The effect of pulsed radiofrequency application on nerve healing after sciatic nerve anastomosis in rats

The Effect of Pulsed Radiofrequency Application on Nerve Healing After Sciatic Nerve Anastomosis in Rats. In this study, we aimed to evaluate the histomorphological and functional effect of Pulsed Radiofrequency (PRF) application on regeneration after experimental nerve damage in rats. Forty Sprague-Dawley male rats were used in the study. Sciatic nerve incision was applied to all rats and then anastomosis was performed. Twenty rats were separated as the control group, and the remaining 20 rats underwent PRF every day at 42oC, for 120 seconds. The groups were divided into two further subgroups to be sacrificed on the 15th and 30th days. Tissue samples were obtained from all groups at 24 hours and 72 hours after the injury. Sections of sciatic nerve samples were stained with hematoxylin-eosin for light microscopic investigation and prepared for evaluation of ultrastructural changes with transmission electron microscopy. In the evaluation of axon numbers and diameters were seen that the 30th-day RF group had an increase compared to the control group. In the electron microscopic examination, it was observed that myelinated and unmyelinated nerve fiber sheaths had borders that are more regular in the RF group, the nucleus structures of schwann cells were better preserved, mitochondrial damage was less, and the extensions of fibroblast and collagen fibers were smoother than the control group. The findings suggested that PRF application has a positive contribution histologically on nerve healing in the early period after full-layer incision nerve injury anastomosis surgery.

Reduced exposure to darunavir and cobicistat in HIV-1-infected pregnant women receiving a darunavir/cobicistat-based regimen

OBJECTIVES

The aim of the study was to evaluate darunavir and cobicistat pharmacokinetics in pregnant women with HIV-1 infection.

METHODS

This phase 3b, open-label study enrolled HIV-1-infected pregnant women (18-26 weeks of gestation) receiving combination antiretroviral therapy with once-daily darunavir/cobicistat 800/150 mg. The plasma pharmacokinetics of darunavir (total and unbound) and cobicistat were assessed over 24 h during the second and third trimesters (24-28 and 34-38 weeks of gestation, respectively) and 6-12 weeks postpartum. Pharmacokinetic parameters [area under the plasma concentration-time curve over 24 h (AUC_24 h ), maximum plasma concentration (C_max ) and minimum plasma concentration (C_min )] were derived using noncompartmental analysis and compared using linear mixed effects modelling (pregnancy versus postpartum). Antiviral activity and safety were evaluated.

RESULTS

Seven women were enrolled in the study; six completed it. Total darunavir exposure was lower during pregnancy than postpartum (AUC_24 h , 50-56% lower; C_max , 37-49% lower; C_min , 89-92% lower); unbound darunavir exposure was also reduced (AUC_24 h , 40-45% lower; C_max , 32-41% lower; C_min , 88-92% lower). Cobicistat exposure was also lower during pregnancy than postpartum (AUC_24 h , 49-63% lower; C_max , 27-50% lower; C_min , 83% lower). At study completion, five of six (83%) women were virologically suppressed (HIV-1 RNA < 50 copies/mL). There was one virological failure (the patient was nonadherent; no emerging genotypic resistance was observed and susceptibility to antiretrovirals was maintained). No mother-to-child transmission was detected among six infants born to the six women who completed the study. Overall, darunavir/cobicistat was well tolerated in women and infants.

CONCLUSIONS

In view of markedly reduced darunavir and cobicistat exposures during pregnancy, this combination is not recommended in HIV-1-infected pregnant women.

Comparison of 0.5% Levobupivacaine, 0.5% Bupivacaine, and 2% Lidocaine for Retrobulbar Anesthesia in Vitreoretinal Surgery

Purpose

The authors compared the efficacy of local anesthetics levobupivacaine, bupivacaine, and lidocaine for retrobulbar anesthesia in vitreoretinal surgery.

