A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

Background and Aim: Obstructive sleep apnea (OSA) syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI) is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20) and non-OSA, (Group C, n = 20)] ASA I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane), a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Results: Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. Conclusion: OSA patient′s DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA

Effects of the general anaesthetic agent, propofol, on erythrocyte deformability

Arslan, Mustafa/0000-0003-4882-5063WOS: 000276730200003PubMed: 20437820Objectives: Propofol is an anesthetic agent frequently used for sedation and general anesthesia. The purpose of our study was to investigate the effect of propofol, a general anesthetic, on erythrocyte deformability in rats. Methodology: The study was performed on 20 male and 20 female rats, with 10 rats in each study group and 10 rats in each control group. The rats in the study group were administered propofol (150 mg.kg(-1)) intraperitoneally, and the rats in the control group were administered SF. Erythrocyte packs were prepared using heparinized total blood samples. Deformability measurements were done by erythrocyte suspensions in PBS buffer. A constant flow filtrometer system was used to measure erythrocyte deformability, and the relative resistance was calculated. Results: The use of propofol resulted in the increase in the relative resistance, which is an indicator for the erythrocyte deformability in both male and female rats (p=0.002, p=0.042, respectively). Conclusion: A negative change in the erythrocyte deformability may cause a functional deterioration in blood flow and tissue perfusion (Fig. 1, Ref. 23). Full Text (Free, PDF) www.bmj.sk

Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery A case report with the literature review

Rationale: Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration. Patient concerns: A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil. At the end of the operation, sugammadex was administered and resulted in initially hypotension and bradycardia then the situation worsened by premature ventricular contraction and bigeminy with tachycardia, bronchospasm, and hypoxia. Diagnosis: The Ring and Messmer clinical severity scale grade 3 anaphylactic reaction occurred just after sugammadex injection and the patient developed prolonged hypotension with recurrent cardiac arrhythmias in postoperative 12 hours. Interventions: Treatment was initiated bolus injections of ephedrine, epinephrine, lidocaine, steroids and antihistaminic and continued with lidocaine bolus dosages and norepinephrine infusion for the postoperative period. Outcomes: The general condition of the patient improved to normal 3 hours after the sugammadex injection, and she was moved to the intensive care unit. At 2nd and 8th hours of intensive care unit follow-up, she developed premature ventricular contraction and bigeminy with the heart rate of 130 to 135 beats/min, which returned to sinus rhythm with 50 mg lidocaine. After that, no symptoms were observed and the patient was discharged to plastic surgery clinic at the following day. Lessons: Sugammadex may result in life-treating anaphylactic reaction even in a patient who did not previously expose to drug. Moreover, prolonged cardiovascular collapse and cardiac arrhythmias may occur

Effects of Sevoflurane and Desflurane on Oxidant/Antioxidant Status of Young Versus Old Rat Liver Tissues

Nurlu Ayan, Nilhan/0000-0002-0844-5050WOS: 000260428600002Anesthetic agents modulate on oxidant/antioxidant activity. This study aimed to evaluate the effects of desflurane and sevoflurane anesthesia on the oxidant/antioxidant activity in the liver of young and aged rats. The study involved 60 male Wistar Albino Rats. Rats, which 5-6 months of age deemed as young (Group Y, n = 30) and 10-11 months of age deemed as old (Group O, n = 30). The weight range of the rats was 270-350 g. The groups of rats were randomly divided into 3 groups as the control group [Group Y, (Young Control 100% O-2; n = 10) and Group O-c (Old Control 100% 0,; n = 10)], desflurane group [Group Y-D, (Young Desflurane; 6% Desflurane in 100% O-2; n = 10)] and Group O-2, (Old Desfluranee; 6% Desflurane in 100% O-2; n = 10)] and sevoflurane group [Group Y-S (Young Sevoflurane; 2% Sevoflurane in 100% O-2; n = 10) and Group O-S (Old Sevoflurane; 2% Sevoflurane in 100% 02; n = 10)]. The rats placed into a transparent plastic cage. The rats were exposed to different anesthetic agents or oxygen for 2 h by the use of half open Anesthesia System (AMS, Senior 425), while rats' simultaneous normal breathing was maintained. At the end of the exposure, they were administered a high dose of ketamine and the livers of the animals were sugically removed. SOD, GST and NOS activities were determined and levels of oxidative stress was monitored by measuring TBARS via levels of MDA in the liver. Desflurane induce oxidative stress in both young and old rats, with higher levels in old rats. However, sevoflurane did not cause oxidative stress in young rats. Sevoflurane increased the oxidative stress in the old rats based on SOD and TBARS levels, while it maintained GST activity and decreased NOS activity. However, further studies are needed

The red blood cell deformability alterations under desfluran anesthesia in rats

General anesthesia, either with inhalation or through nonvolatile anesthetics, is known to affect the overall cardiovascular function as well as the microcirculatory hemodynamics. In this study, the effects of desfluran anesthesia on the red blood cell deformability of young and old rats are investigated. 33 male rats were used in the study and the rats were divided into two groups according to their age (young and old) comprising of two subgroups in each. First group was the young control (n=5), the second was the young group treated with desfluran (n=7), the third group was the old control (n=7) and the last group was the old group treated with desfluran (n=7). %6 of desfluran was applied to the rats with inhalation in an adjustable cage for one hour. The elongation indexes of the erythrocytes were measured by a laser diffractometer (Myrenne Rheodyne SSD). Deformability indexes of red blood cells were significantly increased with desfluran in young rats (p=0.042) whereas they were significantly decreased in old rats (p=0.004) with desfluran application compared with their controls. When we compared the young and old control groups, the deformability indexes were significantly higher in old ones (p < 0.001). However, there was no significant difference between the old and the young desfluran applied groups. The volatile anesthetic agent desfluran impairs the deformability of erythrocytes in old rats compared to their controls, whereas it has the opposite effects on young ones. This may be due to the alterations in membrane structure with age. These results reveal that the inhalation of anesthetics like desfluran may cause more serious problems in the elder people during the surgery and may influence their hemodynamic parameters

The influence of sevoflurane anesthesia on the rat red blood cell deformability

Alterations in blood rheology under the influence of anesthesia have been observed and discussed among the responsible factors for the deterioration of tissue and organ perfusion related to anesthetic procedures. Sevoflurane is one of the volatil anesthetics which is being used very common in surgery. In this study, the effects of sevoflurane anesthesia were investigated in different age groups of rats. 22 male rats were used in the study and the rats were divided into two groups according to their age (young and old) comprising of two subgroups in each. First group was the young control (n=5), the second was the young group treated with sevoflurane (n=5), the third group was the old control (n=7) and the last group was the old group treated with sevoflurane (n=5). %2 of sevoflurane was applied to the rats with inhalation in a adjustable cage for one hour. The deformability indexes of the erythrocytes were measured by a laser diffractometer (Myrenne Rheodyne SSD). Deformability indexes of red blood cells were significantly decreased with sevoflurane in old rats (p=0.028) whereas it had not any significant effect in young group compared with their controls. When we compared the young and old control groups, the deformability indexes were significantly higher in old ones (p < 0.001). However, there were not any significant difference between the old and the young sevoflurane applied groups. A volatil anesthetic agent sevoflurane has impaired the deformability of erythrocytes in old rats compared to their controls, whereas it had not any significant effect in young ones which may be due to the flexibility of the young erythrocytes leading them to tolerate to the environmental changes. These results reveal that the inhalation anesthetics like sevoflurane may cause more serious problems in the elder people and their hemodynamic parameters should be checked more seriously during the surgery