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Costoclavicular brachial plexus block has been described recently as a new technique in adults and pediatric patients. In this study, we aimed to compare the supraclavicular and costoclavicular approaches, which are claimed to be effective and practical in pediatric patients.Sixty children were randomized to receive supraclavicular (SC group) or costoclavicular (CC group) brachial plexus blocks prior to surgical incision. Block performance times were recorded as the primary outcome. Procedural features (ideal brachial plexus cord visualization/needle pathway planning time, needle tip/shaft visualization difficulty, number of needle maneuvers, requirement of extra needle maneuvers due to insufficient local anesthetic distribution) and postoperative pain-related data (sensorimotor block intensities, Wong-Baker and FLACC pain scores and analgesic requirements) were also evaluated. To observe the tendency toward respiratory complications, ultrasonographic diaphragm movement amplitude (with M-mode) and diaphragm thickness (with B-mode) were measured postoperatively.A total of 56 patients were included. Block performance times [70(7-97) vs. 115(75-180) s] were significantly lower in the CC group (p 0.01). The block success rates did not differ (p 0.05). The incidence of hemidiaphragm paralysis was 44% in the SC group (p 0.001), and inspiratory diaphragm thickness was significantly lower (p 0.01). None of CC group patients experienced hemidiaphragm paralysis. All other parameters were comparable (p 0.05).Although costoclavicular block did not show superiority in pain management, the block performance was perceived as more practical than supraclavicular block. We believe that costoclavicular brachial plexus block stands as a good option in upper extremity surgeries with the advantages of shorter block performance time and reduced ipsilateral hemidiaphragm paralysis risk in pediatric patients.

Quadratus lumborum block (QLB) is a new fascial plane block that may be helpful for laparoscopic surgeries. In this present study, we aim to evaluate the analgesic efficacy of QLB in laparoscopic living related donor nephrectomy (LLRDN) applied continuously via a catheter that was placed under laparoscopic vision by the surgeon. Following the approval of the Clinical Research Ethics Committee of Istanbul University, Istanbul Medical Faculty (2019/1552), 9 study (Group QLB) and 26 control (Group M) patients that underwent LLRDN were enrolled in this retrospective study. All donors underwent left nephrectomy via transperitoneal laparoscopic approach. An epidural catheter was placed between the QL and psoas major (PM) fascial plane intraoperatively by the surgeon under laparoscopic direct vision, and bupivacaine 0.25% 20 mL was injected through the catheter. After the operation, for group QLB, we used a continuous infusion of bupivacaine 0.1% 7 mL/h over 24 hours. Group M patients received intravenous morphine patient controlled analgesia for 24 hours, postoperatively. Pain scores, total morphine consumption, and complications during the first 24 hours after surgery were recorded. During the first postoperative 24 hours, morphine requirement decreased by more than 70% in Group QLB (Group QLB: 5.11 ± 1.16 mg vs Group M: 16.8 ± 7.1 mg) (P.0001). Postoperative Numeric Rating Scale (NRS) values at the 45th minute and first hour were both significantly lower in Group QLB than Group M (P.01). This preliminary report showed that QL catheter placement technique provides good postoperative analgesia in patients undergoing LLRDN. However, further randomized controlled studies with extended patient numbers are required to test the efficacy of the technic.

Background: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. Methods: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg-1 bupivacaine as either 0,25% (0,4 ml.kg-1) (Group 1) or 0,125% (0,8 ml.kg-1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with an intercostoiliac approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy and is assessed by postoperative FLACC behavioral pain assessment score at 15’, 30’, 45’, 1h, 2h, 6h, and 24h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients’ parents and the surgeons. Results: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6thhour. No local or systemic complication or side effect related to anesthesia or surgery was reported. Conclusion: TAPB using 1 mg.kg-1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. TAPB is an effective analgesic technique for children undergoing inguinal hernia repair.