Methods

A total of 135 patients presenting for vitreoretinal surgery under local anesthesia were included in the study. Patients were randomly allocated to one of three groups. Group LB patients received 5 mL of 0.5% levobupivacaine, Group L patients received 5 mL of 2% lidocaine, and Group B patients received 5 mL of 0.5% bupivacaine for retrobulbar anesthesia via inferotemporal injection. Sensory and motor block durations were recorded. Intraoperative and postoperative pain was assessed by using verbal pain scala. Anesthesia efficiency, patient and surgeon satisfaction, and akinesia were assessed by using point scales. Hemodynamic data and adverse events were recorded.

Results

The demographic characteristics of patients, duration of surgery, and hemodynamic data in both groups were similar. The duration of motor and sensory block was longer in levobupivacaine and bupivacaine groups than lidocaine group. Pain on injection was found more frequent in Group L and Group B than Group LB and the difference between the Groups LB and B was significant (p<0.05). Surgeon and patient satisfaction were also higher and intraoperative pain was less in levobupivacaine group than lidocaine and bupivacaine groups.

Conclusions

Levobupivacaine provides longer motor and sensory block duration and higher surgeon and patient satisfaction than lidocaine and bupivacaine when used for retrobulbar anesthesia in vitreoretinal surgery.

Inhibition by Egb761 of the effect of cellphone radiation on the male reproductive system

OBJECTIVES

To determine the effects of Egb761 on testicular tissues and semen parameters in rats exposed to cellphone waves.

BACKGROUND

EGb761 has antioxidant properties as a free-radical scavenger. Cellphone electromagnetic radiation (EMR) induces oxidative stress in cells.

METHODS

Twenty-one Wistar albino male adult rats were divided into three groups (control, experimental, treatment), including seven rats in each. The experimental and treatment groups were exposed to cellphone EMR (0.96 W/kg) for six weeks (4 hrs/day). Egb761 (100 mg/kg/day) was also added to the treatment. Testes, epididymal semen and blood plasma were used for analysis.

RESULTS

Exposure to cellular phone radiation resulted in a significant impairment in testicular morphometry and histological structure, reduction of total and motile sperm numbers and plasma testosterone level. Egb761 administration improved testicular damage and led to a marked increase in plasma testosterone levels and total and motile sperm numbers.

CONCLUSION

Male reproductive system is susceptible to cellphone radiation. Cellphone waves induce toxic effects in testicular tissues, impair spermatogenesis and cause an imbalance in testosterone hormone levels. Egb761 ameliorated these toxic effects by reversing testicular tissue damage, restoring normal spermatogenesis and hormone levels. This suggests that Egb761 is a potential therapeutic agent against EMR-induced male reproductive toxicity (Tab. 3, Fig. 6, Ref. 45).

Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block

PURPOSE

Research is ongoing to determine the lowest dose of local anesthetics in brachial plexus block that provides adequate anesthesia and postoperative analgesia and reduces complications related to local anesthetics.

METHODS

Patients 18-65 years of age who underwent upper limb surgery and who received ultrasound-guided supraclavicular brachial plexus block at the Erciyes University Faculty of Medicine Hospital between February 2014 and January 2015 were included in the study (n=50). Supraclavicular brachial plexus blocks were performed on Group B cases by adding 30 ml 0.33% bupivacaine and on Group BD cases by adding 15 ml 0.33% bupivacaine and 1 µg / kg dexmedetomidine. Block success was evaluated by the onset and block duration of motor and sensory block and the duration of analgesia.

RESULTS

The block success of Group B and Group BD was 92.6% and 89.3%, respectively (P = 1.000). Onset time of sensory block, degree of sensory block, duration of sensory block, onset time of motor block, degree of motor block and duration of motor block were similar in both groups in the intergroup comparison (P > 0.05). Duration of analgesia and the operative conditions of groups were similar (P > 0.05).

CONCLUSIONS

In the implementation of ultrasound-guided supraclavicular brachial plexus block, block success, sensory and motor block and analgesia duration were similar for patients anaesthetized with 30 ml of bupivacaine in comparison with dexmedetomidine+bupivacaine (when the bupivacaine dose was reduced by 50% by the addition of the adjuvant).

