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Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normalhastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yanetkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acilserviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olanhastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyetiile başvurdu. Hastada metformin ilişkili laktik asidoz (pH5 mmol/L vebikarbonat

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment.

BACKGROUND: Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. DESIGN AND SETTINGS: A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. METHODS: A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. RESULTS: Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P

Background: Central nervous system complications are the most clinically important of those affecting mortality in patients undergoing coronary artery surgery. Newly developed sophisticated techniques and surgical interventions obviating the need for cardiopulmonary pumps have facilitated avoidance of these complications. In this study, we compared the impact of on-pump and off-pump coronary artery bypass surgery on cerebral oxygenation using near-infrared spectroscopy. Methods: This study included 40 patients with no comorbidities who were scheduled for on-pump (n = 20) and offpump (n = 20) cardiac surgery. Preoperative and postoperative Standardized Mini-Mental State Examination (SMMSE) scores, perioperative mean arterial blood pressure (MAP), hematocrit (Hct), peripheral oxygen saturation (SpO2), regional cerebral oximetry values (rSO2), body temperature, and partial pressure of carbon dioxide (PCO2) were recorded, for all patients. Intergroup and intragroup comparisons were then performed. Results: The mean operative time was longer in the on-pump group. SMMSE scores were similar and relevant postoperative values were lower in both groups. Perioperative MAP, PCO2, and SpO2 were similar in both groups. SpO2 and PCO2 did not differ from baseline levels in either group, while the postextubation MAP at 2 h postoperatively remained low. Hct levels decreased during the perioperative and postoperative periods, while the body temperature declined perioperatively and to a greater degree in the on-pump group. The intraoperative and postoperative rSO 2 decreased in both groups. In the on-pump group, the decrease in rSO2 was more prominent during the interval between the start and closure of the sternotomy. Conclusions: Physiological alterations that occur during coronary artery surgery affect cerebral oxygenation during and after the operation irrespective of the application of a cardiopulmonary pump. Cerebral oxygenation decreases to a greater extent during on-pump surgery; however, probably because of the neuroprotective effects of hypothermia, the postoperative changes resemble those of off-pump surgery. (Korean J Anesthesiol 2014; 67: 391-397)

To assess the adequacy of different amounts of local anesthetics (LA) in infraclavicular blockade (ICB) under ultrasonographic (US) guidance and neurostimulation and compare them to the conventional doses under neurostimulation (NS). In this study 100 patients scheduled for upper limb surgery and suitable for ICB were randomly allocated to 1 of 5 groups: group NS (NS alone group 0.5 ml/kg LA), group FD (full-dose US group 0.5 ml/kg LA), group 30 (30 % reduced dose LA 0.35 ml/kg), group 50 (0.25 ml/kg LA) and group 70 (0.15 ml/kg LA). The ICB was performed under US in conjunction with NS in all groups except group NS in which neurostimulation was used alone. When necessary local anesthetic supplementation to the operation site was administered during surgery and propofol infusion for sedation ensued. Evaluation of sensory and motor block was performed for each terminal nerve (i.e. radial, ulnar, median and musculocutaneous nerves). Block quality (assessing the need for rescue LA and propofol sedation) and duration of the block were documented. None of the patients in the FD and 30 groups required any supplementation or sedation, whereas LA supplementation rates were 5 % in group 50 and 10 % in groups 70 and NS. The propofol sedation rates were 20 % in group NS, 25 % in group 50 and 40 % in group 70. Sensory block was significantly better in groups FD, 30 and NS at 30 min. A complete block was achieved more rapidly in all nerve territories in the full-dose group (p = 0.0001). Block duration was longest in group FD and was significantly longer in group 30 than in the other two groups (p = 0.0001). The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70 % of conventionally used doses seems possible with US guidance. This article is published in English.

