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Background: Hypertension and tachycardia caused by tracheal intubation can be detrimental in hypertensive patients. This study was conducted in order to compare the effects of dexmedetomidine on hemodynamic response to tracheal intubation in hypertensive patients with esmolol and sufentanyl. Methods: Sixty hypertensive patients scheduled for noncardiac surgery under general anesthesia were randomly as-signed to receive one of the three drugs before induction of anesthesia. Groups I, II, and III respectively received esmo-lol (100 mg) dexmedetomidine (1 μg/kg) and sufentanyl (0.25 μg/kg). Heart Rate (HR), systolic (SAP) and diastolic (DAP) arterial pressures were recorded before drug administration (baseline; T1), after drug administration (T2), after induction of anesthesia (T3), immediately after intubation (T4) and 3, 5 and 10 minutes after intubation (T5, T6, and T7, respectively). The mean percentage variations from T1 to T4 were calculated for all variables (HR, SAP and DAP). Thiopental dose, onset time of vecuronium and intubation time were also assessed. Results: No differences were observed between the three groups regarding demographic data (p > 0.05). Median thi-opental dose was significantly lower in Group II (325 mg; range: 250-500) compared to Group I (425 mg; range: 325-500; p < 0.01) and Group III (375 mg; range: 275-500; p = 0.02). The onset time of vecuronium was longest in Group I (245.2 ± 63 s vs. 193.9 ± 46.6 s and 205.5 ± 43.5 s; p < 0.01 and p < 0.05). In Group I, HR significantly decreased after drug administration compared to baseline (83.8 ± 20.4 vs. 71.7 ± 14.8; p = 0.002). Compared to the baseline (90.4 ± 8.4), DAP decreased after induction and remained below baseline values at T5, T6 and T7 (71.3 ± 12.8, 76.2 ± 10.7, 68.9 ± 10.8 and 62.1 ± 8.7, respectively; p < 0.05) in Group II. According to the mean percen-tage variation, a significant reduction in HR was assessed in Group II compared to Group III (-13.4 ± 17.6% vs. 11.0 ± 27.8%; p = 0.003). Increment in SAP was significant in Group I when compared to Group II (9.8 ± 20.9% vs. -9.2 ± 20.2%; p < 0.05). Increment in DAP in Group III was significant compared to Group II (0.07 ± 19.8 vs. 24.5 ± 39.1; p < 0.05). Conclusions: In hypertensive patients, administration of dexmedetomidine before anesthesia induction blunts the he-modynamic response to tracheal intubation and reduces the thiopental dose.

von Recklinghausen disease is a type I neurofibromatosis originating from the nervous system. In this syndrome, there is abnormal deposition of neural tissue in the nervous system, endocrine system, visceral structures, and skin. We report the anesthetic management of a 31-year-old female patient with multiple thorax deformities who was diagnosed as von Recklinghausen disease. The patient was admitted to the Plastic and Reconstructive Surgery Department because of a huge subcutaneous neurofibroma on her right upper extremity. General anesthesia was considered a high risk for this patient on the basis of her laboratory results and physical findings. We planned brachial plexus block with axillary approach under sedation. The subcutaneous neurofibroma was not in contact with the nerve sheath; thus, regional anesthesia was our preference for this particular patient. The anesthetic management of this patient was satisfactory and uneventful, and there were no complications.

Aim: The aim of this study was to determine the effects of low and moderate doses of dexmedetomidine infusions by evaluating hemodynamic and neuroendocrine responses in patients undergoing elective transurethral surgery. Materials and Methods: Fifty patients were randomly allocated to receive 0.45 (Group 1) or 0.6 (Group 2) ?g kg-1 hr-1 dexmedetomidine infusion 10 minutes before induction of anesthesia. Heart rate, blood pressures, ETCO 2 and peripheral oxygen saturation values and parameters of non-invasive cardiac output were monitored. Measurement times were baseline (I), after dexmedetomidine infusion (II), after thiopental induction (III), after intubation (IV) and at 10-minute intervals during desflurane anesthesia. Anesthesia (2L min-1 50% N2O+O2) was maintained with 4-6% desflurane corresponding to a bispectral index (BIS) value of 40-60. Venous blood samples were collected prior to intubation (I), at the 30 th min intraoperatively (II) and after extubation (III) to determine plasma adrenaline and noradrenaline levels. Chi-square, Student's t-test and repeated measures of variance were used for statistical analysis. Results: Two different doses of dexmedetomidine infusion produced similar hemodynamic effects. The cardiovascular and neuroendocrine parameters were suppressed more in Group 2 than in Group 1. Conclusions: These findings suggest that intraoperative 0.45 and 0.6 ?g kg-1 hr-1 doses of dexmedetomidine result in similar intubation, recovery and hemodynamic responses. Cardiovascular and neuroendocrine parameters were suppressed more by the moderate dose of dexmedetomidine. © TÜBİTAK.

