The Effects of Remote Ischemic Preconditioning and N-Acetylcysteine with Remote Ischemic Preconditioning in Rat Hepatic Ischemia Reperfusion Injury Model

Background. Remote ischemic preconditioning (RIP) and pharmacological preconditioning are the effective methods that can be used to prevent ischemia reperfusion (IR) injury. The aim of this study was to evaluate the effects of RIP and N-Acetylcysteine (NAC) with RIP in the rat hepatic IR injury model. Materials and Methods. 28 rats were divided into 4 groups. Group I (sham): only laparotomy was performed. Group II (IR): following 30 minutes of hepatic pedicle occlusion, 4 hours of reperfusion was performed. Group III (RIP + IR): following 3 cycles of RIP, hepatic IR was performed. Group IV (RIP + NAC + IR): following RIP and intraperitoneal administration of NAC (150 mg/kg), hepatic IR was performed. All the rats were sacrificed after blood samples were taken for the measurements of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and liver was processed for conventional histopathology. Results. The hepatic histopathological injury scores of RIP + IR and RIP + NAC + IR groups were significantly lower than IR group (P = 0.006, P = 0.003, resp.). There were no significant differences in AST and ALT values between the IR, RIP + IR, and RIP + NAC + IR groups. Conclusions. In the present study, it was demonstrated histopathologically that RIP and RIP + NAC decreased hepatic IR injury significantly

The effects of remote ischaemic preconditioning and n-acetyl cysteine with remote ischaemic preconditioning in rat hepatic ischaemia reperfusion injury model

Amaç: Şok, kardiyak arrest, turnike uygulamaları, karaciğerin major cer(İR) hasarı hastada ciddi organ yetersizliklerine neden olabilmektedir. Bu hasarı önlemede uzak iskemik ön koşullama (UİÖK) ve farmakolojik ön koşullama etkinliği kanıtlanmış yöntemlerdendir. Bu çalışmanın amacı deneysel rat karaciğer İR modelinde tek taraflı alt ekstremiteye uygulanan UİÖK ve UİÖK'ye farmakolojik ön koşullama olarak eklenen NAS'ın etkilerinin karşılaştırılmasıdır. Gereç ve Yöntem: DEÜTF Hayvan Deneyleri Yerel Etik Kurulu onayı alındıktan sonra ağırlıkları 250-300 g arasında değişen 28 adet erkek Wistar albino rat yedişerli 4 gruba ayrıldı. Tüm gruplara genel anestezi altında laparatomi uygulandı ve hepatik pedikül diseke edildi. Grup I (Sham,n=7) :Laparatomi uygulandıktan ve hepatik pedikül diseke edildikten sonra başka hiçbir işlem yapılmadan batın kapatıldı. Grup II (İR,n=7): Karaciğere 30 dk. total iskemi sonrasında 4 saat reperfüzyon uygulandı. Grup III (UİÖK+İR,n=7): Sol arka bacağa uygulanan 3 döngü iskemik ön koşullama sonrası karaciğerde İR oluşturuldu. Grup IV (UİÖK+NAS+İR,n=7): 3 döngü UİÖK ve ardından intraperitoneal verilen 150 mg/kg NAS sonrası karaciğerde İR oluşturuldu. Tüm gruplarda ratların anestezi süresi eşit tutuldu, histopatolojik değerlendirme için karaciğer çıkarıldıktan ve biyokimyasal değerlendirme (AST,ALT, LDH) için kan alındıktan sonra ratlar sakrifiye edildi. Bulgular: Karaciğer histopatolojik hasar skoru Sham Grubunda diğer gruplara göre anlamlı olarak düşük bulundu (p< 0,01). İskemi Reperfüzyon Grubundaki histopatolojik hasar skorları UİÖK+İR ve UİÖK+NAS+İR gruplarından anlamlı olarak yüksek saptandı (p< 0,01). Uzak İÖK+NAS+İR ve UİÖK+İR grupları arasında hasar skorlarında anlamlı bir fark saptanmadı (p=0,334). Biyokimyasal parametrelerin (AST,ALT,LDH) düzeyleri karşılaştırıldığında İR Grubu ile UİÖK ve UİÖK+NAS grupları arasında anlamlı bir fark bulunmadı. Sonuç: Bu deneysel çalışmada rat karaciğer total İR modelinde UİÖK ve UİÖK+NAS'ın İR hasarını histopatolojik olarak anlamlı düzeyde azalttığı saptanırken UİÖK+NAS ve UİÖK grupları arasında anlamlı bir fark bulunmamıştır. Biyokimyasal parametrelere göre karaciğer İR hasarını azaltmada her iki yöntemin de etkinliği gösterilememiştir. Background: Ischaemia reperfusion (IR) injury which can develope after shock, cardiac arrest, major hepatic surgeries, liver transplantation and tourniquet application may result in severe organ failures. Remote ischaemic preconditioning (RIP) and pharmacological preconditioning are the effective methods that can be used to prevent IR injury. The aim of this study was to evaluate the effects of RIP and N-acetyl cysteine (NAC) with RIP in the rat hepatic IR injury model. Materials and Methods: After obtaining approval from the Instutional Ethics Committee, 28 Wistar albino male rats weighing approximately 250-300 g were divided into 4 groups. Laparotomy and hepatic pedicle dissection were performed to all groups under general anaesthesia. Group I (Sham, n=7): Laparotomy and hepatic pedicle dissection were performed but nothing else was done. Group II (IR, n=7): After 30 minutes of hepatic pedicle occlusion, 4 hours of reperfusion was performed. Group III (RIP+IR, n=7): After 3 cycles of ischemic preconditioning applied to left hind leg, hepatic IR was performed.Group IV (RIP+NAC+IR, n=7): After 3 cycles of RIP and intraperitoneal administration of NAC (150 mg/kg), hepatic IR was performed. Durations of anaesthesia were equal in all groups. All the rats were sacrificed after blood samples were taken and liver was Results: The histopathological injury score of liver (HISL) was significantly lower in the sham group compared with the other groups (p< 0.01). The injury score of IR group was significantly higher than the RIP+IR and RIP+NAC+IR groups (p< 0.01). There was no significant difference in HISL between the RIP+IR and RIP+NAC+IR groups. There were no significant differences in biochemical parameters (AST,ALT, LDH) between the IR , RIP+IR and RIP+NAC+IR groups. Conclusions: In the present study, it was demonstrated histopathologically that both RIP and RIP+NAC decreased hepatic IR injury significantly but there was no significant difference between RIP+IR and RIP+NAC+IR groups. According to the biochemical parameters, both methods could not prevent IR injury

