Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning

Background. The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. Methods. DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n=7), Group II, diabetic sham group (n=6), Group III, diabetic IR group (diabetic IR group, n=6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n=6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. Results. The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. Conclusion. Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model

Effectiveness of sugammadex for cerebral ischemia/reperfusion injury

AbstractCerebral ischemia may cause permanent brain damage and behavioral dysfunction. The efficacy and mechanisms of pharmacological treatments administered immediately after cerebral damage are not fully known. Sugammadex is a licensed medication. As other cyclodextrins have not passed the necessary phase tests, trade preparations are not available, whereas sugammadex is frequently used in clinical anesthetic practice. Previous studies have not clearly described the effects of the cyclodextrin family on cerebral ischemia/reperfusion (I/R) damage. The aim of this study was to determine whether sugammadex had a neuroprotective effect against transient global cerebral ischemia. Animals were assigned to control, sham-operated, S 16 and S 100 groups. Transient global cerebral ischemia was induced by 10-minute occlusion of the bilateral common carotid artery, followed by 24-hour reperfusion. At the end of the experiment, neurological behavior scoring was performed on the rats, followed by evaluation of histomorphological and biochemical measurements. Sugammadex 16 mg/kg and 100 mg/kg improved neurological outcome, which was associated with reductions in both histological and neurological scores. The hippocampus TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and caspase results in the S 16 and S 100 treatment groups were significantly lower than those of the I/R group. Neurological scores in the treated groups were significantly higher than those of the I/R group. The study showed that treatment with 16 mg/kg and 100 mg/kg sugammadex had a neuroprotective effect in a transient global cerebral I/R rat model. However, 100 mg/kg sugammadex was more neuroprotective in rats

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Preparedness for sudden cardiac arrest at sports arenas: A survey in Turkey

WOS: 000392195800021PubMed ID: 2772367

The effects of covid-19 pandemic on the educational status of medical residents of anesthesiology in Türkiye – a survey analysis

Aim: COVID-19 has been one of the biggest challenges that education systems have ever faced. The aim of this study is to determine the educational deficiencies of Medical Residents of Anesthesiology and Reanimation during the COVID-19 pandemic in Turkey. Materials and Methods: Our study was carried out after the approval of the Ministry of Health and Ege University Medical Faculty Hospital Ethics Committee. This study is a cross-sectional survey study. A web-based questionnaire containing 32 questions was sent to the Anesthesiology and Reanimation Specialization Students in Education and Research Hospitals and University Hospitals in Turkey, in a computer environment, by sending it via e-mail with the approval of the Turkish Society of Anesthesiology and Reanimation. Results: The training hours decreased significantly in both University Hospitals and Ministry of Health Training and Research Hospitals (p<0.001). This decrease was significantly higher in Ministry of Health Training and Research Hospitals than in University Hospitals (p=0.032). The resident training process during the pandemic has been interpreted as tiring by 89%, stressful by 85%, and humiliating by 35% of the participants. Conclusion: During the COVID-19 pandemic period, anesthesia assistants both actively participated in COVID-19 patient treatment and continued their operating room missions. During this period assistant training was delayed or canceled. Considering the continuity of the pandemic, we think that we need to develop online training programs and determine the service-training balance well to protect the future of our expertise. These results reveal that residency training should be reorganized during the pandemic period

Evaluation of the Effectiveness of Sugammadex for Verapamil Intoxication

Previous studies have shown that medications from the cyclodextrin family bind to verapamil. The aim of our study was to determine whether sugammadex could bind to verapamil and prevent the cardiovascular toxicity of that drug. Twenty-eight sedated Wistar rats were infused with verapamil at 37.5mg/kg/h. Five minutes after the start of infusion, the animals were treated with a bolus of either 16mg/kg, 100mg/kg or 1000mg/kg sugammadex. The control group was treated with an infusion without sugammadex. The heart rate and respiratory rate were monitored, and an electrocardiogram was recorded. The primary end-point was the time to asystole. The verapamil infusion continued until the animals arrested. The asystole time for the S16 group was significantly longer compared to those for the control and S1000 groups (p<0.05). The asystole time for the S1000 group was significantly shorter than those for all of the other groups (p<0.05). Reflecting these data, there was a near doubling of the mean lethal dose of verapamil from 13.57mg/kg (S.D. +/- 8.1) in the saline-treated rats to 22.42mg/kg (S.D. +/- 9.9) in the sugammadex 16 group (p<0.05). However, for the sugammadex 1000 group, the mean lethal dose was found to be 6.28 +/- 1.11mg/kg. This dose is significantly lower than those for all of the other groups (p<0.05). We found that treatment with 16mg/kg sugammadex delayed verapamil cardiotoxicity in rats. However, 1000mg/kg sugammadex accelerated verapamil cardiotoxicity in rats. Further studies must be conducted to investigate the interaction between verapamil and sugammadex

Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning

WOS: 000369669400001PubMed ID: 26925416Background. The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. Methods. DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n = 7), Group II, diabetic sham group (n = 6), Group III, diabetic IR group (diabetic IR group, n = 6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n = 6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. Results. The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. Conclusion. Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model

Respiratory mechanics with volume-controlled auto-flow ventilation mode in cardiac surgery

WOS: 000454913300008PubMed ID: 30692887Aim: We aimed to investigate the changes in respiratory mechanics in adult patients undergoing open heart surgery (OHS) while using volume-controlled auto-flow (VCAF) ventilation mode. Materials and Methods: After obtaining ethics committee's approval and informed consent, 30 patients (17 males and 13 females; mean age: 57.3 +/- 17.0 years; mean weight; 74.9 +/- 13.6 kg) scheduled for OHS were enrolled. Mechanical ventilation was carried out using VCAF mode (V-T: 5-8 mL./kg, I/E: 1/2, 10 +/- 2 fr/min). Values of dynamic compliance (C-dyn) and resistance (R) were obtained at six time points (TPs). Normally distributed variables were analyzed with repeated measure of analysis of variance and Bonferroni tests. For abnormally distributed variables, Friedman variance analysis and Wilcoxon signed-rank tests were used. Values were expressed as mean +/- standard deviation. P value <0.05 was considered significant. Results: C-dyn (mL/mbar) and R (mbar/L/s) values were as follows - (1) before sternotomy (S): 49.9 +/- 17.1 and 7.8 +/- 3.6: rvn (2) after S: 56.7 +/- 18.3 and 7.1 +/- 3.7; (3) after S and after sternal retractor placement: 48.7 +/- 16.1 and 8.3 +/- 4.4; (4) after weaning from cardiopulmonary bypass and following decannulation while retractor was in place: 49.6 +/- 16.5 and 8.1 +/- 4.0; (5) after retractor removal: 56.5 +/- 19.6 and 7.4 +/- 3.7; and (6) after sternal closure: 43.1 +/- 14.2 and 9.6 t 9.1, respectively. Significant differences were observed in C-dyn and R between; first and second TPs, second and third TPs, fourth and fifth TPs, and fifth and sixth TPs. Also, significant difference in C-dyn was found between first and sixth TPs, but it was not found in R. Conclusion: C-dyn decreases, but R remains the same in cardiac surgical patients when mechanical ventilation is performed dm with VCAF ventilation mode. Additionally, C-dyn is negatively affected by the presence of sternal retractor and the sternal closure in OHS

Comparison of three different insertion techniques with LMA-Unique™ in adults: results of a randomized trial

Background: The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-Unique™. Methods: One hundred and eighty ASA I–II patients aged 18–65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n = 60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n = 60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n = 60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. Results: Successful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5–19]s) compared with the standard (11.78 [6–24]s) and rotational group (11.57 [5–31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. Conclusions: Rotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations. Resumo: Justificativa: A técnica de inserção usando a manobra tripla das vias aéreas permitiu a inserção mais rápida da ML. Este estudo comparou três técnicas diferentes de inserção da máscara laríngea Unique™. Métodos: Foram incluídos no estudo 180 pacientes ASA I-II, entre 18-65 anos. Os pacientes foram aleatoriamente designados para grupos de manobra das vias aéreas padrão, rotacional e tripla. No grupo padrão (n = 60), a máscara laríngea (ML) foi inserida com a técnica digital intraoral. No grupo tripla (n = 60), a ML foi inserida com a técnica de manobra tripla das vias aéreas (abertura bucal, extensão da cabeça e elevação da mandíbula). No grupo rotacional (n = 60), a ML foi inserida com a técnica de inserção de trás para frente, como uma cânula de Guedel. Inserção bem-sucedida na primeira tentativa, tempo de inserção bem-sucedida, avaliação por fibra óptica, morbidade das vias aéreas e respostas hemodinâmicas foram avaliados. Resultados: O sucesso da inserção na primeira tentativa foi de 88,3% para o grupo padrão, 78,3% para o grupo rotacional e 88,3% para o grupo tripla. A taxa de sucesso global (definida como inserção bem-sucedida na primeira e segunda tentativas) foi de 93% para o grupo padrão, 90% para o grupo rotacional e 95% para o grupo tripla. O tempo de inserção bem-sucedida foi significativamente menor no grupo tripla (média [intervalo] 8,63 [5-19]s), em comparação com o grupo padrão (11,78 [6-24]s) e o grupo rotacional (11,57 [5-31]s). A avaliação por fibra óptica, a morbidade das vias aéreas e as respostas hemodinâmicas foram semelhantes em todos os grupos. Conclusões: As técnicas de inserção rotacional e de manobra tripla das vias aéreas são alternativas aceitáveis. A técnica de manobra tripla das vias aéreas apresenta taxas mais altas de sucesso global e permite um tempo menor de inserção da ML e, portanto, deve ser considerada em situações de emergência. Keywords: Insertion technique, Laryngeal mask, Supraglottic airway device, Palavras-chave: Técnica de inserção, Máscara laríngea, Dispositivo supraglótic