Exploring strategies to prevent post-lobectomy space: transient diaphragmatic paralysis using Botulinum Toxin Type A (BTX-A)

OBJECTIVE: Various techniques to reduce air space after pulmonary lobectomy especially for lung cancer have been an important concern in thoracic surgical practice. The aim of this study was to assess the effectiveness of Botulinum toxin A (BTX-A) injection into the diaphragm to reduce air space after right lower pulmonary lobectomy in an animal model. METHODS: Twelve male New Zealand rabbits were randomly allocated into two groups. All animals underwent right lower lobectomy. Then, normal saline of 0,1 ml and 10 units of 0,1 ml Botulinum toxin type A were injected into the muscular part of the right hemidiaphragm in control (n = 6) and BTX-A groups (n = 6) respectively. Residual air space and diaphragmatic elevation were evaluated with chest X-ray pre- and postoperatively. Diaphragmatic elevation was measured as a distance in millimetre from the line connecting the 10th ribs to the midpoint of the right hemidiaphragm. RESULTS: The mean diaphragmatic elevation in BTX-A and control groups were 7.0 ± 2.5 and 1.3 ± 1.2 millimetres respectively. Diaphragmatic elevations were significantly higher in BTX-A group (p = 0.0035). CONCLUSION: Intraoperative Botulinum toxin type A injection may reduce postlobectomy spaces effectively via hemidiaphragmatic paralysis in rabbits. Further studies are needed to validate the safe use of Botulinum toxin type A in human beings

Laparoskopik kolesistektomilerde inhalasyon ve total intravenöz anestezilerinin karşılaştırılması

