Search

In this article, firstly we introduce weak statistical compactness and then, we prove a mean ergodic theorem by using this new concept. Since weak convergence implies weak statistical convergence, our result is a more generalization of Cohen,[3]. [ABSTRACT FROM AUTHOR]

In this article, we show that the existence theorem for fredholm type quadratic integral equation in the space of functions satisfying Hölder the condition, based on the classical Schauder fixed point theorem, has new methods that perform with relative compactness in the Hölder spaces. In section 3, some axioms are introduced to solve the fredholm integral equation. In section 4, one example is presented to verify the effectiveness and applicability of our results. [ABSTRACT FROM AUTHOR]

Snyder and Wilansky give the definition of semiconservative FK space and investigate the properties of this space in [5]. In their article, an FK space X containing ϕ is called semiconservative space if Xf ⊂ cs holds. In this paper, we study a new type of semiconservative space. Also, we give some characterizations of these spaces. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of a ketamine:propofol combination ('ketofol') for electroconvulsive therapy on seizure activity, haemodynamic response and recovery parameters, and to compare with these with the effects of propofol alone. Twenty-four patients underwent a total of 144 electroconvulsive therapy sessions, allocated in this prospective, double-blind, crossover study. Patients were randomly assigned to receive 1 mg/kg ketofol (0.5 mg/kg propofol plus 0.5 mg/kg ketamine) or 1 mg/kg propofol 1% for anaesthesia induction. Seizure duration and quality, haemodynamic data, recovery parameters and side-effects were recorded and analysed between groups. Both motor and electroencephalography seizure durations in the ketofol group (29 ± 17 and 41 ± 17 seconds, respectively) were similar to that in the propofol group (28 ± 13 and 38 ± 16 seconds, respectively). Postictal suppression index was higher in the ketofol group (89.63 ± 7.88) than in the propofol group (79.74 ± 14.6) (P <0.05). In the ketofol group, heart rate after the seizure ended and mean arterial pressures, recorded at 0 and 5 minutes after the seizure ended, were higher than in the propofol group. Time to obeying commands was longer in the ketofol group (P <0.05). There were no untoward psychological reactions following ketofol. Although no superiority to propofol in terms of seizure duration, haemodynamic or recovery parameters was found, the ketofol mixture selected in our study provided better seizure quality than propofol. We conclude that ketofol can be an alternative strategy to enhance the seizure quality and clinical efficiency of electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

We present the full derivation of a one dimensional "Saint-Venant" like equations for barotropic compressible pipe flows including friction. The one dimensional hyperbolic system is called γ -pressurized model where γ is the adiabatic constant. It is obtained through the three dimensional barotropic Navier-Stokes equations under "thin layer" assumptions as a first order approximation. Prescribing suitable boundary conditions, one can introduce a general friction law and then explicitly show its geometrical (w.r.t. the hydraulic radius) and hydrodynamical (w.r.t. the Oser number) dependencies in the reduced model. In particular, for linear pressure law (γ = 1), we justify the one dimensional pressurized model (called P-model) introduced by the author in the context of unsteady mixed flows in closed water pipes. For non linear pressure law (γ ≠ 1), the γ -pressurized model describes the evolution of a compressible (almost) gravityless flow. [ABSTRACT FROM AUTHOR]

We propose an adaptive numerical scheme for hyperbolic conservation laws based on the numerical density of entropy production (the amount of violation of the theoretical entropy inequality). Thus it is used as an a posteriori error which provides information on the need to refine the mesh in the regions where discontinuities occur and to coarsen the mesh in the regions where the solutions remain smooth. Nevertheless, due to the CFL stability condition the time step is restricted and leads to time consuming simulations. Therefore, we propose a local time stepping algorithm. This approach is validated in the case of classical ID numerical tests. Then, we present a 3D application. Indeed, according to an eulerian bi-fluid formulation at low Mach, an hyperbolic system of conservation laws allows an easily parallelization and mesh refinement by "blocks". [ABSTRACT FROM AUTHOR]

