Comparación entre los efectos de la dexmedetomidina, el fentanilo y el esmolol en la prevención de la respuesta hemodinámica a la intubación

ResumenJustificación y objetivosLa laringoscopia y la intubación pueden causar una respuesta hemodinámica. Varios medicamentos pueden ser usados para controlar esa respuesta. En este estudio, nuestro objetivo fue comparar los efectos de la dexmedetomidina, el fentanilo y el esmolol sobre la respuesta hemodinámica.MétodosNoventa pacientes programados para cirugías electivas con intubación endotraqueal, estado físico ASA I-II, y edades entre 21 y 65 años, se incluyeron en el estudio prospectivo, aleatorizado y doble ciego. Las presiones arteriales medias, sistólicas, diastólicas y las frecuencias cardíacas se midieron cuando los pacientes llegaron al quirófano y se registraron como valores basales. Los pacientes fueron aleatorizados en 3 grupos: el grupo i (n=30) recibió 1μg/kg de dexmedetomidina con infusión en 10min; el grupo ii (n=30) recibió 2μg/kg de fentanilo; el grupo iii recibió 2mg/kg de esmolol 2min antes de la inducción. Los pacientes fueron intubados en 3min. Las presiones medias, sistólicas y diastólicas y las frecuencias cardíacas fueron medidas antes de la inducción, antes de la intubación y durante los minutos 1, 3, 5 y 10 después de la intubación.ResultadosCuando los niveles basales fueron comparados entre los grupos, verificamos que en los minutos 5 y 10 la postintubación, las frecuencias cardíacas en el grupo i y las presiones arteriales medias, sistólicas y diastólicas en el grupo iii eran más bajas que en otros tiempos medidos (p<0,05).ConclusionesLa dexmedetomidina fue superior en la prevención de la taquicardia. El esmolol previno el aumento de las presiones arteriales medias, sistólicas y diastólicas después de la intubación. Concluimos que son necesarios algunos estudios adicionales para descubrir una estrategia que prevenga tanto el aumento de la presión arterial sistémica como la frecuencia cardíaca.AbstractBackground and objectivesLaryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response.MethodsNinety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30) received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II (n = 30) received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation.ResultsWhen basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05).ConclusionsDexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both

Pressure support ventilation with the I-gel in intensive care unit: case report

AbstractBackground and objectivesThe I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation.Contents and conclusionsIn this case report we described the use of the I-gel supraglottic airway along 48h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed

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 comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

Background and objectives:Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response.Methods:Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I&#8211;II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30) received 1 &#956;g/kg dexmedetomidine with infusion in 10 min, Group II (n = 30) received 2 &#956;g/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation.Results:When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05).Conclusions:Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both

Which Medium and Ingredients Provide Better Morphological Differentiation of SH-SY5Y Cells?

Human SH-SY5Y cell line has been used as an in vitro model in neuroscience research. However, many researchers emphasized that there are many differences between differentiated and undifferentiated characteristics of SH-SY5Y. Although Retinoic Acid (RA) generally have been used for differentiation of SH-SY5Y cells, which protocol provides better differentiation have not been cleared yet. Therefore, we compared RA and the other mediums in different treatment periods for obtaining better differentiated, carrying a neuron-like phenotype (N-type) characteristics, of SH-SY5Y human cells. The cells were pre-treated with different mediums for different treatment periods and compared with both for each other and the control group. When we pre-treated the cells with RA for 5-day and followed by the Mix medium (Neurobasal, B27, db-cAMP, KCI) and BDNF, neurite length and MAP2 expression of the cells were found significantly higher than the control group. In conclusion, we showed that more than one agent (RA) is clearly necessary to reach better differentiation of SH-SY5Y cells

Protective effects of dexmedetomidine and remote ischemic preconditioning on renal ischemia reperfusion injury in rats

BACKGROUND: The aim of this study was to evaluate the effects of remote ischemic preconditioning (RIPC) and dexmedetomidine as pharmacological conditioning in a rat renal ischemia/reperfusion (IR) injury model

11β-hydroxysteroid dehydrogenase type 1 gene expression is increased in ascending aorta tissue of metabolic syndrome patients with coronary artery disease

İstanbul Bilim Üniversitesi, Tıp Fakültesi.11β-hydroxysteroid dehydrogenase type 1 (11β-HSD-1) activity and mRNA levels are increased in visceral and subcutaneous adipose tissues of metabolic syndrome subjects. We analyzed 11β-HSD-1 expression in human epicardial adipose (EA) and ascending aorta (AA) tissues of metabolic syndrome patients and examined their contribution to the development of coronary atherosclerosis. The 11β-HSD-1 expression was evaluated by qRT-PCR in EA and AA tissues of 20 metabolic syndrome patients with coronary artery disease (metabolic syndrome group) and 10 non-metabolic syndrome patients without coronary artery disease (controls). 11β-HSD-1 expression was increased in EA and AA tissues of the metabolic syndrome group (4.1- and 5.5-fold, respectively). A significant positive correlation was found between 11β-HSD-1 expression in EA tissue and waist hip ratio and 11β-HSD-1 expression in AA tissue and body mass index, while a negative correlation was found between 11β-HSD-1 expression in EA tissue and HDL. Expression of CD68, a macrophage marker, was significantly increased in both tissues of the metabolic syndrome group; it was 2-fold higher in AA tissue compared to EA tissue in the metabolic syndrome group. Our findings of increased expression of 11β-HSD-1 and CD68 in AA tissue of the metabolic syndrome group lead us to suggest that they contribute to coronary atherosclerosis in metabolic syndrome. This positive correlation between obesity markers and 11β-HSD-1 in AA and EA tissues strengthens the evidence that 11β-HSD-1 has a role in metabolic syndrome. To the best of our knowledge, this is the first report showing 11β-HSD-1 and CD68 expression in AA tissue of metabolic syndrome patients. We suggest that there is tissue-specific expression of 11β-HSD-1 in metabolic syndrome and associated cardiovascular disorders