[Show abstract][Hide abstract] ABSTRACT: Both bupivacaine and levobupivacaine are local anesthetics with strong analgesic efficacy that can be used intraarticularly. The aim of this study was to compare the effects of intraarticular bupivacaine and levobupivacaine injection on inflammation in articular cartilage and the synovium of the rat knee joint.
Twenty Sprague-Dawley rats were injected in the right knee joint with 0.2 mL of bupivacaine, while 0.2 mL of levobupivacaine was injected into the left knee joint. Groups of 5 were sacrificed on days 1, 7, 14, and 21 after bupivacaine and levobupivacaine administration and knee joints were examined for subintimal fibrosis, synovial hyperplasia, chronic inflammation, neutrophil infiltration, edema, and synovial and periarticular congestion by microscopy. Alterations in the articular cartilage structure were evaluated using Mankin scoring.
We found that both drugs have similar effects on synovial and articular cartilage resulting in mild to moderate congestion, edema, neutrophil infiltration, chronic inflammation, and synovial hyperplasia, which diminished gradually. However, increases in fibrosis were also seen to varying degrees. Thus, the use of these drugs intraarticularly can be recommended.
Careful usage of bupivacaine and levobupivacaine is recommended in intraarticular applications since they cause inflammation shortly after injection and fibrosis at later time points.
Turkish Journal of Medical Sciences 01/2014; 44(4):540-5. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Contamination risks of propofol 2%, remifentanil, and pantoprazole; and in vitro effects of these drugs on the growth of common infective agents in intensive care units were evaluated.
For detection of contamination risk, drugs were prepared ready to use under intensive care unit conditions, were tested. Effects of these three drugs on bacterial growth were also investigated. Drugs were prepared at the concentrations used in the intensive care unit and inoculated with common pathogens after which they were incubated at 4°C, 22°C and 36°C. Subcultures were made at 0, 2, 4 and 8h and colony counts were evaluated. Minimum inhibitory concentration values were determined for all drugs at 4°C, 22°C and 36°C.
No growth was observed in the drugs prepared in the intensive care unit. Propofol tended to support while remifentanil inhibited bacterial growth. Effect of pantoprozole differed according to the bacteria tested. None of the drugs showed antibacterial activity at the maximum concentrations which may be achieved in blood of the patients.
Propofol strongly supports the growth of the microorganisms tested, although remifentanil and pantoprazole do not. Therefore, it is important to follow the strict aseptic techniques for the preparation of propofol.
Brazilian journal of anesthesiology (Elsevier). 12/2013; 63(6):466-72.
[Show abstract][Hide abstract] ABSTRACT: Experiência e objetivos: Foram avaliados os riscos da contaminação de propofol 2%, remifen- tanil e pantoprazol e os efeitos desses agentes in vitro no crescimento de agentes infecciosos comuns em unidades de terapia intensiva.
Métodos: Para a detecção do risco de contaminação, foram testados agentes preparados para uso imediato em condições de unidade de terapia intensiva. Também foram investigados os efeitos desses três agentes no crescimento bacteriano. Os agentes foram preparados nas con- centrações utilizadas na unidade de terapia intensiva e inoculados com patógenos comuns; em seguida, foram incubados a 4 °C, 22 °C e 36 °C. Foram obtidas subculturas a 0, 2, 4 e 8 h e avaliadas as contagens de colônias. Foram determinados os valores de concentração inibitória mínima para todos os agentes a 4 °C, 22 °C e 36 °C.
Resultados: Não foi observado crescimento nos agentes preparados na unidade de terapia intensiva. Propofol tendeu a suportar o crescimento, enquanto que remifentanil inibiu o crescimento bacteriano. O efeito de pantoprazol foi variável, dependendo com a bactéria tes- tada. Nenhum dos agentes demonstrou atividade antibacteriana nas concentrações máximas que podem ser alcançadas no sangue dos pacientes.
Conclusão: Propofol sustenta vigorosamente o crescimento dos microrganismos testados, o que não ocorre com remifentanil e pantoprazol. Portanto, é importante que sejam praticadas técnicas assépticas rígidas na preparação de propofol.
Revista Brasileira de Anestesiologia 11/2013; 63(6):466–472. · 0.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This investigation was performed to compare the effects of inhalation agents on microcirculation in coronary artery bypass grafting (CABG) using orthogonal polarization spectral imaging.
This prospective and randomized study was performed in patients scheduled for CABG surgery from March through September 2010.
Tertiary care university hospital.
Thirty patients undergoing elective CABG.
Patients were assigned to sevoflurane, desflurane, or isoflurane.