Ultrasound guided caudal epidural block (CEB) and transversus abdominis plane block (TAPB) are two techniques which are used for pain management after inguinal hernia surgeries (IHR). CEB is accepted as gold standard for lower abdominal surgeries while TAPB is more popular.It is aimed to compare ultrasound guided CEB and TAPB for postoperative pain scores, additional analgesic requirement and chronic pain development in pediatric bilateral open IHR.Seventy patients aged 1-7 years undergoing bilateral open IHR were included in this prospective, randomized, double-blinded study. Patients were randomized into group T (Bilateral TAPB) and group C (CEB). Postoperative FLACC (Face, Legs, Activity, Cry, Consolability) scores were evaluated for pain density. Additional analgesic requirement, length of hospital stay was also recorded. Chronic pain is evaluated within a subgroup by using "revised Bieri faces pain scale" in the postoperative second month.Postoperative 15th, 30th, 45th min, first, second hour FLACC scores were similar in both groups (P 0.05). In group C, FLACC scores at postoperative sixth and 24th were significantly higher than group T (1 (0-5) vs 0 (0-2); 1 (0-3) vs 0 (0-2), respectively; P 0.001). Additional analgesic requirement in the postoperative 24 h was found to be statistically higher in Group C (56.7%) than in Group T (20%) (P 0.01). Chronic pain development did not differ between the groups (P 0.05). Length of hospital stay was found to be shorter in patients in Group T compared to patients in Group C [10 (5-14) vs 16 (5-18) hours, respectively; P 0.01)].Our results exhibited that TAPB and CEB for bilateral IHR have similar early analgesic efficacy in children. However; CEB patients experienced higher FLACC scores at the postoperative sixth and 24th hours, and the need for additional analgesics was higher and the length of hospital stay was longer comparing to TAPB. Of note, chronic pain was not observed in any of our subgroup patients (n = 21) who are older than four years.For bilateral IHR, US-guided CEB and TAPB have similar analgesic efficacy in the first six hours, postoperatively, However, TAPB appears to be slightly superior than CEB in terms of subacute pain and length of stay which is still not clinically distinctive.

Introduction Early diagnosis of rejection in kidney transplant (KTx) recipients is of paramount importance for long-term graft survival. Cytokines play an important role in rejection via activating T cells. Neutrophil accumulation in the graft indicates cell-mediated rejection. Cellular infiltration is mediated through chemoattractant factors. The aim of this study was to investigate the relationship between graft function and serum levels of interleukin 2 (IL-2) and interleukin 8 (IL-8) in KTx. Method Sixty-five patients undergoing KTx were enrolled in the study. Serum samples of IL-2 and IL-8 were collected the day before the operation, on postoperative days 1 and 7 day, and during the first and third month after the onset of rejection. The enzyme-linked immunosorbent assay method was used to determine the IL-2 and IL-8 values. Results A total of 9 (13.8%) patients had rejection documented on biopsy samples. Fifty-six patients had stable graft function (SGF). IL-2 and IL-8 values before KTx of both the rejected and SGF patients were not statistically different. Univariate analysis revealed that IL-2 and IL-8 were correlated with rejection (P = .046, P = .015). IL-8 levels were higher in the rejection group compared to the SGF group on the seventh day and first month postoperatively (P = .023, P = .038). The rejection group maintained higher levels of IL-8 for 11 days (range: 7–30) compared to the SGF group (P = .002) and the IL-8 levels correlated with serum creatinine levels (r = 0.621, P = .001). IL-2 levels were higher in the rejection group on days 1 and 7 compared to the SGF group (P = .042, P = .031). IL-2 and IL-8 levels were correlated with low eGFR in the third month in the rejection group (r = 0.421, P = .037; r = 0.518, P = .008). Conclusion Determining the cytokine levels in the early post-KTx period may be helpful in tailoring immunosuppressive regimens in patients with a risk of rejection.

INTRODUCTION AND OBJECTIVE:Kidney transplantation (KTx) has been established as the optimal renal replacement therapy for end-stage renal disease, with a longer life expectancy, better quality of l...