The analysis of patients under mechanical ventilation support in intensive care unit with the diagnosis of H1N1 infection: retrospective study

The aim of this study is to analyze the demographic data of the patients followed in intensive care unit, under mechanical ventilation support, with a proved diagnosis of H1N1 infection. Our secondary aim is to determine the similarities and differences of these data with previous outbreaks. Seventeen patients followed in anesthesiology and reanimation intensive care unit under mechanical ventilation support due to H1N1 infection were conducted in the study. The diagnosis was proved with reverse transcription polymerase chain reaction and virus culture. Patients ages, comorbidities, vaccination stories, complications, mechanical ventilation period and pathological laboratory results were retrospectively recorded. Nine of the patients were male and mean age was calculated as 58.6 ± 19.4. Most common comorbidities were chronic obstructive pulmonary disease, hypertension and diabetes mellitus. Mean duration for onset of respiratory insufficiency was 9.2 ± 3.9 days. The duration was significantly lower in elderly patients. Most frequently seen complication at mechanically ventilated patients was acute respiratory distress syndrome and septic shock. Mean period for mechanical ventilation support was calculated as 15.9 ± 9.2 days. There was a weak correlation between age and mortality. When we analyzed the laboratory results, all patients creatine kinase levels were found to be high. We found our patients to have a long mechanical ventilation period. Older patients were shown to have a higher risk for mortality. The risk groups should be well known and vaccination programmes should be increased to prevent complications. [Med-Science 2017; 6(3.000): 389-92

Alternative approach to autonomic instability of very severe tetanus: stellate ganglion block

Tetanus is an acute and deadly disease caused by Clostridium tetani. A 60-year-old male came to hospital after he injured his thumb with a knife. Ten days later, he returned to hospital with abdominal spasms. He was vaccinated against tetanus and referred to intensive care unit. As he had sudden difficulty in respiration, he was entubated. Midazolam, magnesium and esmolol infusion were started. Next day, muscle spasms progressed all over his body. Midazolam infusion was replaced with propofol and vecuronium. At the third day, morphine infusion was added. At the 16th day, dexmedetomidine infusion was started. At the 20th day, ultrasound guided stellate ganglion block was performed to denervate sympathetic activity. The block was performed three times in a 10 days period. At the 30th, the patient recovered from very severe tetanus. The mainstay of tetanus treatment is adequate sedation. Neuroaxial blocks were proved to be effective for the control of sympathetic overactivity in recent years. Circulatory collapse remains to be the major cause of death. The mechanism is unclear but altered myocardial function is thought to be related to changeable catecholamine levels. The effect of stellate ganglion block on sympathetic and parasympathetic control of heart has been studied since the beginning of 1980s. Recently Scanlon et al. reported they treated a patient with medically refractory ventricular arrhythmias by ultrasound guided bilateral stellate ganglion block. In conclusion, stellate ganglion block can be an alternative method when the autonomic storm cannot be controlled with medical agents. Resumo: O tétano é uma doença aguda e fatal causada por Clostridium tetani. Um homem de 60 anos de idade deu entrada em nosso hospital depois de ferir o polegar com uma faca. Após dez dias, o paciente deu entrada no hospital com espasmos abdominais; foi vacinado contra tétano e encaminhado para a unidade de terapia intensiva. Como apresentava dificuldade súbita na respiração, o paciente foi intubado. Foi iniciada uma de midazolam, magnésio e esmolol. No dia seguinte, os espasmos musculares progrediram para o corpo todo. A infusão de midazolam foi substituída por propofol e vecurônio. No terceiro dia, foi adicionada morfina à infusão. No décimo sexto dia, uma infusão de dexmedetomidina foi iniciada. No 20∘ dia, o bloqueio do gânglio estrelado guiado por ultrassom foi realizado para dessensibilizar a atividade simpática. O bloqueio foi realizado três vezes no período de dez dias. No 30∘ dia, o paciente recuperou-se de um tétano muito grave. A base do tratamento de tétano é a sedação adequada. Nos últimos anos, os bloqueios neuraxiais provaram ser eficazes para o controle da hiperatividade simpática. O colapso circulatório continua sendo a principal causa de morte. O mecanismo não está claro, mas acredita-se que a função alterada do miocárdio esteja relacionada com os níveis de catecolaminas mutáveis. O efeito do bloqueio do gânglio estrelado sobre o controle simpático e parassimpático do coração tem sido estudado desde o início da década de 1980. Recentemente, Scanlon et al. relataram o tratamento de um paciente com arritmia ventricular refratária a medicamentos com bloqueio bilateral do gânglio estrelado guiado por ultrassom. Em conclusão, o bloqueio do gânglio estrelado pode ser um método alternativo quando a tempestade autonômica não pode ser controlada com agentes medicamentosos. Keywords: Sellate ganglion block, Tetanus, Autonomic instability, Intensive care unit, Palavras-chave: Bloqueio do gânglio estrelado, Tétano, Instabilidade autonômica, Unidade de Terapia Intensiv