In this work, we present a fast and parallel finite volume scheme on unstructured meshes applied to complex fluid flow. The mathematical model is based on a three-dimensional compressible low Mach two-phase flows model, combined with a linearised ‘artificial pressure’ law. This hyperbolic system of conservation laws allows an explicit scheme, improved by a block-based adaptive mesh refinement scheme. Following a previous one-dimensional work, the useful numerical density of entropy production is used as mesh refinement criterion. Moreover, the computational time is preserved using a local time-stepping method. Finally, we show through several test cases the efficiency of the present scheme on two- and three-dimensional dam-break problems over an obstacle. [ABSTRACT FROM AUTHOR]

We compared the effectiveness of three anaesthetic regimens (propofol alone, propofol with remifentanil and sevoflurane alone), with respect to seizure duration and seizure quality in patients undergoing electroconvulsive therapy. Thirty-nine patients underwent a total of 234 electroconvulsive therapy treatments in this prospective, observer blinded, crossover study. Each patient received either propofol 1 mg/kg alone (Group P), propofol 0.5 mg/kg and remifentanil 1 µg/kg (Group R), or sevoflurane alone 6% (Group S) for their initial electroconvulsive therapy session. The patients subsequently received an alternative regimen in their next session, such as from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 µg/kg, from propofol 0.5 mg/kg and remifentanil 1 µg/kg to sevoflurane alone 6%, or from sevoflurane alone 6% to a continuing alternation between drugs at each session, until their sixth session. Muscle paralysis was achieved with 1 mg/kg succinylcholine. Seizure duration, postictal suppression index, early and midictal amplitude were recorded. The mean motor and electroencephalogram seizure durations were significantly longer in Groups P and R compared to Group S (P <0.001). The postictal suppression index and early and midictal amplitude values were not significantly different among the groups. These findings indicate that the three anaesthetic regimens had similar effects on seizure quality parameters, although sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil. [ABSTRACT FROM AUTHOR]

The article compares the effectiveness of the anesthetic regimens propofol, propofol with remifentanil, and sevoflurane along, with regard to seizure duration and quality in patients undergoing electroconvulsive therapy. It was found that the mean motor and electroencephalogram seizure durations were longer in patients who received propofol alone and those who received propofol with remifentanil. Indications that the three regimens had similar effects on seizure quality parameters are cited.

The article discusses a study of the administration of Ketofol, a mixture of ketamine and propofol, in patients referred to electroconvulsive therapy. The researchers analyzed the seizure activity, hemodynamic response and recovery parameters in the 25 patients included in the study. They found similar motor and electroencephalography seizure durations in both the ketofol and propofol groups.

Copyright of Journal of Inonu University Medical Faculty is the property of Annals of Medical Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gulhane Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 μg) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side-effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients. [ABSTRACT FROM AUTHOR]

This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. Children in Group F received fentanyl 2.5 microg x kg(-1), children in Group D received dexmedetomidine 0.5 microG x kg(-1) and children in Group C received saline solution. Anaesthesia was induced with 50% N2O and 8% sevoflurane in O2 by mask and atracurium 0.6 mg x kg(-1) was administered for tracheal intubation. All children received paracetamol 40 mg/kg rectally one hour preoperatively and dexamethasone 0.5 mg x kg(-1) intravenously. The time to extubation was shorter in Group D than Group F. The eye-opening time was longer in Group F (16.1 +/- 5.3 minutes) than in Groups C (12.0 +/- 4.2 minutes) and D (12.7 +/- 3.2 minutes). The proportion of pain-free children in early recovery was significantly higher in Groups D (47%) and F (43%) than Group C (13%) (P < 0.05). The proportion of children with agitation scores > 3 was lower in Groups D 17% (5/30) and F 13% (4/30) than in Group C 47% (14/30) (P < 0.05). Fentanyl 2.5 microg x kg(-1) and dexmedetomidine 0.5 microg x kg(-1) had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children. [ABSTRACT FROM AUTHOR]

The article details a study which examined the effects of fentanyl and dexmedetomidine on the emergence characteristics of children who are having adenoidectomy and were anaesthetised with sevoflurane. The study included 90 children, aged two to seven, who were randomly assigned to one of three groups. It found that fentanyl attenuated the hemodynamic response to the onset of surgery and extubation. It concluded that fentanyl and dexmedetomidine had similar hemodynamic effects and emergence characteristics in children.

