The influence of N-acetyl-L-cystein infusion on cytokine levels and gastric intramucosal pH during severe sepsis

INTRODUCTION: The purpose of the present study was to evaluate the effects of continuously infused N-acetyl-L-cystein (NAC) on serum cytokine levels and gastric intramucosal pH in humans suffering from severe sepsis. METHODS: Fifty-three patients were included in the study. In the NAC group (n = 27), after an initial intravenous bolus of NAC (150 mg/kg over 5 min), a continuous intravenous infusion of 12.5 mg/kg per hour was given for 6 hours. Patients in the control group (n = 26) were administered dextrose (5% solution) at the same dosage. We recorded the following: haemodynamic parameters, nasopharyngeal temperature, arterial blood gas changes, plasma cytokine levels, biochemical parameters, intramucosal pH, length of stay in the intensive care unit, duration of of mechanical ventilation and mortality. All measurements were taken at baseline (15 min before the start of the study) and were repeated immediately after the bolus infusion, and at 24 and 48 hours after initiation of the continuous NAC infusion. RESULTS: No differences were found between groups in levels of the major cytokines, duration of ventilation and intensive care unit stay, gastric intramucosal pH and arterial oxygen tension/inspired fractional oxygen ratio (P > 0.05). CONCLUSION: We found that NAC infusion at the doses given did not affect cytokine levels, outcomes, or gastric intramucosal pH in patients with severe sepsis. Because of the limited number of patients included in the study and the short period of observation, our findings need confirmation in larger clinical trials of NAC infused in a dose-titrated manner. However, our results do not support the use of NAC in patients with severe sepsis

Horner's syndrome following uncomplicated internal jugular vein catheterization: A case report

Perkütan internal juguler ven kateterizasyonu, santral venöz kateterizasyon uygulamalarında oldukça yaygın kullanılmaktadır. Santral venöz kateterizasyon uygulamaları sırasında nadir bir komplikasyon olarak Horner sendromu gelişebilir. Bu yazıda sağ internal juguler ven kateterizasyonundan bir gün sonra miyozis, pitozis ve anizokorinin eşlik ettiği Horner sendromu gelişen 47 yaşında kadın hasta sunuldu. Bir hafta sonra, hastanın klinik bulguları düzeldi.Percutaneous cannulation of the internal jugular vein is widely used for central venous cannulations. Horner's syndrome may develop as a rare complication of internal jugular vein cannulation. We presented a 47-year-old female patient who developed Horner's syndrome one day after uncomplicated internal jugular venous cannulation, which was accompanied by miosis, ptosis, and anisocoria. The symptoms improved within a week

The effects of total intravenous anesthesia and inhalational anesthesia on intra-abdominal pressure in the supine prone positions