Week 96 efficacy and safety of darunavir/ritonavir monotherapy vs. darunavir/ritonavir with two nucleoside reverse transcriptase inhibitors in the PROTEA trial

OBJECTIVES

PROTEA is a randomized controlled trial to assess the efficacy and safety of darunavir/ritonavir (DRV/r) monotherapy as an alternative to triple therapy.

METHODS

Patients fully suppressed on first-line antiretrovirals (viral load < 50 HIV-1 RNA copies/mL) were switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 137) or with two nucleoside reverse transcriptase inhibitors (NRTIs) (n = 136). Treatment failure was HIV-1 RNA level ≥ 50 copies/mL at week 96 or discontinuation of study treatment [Food and Drug Administration (FDA) snapshot algorithm].

RESULTS

Patients were mainly male and white, with mean age 44 years. In the primary efficacy analysis, the percentage of patients with HIV-1 RNA < 50 copies/mL by week 96 [intent to treat (ITT)] was lower in the DRV/r monotherapy arm (103 of 137 patients; 75%) than in the triple therapy arm (116 of 136 patients; 85%) [difference -10.1%; 95% confidence interval (CI) -19.5, -0.7%]. In the switch-included analysis, monotherapy was noninferior to triple therapy. In a post hoc analysis, for patients with nadir CD4 count ≥ 200 cells/μL, rates of HIV-1 RNA suppression were 82 of 96 patients (85%) in the DRV/r monotherapy arm and 88 of 106 patients (83%) in the triple therapy arm. No treatment-emergent primary protease inhibitor mutations were detected in either arm. The frequency of adverse events was similar in the two arms; however, one patient in the monotherapy arm was hospitalized with HIV encephalitis and elevated cerebrospinal fluid HIV-1 RNA.

CONCLUSIONS

In this study, in patients with HIV-1 RNA < 50 copies/mL at baseline, switching to DRV/r monotherapy showed lower efficacy vs. triple therapy at week 96 in the primary ITT switch-equals-failure analysis, particularly in patients with CD4 counts < 200 cells/μL.

The effectiveness of intramuscular dexmedetomidine on hemodynamic responses during tracheal intubation and anesthesia induction of hypertensive patients: a randomized, double-blind, placebo-controlled study

BACKGROUND

Hypertensive patients are at risk for increased hemodynamic response to tracheal intubation. Sympatholytic drugs administered during the preinduction period may prevent adverse events.

OBJECTIVE

We assessed the effectiveness of a single preinduction IM bolus dose of dexmedetomidine (DMED) 2.5 μg/kg in attenuating hemodynamic responses to tracheal intubation and rapid-sequence anesthesia induction in hypertensive patients treated with angiotensin-converting enzyme inhibitors.

METHODS

Adult patients (American Society of Anesthesiologists classification II and III) with essential hypertension, scheduled for elective abdominal or gynecologic surgery, were enrolled in this randomized, double-blind, placebo-controlled study. Patients were assigned to i of 2 groups: the DMED group received IM DMED 2.5 μg/kg and the placebo group received IM saline 0.9% 45 to 60 minutes before induction of anesthesia. General anesthesia was induced with thiopental, fentanyl, and vecuronium and maintained with a sevoflurane-nitrous oxide-oxygen mixture. Hemodynamic values were recorded before (baseline) and after anesthesia induction, before endotracheal intubation, and 1, 3, and 5 minutes after intubation. The patients were monitored for hypotension (systolic arterial pressure [SAP] decreased ≥25% from baseline or to <90 mm Hg) or bradycardia (heart rate [HR] decreased ≥25% from baseline or to <50 beats/min).