The aim of this study was to evaluate whether esmolol has an effect on QT interval during induction of anaesthesia using etomidate and fentanyl in patients with known coronary artery disease. Sixty patients were prospectively randomised to either a control group or the esmolol group. Esmolol was administered as a bolus 1 mg.kg−1, followed by a continuous infusion at 250 μg.kg−1min−1. All patients received etomidate 0.3 mg.kg−1 and fentanyl 15 μg.kg−1. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 1 min following etomidate (T2), 3 min following vecuronium (T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. In the esmolol group, QTc interval was significantly shorter at T1, T2 and T4 compared to the control group (p < 0.05). In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. An infusion of Esmolol attenuated the QTc interval prolongation associated with tracheal intubation. [ABSTRACT FROM AUTHOR]

This study was designed to compare the effects of ketamine and alfentanil administered prior to induction of anaesthesia with propofol, on the haemodynamic changes and ProSeal laryngeal mask airway® (PLMA) insertion conditions in children. Eighty children, aged between 3–132 months, were randomly allocated to receive either alfentanil 20 μg.kg−1 (alfentanil group) or ketamine 0.5 mg.kg−1 (ketamine group) before induction of anaesthesia. Ninety seconds following the administration of propofol 4 mg.kg−1, a PLMA was inserted. In the ketamine group, heart rate and mean arterial pressure were higher during the study period compared with the alfentanil group (p < 0.05). The time for the return of spontaneous ventilation was prolonged in the alfentanil group (p = 0.004). In conclusion, we found that the administration of ketamine 0.5 mg.kg−1 with propofol 4 mg.kg−1 preserved haemodynamic stability, and reduced the time to the return of spontaneous ventilation, compared with alfentanil 20 μg.kg−1 during PLMA placement. In addition, the conditions for insertion of the PLMA with ketamine were similar to those found with alfentanil. [ABSTRACT FROM AUTHOR]

Background and Objective: Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability.Methods: We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5mgkg(-1), remifentanil 3microgkg(-1) and propofol 3mgkg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SpO(2) were recorded.Results: The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05).Conclusion: The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses. [ABSTRACT FROM AUTHOR]

The organ that is affected first and most severely in intraabdominal sepsis is the lung. Oxygen radicals and active neutrophils in the lung are important sources for severe pulmonary inflammation leading to acute lung injury (ALI)/acute respiratory distress syndrome. The aim of this study was to investigate the effects of leflunomide, an immunomodulatory agent, on oxidant/antioxidant status with nitric oxide (NO) level and myeloperoxidase (MPO) activity in rats with sepsis-induced ALI. Fifty male Wistar albino rats were divided into five groups: control, sham, sepsis, leflunomide (10 mg/kg, intragastrically for two doses with an 8 h interval prior to the experiment) and sepsis + leflunomide. After the animals were anesthetized with ketamine and xylazine, the abdominal cavity was opened and ligated just below the ileocaecal valve with 3–0 silk. The antimesentric surface of the cecum was perforated and the cecum was gently compressed until fecal matter was extruded to induce sepsis. None of the rats received antibiotics during the experimental procedures. The experiment was ended 24 h after cecal ligation puncture (CLP) with the cervical dislocation under anesthesia. The lung tissues were removed for analysis of biochemical parameters and light microscopic investigation. The lung superoxide dismutase (SOD), catalase and glutathione peroxidase activities were decreased in the sepsis group as compared to the group control, sham, leflunomide and sepsis + leflunomide ( P < 0.05), and SOD activity were significantly higher in group sepsis + leflunomide than sham, control, leflunomide and sepsis group ( P < 0.05). The lung MPO, malondialdehyde (MDA), protein carbonyl and NO levels were higher in the sepsis group when compared to group control, sham, leflunomide and sepsis + leflunomide ( P < 0.05), and MPO, MDA and NO levels were higher in the sepsis + leflunomide group than in the sham, control and leflunomide group ( P < 0.05). The light microscopic evaluation showed that pulmonary architecture was preserved, and infiltration of neutrophil and edema decreased in sepsis + leflunomide group. The grade of alveolar damage was significantly decreased in sepsis + leflunomide group in comparison with sepsis group ( P < 0.05). Our findings suggested that leflunomide attenuated the lung injury after CLP-induced sepsis by inhibition of neutrophils accumulation and increasing endogenous antioxidant capacity. [ABSTRACT FROM AUTHOR]