ResumenJustificación y objetivoel bloqueo central proporcionado por la raquianestesia posibilita la realización de muchos procedimientos quirúrgicos, mientras que las alteraciones hemodinámicas y respiratorias influyen en la administración de oxígeno sistémico conllevando el desarrollo potencial de una serie de problemas, como la isquemia cerebral, el infarto de miocardio y la insuficiencia renal aguda. El objetivo de este estudio fue detectar potenciales efectos adversos de las alteraciones hemodinámicas y respiratorias sobre la administración de oxígeno sistémico, usando métodos oximétricos cerebrales en pacientes sometidos a la raquianestesia.Métodosveinticinco pacientes, entre 65 y 80 años de edad, estado físico ASA I-II, programados para la corrección de hernia inguinal unilateral bajo raquianestesia fueron incluidos en el estudio. De acuerdo con la monitorización estándar, los niveles de oxígeno cerebral fueron medidos al inicio del estudio usando métodos oximétricos cerebrales. El Mini Test Estandarizado del Estado Mental se aplicó antes y después de la operación para determinar el nivel de funcionamiento cognitivo de los casos. Usando una técnica estándar y cantidades iguales de un anestésico local (15mg de bupivacaína al 5%), se realizó el bloqueo intratecal. La presión arterial media (PAM), frecuencia cardíaca máxima (FCM), saturación periférica de oxígeno (SpO2) y niveles cerebrales de oxígeno (rSO2) fueron monitorizados en el preoperatorio durante 60min. Se midieron los niveles pre y postoperatorios de hemoglobina. Las variaciones en los datos obtenidos y sus correlaciones con los niveles cerebrales de oxígeno fueron investigadas.Resultadosno observamos alteraciones significativas en las medidas de hemoglobina, puntuaciones del SMMT y niveles de SpO2 en los períodos pre y postoperatorio. Sin embargo, sí se observaron variaciones significativas en los niveles de PAM, FCM y rSO2 en el período intraoperatorio. Además, se determinó la correlación entre las variaciones de rSO2, PAM y FCM.Conclusiónla evaluación de los datos obtenidos en el estudio demostró que la caída de la presión arterial posraquianestesia y también de la frecuencia cardíaca disminuye la administración de oxígeno sistémico y afectan negativamente los niveles cerebrales de oxígeno. Sin embargo, esa alteración no deterioró la función cognitiva.AbstractObjectiveCentral blockage provided by spinal anaesthesia enables realization of many surgical procedures, whereas hemodynamic and respiratory changes influence systemic oxygen delivery leading to the potential development of series of problems such as cerebral ischemia, myocardial infarction and acute renal failure. This study was intended to detect potentially adverse effects of hemodynamic and respiratory changes on systemic oxygen delivery using cerebral oxymetric methods in patients who underwent spinal anaesthesia.MethodsTwenty-five ASA I–II Group patients aged 65–80 years scheduled for unilateral inguinal hernia repair under spinal anaesthesia were included in the study. Following standard monitorization baseline cerebral oxygen levels were measured using cerebral oximetric methods. Standardized Mini Mental Test (SMMT) was applied before and after the operation so as to determine the level of cognitive functioning of the cases. Using a standard technique and equal amounts of a local anaesthetic drug (15mg bupivacaine 5%) intratechal blockade was performed. Mean blood pressure (MBP), maximum heart rate (MHR), peripheral oxygen saturation (SpO2) and cerebral oxygen levels (rSO2) were preoperatively monitored for 60min. Pre- and postoperative haemoglobin levels were measured. The variations in data obtained and their correlations with the cerebral oxygen levels were investigated.ResultsSignificant changes in pre- and postoperative measurements of haemoglobin levels and SMMT scores and intraoperative SpO2 levels were not observed. However, significant variations were observed in intraoperative MBP, MHR and rSO2 levels. Besides, a correlation between variations in rSO2, MBP and MHR was determined.ConclusionEvaluation of the data obtained in the study demonstrated that post-spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, this downward change did not result in deterioration of cognitive functioning.