RESULTS

Nine hundred sixty patients were assessed for enrollment during a 6-month period. Sixty patients (49 women, 11 men; mean [SD] age, 59.16 [8.39] years) were eligible for the study. There were no significant differences in baseline hemodynamic values between the groups. SAP and diastolic arterial pressure (DAP) before anesthesia induction, 1 and 3 minutes after intubation, and DAP 1 minute after intubation were significantly lower in the DMED group than in the placebo group (all, P < 0.05). There were no significant between-group differences in SAP or DAP 5 minutes after intubation. HR before anesthesia induction, before intubation, and 1, 3, and 5 minutes after intubation were lower in the DMED group than in the control group (all, P < 0.05). In the DMED group, SAP after intubation, DAP before intubation, 3 and 5 minutes after intubation, HR before induction, before intubation, and 3 and 5 minutes after intubation were significantly decreased compared with baseline values (all, P < 0.05). In the control group, SAP at all times, DAP before intubation, 1, 3, and 5 minutes after intubation, HR before intubation, and 3 and 5 minutes after intubation were significantly decreased compared with baseline values (all, P < 0.05). Hypotension and bradycardia were observed together in 3 patients, and hypotension alone was observed in 1 patient 3 minutes after intubation in the DMED group; hypotension was observed in 1 patient at 3 minutes after intubation in the control group.

CONCLUSION

The results of this study suggest that IM DMED 2.5 μg/kg administered 45 to 60 minutes before anesthesia induction attenuated, but did not completely prevent, hemodynamic responses to tracheal intubation in these patients with essential hypertension.

Comparison of preincisional infiltrated levobupivacaine and ropivacaine for acute postoperative pain relief after septorhinoplasty

BACKGROUND

To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo nasal surgery. Levobupivacaine and ropivacaine are relatively new long-acting local anesthetics.

OBJECTIVE

The aim of this study was to compare the analgesic effect and blood loss of preincisional levobupivacaine HCl 0.25% and ropivacaine HCl 0.375% in patients undergoing septorhinoplasty.

METHODS

Sixty American Society of Anesthesiologists (ASA) I and II patients (18-55 years old) who were scheduled for elective open technique septorhinoplasty under general anesthesia were recruited for this study. The anesthetic technique was standardized for both groups. Preoperative and postoperative hemoglobin levels were recorded for all patients. Patients were assigned randomly to 1 of 2 study groups, and preincisional surgical field infiltration with 5 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline (group L; n = 30) or 5 mL of 0.75% ropivacaine plus 5 mL of 0.9% saline (group R; n = 30) was performed by the same surgeon. The degree of pain was measured by visual analogue scale (VAS) for pain and recorded at multiple time points in all patients after surgery.

RESULTS

The analgesic effect at 2 hours in the postanesthesia care unit (PACU) and at 24 hours postoperatively did not differ significantly between the 2 local anesthetics (P > 0.05). Pain scores of patients decreased after the 24 hours in levobupivacaine group and ropivacaine group when compared with 0-minute VAS values, and this was statistically significant (P < 0.05). No significant difference was observed between groups with respect to the preoperative and postoperative hemoglobin (P = 0.767 and 0.824, respectively) values.

CONCLUSIONS

Local tissue infiltration with 0.25% levobupivacaine or 0.375% ropivacaine is similarly effective in reducing the postoperative pain associated with septorhinoplasty.

A comparison of 1 minimum alveolar concentration desflurane and 1 minimum alveolar concentration isoflurane anesthesia in patients undergoing craniotomy for supratentorial lesions

BACKGROUND

A critical point in craniotomy is during opening of the dura and the subsequent potential for cerebral edema. Use of desflurane in neurosurgery may be beneficial because it facilitates early postoperative neurologic evaluation; however, data on the effect of desflurane on intracranial pressure in humans are limited. Isoflurane has been used extensively in neurosurgical patients.

OBJECTIVE

This study compared 1 minimum alveolar concentration (MAC) desflurane with 1 MAC isoflurane in facilitating hemodynamic stability, brain relaxation, and postoperative recovery characteristics in patients who underwent craniotomy for supratentorial lesions.