SUMMARY COMPARISON OF INHALATION AND TOTAL INTRAVENOUS ANESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY In this study inhalation anesthesia (isoflurane) and TIVA (propofol) are compa red in laparoscopic cholecystectomy intra- and postoperatively. 40 ASA I-II-HI patients were aged 23-80 years divided randomly into two equal groups. Inhalation anesthesia group received 1-1.5% isoflurane in a gas mixture of 66% N2O + 33% 02, and the TTVA group received propofol infusion; at the first 15 min 10 mg/ kg/h, at the next 15 min 8 mg/kg/h; then until 10 min before the end of the operation 6 mg/kg/h. Heart rate, arterial pressures and SaÜ2 were measured at the beginning, after induction, intubation, insufflation, positioning, exsufflation, and intraoperatively at 5th, 15th,30th,45th, 60th min, and after return to the horizontal position, at the end of the anesthesia at 5th,15th,30th,45th and 60th min. The level of EtC02 was kept at 30- 40 mmHg with controlled ventilation and cardiac rhythm recorded by ECG. Times to awakening and return of orientation, memory, calculation; postop pain, nausea, vomi ting, analgesic and antiemetic requirements; the postop times to first urination; return of bowel sound; period of hospitalization; the costs of methods were determined. When we evaluated the data there were no statistically significant differrences between two groups in heart rate, arterial pressures (p>0.05). There were arterial pressure fluctuations in inhalation group which had no clinical, but statistical significance. SaÖ2 was statistically significant (p0.01) but not clinically because of 100% 02 ventilation. Postoperative times to awakening, orientation, memory and ability of calculation returned in a shorter time in TIVA group (p0.001). Postop pain and analgesic requirements were less in TTVA group (p0.01). Although it had no statistical significance, nausea and vomiting were seen less in TIVA group (p0.05). Bowel sound and urination returned in a shorter time in TIVA group (p0.05). Both methods of anesthesia were found safe for cardiac rhythm. Period of hospitalization was shorter in TIVA group but there was no statistical significance (p>0.05). The cost of TIVA was found higher of 12.3% than inhalation anesthesia. Although TIVA is more expensive than inhalation anesthesia, because of its stability with respect to haemodynamic changes in pneumoperitoneum; immediate recovery; less pain, nausea and vomiting; times to urinate and return of bowel sound are earlier than inhalation anesthesia; we conclude that TIVA with propofol is superior and preferable in laparoscopic cholecystectomy. 44Laparoskopik kolesistektomide inhalasyon (izofluran) anestezisi ve TİVA (pro- pofol) yöntemlerinin per ve postop karşılaştınldığı bu çalışmada 23-80 yaşlan arasın da, ASA I-II-in sınıflarından 40 hasta aynı indüksiyon uygulamasının ardından rastge- le iki eşit gruba ayrılarak inhalasyon grubuna 6 L %66 N20 + %33 02 karışımı içinde %1-1.5 izofluran, TİVA grubuna da ilk 15 dk'da 10 mg/kg/saat, sonraki 15 dk'da 8 mg/kg/saat, daha sonra ameliyat bitimine 10 dk kalana dek 6 mg/kg/saat hızda propo- fol infüzyonu uygulandı. Kontrol, indüksiyon, entübasyon, insuflasyon ve pozisyon sonrası, perop 5., 15., 30.,45.,60.dk'larda, pozisyon düzeltildikten ve eksuflasyondan sonra, derlenmenin 5., 15.,30.,45.,60.dk'lannda; kalp hızlan, arter basınçları, Sa02'lar kaydedildi, EtC02 öl çülerek solunum ile 30-40 mmHg arasında tutuldu. Kalp ritmi EKG olarak kaydedildi. Postop uyanma, oryantasyon, hafiza ve hesaplama dönüş süresi, ağn, bulantı, kusma, analjezik ve antiemetik gereksinimi, ilk idrar çıkarma ve barsak seslerinin dönüş süre leri, hastanede kalma süresi ve anestezi yöntemlerinin maliyetleri belirlendi. Veriler değerlendirildiğinde per-postop kalp hızlan ve arteriyel basınçlarda grup lar arasında istatistiksel farklılık olmadı (p>0.05). İnhalasyon grubunda arteriyel ba sınçlarda istatistiksel farklılık bulunan (p0.05) ancak klinik önemi olmayan dalgalan malar oldu. Sa02'lann TİVA' da yüksek (p0.01) seyretmesi %100 02 solutulmasına bağlıydı ve klinik önemi yoktu. Postop uyanma, oryantasyon, hafiza ve hesaplamanın dönüş zamanlan TİVA' da daha kısa sürede (p0.001) gerçekleşti. Postop ağn ve analjezik gereksinimi (p0.01) TİVA' da daha az oldu. Bulanti, kusma, TİVA'da daha az oldu ancak istatistiksel farklılık yoktu (p>0.05). Postop idrar çıkarma ve barsak ses lerinin dönüşü TİVA'da daha kısa sürede (p0.05) oldu. Kalp ritmi yönünden her iki anestezi yönteminin de güvenli olduğu anlaşıldı. 'Hastanede kalma süresi TİVA'da daha kısa oldu ancak istatistiksel farklılık saptanmadı (p>0.05). TİVA'nın (propofol) maliyeti inhalasyon (izofluran) anestezisinden %12.3 daha pahalı olduğu belirlendi. Propofol ile yapılan TİVA'nin, izofluran anestezisine göre az oranda pahalı olsa da pnömoperitoneuma bağlı hemodinamik değişikliklerde daha stabil olması, postop derlenmenin çabuk olması, ağn, bulantı ve kusmanın daha az görülmesi, idrar çıkımı ve barsak sesleri dönüşünün erken olması nedenleriyle laparoskopik kolesistektomi için üstün olduğu ve tercih edilebileceği kanısına varidi. 4

Effects of intravenous lidocaine or topical lidocaine applied before upper gastrointestinal endoscopy on hemodynamics and throat pain

Aim: Upper gastrointestinal endoscopy is commonly performed as an outpatient procedure, which may lead to overlooking potential arrhythmias. In this study, we aimed to investigate the effects of intravenous or topical lidocaine on hemodynamics, QT interval and throat pain in patients scheduled for upper gastrointestinal endoscopy. Material and Methods: The patients were randomly divided into three groups: Group I received 1 mg/kg IV(intravenous) propofol induction, Group II received 1 mg/kg IV propofol induction and topical lidocaine (9 sprays, 3 sprays at 10-second intervals, totaling 90 mg), and Group III received 1 mg/kg IV propofol induction and 1.5 mg/kg IV lidocaine induction. ECGs(Electrocardiogram) were obtained before and after the procedure, and hemodynamic data were recorded. Throat pain in patients was assessed after the procedure. Results: There was a statistically significant difference in systolic blood pressure (SBP) values at the 3rd minute among the three groups (p=0.021). The SBP values at the 3rd and 5th minutes in Group I were significantly lower compared to Groups II and III (p=0.021, p=0.012 retrospectively). There was a statistically significant difference in diastolic blood pressure (DBP) values among the three measurements in Group I (p=0.0001). The DBP values at 1 minute in Group I were significantly higher compared to the values at the 3rd and 5th minutes. Additionally, there was a statistically significant difference in postoperative QTc values among the groups (p=0.001). Discussion: We concluded that 1.5 mg/kg IV lidocaine effectively suppressed the hemodynamic response secondary to adrenergic activation during upper gastrointestinal endoscopy and also suppressed the increase in QT and QTc values

Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging

Background: We aimed to investigate effects of low dose ketamine before induction on propofol anesthesia for children undergoing magnetic resonance imaging (MRI). Methods: Forty-three children aged 9 days to 7 years, undergoing elective MRI were randomly assigned to receive intravenously either a 2.5 mg·kg-1 bolus of propofol followed by an infusion of 100 µg·kg-1·min-1 or a 1.5 mg·kg -1 bolus of propofol immediately after a 0.5 mg·kg -1 bolus of ketamine followed by an infusion of 75 µg·kg-1·min-1. If a child moved during the imaging sequence, a 0.5-1 mg·kg-1 bolus of propofol was given. Systolic and diastolic blood pressures, heart rate, peripheral oxygen saturation and respiratory rates were monitored. Apnea, the requirement for airway opening maneuvers, secretions, nausea, vomiting and movement during the imaging sequence were noted. Recovery times were also recorded. Results: Systolic blood pressure and heart rate decreased significantly in the propofol group, while blood pressure did not change and heart rate decreased less in the propofol-ketamine group. Apnea associated with desaturation was observed in three patients of the propofol group. The two groups were similar with respect to requirements for airway opening maneuvers, secretions, nausea-vomiting, movement during the imaging sequence and recovery time. Conclusions: Intravenous administration of low dose ketamine before induction and maintenance with propofol preserves hemodynamic stability without changing the duration and the quality of recovery compared with propofol alone

Side effects and clinical course of omalizumab in patients with severe persistent asthma

Abstract Not Availabl

Fast Hugs with Intensive Care Unit

Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control) was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist) for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics

A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: A randomized controlled trial

Background. The aim of this study was to compare spinal anesthesia effects of low-dose hyperbaric levobupivacaine and low-dose hyperbaric bupivacaine for transurethral procedures. Methods. In this double-blind, randomized, controlled study, a total of 60 patients who were ASA I-III were randomized into two groups. Group B received 7.5 mg hyperbaric bupivacaine plus 25 µg fentanyl, and Group L received 7.5 mg hyperbaric levobupivacaine plus 25 µg fentanyl intrathecally. The onset time to T10 dermatome, times to maximum sensory and motor block levels, time to two-segment regression of sensory block, time to Bromage score zero, time to full recovery of sensory block, and hemodynamic values, as well as adverse effects, were recorded. The primary outcome was the time to complete regression of motor block. Results. The onset time of block to T10, time to maximum sensory block, and time to two-segment regression were similar in both groups. The time to maximum motor block was shorter in Group B (7 ± 3 min) than in Group L (12±5 min), (P0.001). The time to a Bromage score of zero (recovery of motor block) was shorter in Group L (105±19 min) than in Group B (113±7 min), (P=0.04). The time to full recovery of sensory block was shorter in Group B (127±14 min) than in Group L (157±34 min), (P0.001). The requirement for analgesia was earlier in Group B (305±50 min) than in Group L (389±146 min), (P=0.004). Conclusion. Although both techniques provide adequate spinal block and have few similar side effects for transurethral surgery, the use of low-dose hyperbaric levobupivacaine plus fentanyl may be preferable to low-dose hyperbaric bupivacaine plus fentanyl because of the reduced motor block, shorter duration of motor block, longer duration of sensory block and longer time to the first requirement for analgesia

Comparison of spinal, low-dose spinal and epidural anesthesia with ropivacaine plus fentanyl for transurethral surgical procedures