ResumoJustificativa e Objetivoo bloqueio central proporcionado pela raquianestesia possibilita a realização de muitos procedimentos cirúrgicos, enquanto as alterações hemodinâmicas e respiratórias influenciam a oferta de oxigênio sistêmico, levando ao desenvolvimento em potencial de uma série de problemas, como isquemia cerebral, infarto do miocárdio e insuficiência renal aguda. O objetivo deste estudo foi detectar potenciais efeitos adversos das alterações hemodinâmicas e respiratórias sobre a oferta de oxigênio sistêmico, usando métodos oximétricos cerebrais em pacientes submetidos à raquianestesia.Métodosvinte e cinco pacientes, 65‐80 anos de idade, estado físico ASA I‐II, programados para correção de hérnia inguinal unilateral sob raquianestesia foram incluídos no estudo. De acordo com o monitoramento padrão, os níveis de oxigênio cerebral foram medidos no início do estudo usando métodos oximétricos cerebrais. O Mini Teste Padronizado do Estado Mental (Standardized Mini Mental Test – SMMT) foi aplicado antes e depois da operação para determinar o nível de funcionamento cognitivo dos casos. Usando uma técnica padrão e quantidades iguais de um fármaco anestésico local (15mg de bupivacaína a 5%), o bloqueio intratecal foi realizado. Pressão arterial média (PAM), frequência cardíaca máxima (FCM), saturação periférica de oxigênio (SpO2) e níveis cerebrais de oxigênio (rSO2) foram monitorados no pré‐operatório por 60min. Os níveis pré‐ e pós‐operatórios de hemoglobina foram medidos. As variações nos dados obtidos e suas correlações com os níveis cerebrais de oxigênio foram investigadas.Resultadosnão observamos alterações significativas nas mensurações de hemoglobina, escores do SMMT e níveis de SpO2 nos períodos pré‐ e pós‐operatório. No entanto, variações significativas foram observadas nos níveis de PAM, FCM e rSO2 no período intraoperatório. Além disso, a correlação entre as variações de rSO2, PAM e FCM foi determinada.Conclusãoa avaliação dos dados obtidos no estudo demonstrou que a queda da pressão arterial pós‐raquianestesia e também da frequência cardíaca diminui a oferta de oxigênio sistêmico e afeta negativamente os níveis cerebrais de oxigênio. Contudo, essa alteração não resultou em deterioração da função cognitiva.AbstractObjectiveCentral blockage provided by spinal anaesthesia enables realization of many surgical procedures, whereas hemodynamic and respiratory changes influence systemic oxygen delivery leading to the potential development of series of problems such as cerebral ischemia, myocardial infarction and acute renal failure. This study was intended to detect potentially adverse effects of hemodynamic and respiratory changes on systemic oxygen delivery using cerebral oxymetric methods in patients who underwent spinal anaesthesia.MethodsTwenty‐five ASA I–II Group patients aged 65–80 years scheduled for unilateral inguinal hernia repair under spinal anaesthesia were included in the study. Following standard monitorization baseline cerebral oxygen levels were measured using cerebral oximetric methods. Standardized Mini Mental Test (SMMT) was applied before and after the operation so as to determine the level of cognitive functioning of the cases. Using a standard technique and equal amounts of a local anaesthetic drug (15mg bupivacaine 5%) intratechal blockade was performed. Mean blood pressure (MBP), maximum heart rate (MHR), peripheral oxygen saturation (SpO2) and cerebral oxygen levels (rSO2) were preoperatively monitored for 60min. Pre‐ and postoperative haemoglobin levels were measured. The variations in data obtained and their correlations with the cerebral oxygen levels were investigated.ResultsSignificant changes in pre‐ and postoperative measurements of haemoglobin levels and SMMT scores and intraoperative SpO2 levels were not observed. However, significant variations were observed in intraoperative MBP, MHR and rSO2 levels. Besides, a correlation between variations in rSO2, MBP and MHR was determined.ConclusionEvaluation of the data obtained in the study demonstrated that post‐spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, this downward change did not result in deterioration of cognitive functioning.