BACKGROUND Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention. METHODS Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesia was combined with GA. Patients' cognitive function was assessed before and one week after surgery using a neuropsychological test battery. POCD was defined as a drop of one standard deviation from baseline on two or more tests. RESULTS A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups, except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p

Objective Surgical stress combined with general anaesthesia (GA) suppresses the immune system and leads to cancer cell growth and premature metastasis in major oncological interventions. Epidural analgesia decreases the need for inhalation agents and opioids during surgery by suppressing sympathetic and neuroendocrine responses in the postoperative period. This study aimed to compare the effects of combined general/epidural anaesthesia (GEA)+patient-controlled epidural analgesia (PCEA) and GA+IV patient-controlled analgesia (PCA) on serum tumour necrosis factor-alpha TNF-α), interleukin-1 beta (IL-1β) and interferon-gamma (IFN-γ) levels in patients undergoing radical cystectomy. Methods Sixty-five patients were enrolled in this prospective study. Patients were randomly enrolled to the GEA group, i.e., combined GEA+ PCEA (0.1% bupivacaine+1 μg mL-1 fentanyl), and the GA group, namely combined GA+IV PCA (0.03 mg mL-1 morphine). To evaluate the cytokine response, blood samples were collected at preoperative, postoperative 1st and 24th hours. Results There was no statistically significant difference in serum TNF-α, IL-1β and IFN-γ levels between groups GA and GEA at preoperative and postoperative 1st hour and 24th hour. Total remifentanil consumption was significantly lower and length of hospital stay was significantly shorter in the GEA group than in the GA group (p Conclusion There is no difference between two anaesthesia methods in terms of serum cytokine levels; however, combined GEA+PCEA technique appeared to be superior to GA+IV PCA because of lower intraoperative narcotic analgesic consumption and shorter hospital stay.

Most patients have serious digestive complications after renal transplantation. Therefore, it is important to protect gastrointestinal function to improve the survival rate of transplant patients. Proton pump inhibitors (PPIs) such as lansoprazole and rabeprazole are widely administered to renal transplant patients with mycophenolic acid (MPA) in the perioperative period. PPIs are metabolized by cytochrome (CYP) 2C19 enzymes. Mycophenolate sodium (MYF) and mycophenolate mofetil (MMF) have been used in immunosuppression. Clinically relevant drug-drug interactions have been described between immunosuppressive drugs. In the present study, we investigated the drug interaction between MPA and lansoparazole or rabeprazole and the impact of CYP2C19 polymorphisms on these drug interactions after renal transplantation.A total of 125 renal transplant patients taking MPA derivatives between 2012 and 2016 were included in this study. The 125 patients were divided into 6 groups: MMF/tacrolimus/steroid together with lansoprazole or rabeprazole; MYF/tacrolimus/steroid together with lansoprazole or rabeprazole and without PPI. The single nucleotide polymorphisms of CYP2C19 were determined by the polymerase chain reaction-restriction fragment length polymorphism. Plasma concentrations of MPA were measured by cloned enzyme donor immunoassay. Clinical parameters such as incidence of delayed graft function and acute rejection, the rate of change of serum creatinine, toxicity, and gastrointestinal adverse effects were analyzed retrospectively.The mean concentrations of MPA in the MYF group were higher than those in the MMF group. The mean dose-adjusted blood concentration of MPA coadministered with lansoprazole was lower than that of MPA with rabeprazole or without PPI in MMF and MYF groups (P .05). In patients with the CYP2C19*2/*2 genotype, the mean concentrations of MMF with lansoprazole were significantly lower than those with rabeprazole with MMF or without PPI (P .05). Gastrointestinal side effects were significantly higher in MMF with lansoprazole group than in MYF with lansoprazole group (P .05). However, no differences were found according to genotype distribution in all groups (P.05).Polymorphisms in CYP2C19 are related to the metabolic oxidation of drugs to varying degrees. Both genetic and clinical factors in pharmacokinetics may help to make further progress toward individualized therapy to yield maximum efficacy with minimal side effects.

