Comparison of neuroprotective effects of isoflurane and sevoflurane on cerebral ischemia

Çalışmamızda, intrakranial tümör cerrahisi geçirecek hastalarda, isofluran ve sevofluranın eşdeğer konsantrasyonlarda uygulayarak serebral iskemi üzerine olan etkilerini, serum S-100B protein ölçerek değerlendirmeği amaçladık. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra ASA I-III grubu, intrakranial tümör cerrahisi nedeniyle elektif şartlarda opere edilecek 20 hasta rastgele iki gruba ayrıldı. Anestezi indüksiyonu sodyum tiyopental , fentanil ve vekuronyum ile sağlandı. İdamede %50 oksijen-hava karışımı içinde %0,8-1,2 minimum alveolar konsantrasyonda isofluran veya sevofluran verildi. Kalp atım hızı, sistolik arter basıncı, diyastolik arter basıncı, ortalama arter basıncı, periferik oksijen satürasyonu, santral venöz basınç ve end-tidal karbondioksit değerleri oprerasyon süresince ölçüldü. S-100B protein değerlerinin takibi için ise 9 ayrı zamanda periferik kan örneği alındı. Gruplar arası karşılaştırmada demografik veriler ve diğer veriler için mann-Whitney U testi kullanıldı. Verilerin grup içi karşılaştırılmasında wilcoxon sıra toplamları testi uygulandı. Bulgular: Olguların demografik verileri ve operasyon süreleri benzer olarak bulundu. Çalışma grupları karşılaştırıldığında kalp atım hızı, sistolik arter basıncı, ortalama arter basıncı ve end-tidal karbondioksit' deki değişiklikler benzer olarak saptanırken, diyastolik arter basıncı' n da sadece entübasyon sonrasında isofluran grubunda düşme, sevofluran grubunda ise yükselme görüldü (p<0,05). Grup içi ve gruplar arası karşılaştırmada her iki grupta da santral venöz basınç ve periferik oksijen satürasyonu değerlerinde anlamlı fark saptanmadı. Gruplar arası karşılaştırmada her iki grupta da S-100B protein ölçüm ortalamalarında anlamlı fark saptanmadı. Sonuç: İntrakranial tümör cerrahisi sırasında nöroanestezide tercih edilen volatil anestezik ajanlardan isofluranın ile sevofluranın serebral iskemi üzerine benzer nöron koruyucu etkiler meydana getirdiğini ve sevofluranın isoflurana iyi bir alternatif olabileceği sonucuna varıldı.In this study, we aimed to evaluate the effects of isoflurane and sevoflurane on cerebral ischemia in patients undergoing intracranial tumour surgery by measuring serum S-100B protein. Material and Method: After the approval of the ethics committee, 20 ASA I-III group patients, who were to be operated in elective conditions due to intracranial tumour surgery, were randomly assigned to two groups. Anaesthesia induction was performed with thiopental, fentanyl and vecuronium. In the maintenance, isoflurane or sevoflurane was administered in a 50% oxygen-air mixture at a minimum alveolar concentration of 0.8-1.2%. Heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, peripheral oxygen saturation, central venous pressure and end-tidal carbon dioxide values were measured during the operation. For monitoring S-100B protein values, peripheral blood samples were taken at 9 separate times. The Mann-Whitney U test was used for statistical analysis. Wilcoxon rank sums test was applied in intra-group comparisons of the data. Findings: Demographic data and operative times were found to be similar for the cases. Heart rate, systolic arterial pressure, mean arterial pressure and the deviations in the end-tidal carbon dioxide were similar in the study groups, whereas diastolic arterial pressure was found to be significantly higher in isoflurane group after the intubation, and there was an increase in the sevoflurane group (p<0.05). Intra-group and intergroup comparisons revealed no significant difference in central venous pressure and peripheral oxygen saturation values in both groups. There was no significant difference in S-100B protein measurements in both groups in the comparison between groups. Conclusion: It was concluded that isoflurane and sevoflurane, which are among the preferred volatile anaesthetic agents in neuro-anaesthetics during intracranial tumour surgery, have similar neuron protective effects to cerebral ischemia and sevoflurane may be a good alternative to isoflurane

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Background: The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients’ TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505

Eurasian J Med 2014; 46: 135-7 Cerebral Fat Embolism Diagnosed by Cognitive Disorder

Fat embolism syndrome is a rarely seen complication of skeletal trauma, and it is seen at a rate of 2-5 % after fractures of the long bones of the lower extremities. Its classic triad-+consists of hypoxemia, petechial bleedings on the skin and neurological findings. These neurological findings are highly variable and non-specific, and they can present with lethargy, irritability, delirium, stupor, convulsion or coma. In this report, a male case is presented who was diagnosed with cerebral embolism due to acute cognitive disorder after a segmental tibial fracture. Key Words: Cerebral fat embolism, tibial fracture, acute cognitive disorder, diffusion-weighted MR