OBJECTIVE: Central blockage provided by spinal anaesthesia enables realization of many surgical procedures, whereas hemodynamic and respiratory changes influence systemic oxygen delivery leading to the potential development of series of problems such as cerebral ischemia, myocardial infarction and acute renal failure. This study was intended to detect potentially adverse effects of hemodynamic and respiratory changes on systemic oxygen delivery using cerebral oxymetric methods in patients who underwent spinal anaesthesia. METHODS: Twenty-five ASA I-II Group patients aged 65-80 years scheduled for unilateral inguinal hernia repair under spinal anaesthesia were included in the study. Following standard monitorization baseline cerebral oxygen levels were measured using cerebral oximetric methods. Standardized Mini Mental Test (SMMT) was applied before and after the operation so as to determine the level of cognitive functioning of the cases. Using a standard technique and equal amounts of a local anaesthetic drug (15 mg bupivacaine 5%) intratechal blockade was performed. Mean blood pressure (MBP), maximum heart rate (MHR), peripheral oxygen saturation (SpO2) and cerebral oxygen levels (rSO2) were preoperatively monitored for 60 min. Pre- and postoperative haemoglobin levels were measured. The variations in data obtained and their correlations with the cerebral oxygen levels were investigated. RESULTS: Significant changes in pre- and postoperative measurements of haemoglobin levels and SMMT scores and intraoperative SpO2 levels were not observed. However, significant variations were observed in intraoperative MBP, MHR and rSO2 levels. Besides, a correlation between variations in rSO2, MBP and MHR was determined. CONCLUSION: Evaluation of the data obtained in the study demonstrated that post-spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, this downward change did not result in deterioration of cognitive functioning. JUSTIFICATIVA E OBJETIVO: o bloqueio central proporcionado pela raquianestesia possibilita a realização de muitos procedimentos cirúrgicos, enquanto as alterações hemodinâmicas e respiratórias influenciam a oferta de oxigênio sistêmico, levando ao desenvolvimento em potencial de uma série de problemas, como isquemia cerebral, infarto do miocárdio e insuficiência renal aguda. O objetivo deste estudo foi detectar potenciais efeitos adversos das alterações hemodinâmicas e respiratórias sobre a oferta de oxigênio sistêmico, usando métodos oximétricos cerebrais em pacientes submetidos à raquianestesia. MÉTODOS: vinte e cinco pacientes, 65-80 anos de idade, estado físico ASA I-II, programados para correção de hérnia inguinal unilateral sob raquianestesia foram incluídos no estudo. De acordo com o monitoramento padrão, os níveis de oxigênio cerebral foram medidos no início do estudo usando métodos oximétricos cerebrais. O Mini Teste Padronizado do Estado Mental (Standardized Mini Mental Test - SMMT) foi aplicado antes e depois da operação para determinar o nível de funcionamento cognitivo dos casos. Usando uma técnica padrão e quantidades iguais de um fármaco anestésico local (15 mg de bupivacaína a 5%), o bloqueio intratecal foi realizado. Pressão arterial média (PAM), frequência cardíaca máxima (FCM), saturação periférica de oxigênio (SpO2) e níveis cerebrais de oxigênio (rSO2) foram monitorados no pré-operatório por 60 min. Os níveis pré- e pós-operatórios de hemoglobina foram medidos. As variações nos dados obtidos e suas correlações com os níveis cerebrais de oxigênio foram investigadas. RESULTADOS: não observamos alterações significativas nas mensurações de hemoglobina, escores do SMMT e níveis de SpO2 nos períodos pré- e pós-operatório. No entanto, variações significativas foram observadas nos níveis de PAM, FCM e rSO2 no período intraoperatório. Além disso, a correlação entre as variações de rSO2, PAM e FCM foi determinada. CONCLUSÃO: a avaliação dos dados obtidos no estudo demonstrou que a queda da pressão arterial pós-raquianestesia e também da frequência cardíaca diminui a oferta de oxigênio sistêmico e afeta negativamente os níveis cerebrais de