Objectives Renal transplant is the treatment of choice for patients with end-stage renal disease. Ischemiareperfusion damage is a major cause of early renal dysfunction during the perioperative period. Ischemic hypoxic damage increases local inflammation, leading to secretion of cytokines and chemokines. Anesthetic conditioning is a widely described strategy to attenuate ischemia-reperfusion injury. Here, we compared the effects of desflurane and sevoflurane on serum proinflammatory cytokines and urine chemokines in living-donor kidney transplant recipients. Materials and methods Eighty donor-recipient couples were included in this randomized study. Anesthesia maintenance was provided by desflurane or sevoflurane. Patient demographic characteristics, immunologic data, clinical data, and hemodynamic parameters were recorded. Tumor necrosis factor α, interleukins 2 and 8, chemokines 9 and 10, and serum creatinine levels were studied from pretransplant, posttransplant days 1 and 7, and posttransplant months 1 and 3 sample results. Estimated glomerular filtration rates were calculated. Acute rejection episodes and graft loss within 6 months posttransplant were recorded. Results Seventy donor-recipient couples completed the study. There were no significant differences in demographic, immunologic, and clinical data between desflurane and sevoflurane groups (P > .05). Tumor necrosis factor α, interleukin 2, chemokine 9, and chemokine 10 levels were similar preoperatively and on postoperative days 1 and 7 and months 1 and 3 (P > .05). Serum interleukin 8 levels were significantly higher in patients who received sevoflurane on postoperative days 1 (P = .045) and 7 (P = .037). No significant differences were detected in serum creatinine and estimated glomerular filtration rate between groups (P > .05). No graft loss occurred within 6 months posttransplant. Conclusions Although sevoflurane seemed to produce higher interleukin 8 levels posttransplant, both desflurane and sevoflurane had similar effects on posttransplant kidney function. We suggest that both agents have protective effects on ischemic-reperfusion damage in living-donor kidney transplant recipients.

Background: Laparoscopic partial nephrectomy, which minimizes renal function loss due to its nephron sparing nature, has become a standard technique among many experienced centers worldwide for surgical treatment of localized kidney tumors. Although partial nephrectomy will remain the gold standard, we need to improve perioperative management and surgical method to prevent postoperative acute kidney injury. Aims: To demonstrate the frequency of the development of postoperative acute kidney injury following laparoscopic partial nephrectomy in patients with healthy contralateral kidney and determine the early predictive effects of serum neutrophil gelatinase-associated lipocalin on ischemia-reperfusion injury and its association with warm ischemia time. Study Design: Cross-sectional study. Methods: Eighty patients were included. We analyzed tumor size, operating time, duration of anesthesia, and warm ischemia time. Serum samples were obtained for measurement of serum creatinine, estimated glomerular filtration rate, and neutrophil gelatinase-associated lipocalin level preoperatively, at the postoperative 2nd hour, and on postoperative days 1 and 2. We used receiver operating characteristic curve for determining the cut-off point of neutrophil gelatinase-associated lipocalin to detect postoperative acute kidney injury. Correlation analysis was performed using Spearman’s test. Results: Twenty-seven patients developed acute kidney injury on postoperative day 2, and the neutrophil gelatinase-associated lipocalin level increased significantly at the postoperative 2nd hour in the acute kidney injury group (p=0.048). For a cut-off of 129.375 ng/mL neutrophil gelatinase-associated lipocalin, the test showed 70.0% sensitivity and 68.3% specificity for the detection of acute kidney injury at the postoperative 2nd hour. For a cut-off of 184.300 ng/mL neutrophil gelatinase-associated lipocalin, the test exhibited 73.3% sensitivity and 63.3% specificity for the detection of acute kidney injury on postoperative day 1. A significant correlation was found between warm ischemia time and neutrophil gelatinase-associated lipocalin level at the postoperative 2nd hour (r=0.398, p=0.003). The creatinine values were significantly higher and the estimated glomerular filtration rates were significantly lower on postoperative days 1 and 2 in the acute kidney injury group compared with those in the non-acute kidney injury group (p

Background: There are differences in pharmacokinetic of mycophenolic acid among individuals. The UGT1A9 enzyme is of special interest since it is the main enzyme involved in the glucuronidation of MPA. Single nucleotide polymorphisms in the UGT1A9 gene may be responsible for individual differences in the pharmacokinetics of MPA. The aim of this study was to explain MPA pharmacokinetics in UGT1A9 1399 C > T polymorphisms in Turkish renal transplant patients. Patients and methods: One hundred and twenty-five living-donor transplant recipients and 100 healthy control subjects underwent UGT1A9 1399 C > T genotyping using polymerase chain reaction–restriction fragment length polymorphism. Concentrations of MPA were determined with Cloned Enzyme Donor Immunoassay (CEDIA). Besides that, all the patients were monitored for acute rejection and graft function during the study period. Results: The UGT1A9 1399 C > T CC, CT, and TT genotype frequencies among patients were, respectively, 68.0%, 23.2%, and 8.8%. The CC, CT, and TT genotype frequencies among controls were, respectively, 63.0%, 23.0%, and 14.0%. There was no significant difference between patients and controls (p = .480, p = .999, p = .286, respectively). At first month, respectively, through blood concentrations of MPA were significantly higher in UGT1A9 1399 C > T TT carriers than in CT and CC carriers (p = .046). The doses for these patients were lower at first month (p = .021). Acute rejection episodes were not associated with the CC vs CT or TT genotypes (p = .064). Conclusions: Our results demonstrated a correlation between the UGT1A9 1399 C > T polymorphism and MPA pharmacokinetics among renal transplant patients. Determination of UGT1A9 polymorphism may help to achieve target of MPA blood concentrations.