Orthogonal polarization spectral imaging was used to evaluate the sublingual microcirculation. Hemodynamic variables (heart rate, mean arterial pressure, central venous pressure, cardiac output, and pulmonary capillary wedge pressure), laboratory parameters (hematocrit, lactate, and potassium), and microcirculatory variables (total vascular density [TVD] [mm/mm(2)], microvascular flow index [MFI] [arbitrary units], perfused vessel density [PVD] [mm/mm(2)], and proportion of perfused vessels [PPV] [percentage] were obtained before induction, after induction, during cardiopulmonary bypass, at the end of surgery, and 24 hours after surgery. The greatest alterations in microcirculation parameters were found during cardiopulmonary bypass. In the sevoflurane group, TVD (14.7%), PVD (22%), PPV (5.97%, p < 0.05), and MFI (7.69%, p > 0.05) were decreased. In the isoflurane group, TVD (14.7%) and PVD (20.3%) were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p < 0.05). In the desflurane group, there were no changes in TVD and PVD, but MFI (8.99%, p > 0.05) and PPV (1.48%, p < 0.05) were increased in the small vessels. These changes returned to their initial values 24 hours postoperatively.
Sevoflurane had a negative effect on the microcirculation. Isoflurane decreased vascular density and increased flow. Desflurane produced stable effects on the microcirculation. These inhalation agents induced transient alterations in microvascular perfusion.
Journal of cardiothoracic and vascular anesthesia 05/2012; 26(5):791-8. · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intraarticular (i.a) drug application is consider to be a new therapeutic approach for the treatment of postoperative pain after arthroscopic knee surgery without any systemic adverse effects. Lornoxicam, a nonsteroid anti-inflammatory drug is a short acting agent, and its anti-inflammatory and analgesic activity may be effective in the postoperative pain management in minor surgery. In this study, the effects of intraarticular administration of lornoxicam on the synovium and articular cartilage in the rat knee joint were investigated.
Lornoxicam (0.25 ml) was given as an injection into the right knee joint and 0.25 ml of 0.9 per cent saline solution by injection into the left knee joint as a control in 25 rats. Groups of five rats were sacrificed by a lethal injection of ketamine 1st, 2nd, 7th, 14th and 21st days after lornoxicam administration. Knee joints were detached, fixed in 10 per cent buffered formalin and decalcified. Serial sections of 5 microm were stained with haematoxylin-eosin and evaluated for the presence of inflammation in the articular, periarticular regions and synovium. Inflammatory changes in the joints were graded according to a five-point scale, histologically.
There were no significant differences in inflammation and cartilage degeneration, between control and lornoxicam applied knees. Grade 3 inflammatory changes occurred only in one knee in lornoxicam group, at 24 h after injection. No pathological changes were observed in both groups at any time point.
Lornoxicam did not show significant effect on inflammation on rat synovia in knee joint. Further studies including in human need to be done before any recommendations are made for i.a. administration of lornoxicam.
The Indian Journal of Medical Research 05/2008; 127(4):362-5. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients diagnosed with abdominal pain related to mitochondrial neurogastrointestinal encephalopathy (MNGIE) may benefit from splanchnic nerve blockade. MNGIE, varying in age of onset and rate of progression, is caused by loss of function mutation in thymidine phosphorylase gene. Gastrointestinal dysmotility, pseudo-obstruction and demyelinating sensorimotor peripheral neuropathy (stocking-glove sensory loss, absent tendon reflexes, distal limb weakness, and wasting) are the most prominent manifestations. Patients usually die in early adulthood (mean 37.6 years; range 26-58 years). We report a case of an 18-year-old patient with MNGIE. Our patient's abdominal pain was relieved after splanchnic nerve blockade.
[Show abstract][Hide abstract] ABSTRACT: Repeated attacks of venous air embolism during an operation is a very rare situation. We report a case of multiple venous air emboli during an endoscopic surgery of a sphenoidal sinus tumor.
International Journal of Pediatric Otorhinolaryngology 11/2005; 69(10):1437-40. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the effect of ketamine sedation on oxidative stress during arthroscopic knee surgery with tourniquet application by determining blood and tissue malonyldialdehyde (MDA) and hypoxanthine (HPX) levels. Thirty ASA I-II patients undergoing arthroscopic knee surgery with tourniquet were randomly divided into two groups. Spinal anesthesia induced with 12.5 mg bupivacaine was administered to all patients. In the ketamine group, after IV administration of 0.01 mg/kg midazolam, a continuous infusion of ketamine (0.5 mg . kg(-1) . h(-1)) was used until the end of surgery whereas the placebo group received a volume-equivalent placebo infusion. Ramsey Sedation Scale (RSS) was used for assessing the sedation level. Venous blood and synovial membrane tissue samples were obtained before ketamine infusion, at 30 min of tourniquet ischemia, and at 5 min after tourniquet deflation for MDA and HPX measurements. Tissue MDA and HPX levels were significantly less in the ketamine group than the control group after reperfusion. RSS scores were higher in the ketamine group without any adverse effect. We conclude that ketamine sedation attenuates lipid peroxidation markers in arthroscopic knee surgery with tourniquet application.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the attention, learning and memory related cognitive functions after 12-hour day versus night shift-work in anaesthesia residents.