PubMed: 19117154 Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 microg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 microg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24+/-4.20 mL for Group-I and 81.1+/-6.44 mL for Group-II, (P

PubMed: 18822693 Aims and background. Cyclin-dependent kinase inhibitors have important roles in the oncogenesis of various tumors including urothelial cancer. The aim of this study was to establish the importance of p57Kip2, a unique cyclin-dependent kinase inhibitor, in the oncogenesis of bladder carcinoma. This article also focused on another cyclin-dependent kinase inhibitor, p27 Kip1, and telomerase enzyme and examined the relationship between these proteins. Material and methods. Thirty-one patients with urothelial carcinomas of the bladder and 7 cases with normal urinary bladder mucosa were included in the study. Immunohistochemical study was performed by monoclonal antibodies of p27Kip1, p57Kip2, and the telomerase subunit (hTERT). All immunohistochemical preparations were evaluated by an immunohistochemical histological score. Results. p57Kip2 and p27 Kip1 expression were seen in all of the cases of normal mucosa. In carcinoma cases, 8 of 31 (25.8%) showed p57Kip2 nuclear positivity and 20 of 31 (64.5%) expressed nuclear p57Kip1. HSCOREs of carcinoma cases showed lower scores of nuclear p57Kip2 and p27Kip1 than normal mucosa, but only HSCOREs of nuclear p57Kip2 (P = 0.001) showed statistical significance. Despite unknown significance, cytoplasmic p57 Kip2 and p27Kip1 were also evaluated. Immunohistochemical analysis showed that carcinomas expressed higher HSCOREs of hTERT than normal mucosa, and there was a significant difference (P = 0.026) between muscle invasive carcinomas and normal mucosa. Conclusions. The data showed that p57Kip2 down-regulation along with p27Kip1 is a well-established feature of urothelial carcinoma. Probably, this down-regulation of cyclin-dependent kinase inhibitors supports the proliferation phase of oncogenesis. In the study, we also showed that hTERT expression was up-regulated in higher stages of urothelial carcinoma.

Introduction: The aim of the present study was to asses the effects of sevoflurane and desflurane as inhalational anaesthetics on heart rate variability, dysrhythmias, QT interval and QT dispersion in patients who will undergo laporoscopic cholecystectomy under general anaesthesia. Material and Methods: 34 patients who will undergo elective laparoscopic cholecystectomy are enrolled in the study. The patients were monitored with Holter device 15 minutes before the anaesthesia induction till 30 minutes in recovery room. Anaesthesia was induced using 4-7 mg kg-1 thiopental sodium, l ?g kg -1 fentanyl and 1 mg kg-1 vecuronium for muscle relaxation. Cases were randomized into 2 groups; Group 1 Sevoflurane, Croup 2 Desflurane. End tidal CO2, O2, N2O were monitorized and ventilation were maintained to Keep EtCO2 between 30-40 mmHg. Minimum, maximum, mean heart rates and heart rate variability parameters included low frequency (LF), high frequency (HF) values which are heart rate variability Parameters, LF/HF ratio, Global Sympathetic Index (GSI), R-R intervals were measured in preoperative, intraoperative periods and 2 nd, 10th and 30th minutes after extubation. Atrial and ventricular dysrhythmias (AES, VES) were determined. QT interval was corrected using Bazett's formula (QTc=QT?RR). QT dispersion was calculated by finding shortest and longest QT interval. Results: Assessing data from Holter Monitor maximum heart rates values were significantly higher in Desflurane group (p=0.049). LF/HF ratio, GSI values were higher in Desflurane group in perioperative period except in induction-extubation events. Maximum R-R intervals in Sovoflurane group in perioperative period were significantly higher. In desflurane group QT intervals were significantly longer and QT dispersion was significantly more frequent. Positive correlation between sympathetic tonus increase and YES was recognized in both groups. Conclusion: In this study sympathetic activation was frequently seen in desflurane group, Severe dysrhythmias did not occur in both groups. Although both desflurane and sevoflurane increased the rate of QT, the increased of QTc and QTd in desflurane anesthesia were significantly higher than sevoflurane anesthesia.