Neurofibromatosis type 1 is an autosomal dominant condition characterized by cutaneous and/or plexiform neurofibromas and hyperpigmented cafe-au-lait spots. It affects multiple endocrine and visceral organs and can be associated with several difficulties such as potential airway (ventilation/intubation) problems, abnormal spinal anatomy, and peripheral neurofibromas. Therefore, anesthesia technique selection becomes more of an issue in terms of avoiding complications and decreasing morbidity and mortality. In the present case, we describe the use of ultrasound and the successful performance of supraclavicular brachial plexus block for surgery on the arm and forearm in a patient with neurofibromatosis type 1.

We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day.Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient-controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue.Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p0.05).Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours. ClinicalStudys.gov: (NCT02622893).

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p

Background: Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV) magnesium sulphate (MgSO4) therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. Aims: The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. Study Design: Case-control Study. Methods: Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C) and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg). Following blood and cerebrospinal fluid (CSF) sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 µg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. Results: Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015). Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p

OBJECTIVES This prospective study aims to compare maternal and neonatal effects of spinal and general anesthesia for elective cesarean section. METHODS Term parturients receiving routine spinal (Group SA, n=95) or general (Group GA, n=93) anesthesia and standard postoperative analgesia for elective cesarean section were included in this study. Operation time, incision-hysterotomy (TS-H) and hysterotomy-umbilical cord clamping (TH-U) intervals, oxytocine requirement, intraoperative fluids, ephedrine requirement, incidence of hypotension, time to first analgesic requirement (Tanalg), pethidine consumption, adverse events, time to first breastfeeding, oral food intake (TOI), flatulence (TF), defecation (TD), mobilization, and postoperative hospital stay were compared between the groups. Newborn Apgar scores, umbilical venous blood gas analysis, incidence of hypoglycemia, nutritional support, phototherapy and ventilatory support were also analyzed. RESULTS Spinal anesthesia was associated with longer TS-H and TH-U durations, lower oxytocine requirements, higher incidence of hypotension, increased ephedrine and fluid consumption, and delayed Tanalg. Furthermore, TOI, TF, TD and postoperative hospital stay was shorter in patients given spinal anesthesia when compared with patients given general anesthesia (48h vs. 52 h, respectively; p

BACKGROUND This study investigates whether ultrasound-guided thoracic paravertebral blocks would improve postoperative analgesia in patients undergoing bilateral reduction mammaplasty. METHODS After obtaining ethics committee approval, data of 70 patients who underwent bilateral reduction mammaplasty were reviewed. Sixty-four patients' data were evaluable; 30 were in the general anesthesia group and 34 were in the thoracic paravertebral block group. Data such as time to first pain, intraoperative fentanyl requirement, postoperative numeric rating scale scores, number of patients who required tramadol in the postoperative care unit, and rescue analgesic consumption through the first 2 postoperative days were analyzed. RESULTS Time to first pain was 311 minutes (range, 0 to 1605 minutes) and 20 minutes (range, 0 to 120 minutes) in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Fentanyl requirement was 52.94 ± 11.94 µg and 115 ± 29.79 µg in the thoracic paravertebral block and general anesthesia groups, respectively (p < 0.001). Numeric rating scale scores were lower in the thoracic paravertebral block group through the first 2 postoperative hours (p < 0.001), and only two of 34 patients required tramadol in the postoperative care unit (p < 0.001). On postoperative day 1, both metamizole sodium (p < 0.001) and paracetamol (p = 0.018), and on day 2, only metamizole sodium (p < 0.001) consumption was lower in the thoracic paravertebral block group. CONCLUSION Adding ultrasound-guided thoracic paravertebral blocks to general anesthesia postponed time to first pain and reduced analgesic consumption in patients undergoing bilateral reduction mammaplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