METHODS

A total of 70 patients (aged 18-65 years), with American Society of Anesthesiologists (ASA) 1 or 2 physical status, who underwent craniotomy for supratentorial lesions, were enrolled in the study. For induction of anesthesia, fentanyl (2 μg/kg IV) and propofol (2 mg/kg IV) were administered. Endotracheal intubation was performed after administration of vecuronium (0.1 mg/kg IV) for total muscle relaxation. Before insertion of the skull pins, additional fentanyl (2 μg/kg IV) was administered. Patients were randomly allocated to 1 of 2 anesthetic regimens. For maintenance of anesthesia, 35 patients received 1 MAC of desflurane (group 1) and 35 patients received 1 MAC of isoflurane (group 2) within 50% oxygen in nitrous oxide. Intraoperatively, heart rate (HR) and mean arterial pressure (MAP) were measured and recorded before induction and 1 minute after induction, after endotracheal intubation, before skull pin insertion and 1 minute after skull pin insertion, before incision and 1 minute after incision, and before extubation and 1 minute after extubation. Also, HR and MAP were recorded at 30-minute intervals. Postoperatively, extubation time, eye opening time to verbal stimuli, orientation time, and time to reach an Aldrete postanesthetic recovery score of ≥8 were recorded. In addition, opioid consumption was calculated and recorded. Brain relaxation was evaluated according to a 4-step brain relaxation scoring scale. All outcomes of the study were assessed and recorded by an anesthesiologist blinded to the volatile anesthetic gases studied.

RESULTS

No significant difference in HR was observed between the 2 groups. Intraoperative MAP values in group 1 were higher than in group 2 (P < 0.05). No significant difference was found between these groups in brain relaxation and opioid consumption. Extubation time, eye opening time to verbal stimuli, and time to reach an Aldrete score of ≥8 were found to be significantly shorter in patients in group 1 compared with patients in group 2 (P < 0.05).

CONCLUSIONS

In patients who underwent craniotomy for supratentorial lesions, patients who received 1 MAC desflurane-based anesthesia had earlier postoperative cognitive recovery and postoperative neurologic examination compared with patients who received 1 MAC isoflurane-based anesthesia. The observed benefits of early recovery from anesthesia, however, should be considered with risks such as higher MAP in patients administered 1 MAC desflurane.

The effect of different doses of flumazenil on acetaminophen toxicity in rats

BACKGROUND

Acetaminophen is an analgesic drug that is used safely in therapeutic doses. At high doses, it causes hepatotoxicity, resulting in hepatic necrosis. Some medications and methods are available for treatment of acetaminophen overdose. However, results are inconsistent, and sufficient outcomes cannot always be obtained.

OBJECTIVE

The mechanism of action of acetaminophen has not been fully understood. It has been suggested that it exerts its effects on GABA receptors. Flumazenil has been experimentally proven to produce an antagonism on acetaminophen's analgesic effect.The purpose of this study was to determine whether flumazenil antagonized the toxic effects of acetaminophen overdose in rats.

METHODS

A total of 49 Wistar albino rats weighing between 250 - 350 g were used in the study. Nine rats were examined for a preliminary study, and the other rats were randomly divided into five groups with eight subjects in each.

CONTROL GROUP

Saline; Acetaminophen group: 3 g/kg acetaminophen; Experimental Group F1: 3 g/kg acetaminophen + 0.1 mg/kg flumazenil; Experimental group F2: 3 g/kg acetaminophen + 1 mg/kg flumazenil; Experimental group F3: 3 g/kg acetaminophen + 10 mg/kg flumazenil. Acetaminophen was administered in a 3 ml saline solution by way of gastric catheter. Flumazenil was administered by way of intraperitoneal injections. Serum levels of acetaminophen, AST, ALT, LDH, ALP and bilirubin were recorded over a 24-hour period.

RESULTS

Serum acetaminophen levels were similar between the groups. The AST, ALT, ALP, LDH, total bilirubin and direct bilirubin levels of Group A were significantly higher compared with the Group C, Group F1, Group F2 and Group F3. There was not a statistically significant difference in the AST, ALT, ALP, LDH, total bilirubin or direct bilirubin levels of the flumazenil-administered groups.

