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The liver has long been identified as a target organ of arsenic exposure. Arsenic is a potent environmental toxicant and its accumulation in the liver causes hepatotoxicity. In our study, the investigation of effects of melatonin on arsenic-induced liver damage in rats was planned. In our study, 27 male rats were divided into three groups: control (saline, 5 ml/kg/day, intragastrically), arsenic (sodium arsenite, 5 mg/kg/day, intragastrically), and arsenic+melatonin (sodium arsenite, 5 mg/kg/day, intragastrically and melatonin, 25 mg/kg/day, intraperitoneally) group. At the end of 15 days, the rats were weighed and sacrificed then liver tissues were collected. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidise (GSH-Px) activities as well as malondialdehyde (MDA) levels were determined by spectrophotometry. The amount of arsenic in liver tissue was analyzed by Inductively Coupled Plasma/Optical Emission Spectrometer (ICP-OES). There were no significant differences in respect to weights of rats among the groups. Arsenic significantly decreased the enzyme activities of SOD, CAT, and GSH-Px as well as increased the levels of MDA in liver tissues. Melatonin treatments significantly increased of reduced SOD, CAT, and GSH-Px enzyme activities and decreased the elevated tissue MDA levels in liver tissues. The amount of arsenic in liver tissues significantly increased in arsenic group. There were no significant differences in respect to the amount of arsenic in liver tissues between the arsenic group and melatonin group. These data suggested that melatonin has beneficial effects against arsenic-induced liver damage by decreasing oxidative stress and lipid peroxidation. [ABSTRACT FROM AUTHOR]

Background/aim: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient’s airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP., Material and Methods: Sixty-one patients underwent ERCP (Group I: propofol, n = 31; Group II, sevoflurane, n = 30), with sedation controlled by the Ramsay sedation scale (RSS). The patients’ demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated., Results: The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II’s saturation levels increased during sedation., Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients., Competing Interests: The authors have no conflicts of interest relevant to this article to disclose., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background/aim: The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA)., Materials and Methods: Forty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure., Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure., Conclusion: In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term., Competing Interests: None declared., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Reactive arthritis is defined as arthritis that occurs during or after an extraarticular infection. It is mostly difficult to determine the causative agent that causes inflammation in the joints. Initially, salmonella, shigella, chlamydiaand yersinia were considered to be pathogenic agents. But recently, in addition to demonstrated viral and bacterial agents, there are also other cases of reactive arthritis after vaccinations with Rubella and Influenza. Herein a 3-year old boy is reported with reactive arthritis of left knee that developed shortly after hand-foot and mouth disease. This report represents the first detailed description of a paediatric case in literature with reactive arthritis following hand-foot and mouth disease.

Background: Cytokines are essential mediators of immune response. Chronic renal failure patients suffer from chronic inflammation that results from factors such as impaired renal function, accumulation of uremic toxins and bio incompatibility of dialyzer membranes. These patients are also at increased risk of cardiovascular diseases. We have evaluated cytokines, adipocytokines and inflammatory markers in patients with chronic renal failure undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)., Material and Methods: We have determined serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), leptin and ghrelin levels of chronic renal failure patients treated with either HD (n = 20) or CAPD (n = 20). TNF-α, IL-6, ghrelin and leptin measurements were performed by commercially available kits based on enzyme-linked immunosorbent assay (ELISA) method. hsCRP levels were determined by turbidimetric methods., Results: Serum TNF-α and IL-6 levels of patients on HD were significantly higher than those of the ones on CAPD (p < 0.05). Ghrelin, leptin and hsCRP concentrations were similar in both groups., Conclusions: We can conclude that cytokine production is more obvious in HD process.

Background and Objectives: The importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors., Methods: 60 ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500mcg/kg followed by a 100mcg/kg/min infusion which continued until the 4th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5min after esmolol and saline administration, 3min after the induction and 30s, 2min and 4min after intubation., Results: The corrected-QT interval was shorter in the esmolol group (p=0.012), the corrected-QT interval dispersion interval was longer in the control group (p=0.034) and the mean heart rate was higher in the control group (p=0.022) 30s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (p=0.038)., Conclusion: Endotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500mcg/kg bolus, followed by 100mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia., Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2-7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75mLkg(-1), 0.25% bupivacaine. At the end of the surgery, ketamine 0.25mgkg(-1), midazolam 0.03mgkg(-1) and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale., Results and Conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: [corrected] We aimed to evaluate analgesic efficacy, opioid-sparing, and opioid-related adverse effects of intravenous paracetamol and intravenous dexketoprofen trometamol in combination with iv morphine after total abdominal hysterectomy., Materials and Methods: Sixty American Society of Anesthesiologist Physical Status Classification I-II patients scheduled for total abdominal hysterectomy were enrolled to this double-blinded, randomized, placebo controlled, and prospective study. Patients were divided into three groups as paracetamol, dexketoprofen trometamol, and placebo (0.9% NaCl) due to their post-operative analgesic usage. Intravenous patient controlled analgesia morphine was used as a rescue analgesic in all groups. Pain scores, hemodynamic parameters, morphine consumption, patient satisfaction, and side-effects were evaluated., Results: Visual Analog Scale (VAS) scores were not statistically significantly different among the groups in all evaluation times, but decrease in VAS scores was statistically significant after the evaluation at 12(th) h in all groups. Total morphine consumption (morphine concentration = 0.2 mg/ml) in group paracetamol (72.3 ± 38.0 ml) and dexketoprofen trometamol (69.3 ± 24.1 ml) was significantly lower than group placebo (129.3 ± 22.6 ml) (P < 0.001). Global satisfaction scores of the patients in group placebo was significantly lower than group dexketoprofen trometamol after surgery and the increase in global satisfaction score was significant only in group placebo., Conclusion: Dexketoprofen trometamol and Paracetamol didn't cause significant change on pain scores, but increased patients' comfort. Although total morphine consumption was significantly decreased by both drugs, the incidence of nausea and vomiting were similar among the groups. According to results of the present study routine addition of dexketoprofen trometamol and paracetamol to patient controlled analgesia morphine after hysterectomies is not recommended.

Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage is still a leading cause of morbidity and death. This 50-year-old man underwent surgery for aneurysm clipping. After the aneurysm was clipped, papaverine was instilled into the surgical area. Bradycardia, hypotension, and sinus arrest developed in the first minute after applying the papaverine. Thus, the authors concluded that the application of papaverine to the surgical area can result in fatal bradycardia and hypotension.

The objective of this study was to evaluate the effectiveness of bilateral extraoral infraorbital nerve block with 0.25% bupivacaine administered at the end of surgery in postoperative pain relief after cleft lip repair. Forty ASA I-II children were randomly divided into 2 groups. Group I received 1.5 mL 0.25% bupivacaine and group II received 1.5 mL saline. FLACC scores of the patients in the recovery room in group I were 4 times less than in group II (P = 0.001) and in the first 4 hours postoperatively were apparently less in group I (P = 0.001). Mean time to first paracetamol requirement was longer in group I (P = 0.001). Total paracetamol consumption was lower in group I (P = 0.001). None of the patients required rescue tramadol in group I, whereas all patients in group II needed. In group I, parent satisfaction scores were higher (P = 0.001). Vomiting incidence was higher in group II (P = 0.028). Bilateral extraoral, infraorbital nerve block administered at the end of surgery provides satisfactory analgesia with high parental satisfaction and lower complication rates and reduces rescue analgesic consumption in patients undergoing repair of cleft lip.

Background: In this prospective, randomized study, we evaluate the postoperative analgesic effect of lornoxicam after myomectomy operations., Material-Method: Forty ASA I-II patients scheduled for myomectomy operation were enrolled to this study. Patients were randomly divided into two groups and epidural block was performed with 0,75 % ropivacaine. After the operation, morphine Patient Controlled Epidural Analgesia (PCEA) combined with placebo (saline 2 ml iv) and morphine PCEA combined with lornoxicam 8 mg iv were administered to patients in Group I and Group II, respectively. Pain was assessed at the 0,1st, 2nd, 4th, 6th, 8th, 12th and 24th hours postoperatively. Chi-square and student's t tests were used for statistical analysis., Results: VAS( Visual Analog Scale) scores were higher in Group I than Group II at 2nd, 4th, 6th and 24th hours. Total morphine consumption was 10.45+/- 4.03 in Group I and 4.25 +/- 1.74 in Group II., Conclusion: Single dose iv lornoxicam is a safe and an effective treatment option of post-myomectomy pain as it produces effective analgesia, reduces morphine consumption and does not increase the side effects.

Background: We investigated the protective effects of IV anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury., Methods: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with propofol in Groups 1 and 3 and with thiopental in Groups 2 and 4 during the experiment. All animals developed intestinal ischemia after occlusion of the superior mesenteric artery for 30 min. Reperfusion was induced by removal of the microvascular clamp and was allowed to continue for 120 min. The animals in Groups 3 and 4 were given verapamil 10 min before reperfusion. Liver and ileum samples were taken for measurement of malondialdehyde (MDA) and histopathologic examination before ischemia and 30 and 120 min after reperfusion. Blood samples were also obtained for measurement of plasma tumor necrosis factor-alpha and interleukin-6 levels., Results: Gut ischemia/reperfusion-induced significant increases in MDA contents of liver and gut and serum cytokines, consistent with histopathologic injury scores. Propofol effectively stabilized the MDA levels and decreased the tissue injury scores of the liver and gut. Tumor necrosis factor-alpha and interleukin-6 levels increased less in the propofol groups than in the thiopental groups. There was no additive preventive effect of verapamil on propofol. The addition of verapamil to thiopental was effective in decreasing the serum cytokines and liver MDA content., Conclusion: Propofol may offer advantages by inhibiting lipid peroxidation and inflammatory cytokine production in an animal model of gut ischemia/reperfusion-induced liver injury.