Objective: This retrospective, case-controlled study compares the operative outcomes of retroperitoneoscopic nephrectomy (RN) and transperitoneal laparoscopic nephrectomy (TLN) in obese patients. Materials and Methods: A total of 202 operations, including 114 radical and 88 simple nephrectomies were identified from our prospectively collected institutional laparoscopic nephrectomy database. Patients were stratified into 3 groups according to the World Health Organization’s body mass index (BMI) classification: normal (Group 1-BMI

With an experienced laparoscopic team of surgeons, laparoscopic nephrectomy may be performed safely., Background and Objectives: To report our experience with laparoscopic nephrectomy (LN) in patients undergoing hemodialysis compared with normal counterparts. Methods: Seventeen patients (20 renal units, Group 1) undergoing hemodialysis underwent LN, which was indicated due to nonfunctioning kidney in 17 and suspected malignancy in 3 renal units. Radical nephrectomy (RN), simple nephrectomy (SN), and simple nephroureterectomy (SNU) were performed in 3, 9, and 8 cases, respectively. For comparison, 101 patients (Group 2) without CRF (chronic renal failure) who had undergone LN were evaluated. In this group, RN, SN, SNU and radical nephroureterectomy (RNU) were performed in 48, 41, 8, and 4 patients, respectively. Results: The mean age (36.9±13.1 vs. 48.7±19.4yr, P=0.002) and BMI (22.1±4.8 vs. 26.2±5.1kg/m2, P=0.001) were lower in Group 1, whereas ASA (physical status score of American Society of Anesthesiologists) score (2.8±0.4 vs. 1.5±0.7, P

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 μg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 μg (group R, n=26) or plain bupivacaine 13 mg with fentanyl 20 μg (group B, n=26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher. The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P 0) was shorter in group R (139±39 minutes vs group B 182±46 minutes, P We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 μg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 μg for spinal anaesthesia in lower abdominal surgery.

Background In this prospective, clinical study we tested the hypothesis whether two different doses of spinal administered bupivacaine and accordingly, two different levels of spinal anaesthesia can affect the dose requirement of propofol during BIS guided sedation. Methods Fifty women undergoing vaginal hysterectomy (high spinal group, HS) or transvaginal tape (TVT) procedure for urinary incontinence (low spinal group, LS) under spinal anaesthesia were enrolled to the study. In group HS, 17.5 mg and in group LS, 7.5 mg of hyperbaric bupivacaine were given intrathecally. After 15 min to obtain the appropriate level of spinal anaesthesia, propofol infusion was started at a rate of 100 μg kg−1 min−1 to reach a BIS level of less than 75 (onset time), and titrated to maintain the BIS value between 65 and 75. Propofol infusion was stopped 45 min after placing the spinal to measure the time to reach a BIS level of 90 (recovery time). Results Median anaesthetic level was T3 (T1–4) in the HS group and T10 (T9-11) in the LS group. In both the HS and the LS groups, onset time was 226 (47) vs 273 (48) s (P=0.001), recovery time was 234 (47) vs 202 (56) s (P=0.03), total dose of propofol was 2.17 (0.43) vs 3.14 (0.56) mg kg−1 (P Conclusion A high spinal block obtained with hyperbaric bupivacaine 17.5 mg was associated with a faster onset, delayed recovery and lower doses of propofol sedation compared with a low spinal block with 7.5 mg of the same drug.