Alternative approach to autonomic instability of very severe tetanus: stellate ganglion block

Abstract Tetanus is an acute and deadly disease caused by Clostridium tetani. A 60-year-old male came to hospital after he injured his thumb with a knife. Ten days later, he returned to hospital with abdominal spasms. He was vaccinated against tetanus and referred to intensive care unit. As he had sudden difficulty in respiration, he was entubated. Midazolam, magnesium and esmolol infusion were started. Next day, muscle spasms progressed all over his body. Midazolam infusion was replaced with propofol and vecuronium. At the third day, morphine infusion was added. At the 16th day, dexmedetomidine infusion was started. At the 20th day, ultrasound guided stellate ganglion block was performed to denervate sympathetic activity. The block was performed three times in a 10 days period. At the 30th, the patient recovered from very severe tetanus. The mainstay of tetanus treatment is adequate sedation. Neuroaxial blocks were proved to be effective for the control of sympathetic overactivity in recent years. Circulatory collapse remains to be the major cause of death. The mechanism is unclear but altered myocardial function is thought to be related to changeable catecholamine levels. The effect of stellate ganglion block on sympathetic and parasympathetic control of heart has been studied since the beginning of 1980s. Recently Scanlon et al. reported they treated a patient with medically refractory ventricular arrhythmias by ultrasound guided bilateral stellate ganglion block. In conclusion, stellate ganglion block can be an alternative method when the autonomic storm cannot be controlled with medical agents

Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial

Abstract Background Breast cancer surgery is one of the most common surgeries among the female population. Nearly half of the patients suffer chronic pain following breast cancer surgery, and 24% of them categorizing their pain as moderate to high. In this study, effects of ultrasound-guided erector spinae plane (ESP) block performed using two different concentrations of bupivacaine on postoperative tramadol consumption, pain scores, and intraoperative fentanyl requirements among patients who underwent radical mastectomy surgery were compared. Methods This double-blinded, prospective, and randomized study included patients with age ranged 18–70, American Society of Anesthesiologist physical status I–II, and scheduled for unilateral modified radical mastectomy surgery. The patients were randomly allocated into two groups. In group I, ESP block was performed with 0.375% bupivacaine. In group II, ESP block was performed with 0.25% bupivacaine. General anesthesia was induced in both groups according to the standard procedures. When the pain score was ≥4, patients received intravenous (i.v.) 25 mcg fentanyl in the recovery room or 4 mg of morphine in the surgical ward as a rescue analgesia. The main measurements were postoperative tramadol consumption; Numerical Rating Scale (NRS) scores 15, 30, and 60 min and 12 and 24 h postoperatively; and intraoperative fentanyl requirements. Results In total, 42 patients (21 patients in each group) were included in the study. The mean tramadol consumption at the postoperative 24th h was 149.52 ± 25.39 mg in group I, and 199.52 ± 32.78 mg in group II (p = 0.001). In group I, the NRS scores were significantly lower at every time points compared with those in group II. The mean intraoperative fentanyl requirement was similar in the two groups. Conclusion Although ESP block performed with both concentrations of bupivacaine provided effective postoperative analgesia, the higher concentration of bupivacaine significantly reduced postoperative tramadol consumption after radical mastectomy surgery. Clinical trial registration The study was registered prospectively with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12618001334291at 08/08/2018)