oxigênio. Contudo, essa alteração não resultou em deterioração da função cognitiva. JUSTIFICACIÓN Y OBJETIVO: el bloqueo central proporcionado por la raquianestesia posibilita la realización de muchos procedimientos quirúrgicos, mientras que las alteraciones hemodinámicas y respiratorias influyen en la administración de oxígeno sistémico conllevando el desarrollo potencial de una serie de problemas, como la isquemia cerebral, el infarto de miocardio y la insuficiencia renal aguda. El objetivo de este estudio fue detectar potenciales efectos adversos de las alteraciones hemodinámicas y respiratorias sobre la administración de oxígeno sistémico, usando métodos oximétricos cerebrales en pacientes sometidos a la raquianestesia. MÉTODOS: veinticinco pacientes, entre 65 y 80 años de edad, estado físico ASA I-II, programados para la corrección de hernia inguinal unilateral bajo raquianestesia fueron incluidos en el estudio. De acuerdo con la monitorización estándar, los niveles de oxígeno cerebral fueron medidos al inicio del estudio usando métodos oximétricos cerebrales. El Mini Test Estandarizado del Estado Mental se aplicó antes y después de la operación para determinar el nivel de funcionamiento cognitivo de los casos. Usando una técnica estándar y cantidades iguales de un anestésico local (15 mg de bupivacaína al 5%), se realizó el bloqueo intratecal. La presión arterial media (PAM), frecuencia cardíaca máxima (FCM), saturación periférica de oxígeno (SpO2) y niveles cerebrales de oxígeno (rSO2) fueron monitorizados en el preoperatorio durante 60 min. Se midieron los niveles pre y postoperatorios de hemoglobina. Las variaciones en los datos obtenidos y sus correlaciones con los niveles cerebrales de oxígeno fueron investigadas. RESULTADOS: no observamos alteraciones significativas en las medidas de hemoglobina, puntuaciones del SMMT y niveles de SpO2 en los períodos pre y postoperatorio. Sin embargo, sí se observaron variaciones significativas en los niveles de PAM, FCM y rSO2 en el período intraoperatorio. Además, se determinó la correlación entre las variaciones de rSO2, PAM y FCM. CONCLUSIÓN: la evaluación de los datos obtenidos en el estudio demostró que la caída de la presión arterial posraquianestesia y también de la frecuencia cardíaca disminuye la administración de oxígeno sistémico y afectan negativamente los niveles cerebrales de oxígeno. Sin embargo, esa alteración no deterioró la función cognitiva.

Summary Background and objectives We aimed to investigate the effect on children undergoing Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), their parents and attending anesthesiologist of “multiphase sedation” which we define as “the intended sedation level achieved with one or more agents through the same or different routes with more than one administration”. Material and Methods One hundred children and their parents were randomly allocated to one of two study groups. In phase 1; in Group I the patients were given midazolam (0.5 mg.kg−1) in 5 mL fruit juice, and the ones in control group (Group II) were given only fruit juice. After intravenous (iv) cannulation; in phase II, boluses of propofol were given to achieve the adequate sedation for imaging. Anxiety scores of children and their parents were recorded using Oucher scale and STAI, respectively, and parental satisfaction was evaluated by visual analogue scale (VAS). The number of attempts for iv cannulation, length of time for preparation, and amount of hypnotics were recorded. Results Anxiety state of children was similar between groups before premedication, but later it was lower in Group I. Before procedure, STAI score of parents was similar and later it was lower in Group I. Parental satisfaction in Group I was higher. The number of attempts for iv cannulation and required propofol dose was less in Group I. Conclusion “Multiphase sedation” procedure provides children to feel less pain and anxiety, and decreases parental anxiety while increasing their satisfaction. It supplies a comfortable and safe sedation, as it provides a short and problem-free preparation process for the attending anesthetist as well.