Background: This study was designed to evaluate the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity and recovery times in patients undergoing electroconvulsive therapy (ECT). Methods: Fourteen patients underwent a total of 84 ECT sessions as a crossover design. Patients were randomly allocated to receive either dexmedetomidine (1 μg/kg IV over a period of 10 min) or saline (control). Anaesthesia was induced with propofol 1 mg/kg, and then succinylcholine 0.5 mg/kg IV was administered. Arterial blood pressure and heart rate (HR) were recorded during the study period. Results: HR in the dexmedetomidine group was lower than that in the control group at 5 and 10 min after the start of study drug infusion, and at 1, 3 and 10 min after the seizure ended ( P<0.05). Peak HR was lower in the dexmedetomidine group compared with that in the control group ( P<0.05). The mean arterial pressure (MAP) values in the dexmedetomidine group were lower at 0, 1, 3 and 10 min after the seizure ended compared with the control group ( P<0.05). Both motor and electroencephalography (EEG) seizure duration in the control group (35.65 ± 14.89 and 49.07 ± 9.94 s, respectively) were similar to that in the dexmedetomidine group (33.30 ± 12.01 and 45.15 ± 17.79 s, respectively) ( P>0.05). Time to spontaneous breathing, eye opening and obeying commands were not different between the groups. Conclusion: A dexmedetomidine dose of 1 μg/kg IV administered over 10 min before the induction of anaesthesia with propofol may be useful in preventing the acute hyperdynamic responses to ECT without altering the duration of seizure activity and recovery time. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of a single dose of tramadol administered prior to extubation on post-operative pain and morphine consumption after coronary artery bypass surgery. Methods: Patients were randomized post-operatively into two groups (group T, n= 30; group P, n= 30). The technique of anaesthesia was standardized for all patients. The patients in group T received intravenous tramadol, 1 mg/kg, and the patients in group P received 2 ml of saline 0.9%, both approximately 1 h before extubation. After extubation, all patients were allowed to use the morphine patient-controlled analgesia (PCA) device for 24 h post-operatively. Post-operative data were recorded in the cardiac intensive care unit at 30 min, 1 h, 2 h, 4 h, 12 h and 24 h after extubation by the same anaesthesiologist, who had no knowledge of the groups, and the side-effects were also evaluated. Results: In group P, the visual analogue scale (VAS) scores were found to be higher 30 min ( P < 0.01), 1 h ( P < 0.01), 2 h ( P < 0.01) and 4 h ( P < 0.05) after extubation. The patient comfort scores were higher in group T 30 min ( P < 0.01), 1 h ( P < 0.05), 2 h ( P < 0.01) and 4 h ( P < 0.01) after extubation. The total morphine consumption was higher in group P at all evaluation times ( P < 0.01), and the numbers of PCA demands and boluses were also higher in group P ( P < 0.01). Conclusions: The study demonstrated that a single dose of tramadol administered prior to extubation following coronary artery bypass surgery is associated with a decrease of up to 25% in morphine consumption, a decrease in the VAS scores and an improvement in patient comfort within the first 4 h post-operatively. [ABSTRACT FROM AUTHOR]