Fifteen residents working on the day shift and 18 working on the night shift volunteered. All were interviewed with the Rey Auditory Verbal Learning Test (AVLT), Visual Aural Digit Span Test (VADST), and State Trait Anxiety Inventory (STAI) before and after the shifts. Residents' self-evaluations of their fatigue, stress, sleep quality and duration of sleep were sought.
The two groups were similar regarding age, gender, attention, fatigue, stress, affection, sleep quality and duration of sleep. The number of words learned in the first trial of the Rey AVLT decreased after the shifts in both groups. Before the night shift the word list could be learned more effectively and with fewer trials compared to the pre-day shift. The learning deteriorated, and repetitions and forgotten words increased after the night shift. The aural oral, aural written and visual written subtest scores deteriorated after the night shift. State anxiety levels did not differ between the night and day shift groups or before and after the shifts.
The cognitive functions of residents may be impaired after the night shift. We think that close supervision of residents and provision of more rest for them during night shifts would be beneficial in decreasing their errors, which may affect patients.
Turk psikiyatri dergisi = Turkish journal of psychiatry 02/2005; 16(2):106-12. · 0.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The minimum effective dose of dexamethasone in conjunction with 50 microg x kg(-1) ondansetron was evaluated in the treatment for vomiting after elective tonsillectomy or adenotonsillectomy.
A total of 102 healthy children between 2 and 12 years of age participated in this prospective, randomized, double-blind study. A single intravenous (i.v.) dose of dexamethasone (50, 100, 150 microg x kg(-1), maximum dose 8 mg) with ondansetron (50 microg x kg(-1)) was administered just before the end of surgery. Equal volumes of normal saline were given to the control group. General anaesthesia was induced and maintained by inhalation of N2O/O2 and sevoflurane. All other preoperative and postoperative medications (including a supplementary dose of antiemetics if necessary), anaesthesia and surgical techniques were standardized.
No significant differences were observed between groups in postoperative vomiting on the day of surgery and the next day, or in the need for postoperative pain medication and supplementary doses of antiemetics (P > 0.05).
These results indicate that surgical technique and anaesthetic management used in this study could be the cause of the lower incidence of nausea and vomiting. Assessment of nausea and vomiting in a prospective study with larger groups of patients may reflect different results.
[Show abstract][Hide abstract] ABSTRACT: This case report suggests that the nonionic contrast agents may cause myoclonic spasms and seizures like the ionic ones. A 14-year-old female with congenital scoliosis was scheduled for T2-L3 scoliosis surgery. She had no medical history of a seizure disorder. After a negative wake-up test, myelography was performed with iohexol. Myoclonic spasms, disseminated intravascular coagulopathy (DIC) and rhabdomyolysis were diagnosed postoperatively. Anaesthesiologists should be aware of the complications which may occur after the use of nonionic and water-soluble contrast agents.
[Show abstract][Hide abstract] ABSTRACT: Tracheal intubation through a laryngeal mask airway is an alternative to secure the ventilation in patients with difficult airway. Different techniques have been described to intubate these patients. A case of micrognathia in remote location anesthesia is reported. Endotracheal intubation was unsuccessful with the conventional methods. A soft tip angiography guidewire was advanced through a laryngeal mask airway. The position of the catheter was confirmed by fluoroscopy. Laryngeal mask airway was removed after endotracheal tube was inserted over the guidewire. This technique is recommended as an alternative where fiberoptic bronchoscopy is unavailable and in emergency situations.
The Turkish journal of pediatrics 01/2003; 45(1):78-9. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate whether maternal presence during induction has additional beneficial effects on a mother's anxiety or changes in the child's behavior when an information booklet was given to all mothers and premedication was given to all patients. One hundred children, aged 2-10 years, scheduled for ambulatory surgery were randomly assigned to a mother-present (Group M) or mother-absent group (Group C) after premedication with intranasal midazolam. All mothers were informed about general anesthesia with a detailed information booklet. Preoperatively (pre) and one week after the operation (post), maternal anxiety was assessed using State-Trait Anxiety Inventory (STAI), and Posthospitalization Behavior Questionnaire (PHBQ) was used to measure changes in children's behavior. Anesthesia was induced using sevoflurane-oxygen-nitrous oxide inhalation. The anesthesiologist graded the level of the children's stress at anesthesia induction with a four-point scale. There were no differences between the two groups regarding demographics, anxiety levels of the mothers and postoperative behavioral changes and stress scores of the children (p>0.05 between the groups *p<0.005 within groups). In summary, maternal presence during induction in addition to premedication for children and information booklets for mothers had no additive effects in terms of reducing the mother's or the child's anxiety or postoperative behavioral changes.
The Turkish journal of pediatrics 50(6):566-71. · 0.56 Impact Factor