Objective: It is known that diabetes leads to depletion of the cellular antioxidant de - fense system and this causes the organ injuries related to the diabetic complications. Antioxidants have been shown to reduce indices of oxidative stress measures in experimental disease models and in humans. The present study was designed to evaluate the oxidative stress in lungs as well as the therapeutic effect of pomegranate juice (PJ), as an antioxidant, in rats with streptozotocin-induced diabetes. Material and Methods: Twenty seven rats were enrolled in the study where diabetes was induced by streptozotocin injection. Rats were treated with either PJ or saline for 10 weeks, and their lungs were harvested for histologic and immunohistochemical evaluation at the end. Protein carbonyl content (PCC), sialic acid (SA), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured in the pulmonary tissue as well as the presence of endothelial ni - tric oxide synthase (eNOS), through immunohistochemistry. Results: The pulmonary tissue in di - abetic rats showed oxidative alterations related to the streptozotocin treatment. There was increased eNOS expressions in diabetic lungs, but PJ treatment diminished both eNOS expressions and in - flammatory changes in pulmonary tissue. PCC and SA levels were higher in diabetic lungs (p

Massive Pulmonary Eden During Extracorporeal CirculationLung pump is a result of immune system activation due to cardiopulmonary bypass. It is frequently seen during post-operative follow-up of the patients in the intensive care units and services. It is rare during or immediately after extracorporeal circulation. In this presentation, we discussed sudden, unexpected and massive pulmonary edema developed during coronary artery bypass surgery. We have successfully treated pulmonary edema developed after cardiopulmonary bypass surgery with appropriate medical treatment and mechanical ventilation.

JUSTIFICATIVA E OBJETIVOS: O nosso objetivo foi investigar o efeito da "sedação multifásica" em crianças submetidas à Tomografia Computadorizada (TC) ou Ressonância Magnética (RM), em seus pais e nos anestesiologistas responsáveis. "Sedação multifásica" foi definida como "o nível de sedação pretendido obtido com um ou mais agentes através da mesma via ou vias diferentes com mais de uma administração". MATERIAL E MÉTODOS: Cem crianças e seus respectivos pais foram randomicamente designados para um dos dois grupos de estudo. Na fase 1, os pacientes do Grupo I receberam midazolam (0,5 mg.kg-1) em 5 mL de suco de frutas e os pacientes do Grupo II (grupo controle) receberam apenas suco de frutas. Na fase 2, após a canulação intravenosa (iv), bolus de propofol foi administrado para alcançar a sedação adequada para realização do exame de imagem. Os escores de ansiedade das crianças e de seus pais foram registrados usando a escala de Oucher e o IDATE, respectivamente, e a satisfação dos pais foi avaliada pela escala analógica visual (EAV). O número de tentativas para canulação iv, tempo de preparação e quantidade de hipnóticos foram registrados. RESULTADOS: O estado de ansiedade das crianças foi semelhante entre os grupos antes da pré-medicação, porém mais tarde esse nível foi menor no Grupo I. Antes do procedimento, o escore dos pais no IDATE foi semelhante, mas depois foi menor no Grupo I. A satisfação dos pais no Grupo I foi maior que no Grupo II. O número de tentativas de canulação iv e a dose necessária de propofol foi menor no Grupo I. CONCLUSÃO: O procedimento de "sedação multifásica" diminui a dor e a ansiedade das crianças e a ansiedade dos pais, aumentando a sua satisfação. Ele fornece uma sedação confortável e segura, pois possui um processo de preparação curto e sem problemas também para o anestesiologista responsável. BACKGROUND AND OBJECTIVES: We aimed to investigate the effect on children undergoing Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), their parents and attending anesthesiologist of "multiphase sedation" which we define as "the intended sedation level achieved with one or more agents through the same or different routes with more than one administration". MATERIAL AND METHODS: One hundred children and their parents were randomly allocated to one of two study groups. In phase 1; in Group I the patients were given midazolam (0.5 mg.kg-1) in 5 mL fruit juice, and the ones in control group (Group II) were given only fruit juice. After intravenous (iv) cannulation; in phase II, boluses of propofol were given to achieve the adequate sedation for imaging. Anxiety scores