Background and Goal of Study: After the removal of exhaled CO2, rebrcathing of 50% or more of exhaled gases is possible during low flow anaesthesia. The purpose of this study is to compare the thoracic electrical bioimpedancc (TEB) method for hcmodynamic monitoring under low flow and high flow desfluranc anaesthesia. Material and Methods: After Institutional Ethics Committee approval, 40 ASA I-II patients scheduled for elective surgery were included into the study. For all patients, anaesthesia was induced with 1.5 ?g kg-1 fentanyl and 5-7 mg kg-1 thiopcnthal. The trachea was intubated after 0,1 mg kg-1 vecuronium, Patients were randomly divided into two groups to receive low flow (1 L min-1 50% N2O+O2) in group I or high flow (4 L min-1 50% N2O+O2) in group II with 4-6%. Ejection fractions (EF), end-diastolic indexes (EDI), cardiac indexes (CI), stroke indexes (SI) were monitored and recorded with noninvasivc TEB for basal, induction, intubations and 15 min. intervals. The level of anaesthesia was adjusted by the concentration of dnsflurane to achieve a target BIS in the range of 40-60. Postoperative Aldrete Recovery Score (ARS) was recorded. Student-t test and repeated measures of variance were used to statistical analysis. p

Objective: The aim of this study was to assess the effectiveness of preloading with crystalloid and colloid fluids on hypotension following spinal anaesthesia. Method: One hundred ASA Class I-II patients were randomly assigned to the study and divided into five groups. Group I: Lactated Ringer (LR) 1000 mL 30 minutes before spinal anaesthesia, Group II: HES %6 500 mL solution before the procedure, Group III: 500 mL RL before and HES %6 250 mL within 15 minutes after the procedure. Group IV and Group V received RL 500 mL + 500 RL mL, and HES %6 250 mL + HES %6 250 mL respectively, using the same timing protocol. Systolic, diastolic and mean arterial pressures and heart rates were measured at 1 minute intervals in the first 20 minutes and then every 5 minutes. Results: With the exception of the differences in diastolic blood pressures at the 2nd, 3rd, and 5th minutes, there was no difference in arterial blood pressures and heart rates between Group III and IV or Group IV and V. Conclusion: While significant correlation was found between spinal block level and the incidence of spinal hypotension, no difference was observed regarding the type, dosage, and timing of loading solutions before spinal anaesthesia.

Combined sciatic-femoral nerve block was performed in a 48-year-old woman for the removal of a right lateral malleolar lesion. The patient became unconscious at the 12th minute of the block. As vital signs were stable and no additional complication was seen, the operation was carried out and completed. The patient began to respond to painful stimulus, and was conscious and fully oriented. 95 and 135 minutes after the block respectively. Although the patient's symptoms were not consistent with classical central nervous system toxicity, relatively high dose of lidocaine used, and coexistence of anemia, occurrence of muscular twitching which could be related to seizure activity, and the treatment of this twitching with a small dose of midazolam were thought to indicate toxicity.