Objective: To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement. Design: Prospective clinical investigation. Setting: University hospital. Participants: Thirty-four adult patients. Interventions: After administration of midazolam, 0.025 mg/kg, and fentanyl, 0.5 to 1 μg/kg, surgery was performed under topical infiltration with 1% lidocaine. In group I (GI) (n = 17), patients received thiopental by slow injection and patients in group II (GII) (n = 17) received propofol before induction of ventricular fibrillation (VF). Measurements and main results: Patients received 4.1 ± 1.4 mg of midazolam, 114 ± 34 μg of fentanyl, and 280 ± 78 mg of thiopental in GI; and 4.6 ± 1.7 mg of midazolam, 119 ± 62 μg of fentanyl, and 147 ± 40 mg of propofol in GII (p > 0.05). Hemodynamics did not show significant differences between the groups at any recording time. Average time needed to regain the pretest sedation level was 16.4 ± 8.8 minutes in GI and 10.9 ± 5.5 minutes in GII (p = 0.03). Time required to achieve a score of 10 using a modified Aldrete score was 26.4 ± 9.3 minutes in GI and 17.4 ± 4.9 in GII (p = 0.001). Seven patients in GII (41%) and 1 patient in GI (6%) became hypotensive after DFT (p = 0.04). Conclusions: Deepening the sedation level by slow injection of thiopental or propofol before DFT provided satisfactory conditions during brief episodes of VF. Delay in recovery of arterial pressure after DFT with propofol and delay in arousal and discharge of patients with thiopental are major disadvantages of the regimens.

Background and objectives: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. Methods: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients’ internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5 min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4) min. Results: There was a significant decrease between T0 and T1 in heart rate (80.5 ± 11.6 vs. 75.9 ± 14.4 beats/min), MAP (105.8 ± 21.9 vs. 78.9 ± 18.4 mmHg) and PSI (88.5 ± 8.3 vs. 30.3 ± 9.7) (all p

Cytokines are essential for the control of the immune response as most of the immunosuppressive drugs target cytokine production or their action. The calcineurin inhibitors (CNIs) cyclosporine (CsA) and tacrolimus are immunosuppressive drugs widely used after renal transplantation to prevent allograft rejection. They are characterized by large interindividual variability in their pharmacokinetics; therefore, monitoring their blood concentrations is important to predict their optimal dosage following transplantation. Calcineurin inhibitors inhibit the phosphatase activity of calcineurin, thereby suppressing the production of other cytokines such as transforming growth factor (TGF-β), tumour necrosis factor-α (TNF-α), interleukin (IL)-6, IL-2, and IL-4. The aim of this study was to investigate the relationship between polymorphisms of cytokines and blood concentrations of CNIs in renal transplant patients. The study included 53 CsA-treated renal transplant patients and 37 tacrolimus-treated renal transplant patients. Cytokine polymorphisms were analysed using polymerase chain reaction (PCR) sequence-specific primers with the cytokine CTS-PCR-sequence-specific primers Tray Kit; University of Heidelberg. Blood concentrations of CNIs were determined with Cloned Enzyme Donor Immunoassay (CEDIA) method. Patients with TC genotype of TGF-β at codon 10 had lower CsA blood concentrations than the TT and CC genotypes (P = 0.005) at 1 month in CsA treatment group. The ratio of blood concentration/dose of CsA for patients with TGF-β1-codon 10 TC genotype was lower than for patients with TT, CC genotypes, and the dose given to these patients was higher in the first month (P = 0.046). The ratio of blood concentration/dose of CsA for patients with IL-2-330 GG genotype was higher than for patients with GT, TT genotypes, and the dose given to these patients was lower at first month and sixth months (P = 0.043, P = 0.035 respectively). The tacrolimus blood concentrations were significantly higher in patients with the genotype GG of IL-2-330 (P = 0.012) at the third month. Patients who had the TC genotype TGF-β codon 10 had lower CsA blood concentrations and this group had higher acute rejection (P = 0.033). These results suggest that the genotyping for TGF-β-codon 10, IL-2-330 and IL-6-174 polymorphisms may help individualized immunosuppressive dosage regiments.

In the present study, we applied the method of the multi-center Prospective Evaluation of a Risk Score for postoperative pulmonary Complications in Europe (PERISCOPE) study, which was designed to predict postoperative complications and funded by the European Society of Anaesthesiology, to patients in our institution with the aim of prospectively analyzing the postoperative risk factors of pulmonary complications.One hundred patients over 18 years of age who had emergency or elective non-thoracic or non-obstetric surgery under general anaesthesia or neuraxial blocks were included in the study. Collected data regarding the preoperative and postoperative period were filled in separate forms for all patients.A total of 11 patients developed pulmonary complications. We observed respiratory failure in 8 patients, pleural effusion in 3 patients, atelectasis in 5 patients, bronchospasm in 3 patients, and pneumothorax in 1 patient. In the univariate logistic regression model, patient age, gender, weight, rate of preoperative respiratory symptoms, cough test results, American Society of Anesthesiology (ASA) score, and the duration of surgery did not significantly increase the complication risk (p0.05). However, in the univariate logistic regression model, the presence of respiratory symptoms increased the risk for complications approximately 5.34-fold (p=0.014). There was an increase in the possibility of complications in parallel with the increase in the duration of postoperative hospital stay (p=0.012). More respiratory symptoms (p=0.019) and longer hospital stay (6.5 vs. 3.5 days respectively, p=0.029) were recorded in patients with postoperative pulmonary complications.Considering patients undergoing non-thoracic or non-obstetric surgery, the prevalence of postoperative pulmonary complications is higher in patients diagnosed with respiratory symptoms in the preoperative period. These complications significantly extend the length of hospital stay.