In this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section. One hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 µg and hyperbaric bupivacaine 12 mg. Patients were randomly allocated to three groups, each with 36 participants. Immediately following delivery, patients received either lornoxicam 8 mg IV (group L; n = 36), ondansetron 8 mg IV (group O; n = 36), or normal saline 2 ml IV (group P; n = 36). Pruritus, pain, and nausea and vomiting scores were recorded during the initial 24 h postoperatively. The incidence of pruritus was significantly lower in group O from 4 to 12 h postoperatively when compared to that in group L and group P. According to the pruritus grading system we used, the number of patients without pruritus was significantly higher in group O when compared to that in group L and group P. The number of patients experiencing moderate pruritus was significantly lower in group O when compared to that in group P. We observed that the administration of 8 mg IV lornoxicam failed to prevent intrathecal fentanyl-induced pruritus in parturients. Also, our data confirmed that ondansetron is likely to attenuate intrathecal fentanyl-induced pruritus. [ABSTRACT FROM AUTHOR]

Background and objective: The aim of this study was to evaluate the efficacy of dexmedetomidine, an α2-adrenoceptor agonist, on intraoperative bleeding, anaesthetic drug requirement and postoperative pain. Methods: Forty patients scheduled for elective tympanoplasty and septorhinoplasty operations under general anaesthesia were included in the study. The patients were randomly assigned to receive either a dexmedetomidine 1 μg kg-1 bolus 10mm before induction of anaesthesia plus 0.5 μg kg-1 h-1 infusions during maintenance or placebo. Mean arterial pressure was maintained between 60 and 80 mmHg. Perioperative mean arterial pressure, heart rate, time to extubation and time to awakening were recorded. Bleeding during surgery was assessed by the surgeon, blinded to the study drugs, both intraoperatively and postoperatively as a final personal opinion about the whole surgical process. Results: The heart rate and mean arterial pressure were significantly lower during induction, operation and extubation in the dexmedetomidine group (P < 0.05). Blood losses were lower in the dexmedetomidine group (P < 0.05). Propofol dose required for induction, and fentanyl and isoflurane consumption were significantly reduced in the dexmedetomidine group (P < 0.05). The total amounts of nitroglycerin and meperidine used were higher in the control group (P < 0.05). Conclusions: Dexmedetomidine decreased bleeding, postoperative analgesic requirements and intraoperative anaesthetic requirements and was associated with more stable haemodynamic responses to anaesthesia. We conclude that dexmedetomidine is a useful adjuvant to decrease bleeding when a bloodless surgical field is requested. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the effects of a combination of gabapentin and paracetamol with gabapentin alone and placebo on post-operative pain and morphine consumption. Methods: Seventy-five ASA I–II patients undergoing abdominal hysterectomy were included in the study and randomly divided into three groups. Placebo capsules (Group I, n= 25), 1200 mg of gabapentin (Group II, n= 25), or 1200 mg of gabapentin and 20 mg/kg paracetamol in combination (Group III, n= 25) were administered 1 h prior to surgery. Anaesthesia was standardized for all patients. Non-invasive arterial pressure, heart rate, respiratory rate, peripheral oxygen saturation, morphine consumption, nausea and vomiting, visual analogue scale-pain intensity scores (VAS-PI) and sedation scores were recorded at 1, 2, 4, 6 and 24 h following the operation. Results: Morphine consumption at 24 h was 66.60 ± 11.49 mg, 42.74 ± 12.33 mg and 30.50 ± 11.55 mg, respectively, in groups I, II and III ( P < 0.05). Post-operative VAS-PI scores at movement and at rest were decreased with gabapentin and even more with a combination of gabapentin and paracetamol. Post-operative sedation scores were higher in groups II and III during the initial 4 h while these scores were higher in group I at 24 h. Conclusions: The single dose of gabapentin as well as a combination of gabapentin and paracetamol decreased the opioid requirement and increased the patients’ satisfaction post-operatively. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to compare the effectiveness of dexpanthenol pastille and benzydamine hydrochloride spray on the prevention of a sore throat. Methods: One hundred and eighty patients undergoing general anaesthesia, who were ASA I–II and with their ages ranging between 15 and 70 years, were randomly allocated to three groups, each consisting of 60 patients. For group B, four puffs of benzydamine hydrochloride were sprayed into the mouth initially 30 min before the operation and repeatedly 5 min before anaesthesia induction. For group D, two pastilles of dexpanthenol were administered orally to be sucked 30 min before the operation. For group P, four puffs of distilled water were sprayed into the mouth initially 30 min before the operation. Post-operatively, patients were evaluated for a sore throat for the duration of 24 h. Results: The incidence of a sore throat was significantly lower for group D when compared with group B and group P. The incidence of a sore throat was similar for group B and group P. According to the sore throat grading system, the number of patients experiencing no complaints was significantly higher for group D when compared with group B and group P. The number of patients achieving moderate scores was significantly higher for group B when compared with group D. Conclusion: The administration of 200 mg of dexpanthenol prophylactically before endotracheal intubation is effective in the prevention of post-operative sore throat. [ABSTRACT FROM AUTHOR]