Purpose: The effect of repeated administrations of sevoflurane in rats was evaluated with free inorganic plasma fluoride concentrations and the effect of sevoflurane on the kidneys. Methods: Thirty-five rats were divided into two groups. The control group consisted of 7 rats, and the sevoflurane group consisted of 28 rats. The sevoflurane group was divided equally into 4 subgroups according to the time of sacrifice (S1, S3, S5, S10). All rats in the sevoflurane group were administered 3% sevoflurane for 30 minutes for 5 days. After anesthesia, the rats were sacrificed at the end of the 1st, 3rd and 5th days. The other 7 were kept without anesthesia for 5 days and they were sacrificed at the end of the 10th day. Plasma inorganic fluoride concentrations were measured by ion-selective electrode methods in aspirated heart blood samples. Renal biopsies were taken just after sacrifice and the renal histopathologic effects of sevoflurane were investigated under light and transmission electron microscopy (TEM). Results: Plasma fluoride concentrations were significantly different between the sevoflurane and control groups. However, there was no statistical difference between the sevoflurane subgroups. Plasma BUN levels did not differ between the control and sevoflurane groups, except on the 10th day. Ultrastructurally, the sevoflurane subgroups (S-3, S-5, S-10) showed significant tubular histopathologic changes compared to the control group. However, these changes showed a significant regression on the 10th day. Conclusion: Repeated sevoflurane administration is a safe procedure since histopathological changes showed significant regression.

Introduction: A 42 year- old man with adult policystic renal disease admitted to Urology out-patient with men hemospermia without any other symptoms. Result: After detailed evaluation including transrectal ultrasonography (TRUS) and specific and nonspecific cultures, multiple seminal vesicle cysts were detected. After treatment with anti-inflammatory and antiboitics, hemospermi was resolved and did not recurrence in 6 months follow up.

Adult polikistik böbrek hastalığı ile takip edilen 42 yaşında erkek hasta hemospermi yakınması ile başvurdu. Transrektal Ultrasonografi (TRUS) ve spesifik, non-spesifik kültürleri içeren detaylı değerlendirme sonrası hastada vezikülo seminalis kistleri dışında herhangi bir hemospermi nedeni saptanmadı. Anti-inflamatuar ve antibiyotik tedavisi sonrası hastanın yakınmaları düzeldi ve 6 aylık takipte hemospermi tekrarlamadı. Introduction: A 42 year- old man with adult policystic renal disease admitted to Urology out-patient with men hemospermia without any other symptoms Result: After detailed evaluation including transrectal ultrasonography (TRUS) and specific and non-specific cultures, multiple seminal vesicle cysts were detected. After treatment with anti-inflammatory and antiboitics, hemospermi was resolved and did not recurrence in 6 months follow up.

Sevoflurane, one of new inhalation agents, is metabolized to organic and inorganic fluoride metabolites. Nephrotoxicity is due to free fluoride. In this study; we investigated the renal effects of repeated and different concentrations of sevoflurane anesthesia, experimentally. Sensitive urinary indicators n-asetil-d- glukozaminidaz (NAG), alkalen phosfatase (ALP), and gamma glutamil transferase (GGT) were assessed. This study was performed in 14, male New Zelland rabbits. Rabbits were divided into two groups (n=7). Group I (n=7) received sevoflurane 1% and Group II (n=7) 3% sevoflurane with O2+N2O (4 Lmin-1) 3 hours a dayfor 3 days Urine samples were collected via a special apparatus for 24 hours preoperative and after anesthesia. Urine samples were taken five days after the last administration of anesthesia and NAG, ALP and GGT levels in urine were determined. Blood samples taken from ear veins were obtained to determine BUN and Creatine. In Group II, urinary NAG levels increased significantly on the third day and a significant increase in GGT was observed on second and third days. There was no significant change in BUN, Cre and urinary ALP. NAG and GGT levels returned to normal on the 9th day. We concluded that, the effects of repeated sevoflurane administration on renal system are temporary.