Amaç: Sırtüstü ve yüzüstü pozisyonları verilerek ameliyat edilen olgularda, total intravenöz anestezi ve inhalasyonda sevofluran anestezisinin intraabdominal basınç, kardiyovasküler ve solunum sistemlerine etkileri karşılaştırıldı. Çalışma Planı: Çalışmaya, lomber diskektomi ameliyatı geçirecek ASA I-II 30 olgu (17 erkek, 13 kadın; ort. yaş 50; dağılım 35-70) total intravenöz anestezi (grup I, n=15) ve sevofluran anestezisi (grup II, n=15) uygulanmak üzere rastgele iki gruba ayrıldı. Grup I’de, intravenöz olarak uygulanan alfentanil ve propofol ile sağlanan indüksiyondan sonra entübasyon atrakuryum ile gerçekleştirildi. Anestezinin idamesinde ise alfentanil ve 10 dakikalık sürelerle azalan dozlarda propofol infüzyon şeklinde kullanıldı. Grup II’de, intravenöz propofol ile sağlanan indüksiyondan sonra atrakuryum ile entübasyon gerçekleştirildi. Anestezi sürekliliği sevofluran ile sağlandı. Olguların sırtüstü pozisyonda anestezi indüksiyonundan önce ve hemen sonra; yüzüstü pozisyonuna çevrildikten hemen sonra, ameliyat boyunca her 30 dakikada bir ve sırtüstü pozisyonda ekstübasyondan hemen sonra intraabdominal basınç, arter basıncı, kalp atım hızı, periferik oksijen satürasyonu, endtidal CO2 basıncı ölçülerek kaydedildi. Bulgular: İki grup arasında bütün ölçüm zamanlarında, intraabdominal basınç, hemodinamik ve solunum parametre değerleri arasında anlamlı farklılık bulunmadı. Sonuç: Her iki pozisyonda uygulanan total intravenöz anestezi ve sevofluran anestezisinin, intraabdominal basınç ile hemodinamik ve solunum parametrelerinde değişiklik oluşturmadığı belirlendi.Objectives: We compared the effects of total intravenous anesthesia and inhalational anesthesia with sevoflurane on intra-abdominal pressure and cardiovascular and respiratory systems in patients undergoing surgery in the supine and prone positions. Study Design: Thirty ASA I-II patients (17 males, 13 females; mean age 50 years; range 35 to 70 years) undergoing elective lumbar discectomy were randomly assigned to total intravenous anesthesia (group I, n=15) and inhalational anesthesia with sevoflurane (group II, n=15). In group I, after anesthesia induction with intravenous alfentanil and propofol, entubation was performed with atracurium. Anesthesia was maintained with alfentanil and decreasing doses of propofol. In group II, induction was obtained with intravenous propofol, entubation with atracurium, and maintenance with sevoflurane. Intra-abdominal pressure, arterial pressures, heart rate, peripheral oxygen saturation, and endtidal CO2 were monitored and recorded in the supine position before and after anesthesia induction, immediately after turning to the prone position, every 30 minutes throughout the operation, and immediately after extubation in the supine position. Results: At all times of monitoring, no significant differences were found between the two groups with respect to intraabdominal pressure, hemodynamic and respiratory parameters. Conclusion: Total intravenous anesthesia and sevoflurane anesthesia do not appear to affect intra-abdominal pressure, hemodynamic and respiratory parameters in both positions

Continuous spinal anesthesia application in a patient with high cardiac risk: Case report

Alt ekstremite cerrahisi anestezisinde, genel anesteziden çok rejyonel yöntemler tercih edilmektedir. Özellikle yaşlı ve yüksek kardiyak riskli hastalarda hemodinamik stabiliteyi koruyarak yeterli anestezi sağlanması temel amaçtır. Acil sağ diz üstü amputasyon planlanan 63 yaşındaki kadın hasta, altı gün önce ST yükselmesiz miyokard infarktüsü (Mİ) tanısı konularak tedavi edilmişti. Olgunun 15 yıldır tip 2 diabetes mellitusu, 10 yıldır hipertansiyonu vardı. İki yıl önce iki damar baypas ile mitral annuloplasti ve iki ay önce sağ diz altı amputasyon uygulanmıştı. Sağ lateral pozisyonda, L3-4 intervertebral aralıktan kateter içinden iğne tekniği ile intratekal kateter yerleştirildi. Serbest BOS akışı görüldükten sonra 2.5 mg %0.5'lik bupivakain uygulandı. Yeterli duyusal blok seviyesi sağlanana kadar her beş dakikada bir tekrarlanan 2.5 mg'lık dozlarla toplam 7.5 mg %0.5 bupivakain uygulanarak anestezi sağlandı. Duyusal blok T10 seviyesine ulaştıktan sonra sırtüstü pozisyon verildi. Ameliyat süresince hemodinamik olarak stabil seyreden olguya kateterden ek ilaç uygulanmadı ve bir saatlik ameliyat sonunda spinal kateteri çıkarılarak servise gönderildi. Sonuç olarak, özellikle yaşlı ve kardiyak riski yüksek olgularda alt ekstremite ameliyatları için sürekli spinal anestezi tekniğinin uygun bir anestezi seçeneği olarak kullanılması gerektiğini düşünmekteyizRegional techniques are preferred to general anesthesia in lowerextremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T10 level. The patient was hemodynamically stable during the operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery

Comparison of recovery criteria following anaesthesia with sevoflurane and isoflurane in geriatric patients