Background and objective: Pain on injection is still a major problem with propofol. In this study, we compared the efficacy of single-dose premedication of dexmedetomidine for pain on injection of propofol and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 100 patients scheduled to undergo surgery. Patients were randomly assigned to one of two groups, either receiving dexmedetomidine (Group D) or saline (Group C) before the injection of propofol. Patients in Group D (n = 50) were given dexmedetomidine infusion 0.6 μg/kg for 10 min. Patients in Group C (n = 50) were given saline infusion in an identical manner. Pain perception was assessed during injection of propofol in all patients. Results: The median pain score on injection of propofol was significantly lower in Group D than in Group C (median pain score 2 [1–3] vs 1 [0–2]; P < 0.006). The number of patients with pain in Group D decreased (48/50 [96%] in Group C vs 42/50 [84%] in Group D; P = 0.046). Conclusions: Intravenous administration of a single dose of dexmedetomidine as a premedication reduced the incidence and severity of pain on propofol injection without significant adverse haemodynamic effects. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Methods: Patients were randomly divided into placebo (group P, n= 16) and dexmedetomidine (group D, n= 16) groups. In group D, a 1 μg/kg bolus dose of dexmedetomidine was administered 10 min before the induction of anesthesia, followed by a 0.4 μg/kg/h infusion until the surgical incision. Anesthesia was induced with lidocaine (1 mg/kg), midazolam (0.2 mg/kg) and fentanyl (5 μg/kg) in both groups. Anesthesia was maintained with 0.5% isoflurane and fentanyl depending on the hemodynamic situation. The hemodynamic values during the investigation were obtained. Results: In group D, the mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were decreased effectively in comparison with the values in the placebo group ( P < 0.05), and there was an attenuation in the increase in the systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) at the post-sternotomy period. Conclusions: The pre-operative administration of the α2-agonist dexmedetomidine decreases the fentanyl requirement and attenuates the increase in SVRI and PVRI at the post-sternotomy period relative to the baseline levels, and decreases effectively MAP, MPAP and PCWP in comparison with the values in the placebo group, in patients with pulmonary hypertension undergoing mitral valve replacement surgery. [ABSTRACT FROM AUTHOR]

