A Comparison of Epidural Anesthesia and Lumbar Plexus-Sciatic Nerve Blocks for Knee Surgery

OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery

Commuter Exposure to Black Carbon, Fine Particulate Matter and Particle Number Concentration in Ferry and at the Pier in Istanbul

This paper presents measurements and analyses of the concentrations of black carbon (BC), particle number concentration (PNC), and PM2.5 (<= 2.5 mu m) while commuting by ferries in Istanbul. In this context, exposures to the mentioned pollutants were estimated for car ferry, fast ferry, and at the piers, and for two travel routes, for a total of 89 trips. BC, PNC, and PM2.5 measurements were simultaneously performed in a ferry and at the piers, and the correlation between pollutant concentrations, meteorological parameters, and environmental factors were analyzed. The mean concentrations for all pollutants in car ferry were lower than the average concentrations in fast ferry. The concentration ratios of fast ferry to car ferry for BC, PNC, and PM2.5 were 6.4, 1.2, and 1.3, respectively. High variability in the concentrations was observed at the piers and in ferry during berthing. The highest mean concentrations (+/- standard deviation) of BC (14.3 +/- 10.1 mu g m(-3)) and PNC (42,005 +/- 30,899 pt cm(-3)) were measured at Yalova pier. The highest mean concentration (+/- standard deviation) of PM2.5 (26.1 +/- 11.5) was measured at Bostanci pier. It was observed that the main external sources of BC, PNC, and PM2.5 at the piers were road transport, residential heating, and shipping activity. There were no significant correlations between BC, PNC, and PM2.5 in fast ferry, while BC was positively correlated with PNC (r = 0.61, p < 0.01) and PM2.5 (r = 0.76, p < 0.01) in car ferry. At the piers, significant relations between pollutants and meteorological variables were observed. It was noticed that there was no significant difference between summer and winter in ferry and at the pier concentrations of BC, PNC, and PM2.5 except for Yenikapi pier and Bakirkoy pier. The highest total exposure to PNC and PM2.5 was in car ferry mode, while the highest total exposure to BC was in fast ferry mode

Determinants of exposure to ultrafine particulate matter, black carbon, and PM2.5 in common travel modes in Istanbul

The personal exposure concentrations of ultrafine particles (UFPs), black carbon (BC), and particulate matter with an aerodynamic diameter <= 2.5 mu m (PM2.5) were measured in often-used transport vehicles and routes in Istanbul, Turkey. Exposure to these pollutants were estimated for four different travel modes (bus, metrobus, car, light rail) and five travel routes. Pollutant measurements were simultaneously conducted in the vehicles, and the relationship between pollutant concentrations, meteorological variables, and environmental factors were investigated. The seasonal statistically correlation results indicated that the relation between the meteorological variables and in-vehicle pollutant concentrations were variable with the seasonal differences. UFP concentrations were significantly higher in winter, while in-vehicle BC concentrations were significantly higher in summer. No significant difference was found between the summer and winter in-vehicle PM2.5 concentrations for bus, metrobus and light-rail. There was a significant positive correlation between UFP and BC with transport over roads. The highest average concentrations of UFP, BC, and PM2.5 were observed when car windows were open while traveling, and wind speed negatively affected pollutant concentrations and accounted for between 1 and 29% of their variability. Atmospheric pressure was significantly negatively correlated with BC but positively correlated with UFP and PM2.5. Humidity was a significant factor for UFP (1-12%) and PM2.5 (0-10%), but was not a factor for BC. The pollutant concentrations at the station/platform were the common significant factor for those concentrations in buses, metrobuses and light rail; the variability was determined between 4 and 66% for BC, 3 and 36% for UFP, and 1 and 75% for PM2.5. The time of day was also significant for BC (variation of 3-10%) and UFP (variation of 2-10%) for bus, metrobus, and car trips. The highest average exposures per kilometer for all pollutants was in buses, with exposure levels of UFP, BC, and PM2.5 at 12.3 x 10(8) particles km(-1), 0.40 mu g km(-1), and 1.33 mu g km(-1), respectively, while the lowest average exposures per kilometer for all pollutants were in the car with the windows closed and on light rail. It was observed that the metrobus near the highway provided the least concentrations of pollutant exposure

Wpływ alogenicznego przeszczepienia płodowej tkanki pępowiny na morfologię pęcherza moczowego w eksperymentalnym uszkodzeniu rdzenia kręgowego