Amaç: Bu çalışmada, geriyatrik hastalarda volatil anesteziklerden sevofluran ve isofluranın derlenme kriterleri üzerine etkileri karşılaştırıldı. Çalışma Planı: Elektif ürolojik ve jinekolojik cerrahi girişim planlanan ASA I-II grubundan 65 yaş ve üzeri 40 hasta rastgele eşit sayıda iki gruba ayrıldı. Tüm olguların premedikasyonu intramusküler 0.06 mgkg-1 midazolam, anestezi indüksiyonu intravenöz 1.5 mgkg-1 propofol, 0.6 mgkg-1 atrakuryum besilat ve 500 ?g alfentanil ile gerçekleştirildi. Anestezi idamesi grup I’de 1 MAC isofluran, grup II’de 1 MAC sevofluran ve gerektikçe intravenöz 0.1 mgkg-1 atrakurium ile sürdürüldü. Ameliyat sonunda her iki grupta da derlenme kriterleri olarak belirlenen spontan göz açma, ekstübasyon, sözel yanıt ve oryantasyon süreleri kaydedildi. Bulgular: Sevofluran grubunda, isofluran grubuna göre spontan göz açma (p=0.0002), ekstübasyon (p=0.0002), sözel yanıt (p=0.0001) ve oryantasyon (p=0.0001) süreleri anlamlı derecede kısa bulundu. Sonuç: Geriyatrik olgularda sevofluranın derlenme kriterleri açısından isoflurana göre daha avantajlı olduğu kanısına varıldı.Objectives: The aim of this study was to compare the effects of volatile anesthetics, sevoflurane and isoflurane, on recovery criteria in geriatric patients. Study Design: Forty ASA I-II patients at the age of 65 years or above, who were planned for elective urological or gynecological operation were randomized to two groups equal in number. Each group received 0.06 mgkg-1 intramuscular midazolam for premedication, and intravenous 1.5 mgkg-1 propofol, 0.6 mgkg-1 atracurium besylate, and 500 µg alfentanil for induction. Anesthesia was maintained with approximately 1 MAC isoflurane in group I, and 1 MAC sevoflurane in group II, and, when necessary, intravenous 0.1 mgkg-1 atracurium. Recovery criteria included spontaneous eye opening, extubation, verbal response, and orientation times at the end of operation. Results: Compared to the isoflurane group, durations of spontaneous eye opening (p=0.0002), extubation (p=0.0002), verbal response (p=0.0001), and orientation (p=0.0001) were significantly shorter in the sevoflurane group. Conclusion: We concluded that sevoflurane anesthesia is more advantegous over isoflurane in geriatric patients

Isostasy of the Eastern Anatolia (Turkey) and Discontinuities of its Crust

This paper presents a probable isostatic model of the East Anatolian Region, which lies in a belt of significant plate movements. Probable locations of the horizontal and vertical discontinuities in the crust structure were determined using the normalized full gradient (NFG) method. For the purpose of explaining the mechanism that supports topography corresponding to the crust thickness in the region, calculations of effective elastic thickness (T(e)) were carried out initially by utilizing admittance and misfit functions. According to these results, the effective elastic thickness value obtained was less than the crust thickness, even though the isostatic model does not conform with the Airy model. Consequently, it was assumed that there could be problems beneath the crust. Hence, the NFG method was applied on the Bouguer gravity data of the region in order to investigate probable discontinuities in the crust structure. According to the NFG results, vertical structural transitions were observed at a depth ranging between 10 and 30 km, which begin immediately north of the Bitlis Zagros Suture Zone (BZSZ) and continue in a northerly direction. The relationship between the effective elastic thickness (T(e); 13 km in average as determined in the last stage), and the seismogenic zone in the region was investigated. If the T(e) value happens to be less then the crustal thickness, then one can say that there are problems in the crustal structure of the region similar to Eastern Anatolia. Indeed, when NFG results of the study area are examined, numerous vertical and horizontal discontinuities in the crust can be observed. These discontinuities, which correspond to low Bouguer gravity anomalies and shallow focal depth-earthquakes, are probably the source of the factors which rule the tectonic mechanism of the region

MAGNETIC STUDIES AROUND THE BITLIS ZAGROS SUTURE ZONE (TURKEY)

The tectonics of the Turkey is dominated by the collision between the Arabian and Eurasian plates. In this collision, the Bitlis Zagros Suture Zone is the most prominent tectonic structure. There exist metamorphics of the accretionary prism. Tectonic forces of the study area can be effective on thermal structure and mantle flow