.5 mL ILE + 0.25 μg/kg/min ILE infusion, group C received 3 μg/kg/min bupivacaine infusion, and group D received 3 μg/kg/min bupivacaine infusion followed by 1.5 mL ILE + 0.25 μg/kg/min ILE infusion after observing cardiac toxicity. Heart rate and respiratory rate were recorded. Blood samples were collected post-procedure to measure LDH, CK-MB, and troponin levels. Cardiac tissue samples were obtained for histopathological examination. There was no significant difference in baseline heart rate and respiratory rate among the groups (P>0.05). However, in the second measurements, heart rate and respiratory rate were higher in group D compared to group C (P<0.05). LDH and CK-MB levels were higher in group C compared to the other groups (P<0.05). Irisin and asprosin scores were higher in group D compared to the other groups (P<0.05). ILE was found to have a cardioprotective effect in the treatment of bupivacaine-induced cardiac toxicity, as it improved both clinical and laboratory parameters. However, histologically, cardiac damage persisted

Investigation of infraclavicular block success using the perfusion index: A randomized clinical trial

The results of the pinprick and cold tests performed on the arm, forearm, and wrist-wrist areas of patients scheduled for upper extremity procedures are subjective and dependent on patient's compliance. The purpose of this study was to determine whether the perfusion index (PI) could be used as an objective indicator to demonstrate block efficacy. Fifty patients between the ages of 18 and 65 years who were scheduled for upper extremity procedures and had an American Society of Anesthesiologists risk assessment class of I-II were included in this study. Infraclavicular block was performed on the patients using the peripheral nerve stimulation and ultrasonography. Preoperative and postoperative PI values were measured and recorded. The pinprick test took an average of 7.98 ± 1.49 minutes to turn positive, whereas the grade 3 of Modified Bromage Scale took an average of 11.08 ± 1.71 minutes. Differences between baseline values and perioperative values were found to be significantly different in the paired comparisons of the PI values. With 80% sensitivity and 80% specificity, increases in the PI value by or above 3.8 units were indicative for sensory block. With 84% sensitivity and 84% specificity, increases in the PI value by or above 3.9 units were indicative for grade 3 of Modified Bromage Scale in patients. It was determined that the PI is a faster, more reliable, and simpler technique than conventional methods for determining the efficacy of a block because of the vasodilatation that occurs before sensory and motor block

Perfusion index (PI) measured in the brachial plexus blocks performed by ultrasonography: investigation of correlation with block success

Abstract Background Brachial plexus block is one of the peripheral nerve blocks commonly used in regional anesthesia. We aimed to investigate whether the perfusion index (PI) measurement can be used to evaluate the adequacy of the upper limb blocks accompanied by ultrasonography. Thirty-three patients between the ages of 18 and 65 who were in the ASA I–II group who will have a hand, forearm, and arm operation were included in the study. An appropriate type of brachial plexus block was applied to these patients under the guidance of ultrasonography. After the block application was completed, the sensory and motor blocks were evaluated at the 5th, 10th, and 20th min. In addition, perfusion indices measured from both extremities of the patient were recorded at the 5th, 10th, and 20th min. Results In 32 of 33 patients who underwent brachial plexus block, our block was successful, and perfusion index measurements in the applied limb increased continuously from the 5th min over the 20-min observation period. In one patient who failed the block and in the arm group without block, no statistically significant difference was detected in the 5th, 10th, and 20th min perfusion index measurements. Conclusions Perfusion index measurement is a very valuable and usable method to evaluate the success of peripheral nerve blocks early, easily, and objectively

Where are We on Organ Donation?

Objective: It was aimed to present the acceptance rate of organ donation of cases that were diagnosed with brain death and evaluated in terms of their demographic and clinical properties retrospectively in Adıyaman University Training and Research Hospital. Material and Method: In the intensive care unit of our hospital, cases that were diagnosed with brain death between the dates of January 2008 and December 2014 were retrospectively analyzed. Cases were evaluated in terms of age, sex, cause of brain death, blood groups, donation status, reasons for acceptance or rejection of donation, cardiac arrest, vasopressin treatment, laboratory test results, arterial blood gas values before and after the apnea test, intensive care unit follow-up durations, apnea test, seasonal and annual distribution. Also, potential donors and recipients were analyzed in accordance with their demographic characteristics. Results: The diagnosis of brain death was made in totally 57 cases; of those, 34 (59.6%) were men and 23 (40.4%) were women. The most common causes for brain death were traumatic subarachnoid hemorrhage (SAH) and intracerebral hematoma. Most of the cases had A Rh+ blood type (n=18, 31.5%) and the rate of brain death was 4.7 times higher in Rh (+) patients in comparison to Rh (-) patients. The rate of incidence of cardiac arrest was 12.3% (n=7), and it was more common in traumatic SAH patients. The rate of receiving vasopressor therapy was 21.1% (n=12), and the mean duration of therapy was 1.3±0.8 days. It was more commonly used in traumatic SAH patients (n=10). The follow-up period was 2.7±3.2 (minimum: 1, maximum: 17) days. Five patients were considered to be organ donors. The most common reason for acceptance of donation was the effect of organ transplantation coordinator during family interviews (n=3, 60%). In total, 4 livers, 5 kidneys and 1 heart transplantation operations were performed to 10 patients. Conclusion: Due to problems in organ donation, patients that might be potential organ donors must be transferred to intensive care unit and taken under critical patient care since then, and brain death should be considered in patients with Glasgow coma scale <7. The raising the awareness and training of the staff in intensive care units about the recognition of brain death and donor care are also important. Also, the interview with the families must be performed by an experienced coordinator to increase the rate of acceptance of donation and raise the awareness of the community regarding the organ donation