Background and purpose In continuation of our previous experimental study on spinal cord injury (SCI) using fetal stem cells, we investigated here the effects of fetal allogeneic umbilical cord tissue transplant on the urinary bladder morphology in a rat SCI model. Material and methods Five pregnant albino Wistar rats at 12 days of gestation were used to obtain the umbilical cord cell graft. In Group 1 (n = 5), Th8-Th9 laminectomy was performed. Group 2 (n = 5) received spinal cord injury. In Group 3 (n = 5), the cultured fetal umbilical cord cells coated with alginate gel were placed into the lesion cavity. In Group 4 (n = 5), only alginate sponges without umbilical cord cells were placed into the injury cavity. The bladders of animals were analyzed pathologically at 21 days after surgery. Results The thickness of the epithelium and the lamina propria did not differ among studied groups (p &gt; 0.05). The lamina muscularis thickness was significantly higher in Group 2 and Group 4 than the others (p &lt; 0.05). The bladder weight was similar among Groups 1, 2, and 3 (p &gt; 0.05). Fibrosis was significantly increased in Group 2 (p &lt; 0.05); it was greater in Group 2 than in Group 3 (p &lt; 0.05) but did not differ between Groups 1 and 3 (p &gt; 0.05). Conclusions This study suggests that allogeneic umbilical cord tissue transplantation after SCI may prevent bladder wall hypertrophy and fibrosis in the rat SCI model.Wstęp i cel pracy Kontynuując nasze wcześniejsze badania nad zastosowaniem płodowych komórek macierzystych w urazowym uszkodzeniu rdzenia kręgowego (spinal cord injury – SCI), przeprowadziliśmy badanie wpływu alogenicznego przeszczepienia płodowych komórek tkanek pępowiny na morfologię pęcherza moczowego w szczurzym modelu SCI. Materiał i metody Do uzyskania komórek pępowiny służących do przeszczepienia wykorzystano pięć ciężarnych samic białych szczurów rasy Wistar w 12. dniu ciąży. W grupie 1 (n = 5) wykonano laminektomię Th8-Th9. W grupie 2 (n = 5) dokonano urazowego uszkodzenia rdzenia kręgowego. W grupie 3 (n = 5) w miejscu uszkodzenia umieszczono hodowane komórki płodowe pępowiny powleczone żelem z alginianem. W grupie 4 (n = 5) do miejsca uszkodzenia podano wyłącznie gąbkę z alginianem bez komórek pępowinowych. Pęcherze moczowe zwierząt poddano ocenie patomorfologicznej po 21 dniach od zabiegu. Wyniki Grubość nabłonka i blaszki właściwej nie różniła się pomiędzy badanymi grupami (p &gt; 0,05). Grubość mięśniówki błony śluzowej była istotnie większa w grupie 2 i 4 w porównaniu z pozostałymi (p &lt; 0,05). Masa pęcherza była podobna w grupach 1, 2 i 3 (p &lt; 0,05). Zwłóknienie pęcherza było istotnie większe w grupie 2 (p &lt; 0,05); było ono istotnie większe w grupie 2 w porównaniu z grupą 3 (p &lt; 0,05), ale nie różniło się pomiędzy grupą 1 i 3 (p &gt; 0,05). Wnioski Wyniki badania wskazują, że alogeniczne przeszczepienie płodowej tkanki pępowiny w eksperymentalnym SCI może zapobiegać przerostowi i zwłóknieniu ściany pęcherza moczowego w szczurzym modelu SCI

Efeitos do óxido nitroso em hipotensão controlada durante anestesia com baixo fluxo

JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O) em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina) em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1) foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6 mg.kg-1) e brometo de vecurônio (0,08 0,12 mg.kg-1) foram administrados na indução de ambos os grupos. Isoflurano (2%) foi administrado para manutenção da anestesia. O Grupo N recebeu uma mistura de 50% de O2-N2O e o Grupo A recebeu uma mistura de 50% de O2-ar como gás de transporte. Anestesia com baixo fluxo (1 L.min-1) foi iniciada após um período de 10 minutos de alto fluxo inicial (4,4 L.min-1). Os valores de pressão arterial, frequência cardíaca, saturação periférica de O2, isoflurano inspiratório e expiratório, O2 inspiratório e expiratório, N2O inspiratório e expiratório, CO2 inspiratório, concentração de CO2 após expiração e concentração alveolar mínima foram registrados. Além disso, as taxas de consumo total de fentanil, dexmedetomidina e isoflurano, bem como de hemorragia, foram determinadas. RESULTADOS: A frequência cardíaca diminuiu em ambos os grupos após a carga de dexmedetomidina. Após a intubação, os valores do Grupo A foram maiores nos minutos um, três, cinco, 10 e 15. Após a intubação, os valores de hipotensão desejados foram alcançados em 5 minutos no Grupo N e em 20 minutos no grupo A. Os valores da CAM foram mais altos no Grupo N nos minutos um, três, cinco, 10 e 15 (p < 0,05). Os valores da FiO2 foram mais altos entre 5 e 60 minutos no Grupo A, enquanto foram mais altos no Grupo N aos 90 minutos (p < 0,05). Os valores de Fi Iso (isoflurano inspiratório) foram menores no Grupo N nos minutos 15 e 30 (p < 0,05). CONCLUSÃO: O uso de dexmedetomidina em vez de óxido nitroso em anestesia com isoflurano pela técnica de baixo fluxo atingiu os níveis desejados de pressão arterial média (PAM), profundidade suficiente da anestesia, estabilidade hemodinâmica e parâmetros de inspiração seguros. A infusão de dexmedetomidina com oxigênio-ar medicinal como gás de transporte é uma técnica anestésica opcional