CONCLUSION

Flumazenil's prevention of the acetaminophen-induced increase in liver enzymes is promising. There is some indication that flumazenil could be used in treatment of acetaminophen intoxication (Tab. 2, Ref. 25).

Nasal and buccal treatment of midazolam in epileptic seizures in pediatrics

Acute seizure and status epilepticus constitute major medical emergencies in children. Four to six percent of children will have at least one seizure in the first 16 years of life. Status epilepticus is a common neurological emergency in childhood and is associated with significant morbidity and mortality. The early application of antiepileptic treatment is very important. Because early treatment prevents the status epilepticus formation and shortens the duration of seizure activity. For this reason administration of anticonvulsant therapy in the prehospital setting is very important. Seizures generally begin outside the hospital, and thus parents and caregivers need simple, safe and effective treatment options to ensure early intervention. The only special preparation used for this purpose is rectal diazepam but has some disadvantages. Midazolam is a safe, short-acting benzodiazepin. It is suitable to use oral, buccal, nasal, im and iv routes. This provides a wide area for clinical applications. Recently there are many clinical studies about the usage of nasal and buccal midazolam for treatment of pediatric epileptic seizures. The nasal and buccal applications in pediatric seizures are very practical and effective. Parents and caregivers can apply easily outside the hospital.

Different doses of palonosetron for the prevention of postoperative nausea and vomiting in children undergoing strabismus surgery

Objective: The aim of this study was to evaluate the efficacy of different doses of palonosetron for the prevention of PONV in children undergoing strabismus surgery.

Patients and Method: A total of 150 children who were classified with an American Society of Anesthesiologists physical status of I, were aged between 2 and 12 years, and were undergoing strabismus surgery under general anesthesia were enrolled in the study. A random numbers table was used to assign each child to receive palonosetron 0.5, 1.0, or 1.5 μg/kg (n = 50 in each group).All episodes of PONVat the intervals of 0–2, 2–6, 6–24, and 24–48 hours were evaluated using a numeric scoring system for PONV. A p-value of <0.05 was considered statistically significant.

Results: The percentage of children with PONV during 0–48 hours after anesthesia was 24% with palonosetron 0.5 or 1.0 μg/kg, and 20% with palonosetron 1.5 μg/kg. There was no statistically significant difference between the study groups with respect to the number of children with PONV scores of 1, 2, or 3 during 0–48 hours after anesthesia. There was no statistically significant difference between the study groups with respect to the number of children with postoperative vomiting during all time periods after anesthesia. The percentage of children aged >6 years with postoperative nausea during 0–48 hours after anesthesia was 8.6%, 18.2%, and 15.4% with palonosetron 0.5, 1.0, or 1.5 μg/kg, respectively, but there was no statistically significant difference between the study groups.

Conclusion: Palonosetron doses of 0.5, 1.0, and 1.5 μg/kg are recommended for further evaluation, as they appear to be the effective doses for the prevention of PONV following strabismus surgery in children.

Myotoxic effects of levobupivacaine, bupivacaine and ropivacaine in a rat model

Aim: The aim of this study is to histopathalogically compare the myotoxic effects of a single injection of levobupivacaine, bupivacaine and ropivacaine in rat skeletal muscle. Materials and Methods: Rats received intramuscular injections of 0.5% bupivacaine (Group B), 0.5% ropivacaine (Group R), 0.5% levobupivacaine (Group L), or 0.9% normal saline (Group SF) (30 rats/group). At two, 10 and 20 days, 10 rats from each group were sacrificed and muscle samples were examined for myotoxic effects using hematoxylin-eosin staining under a light microscope. Results: Muscle damage in Groups B, L and R was similar qualitatively. In samples taken two days after injection, the muscle damage in Group B was maximal [Damage score: 3.0 (2.0-3.0)], Group R had less damage than Group B [damage score: 2.0 (2.0-3.0)] and the damage in Group L was minimal [Damage score: 1.0 (1.0-2.0)]. In muscle samples taken 10 days after injection, there was no significant difference in muscle damage scores among Groups B, R and L. In muscle samples taken 20 days after injection, regeneration was complete, and muscle mass was histologically normal for each of the three groups (B, L and R). Conclusion: Levobupivacaine’s myotoxic effect is qualitatively similar to that seen (and previously reported) with bupivacaine and ropivacaine. Levobupivacaine was found to be quantitatively less myotoxic than bupivacaine and ropivacaine after a single intramuscular injection, only two days after injection. Myonecrosis developed after a single intramuscular injection of local anesthetic but was completely regenerated by the 20th day after injection.