of children and their parents were recorded using Oucher scale and STAI, respectively, and parental satisfaction was evaluated by visual analogue scale (VAS). The number of attempts for iv cannulation, length of time for preparation, and amount of hypnotics were recorded. RESULTS: Anxiety state of children was similar between groups before premedication, but later it was lower in Group I. Before procedure, STAI score of parents was similar and later it was lower in Group I. Parental satisfaction in Group I was higher. The number of attempts for iv cannulation and required propofol dose was less in Group I. CONCLUSION: "Multiphase sedation" procedure provides children to feel less pain and anxiety, and decreases parental anxiety while increasing their satisfaction. It supplies a comfortable and safe sedation, as it provides a short and problem-free preparation process for the attending anesthetist as well. JUSTIFICATIVA Y OBJETIVOS: Nuestro objetivo fue investigar el efecto de la "sedación multifásica" en niños sometidos a la tomografía computadorizada (TC) o resonancia magnética (RM), en sus padres y en los anestesiólogos responsables. La "sedación multifásica" fue definida como "el nivel de sedación pretendido que se obtiene con uno o más agentes por medio de la misma vía o vías diferentes con más de una administración". MATERIAL Y MÉTODOS: Cien niños y sus respectivos padres fueron randómicamente designados para uno de los dos grupos de estudio. En la fase 1, los pacientes del Grupo I recibieron midazolam (0,5 mg.kg-1) en 5 mL de jugo de frutas, y los pacientes del Grupo II (grupo control) recibieron solamente jugo de frutas. En la fase 2 después de la canulación intravenosa (i.v.), un bolo de propofol se administró para alcanzar la sedación adecuada para la realización del examen de imagen. Las puntuaciones de ansiedad de los niños y de sus padres se registraron usando la escala de Oucher y el IDATE respectivamente, y la satisfacción de los padres fue evaluada por la escala visual analógica (EVA). También se registraron el número de intentos para canulación i.v., tiempo de preparación y cantidad de hipnóticos. RESULTADOS: El estado de ansiedad de los niños fue parecido entre los grupos antes de la premedicación sin embargo, más tarde ese nivel disminuyó en el Grupo I. Antes del procedimiento, la puntuación de los padres en el IDATE fue similar pero después cayó en el Grupo I. La satisfacción de los padres en el Grupo I fue mayor que en el Grupo II. El número de intentos de canulación i.v. y la dosis necesaria de propofol fue menor en el Grupo I. CONCLUSIONES: El procedimiento de "sedación multifásica" reduce el dolor y la ansiedad de los niños y de los padres, aumentando su satisfacción. El procedimiento suministra una sedación cómoda y segura porque posee un proceso de preparación corto y sin problemas también para el anestesiólogo responsable.

Background: Diabetes mellitus (DM) causes debilitating complications and, as a result, diabetics frequently require intensive care. Although lungs are not thought to be affected primarily by DM, an increasing number of studies indicate physiological and structural abnormalities in diabetic lungs. Objectives: Pyrrolidine dithiocarbamate (PDTC) is a metal chelator and a potent inhibitor of NF-ĸB. Keeping in mind that NF-ĸB activation may be crucial in end-organ injury due to DM, we studied the role of PDTC on the inhibition of NF-ĸB activation and its effects on possible lung injury in rats with streptozotocin-induced DM. Methods: 36 Sprague-Dawley rats were allocated into 4 groups: diabetes, diabetes + PDTC, control and control + PDTC. At the end of 10 weeks, rats were sacrificed and their lungs were taken for histopathological and immunohistochemical evaluation [for NF-ĸB (p65) and endothelial nitric oxide (eNOS) immunoreactivities]. Protein carbonyl content (PCC), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured. Results: Histopathologically, basal membranes were thickened and there was intense inflammatory reaction in diabetic lungs. However, the PDTC group, in which there were poor positive expressions of eNOS and p65 activity compared to diabetes group, revealed fewer inflammatory changes. PCC levels in diabetic lungs were higher, but SOD and GSH activities were lower. However, measurements of these parameters in the PDTC group and controls gave similar results. Conclusion: Lungs are exposed to changes induced by oxidative stress in diabetes through NF-ĸB activation and PDTC seems to be useful to prevent diabetic lung injury.