Study objective: To determine the effects of intra-operative low-dose dexmedetomidine infusion on postoperative morphine consumption, pain, sedation and patient satisfaction in patients undergoing septorhinoplasty. Method: Fifty adult patients were randomised to receive either dexmedetomidine (a loading dose of 1 μg kg-1 for the first ten minutes and a maintenance dose of 0.2 μg kg-1 h-1 afterwards, Group D) or 0.9% saline in the same manner (Group C) after induction of anaesthesia. At the end of the operation, the infusions were discontinued. After extubation, patient controlled analgesia was started intravenously. Results: Patients in Group D consumed 47% less morphine than patients in Group C during the first 24 h and had a lower cumulative morphine consumption at all times after starting patient controlled analgesia (7.08 mg vs. 8.56 mg at 2 h (p < 0.05), 10.84 mg vs. 14.0 mg at 4 h (p < 0.05), 13.56 mg vs. 18.28 mg at 6 h (p < 0.05) and 17.96 mg vs. 33.72 mg at 24 h (p < 0.05), respectively in Group D and Group C). Visual analogue scale scores for pain were higher at all times in Group C than in Group D (p < 0.05). Sedation scores were higher in Group D than in Group C at 30 min after starting patient controlled analgesia (p < 0.05). Patient satisfaction scores were higher at all times in Group D than in Group C (p < 0.05). Conclusions: Intra-operative low-dose dexmedetomidine infusion during septorhinoplasty decreases postoperative morphine consumption, provides effective postoperative pain relief and achieves better patient satisfaction without increased adverse effects. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the effects of methylene blue (MB) on NO production, myeloperoxidase (MPO) activity, antioxidant status and lipid peroxidation in lung injury during different stages of sepsis in rats. Material and Methods: Rats were randomly divided into 4 groups (n = 20): group C, sham operated; group CMB, sham operated and receiving MB (25 mg/kg, i.p.); group S, sepsis; group SMB, sepsis and receiving MB (25 mg/kg, i.p.). Sepsis was induced by cecal ligation and puncture (CLP). The MB dose was administered after CLP. Each group was subdivided into two subgroups (n = 10) which were sacrificed at 9 or 18 h after the surgical procedure. The levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX) and MPO activity, total nitrite/nitrate and malondialdehyde (MDA) in the lung tissue were measured. Lung injury was graded from 1 (injury to 25% of the field) to 4 (diffuse injury) by the pathologist. Results: In group SMB, while SOD and CAT increased in both early and late sepsis periods, GSH-PX increased significantly only in the early sepsis period when compared with group S. Increase in lung MPO activity after CLP-induced sepsis was prevented by MB administration. MB significantly decreased to nitrite/nitrate and MDA levels both in early and late sepsis periods when compared with group S (p < 0.05). Group S showed a marked increase in neutrophil infiltration into the interstitial space and thickening of the alveolar septa, whereas the alveolar damage score was lower in the SMB group (p < 0.05). Conclusion: MB reduced the MPO activity and lipid peroxidation by both decreasing oxidative stress and NO overproduction in the lungs, which resulted in the attenuation of lung injury after CLP-induced sepsis in rats. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background and objective: Magnesium administered before anaesthesia induction results in a significant reduction in intravenous anaesthetic consumption. The purpose of this study was to evaluate whether the dose of intravenous magnesium sulphate reduces the minimum alveolar anaesthetic concentration of sevoflurane for endotracheal intubation (MACEI) and skin incision (MAC), and attenuates haemodynamic responses. Methods: We studied 60 patients who were scheduled for elective surgery. Patients were not premedicated before induction of anaesthesia and were randomly assigned to receive intravenous saline 0.9% (Group I, n = 20) or magnesium sulphate 30 mg kg-1 bolus + 10 mg kg-1 h-1 continuous infusion (Group II, n = 20) or 50 mg kg-1 bolus + 10 mg kg-1h-1 continuous infusion (Group III, n = 20). Results: Median and 95% confidence limits for sevoflurane MACEI were 2.68 (2.48–2.85), 2.88 (2.70–3.06) and 2.96 (2.70–3.16), and for sevoflurane MAC were 2.08 (1.76–2.40), 2.26 (2.08–2.47) and 2.40 (2.19–2.68) in Groups I, II and III, respectively. The differences in MACEI and MAC among groups were not statistically significant, except Group III in MAC study (P < 0.05). Mean arterial pressures and heart rate did not increase in Groups II and III after endotracheal intubation and skin incision. Conclusions: Magnesium sulphate administered before induction of anaesthesia increases MAC of sevoflurane and reduces cardiovascular responses to intubation. [ABSTRACT FROM AUTHOR]