Bu çalışmada ESWL'nin hastalarda yarattığı anksiyetenin ağrı yoğunluğu üzerinde olumsuz etkisinin ortaya konması amaçlanmıştır. ASA fiziksel durum I-II 20-64 yaşları arasında (Ortalama: 39.1) 71 hasta çalışmaya alındı. Hastalar randomize iki gruba ayrıldı. Grup I'deki hastalara işlem ile ilgili ayrıntılı bilgi verilirken Grup Il'deki hastalara bilgi verilmedi. ESWL, 3.kuşak litotriptörlerden elektrohidrolik Litho3pter (PCK ) ile gerçekleştirildi. Analjezik amaçlı Fentanyl 1mugr/kg. işlemden 2 dakika önce intravenöz olarak uygulandı. Hastaların ağrı yoğunluğu işlemin birinci dakikası ve her 10 dakikada bir 0-100 mm Visuel Analog Scala (VAS) ile değerlendirildi. Durumluk ve sürekli anksiyete State/Trait Anxiety Inventory-Trait Anxiety (STAI-TA) ve State/Trait Anxiety Inventory-State Anxiety (STAI-SA) ile ölçüldü. Sürekli anksiyete skoru ile ağrı yoğunluğu arasında ilişki tespit edilmedi. Bununla birlikte STAI-TA skoru yüksek olan hastalarda ağn yoğunluğunun daha fazla olduğu gözlendi ve bu hastalarda ek analjezik ihtiyacı daha fazla oldu. işlem ile ilgili ayrıntılı bilgi verilen grupta durumluk anksiyete ve ağrı yoğunluğu skorları daha düşük bulundu. 20-29 yaş grubundaki genç kadınlarda ağn yoğunluğu daha fazla olup durumluk anksiyete düzeyleri daha yüksek olarak tespit edildi. ESWL, anksiyete yaratan bir işlemdir. Anksiyetesi daha yoğun olan hastalarda ağrı yoğunluğunun daha fazla olduğu ve bunun da hasta memnuniyetini olumsuz etkilediği düşünülmüştür. ESWL öncesi hastaya aynntılı bilgi verilmesi, genç kadınlarda daha çok ağrı ve anksiyete olabileceğinin bilinmesi ürolog için önemli avantaj yaratabilir. Introduction: To clarify the negative effect of anxiety on pain intensity in patients, who underwent Extracorporeal Shock Wave Lithotripsy (ESWL). Patients and Method: ASA physical status I and II 71 patient with the age ranging 10 to 64 were included the study. Patients divided into two groups randomly. Detailed information about ESWL session was given to the patients in Group I and patients in Group II did not receive any descriptive information. All procedures were performed by a third generation electrohydraulic Stone LithoSpter (PCK ). Intravenous fentanyl 1mugr/kg. was administered 2 minutes before the procedure for analgesic purposes. Pains intensity was evaluated by 0-100 mm Visuel Analog Scala (VAS) at the first minute and every 10 minutes of the treatment. Conditional and continual anxiety were assessed by State/Trait Anxiety Inventory-Trait Anxiety (STAI-TA), and State/Trait Anxiety Inventory-State Anxiety (STAI-SA). Results: There was no correlation between STAI-SA and pain intensity. However, patients with higher STAI-TA scores needed higher doses of supplement analgesics because of higher pain intensity. Patients, who had received information, had lower scores of STAI-TA and pain intensity. Young female patients between 20-29 years old had the highest anxiety with high pain intensity. Conclusion: ESWL is an anxiety promoting procedure. The more intense pain and anxiety negatively effected the overall patient satisfaction. Detailed information of patients about the procedure and the knowledge of pain intensity has been higher in young female patients may be advantageous for patients and care givers.

Ketamine is known as a N-Methyl-D-Aspartate (NMDA) antagonist. Purine analogues attenuate pain transmission and also act as glutamate antagonists. The aim of the present study was to determine the antiallodynic effect of adenosine A1 receptor agonist, cyclohexyladenosine (CHA) and ketamine on thermal nociception in chronic constriction injury model in the rat. The present study was constituted on 32 male Sprague Dawley rats weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic catgut under barbiturate anaesthesia. Drugs were administered after 7th postoperative day and given through four days. Treatment protocol was two injections/day performed by a 20 min interval through intraperitoneal route. Adenosine analogues were administered as the first drug. Doses were 1 mg/kg and 10 mg/kg for CHA and ketamine respectively. Doses were reduced to half when both of drugs were combined. Nociceptive tests were performed by Hot Plate Test (HPT) at 46°C through 120 min period every 30 minutes. Initiation time of jumping and licking movements at the operated side of the rats on the HPT was determined. Motor activity were increased on animals that received ketamine. Adenosine receptor analogue CHA clearly produced antinociception. Ketamine abolished CHA induced analgesia. The results were disappointing, antagonism was observed by two class of drugs known as glutamate antagonist and can be explained by excitatory phenomenon induced by ketamine. Future studies directed at other routes may show promise.