Psychological status of patients during epidural and intravenous (i.v.) morphine administration are not known enough. It's known that after administration of morphine epidurally and intravenously plasma concentrations are similar but the concentrations in cerebrospinal fluide are different. The effects of two postoperative analgesia treatment regimens on the psychological and mental functions of the elderly after major orthopedic surgery were investigated in this randomized, blinded study. Morphine was used epidurally in Group E and intravenously in Group IV with patient controlled analgesia method for postoperative analgesia treatment. All patients were assessed for psychological status the day before surgery and 2 days after surgery using the Brief Symptom Inventory (BSI). The results of the BSI were assessed with the Global Severity Index (GSI). Nine subscales were also derived: depression, somatization, obsessive-compulsive, anxiety, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, and psychoticism. There was not significant difference between the groups for preoperative and postoperative GSI results (p>0.05). Only interpersonal sensitivity subscale results in Group i.v. were decreased compared to the baseline (p<0.001). Preoperative BSI and submeasurement test scores revealed no correlation with total morphine consumption in both groups (p>0.05). Mental changes like agitation, time and place disorientation were seen equally in both groups. This study showed that after epidural and intravenouse morphine administration, no psychologycal changes were observed in the postoperative period compared with baseline. Patients who received morphine intravenously were showed less interpersonal sensitivity in the postoperative period.

In total knee replacement operation, patients have a severe pain in the postoperative period. Because of side effects of opioids, multiple postoperative pain treatment regimens are more suitable in these elderly patients. In this double-blind, randomized, placebo controlled study, the effect of lornoxicam administration (32 mg/48 hour) on morphine consumption and drug-related side effects were investigated in elderly patients undergoing total knee replacement. Group M (n=23) and Group L (n=23) received morphine with patient controlled analgesia (PCA) device postoperatively. Additionally Group L received lornoxicam 16 mg intravenously 15 minutes before surgery and 8 mg at postoperative 12th and 24th hours. Morphine consumption in Group L were significantly lower than in Group M at 2, 3, 6, 8, 24, 36 and 48th postoperative hours (p<0.05). At the end of 48th hour mean total morphine consumptions (mean+/-SD) for Group M and Group L were 63.70+/-15.70 mg and 34.60+/-16.32 mg, respectively. AUC (area under the curve) Morphine 0-48h in Group M was 59+/-13 and in Group L it was 30+/-13 (p<0.001). Incidence of side effects in Group M were 60% and 25% in Group L (p<0.05). In Group M, 8 patients (40%) experienced nausea and 3 (15%) patients experienced itching where as in Group L, 3 patients (15%) experienced nausea, 1 patient (5%) itching, 1 patient (5%) dry mouth. Lornoxicam administration in total knee replacement is associated with decreased morphine consumption for postoperative analgesia and fewer side effects.

Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375% ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 mll of ropivacaine 0.375%. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and postoperatively had a PCA pump programmed to deliver morphine. VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0, 1, 2, 3, 4, 6, 8 postoperative hours were significantly lower in group R in resting position (p<0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ? 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p<0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine 0.375% provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.

Background: Bacterial translocation (BT) occurs after thermal injury and may result from an ischemic intestinal insult. The aim of the study was to investigate the effects of ketamine and propofol as anesthetic agents on BT in an animal model of burn injury., Methods: Sixty male Wistar Albino rats were randomly assigned to six groups of 10 rats each. Anesthesia was induced and maintained with ketamine in groups 1, 2 and 3 and with propofol in groups 4, 5 and 6 during 6 h. Groups 2, 3, 5 and 6 received 30% total body surface area (TBSA) third-degree burns. Groups 1 and 4 had no burn injury. Then, they were allowed to recover from the anesthesia at the end of 6 h. Mean arterial pressure (MAP) was monitored continuously and maintained within 10% of baseline (before burn injury) levels in all animals. Animals in groups 3 and 6 had a laparotomy to obtain a tissue sample from the terminal ileum for determination of intestinal lipid peroxidation by-product malondialdehyde (MDA) before (baseline) and 6 and 24 h after burn injury (ABI). So these animals were not included in the BT studies. At postburn 24 h, animals in groups 1, 2 and 4, 5 were sacrified and samples were taken from the mesenteric lymph nodes (MLN), liver and spleen for bacteriologic cultures., Results: The incidence of BT was found to be significantly higher in group 2 than in all the other groups. Bacterial translocation incidence of group 5 was not significantly different from that of groups 4 and 1. Group 5 was associated with a significantly reduced number of enteric organisms per gram of tissue compared to group 2. Baseline MDA contents of groups 3 and 6 were similar. Ileal MDA levels were increased in group 3, but there were no significant changes in group 6 at 6 and 24 h ABI compared to baseline., Conclusion: Our results suggest that propofol as an anesthetic agent may prevent BT by scavenging reactive oxygen species and inhibiting lipid peroxidation in an animal model of burn injury.