The aim of This study was to compare spinal, low-dose spinal, and epidural anesthesia using ropivacaine and fentanyl combinations for transurethral surgical procedures. Sixty patients with American Society of Anesthesiologists scores of I-III were allocated into three groups. After pre- loading with 5 mL/kg normal saline, patients in the spinal anesthesia group (Group S) received 15 mg of hyperbaric ropivacaine plus 25 µg of fentanyl intrathecally; patients in the epidural anesthesia group (Group E) received 112.5 mg of ropivacaine plus 25 µg of fentanyl epidurally via an epidural catheter; and patients in the low-dose spinal anesthesia group (Group L) received 10 mg of hyperbaric ropivacaine plus 25 µg of fentanyl intrathecally. Blood pressure, heart rate, peripheral oxygen saturation, time to onset of thoracic (T)-10 dermatome, two-segment sensorial block regression time, full recovery of sensorial block, maximum motor blockade levels, motor blockade regression time, additional analgesic administration, patient comfort, and complications were recorded. The time to the onset of T10 dermatome level was shortest in Group S and longest in Group E (p 0.001). The sensorial blockade time and motor blockade regression time were shorted in Group L (p 0.001). The two-segment sensorial block regression time in Group E exceeded that in the other groups. Additional analgesic administration was not needed in any group. No complications or adverse effects were observed in any patient. We conclude that all three anesthetic techniques may be used safely and are appropriate for transurethral surgical procedures. However, low-dose spinal anesthesia with ropivacaine plus fentanyl may be preferable in transurethral surgery because we reach an adequate sensorial level with less motor blockade. © 2010 Elsevier

Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

Background: Ventilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods: This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results: Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5) and 2.5 (IQR: 2.0) days respectively (P0.0001). Respiratory failure (OR, 11.8; 95%, CI, 2.2- 62.5; P0.004), coma in admission (Glasgow coma scale9) (OR, 17.2; 95% CI, 2.7-107.7; P 0.002), depressed consciousness (OR, 8.8; 95% CI, 2.9-62.5; P0.02), enteral feeding (OR, 5.3; 95% CI, 1.0-27.3; P=0.044) and length of stay (OR, 1.3; 95% CI, 1.0-1.7; P0.04) were found as important risk factors. Most commonly isolated microorganism was methicillin resistant Staphylococcus aureus (30.4%). Mortality rates were higher in patients with VAP (70.3%) than the control patients (35.5%) (P0.003). Mean cost of patients with and without VAP were 2832.2+/-1329.0 and 868.5+/-428.0 US Dollars respectively (P0.0001). Conclusion: Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately fivefold higher than non-infected patients. © 2004 Erbay et al, licensee BioMed Central Ltd

DENİZLİİLİ YENİŞEHİR SAĞLIK OCAĞI BÖLGESİNDE HALKIN ANESTEZİYOLOJİ UYGULAMALARINA İLİŞKİN BİLGİ, TUTUM VE ÖNCEKİANESTEZİ DENEYİMLERİ

Toplumun anestezi uygulamaları hakkındaki bilgisi girişimsel tıp uygulamaları sırasındaki hasta hekim ilişkisinin sağlıklı kurulmasını belirleyen bir unsur olabilir. Toplumun bu konu hakkındaki durumunun belirlenmesi ise hekimlerin hastalarına daha doğru bir yaklaşım göstermesi için bir fırsat verebilir. Bu çalışmada toplumun anestezi uygulamaları hakkındaki bilgi, tutum ve davranışlarının belirlenmesi amaçlanmıştır. Bu araştırma 2005 yılı Nisan ayında Denizli ili Yenişehir sağlık ocağı bölgesinde 20 yaş üzeri toplam 500 kişi (162 erkek, 338 kadın) üzerinde "anestezi ve uygulamaları" ile ilgili bilgi, tutum ve davranışlarını belirlemek amacıyla anket çalışması olarak gerçekleştirildi. Çalışma anket form kullanılarak Denizli ili Yenişehir bölgesinde ikamet eden 20 yaş üzeri bireyler arasından toplam 500 kişi üzerinden gerçekleştirildi. Ankete katılanların %48.8'i anestezinin ne olduğunu; %40.2'si anestezistin kim olduğunu biliyordu. Ankete katılanların %45.6'sı anesteziden korktuğunu belirtti. Ankete katılanların anestezi konusundaki bilgi düzeylerini etkileyen etken olarak eğitim durumu ve yaşın istatistiksel olarak anlamlı olduğu bulundu. Eğitim durumu yükseldikçe kişilerin anestezi konusunda bilgilerinin arttığı görüldü. (Pam Tıp Derg 2008;2(2):76-82