The effects of intraoperative infusion of dexmedetomidine on early renal function after percutaneous nephrolithotomy

BACKGROUND

Percutaneous nephrolithotomy (PCNL) may interfere with renal function because of continuous fluid irrigation and compression. The aim of this study was to evaluate the effects of an intraoperative infusion of dexmedetomidine on renal function in patients undergoing PCNL.

METHODS

This study included 40 patients between the ages of 18 and 65 years who underwent PCNL. After induction of anesthesia, we administered 100 ml of normal saline to the patients in the control group (n=20) and 1 mcg/kg dexmedetomidine in 100 ml of normal saline to the patients in the dexmedetomidine group (n=20) over 10 min. Throughout the surgery, 1 mcg/kg/h dexmedetomidine and 1 ml/kg/h normal saline infusions were given to the dexmedetomidine and control groups, respectively. Renal function, electrolytes, serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C were analyzed after induction and post-operatively at 2, 8 and 24 h. Renin levels and blood gas analyses were performed after induction and before extubation.

RESULTS

No statistically significant differences were found between the two groups with regard to renal function, creatinine clearance (CrCl), NGAL, cystatin C and serum electrolyte levels at 0, 2, 8 and 24 h post-operatively. End-surgery renin levels in the dexmedetomidine group were significantly lower than the baseline levels in the control group.

CONCLUSION

In PCNL, an intraoperative infusion of dexmedetomidine was not found to have beneficial effects on CrCl, NGAL or cystatin C levels early after the procedure; however, it reduced renin levels.

The comparison of the effects of dexmedetomidine and midazolam sedation on electroencephalography in pediatric patients with febrile convulsion

BACKGROUND

When electroencephalogram (EEG) activity is recorded for diagnostic purposes, the effects of sedative drugs on EEG activity should be minimal. This study compares the sedative efficacy and EEG effects of dexmedetomidine and midazolam.

SUBJECTS AND METHODS

EEG recordings of 60 pediatric subjects with a history of simple febrile convulsions were performed during physiologic sleep. All of these patients required sedation to obtain follow-up (control) EEGs. Subjects in Group D received 0.5 μg·kg(-1) of dexmedetomidine, and those in Group M received 0.1 mg·kg(-1) of midazolam. For rescue sedation, the same doses were repeated to maintain a Ramsey sedation score level of between 4 and 6.

RESULTS

The mean doses that were required for sedation were 0.76 μg·kg(-1) of dexmedetomidine and 0.38 mg·kg(-1) of midazolam. Diastolic blood pressure and HR were lower in Group D than in Group M (P < 0.05). Hypoxia was observed in 11 (36.7%) subjects in Group M and none in Group D; this was statistically significant (P < 0.001). Frontal and parieto-occipital (PO) EEG frequencies were similar during physiologic sleep and dexmedetomidine sedation. However, EEG frequencies in these areas (P < 0.001) and PO EEG amplitude (P = 0.030) were greater during midazolam sedation than during physiologic sleep.

CONCLUSIONS

Dexmedetomidine is a suitable agent to provide sedation for EEG recording in children. There is less change in EEG peak frequency and amplitude after dexmedetomidine than after midazolam sedation.

Complications of bronchoscopy for foreign body removal: experience in 1,035 cases

BACKGROUND

Tracheobronchial foreign body aspirations, which threaten lives in childhood, also carry potential risks during and after bronchoscopy. The aim of this study is to review complications and precautions that need to be taken against possible risks.