Background and objective: Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy. Methods: Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60s (alfentanil 10μg kg-1 or remifentanil 1 μg kg-1) followed by a continuous infusion (alfentanil 15 μg kg-1 h-1 or remifentanil 0.15 μg kg-1 min-1). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 μg kg-1 min-1 in both groups. Atracurium was given for endotracheal intubation at a dose of 0.5 mg kg-1 and maintained with a continuous infusion of 0.4 mg kg-1 h -1. Mean arterial pressure heart rate, the tota amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded. Results: In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05). Conclusions: Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation. [ABSTRACT FROM AUTHOR]

Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 μg kg 1 was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. Methods: One hundred anti twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg-1. Alter intravenous induction with thiopental and atracurium to facilitate endorracheal incubation, patients were randomly assigned to one of four groups: Patients in Groups 1 and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 μgkg during induction. Anaesthesia was maintained with sevoflurane in Groups 1 and 2 and with desflurane in Groups 3 and 4. Alter discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 ± 1.7 mm) and 4 (6.4 ± 2.1 mm) than in Groups 1 (8. 1 ± 2.1 mm) (P = 0.0001 and 0.006, respectively) and 2 (8.8 ± 1 .9 mm) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 ± 3.9mm) than in Groups 1 (1 3.8 ± 4.9 mm) (P = 0.01 7) and 2 (14.9 ± 4.1 mm) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10%. in Groups 2 and 4, respectively (P> 0.05). Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 μg kg did nor provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: We performed this study to investigate the morphologic and topographic anatomy, and variations of the infraorbital canal (IOC), infraorbital nerve (ION), and infraorbital foramen (IOF).Study Design and Setting: This study was performed at the Anatomy Department of Ankara University School of Medicine between 1999 and 2000. The morphometry of these anatomic areas on cadaver heads were studied microscopically. The morphologic and topograpic anatomies of IOC, ION, and IOF were carried out microscopically with x 25 to x 40 magnification on 10 cadaver heads (20 sides).Results: We found the shape of the IOF as oval in 30% (6 sides), round in 40% (8 sides), and semilunar in 30% (6 sides) of the cadaver heads. We detected the IOF as single in 90% (18 sides), double in 5% (1 side), and triple in 5% (1 side) of the cases. We determined a complete roof (we called it as "canal") in 50% of cases and groove plus canal in 50% of the heads. The mediolateral relationship of the vessels to the nerve while emerging from the IOF was investigated, and the artery was always found in a mediosuperior position and the vein was inferior to it. In all specimens, the ION was found to be consisting of 3 to 8 fascicles interwoven with the artery and the vein in the loose connective tissue sheath.Conclusion: A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon while performing maxillofacial surgery and regional block anesthesia. Anatomic variations on this area may take place and a surgeon must take this into consideration so as to increase the surgical success. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery.Methods: Eighty ASA physical status I children aged 3-12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 micro g kg-1 in apple juice 0.2 ml kg-1, and each of the controls (n=40) received apple juice 0.2 ml kg-1 only. The protocol for general anesthesia was propofol-sevoflurane in N2O/O2. A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0-48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic.Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h.Conclusion: Oral premedication with clonidine 4 micro g kg-1 did not reduce the rate of POV in the children undergoing strabismus surgery. [ABSTRACT FROM AUTHOR]

This study aims to determine the microscopic anatomy of the layers of the lateral wall of the cavernous sinus (CS) and, in particular, intends to examine the location and relations of the dural openings on the deep layer. Forty sides of 20 formalin-fixed and fresh cadavers were dissected and their CS examined. In 12 cases we found an opening on the deep dural layer; however, in four of them the inferolateral trunk of the internal carotid artery (ICA) was identified through these dural openings. We noticed the trochlear nerve making a curve (5% of cases) or lying close to the ophthalmic nerve (12.5%) on the lateral wall. In one case, the triangular area described by Parkinson could not be exposed surgically. Our findings indicate the importance of the heterogeneous courses of the cranial nerves lying on the lateral wall and point to the significance of the dural openings, which can influence the etiology of neoplastic invasions originating from the CS. [ABSTRACT FROM AUTHOR]