Evaluation of In-Hospital Cardiopulmonary Resuscitations at Istanbul This study aimed to investigate cardiopulmonary resuscitations (CPR) performed within the last year at Istanbul Medical Faculty and to determine success rates, to evaluate the factors affecting success rates and to compare outcomes to those previously performed.

Background. In this pilot observational study, we aimed to investigate the effect of preoperative magnesium infusion on laryngospasm frequency and other res-piratory complications in children with respiratory findings undergoing esopha-geal dilatation after the ingestion of caustic substances.Methods. Sixty children between the ages of 2 and 12 scheduled for esophageal dilatation were divided into two groups: the magnesium group (Group M), which consisted of children with respiratory symptoms and who received IV 30 mg/kg magnesium sulfate preoperatively, and the control group (Group C), who received the same volume of saline. Anesthesia was induced with fentanyl, propofol, and miva-curium and maintained using a 60% N2O and 2-3% sevoflurane mixture in oxygen. Demographic and hemodynamic data, as well as the incidence of respiratory com-plications (laryngospasm, bronchospasm, apnea, cough, and desaturation) during the perioperative period were recorded until the time of discharge from the recov-ery room.Results. Demographic data and hemody-namics were similar in the two groups. The laryngospasm, bronchospasm, apnea, and cough incidences were also similar between the groups, although the desatu-ration incidence was lower in Group M than in Group C (p=0.013). The number of complications in total was lower in Group M as well (p=0.008), although the number of children who experienced complica-tions in each group was similar.Conclusion. Prophylactic administration of 30 mg/kg of magnesium to children with respiratory symptoms may decrease the frequency of postoperative respiratory complications in children undergoing es-ophageal dilatation.

In this randomized, double-blind study, the effects of thoracic and lumbar epidural anaesthesia on the induction doses (IDs) and maintenance doses (MDs) of propofol during bispectral index (BIS) guided total i.v. anaesthesia were compared.Fifty-four patients (three groups, n=18 each) undergoing urological surgery in lumbotomy position were studied in Groups T (Th7-8) and L (L3-4), epidural anaesthesia was performed with initial doses obtaining sensorial block at Th4 (sd 1) followed by 7 ml h(-1) infusion; Group C received no epidural anaesthesia intraoperatively. The ID (BIS45) and MD (BIS: 40-50) of propofol and recovery (BIS80) and extubation times were recorded.The volume to obtain a block was significantly lower in Group T than in Group L [10.7 (1.5) vs 14.7 (1.0) ml; P0.001]. ID was significantly higher in Group C compared with that in Groups T and L [2.16 (0.15) vs 1.33 (0.19) vs 1.46 (0.14) mg kg(-1), respectively; P0.001] with no significant difference between Groups T and L. For MD, there were significant differences between all groups [3.82 (0.9) vs 5.8 (1.32) vs 9.21 (0.55) mg kg(-1) h(-1) in Groups T, L, and C, respectively; P0.001]. For recovery and extubation times, Group TGroup LGroup C [1.4 (0.5) vs 3.3 (1.2) vs 8.1 (0.99) min, respectively, P0.001; and 3.4 (0.52) vs 5.8 (1.32) vs 11.4 (1.96) min, respectively; P0.0001].Similar segments blocked with epidural anaesthesia have resulted in similar ID. During maintenance, identical amounts of bupivacaine applied from different levels have resulted in different MD of propofol. The concentration of the epidural anaesthesia appears to play a more important role than the applied amount of the local anaesthetic.