METHODS

From 1987 to 2005, bronchoscopy was done in 1,035 children in our department on suspicion of foreign body aspiration. The average age of these patients, mostly male (55%), was 4.1 years. Medical history, physical examination, radiological methods and bronchoscopy were used in the diagnosis. Bronchoscopy was applied under general anaesthesia, and the respiratory and cardiac systems were closely observed for 4 hours after the process.

RESULTS

Nine hundred eleven of 1,035 patients (88%) had a foreign body in the tracheobronchial system. In 42 of the patients, infection required aggressive medication; in 30, hypoxia and bradycardia occurred as a result of obstruction during bronchoscopy; in 37, laryngeal edema, laryngeal spasm and/or bronchospasm required ventilation support; in 6 patients, tracheobronchial system bleeding occurred; in 2 patients pneumothorax occurred, in 1 patient pneumomediastinum was observed and 6 patients needed thoracotomies because of foreign body aspiration. In this series there were 8 deaths.

CONCLUSION

Bronchoscopy, performed for tracheobronchial foreign body aspiration, carries a potential life-threatening risk during and after the process. The clinician needs to be aware of these risks, take proper precautions, and perform bronchoscopy by taking the medical condition of the patient and characteristics of the inspired foreign body into consideration.

Turban Pin Aspiration: Non-Asphyxiating Tracheobronchial Foreign Body in Young Islamic Women

BACKGROUND

Foreign body aspiration is rare in adults. However, in recent years, the aspiration of pins which are used for securing turbans (headscarves) is seen frequently in young women. The aim of this article was to review 105 patients who were admitted to our hospital for turban pin aspiration.

METHODS

Chest X-rays were used for diagnosis. Various methods of treatment were performed: laryngoscopy in 6 patients, flexible fiberoptic bronchoscopy in 16, rigid bronchoscopy in 93, and thoracotomy in one patient, while in the other patient the turban pin was spontaneously expectorated.

RESULTS

Localization of the pin in the right bronchial system was common (52%). In 6 patients, turban pins located in the larynx were extracted successfully by direct laryngoscopy. Turban pins were successfully removed with a flexible fiberoptic bronchoscope in 4 patients of the 16 (25%) and by rigid bronchoscope in 93 patients of 94 (99%). The average time until discharge was 18 hours and there was no mortality.

CONCLUSIONS

Turban pin aspiration is common in Islamic populations and treatment usually requires bronchoscopic procedures. In order to minimize turban pin aspiration frequency, we recommend that turbans should be secured by traditional fastening methods or with an apparatus which cannot be aspirated.

Dexmedetomidine and meperidine prevent postanaesthetic shivering

BACKGROUND AND OBJECTIVE

This placebo-controlled study was performed to evaluate the efficacy of dexmedetomidine compared with meperidine and placebo in preventing postanaesthetic shivering.

METHODS

We studied 120 patients (ASA I-II) scheduled for elective abdominal or orthopaedic surgery of about 1-3 h duration. Forty patients in each group randomly received 1 microg kg(-1) of dexmedetomidine, 0.5 mg kg(-1) of meperidine or saline 0.9% as placebo, intravenously (i.v.). Mean arterial pressure, heart rate, oxygen saturation and central body temperature were measured. Extubation, awakening and orientation times, shivering, pain, recovery and sedation scores were recorded.

RESULTS

Postanaesthetic shivering was seen in 22 patients in the placebo group, four patients in the meperidine group and six patients in the dexmedetomidine group. Sedation scores were significantly higher in the dexmedetomidine group compared with meperidine and placebo groups. Both dexmedetomidine and meperidine caused a significantly prolonged extubation and awakening time compared with placebo. Also, dexmedetomidine caused a significantly prolonged orientation time compared with other two groups.

CONCLUSION

Intraoperative intravenously administration of dexmedetomidine 1 microg kg(-1) reduces postanaesthetic shivering as does meperidine 0.5 mg kg(-1) in patients after major surgery.