The effects of intravenous aminoacid infusion on myocardial functions and postoperative analgesia during abdominal aortic surgery

Objective: Effects of intravenous aminoacid infusion onmyocardial functions and postoperative analgesia in abdominalaortic surgery were investigated.Materials and methods: Forty patients were randomlydivided into groups of general anaesthesia with or withoutaminoacid infusion (Group 1 and 2, n=10), combinedgeneral+epidural with or without amino acid infusion (Group3 and 4, n=10). Cardiac risk was evaluated using 2007 AHA/ACC and modified Goldman classifications. Intravenousaminoacid solution of 80 g/L was infused at 2.5 ml/kg/h for atotal of 8 hours. General anaesthesia included intravenousremifentanil, rocuronium, sevoflurane. The lumbar epiduralinclude; 10 mL of 0.25% bupivacaine; bolus dose, an infusionof 0.25% bupivacaine; 4 ml/h for 24 hours. Heart rate,arterial blood pressures were collected intraoperative every10 minute, 1, 24 hour postoperatively. Plasma creatinekinase MB fraction, troponin levels, pain assessment withnumeric analog scale were collected preoperatively, 1, 24hour postoperatively. Postoperative 24 hour analgesic usage,complications were recorded.Results: Patients with mild and severe cardiac risk werehigher in 2007 AHA/ACC classification (26/40, 65%) thanmodified Goldman risk classification (5/40, 12.5%) (p=0.04).In comparison between groups, myocardial enzyme levelsand complications showed no difference (p>0.05). The useof analgesics were lower in group 3 and 4 in comparison togroup 1 and 2 (p=0.002).Conclusion: During abdominal aortic surgery, intravenousinfusion of amino acid did not show significant changes onintraoperative and postoperative hemodynamic parametersand myocardial enzymes. The patients received combinedgeneral plus epidural anaesthesia showed more successfulpostoperative analgesia.Key words: Amino acid, abdominal aorta, vascular surgery,epidural anesthesia, general anesthesia, keratin kinase,troponin, postoperative analgesi

Characteristics of poisoning cases in Adiyaman city

Objective: Aim of this study was to retrospectively evaluate poisoning cases in an intensive care unit (ICU) in order to determine the profile of poisoning cases, update epidemiological data in Adiyaman, and contribute to data about poisoning in our country. Methods: Between 01-01-2012 and 31-12-2013 174 patients (116 males, 58 females) with a mean age of 23.7 years were treated. Demographic characteristics, reasons and ways of poisoning, types of toxic substances, length of their ICU stay and prognosis were evaluated. Results: 2733 patients admitted to the intensive care unit were 174 poisoning cases. Poisoning ways were suicide by drug overdose (n=162, 93.1%), and accidental poisoning (n=12,6.9%).119 patients (66.5%) had single drug intake, thirty-three patients (18.4%) with multiple drug intake, and 16 (8.9%) were poisoned by organic phosphates. The most common drug used for suicide was antidepressants (n=87.5%). 32 patients (18.4%) took analgesics and anti-inflammatory drugs. A total of 152 patients taking the drug, 22 patients were poisoned by other means. The median length of patient stay was 2 days (range 1-20 days). Ninety-nine patients (56.9%) recovered and were discharged.72 patients (41.4%) were admitted to inpatient after intensive care unit. Patients were followed up by asking poisoning suicidal psychiatric consultation.1 patient was followed up for 20 days in intensive care due to alcohol poisoning but was died.2 patients (1.1%) were referred to a center forward. Conclusion: Majority of the patients were females, who took drugs with suicidal intention. Frequent use of antidepressants, which are not subject to control by authorities, to commit suicide was remarkable