The Effects of Nitrous Oxide on Controlled Hypotension During Low Flow Anesthesia

Background and objectives: : We investigated the effect of Nitrous Oxide (N2O) on controlled hypotension in low-flow isoflurane-dexmedetomidine anesthesia in terms of hemodynamics, anesthetic consumption, and costs. Methods: We allocated forty patients randomly into two equal groups. We then maintained dexmedetomidine infusion (0.1 μg.kg-1.min-1) for 10 minutes. Next, we continued it until the last 30 minutes of the operation at a dose of 0.7 μg.kg-1.hour-1. We administered thiopental (4-6 mg. kg-1) and 0.08-0.12 mg.kg-1 vecuronium bromide at induction for both groups. We used isoflurane (2%) for anesthesia maintenance. Group N received a 50% O2-N2O mixture and Group A received 50% O -air mixture as carrier gas. We started low-flow anesthesia (1 L.min-1) after a 10-minute period of initial high flow (4.4 L.min-1). We recorded values for blood pressure, heart rate, peripheral O2 saturation, inspiratory isoflurane, expiratory isoflurane, inspiratory O2, expiratory O2, inspiratory N2O, expiratory N2O, inspiratory CO2, CO2 concentration after expiration, Minimum Alveolar Concentration. In addition, we determined the total consumption rate of fentanyl, dexmedetomidine and isoflurane as well as bleeding. Results: In each group the heart rate decreased after dexmedetomidine loading. After intubation, values were higher for Group A at one, three, five, 10, and 15 minutes. After intubation, the patients reached desired hypotension values at minute five for Group N and at minute 20 for group A. MAC values were higher for Group N at minute one, three, five, 10, and 15 (p < 0.05). FiO2 values were high between minute five and 60 for Group A, while at minute 90 Group N values were higher (p < 0.05). Fi Iso (inspiratuvar isofluran) values were lower in Group N at minute 15 and 30 (p < 0.05). Conclusion: By using dexmedetomidine instead of nitrous oxide in low flow isoflurane anesthesia, we attained desired MAP levels, sufficient anesthesia depth, hemodynamic stability and safe inspiration parameters. Dexmedetomidine infusion with medical air-oxygen as a carrier gas represents an alternative anesthetic technique. Keywords: Hypotension, Controlled, Anesthesia, Closed-Circuit, Nitrous Oxide, Dexmedetomidin

Effect of the selective mitochondrial KATP channel opener nicorandil on the QT prolongation and myocardial damage induced by amitriptyline in rats.

Abstract Objectives The aim of this study is to evaluate the protective effect of nicorandil, a selective mitochondrial KATP channel opener, on QT prolongation and myocardial damage induced by amitriptyline. Methods The dose of amitriptyline (intraperitoneal, i.p.) that prolong the QT interval was found 75 mg/kg. Rats were randomized into five groups the control group, amitriptyline group, nicorandil (selective mitochondrial KATP channel opener, 3 mg/kg i.p.) + amitriptyline group, 5-hdyroxydecanoate (5-HD, selective mitochondrial KATP channel blocker, 10 mg/kg i.p.) + amitriptyline group and 5-HD + nicorandil + amitriptyline group. Cardiac parameters, biochemical and histomorphological/immunohistochemical examinations were evaluated. p &amp;lt; 0.05 was accepted as statistically significant. Key findings Amitriptyline caused statistically significant prolongation of QRS duration, QT interval and QTc interval (p &amp;lt; 0.05). It also caused changes in tissue oxidant (increase in malondialdehyde)/anti-oxidant (decrease in glutathione peroxidase) parameters (p &amp;lt; 0.05), myocardial damage and apoptosis (p &amp;lt; 0.01 and p &amp;lt; 0.001). While nicorandil administration prevented amitriptyline-induced QRS, QT, QTc prolongation (p &amp;lt; 0.05), myocardial damage and apoptosis (p &amp;lt; 0.05), it did not affect the changes in oxidative parameters (p &amp;gt; 0.05). Conclusions Our results suggest that nicorandil, a selective mitochondrial KATP channel opener, plays a protective role in amitriptyline-induced QT prolongation and myocardial damage. Mitochondrial KATP channel opening and anti-apoptotic effects may play a role in the cardioprotective effect of nicorandil. </jats:sec