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Objective: Vagal nerve stimulation is an alternative treatment method for epileptic patients who are resistant to medical treatment. In this retrospective case series, we investigated our anesthetic approach and possible complications in patients implanted vagal nerve stimulator (VNS). Method: In this study, the results of 10 patients, who were implanted VNS between January 2015 and December 2016, were examined. Cases were ASA I-II adult patients between 19-35 years of age. Intraoperative arrhythmia or asystole and possible postoperative complications such as aspiration, hypoxia, vocal cord paralysis were noted. Results: Intraoperative bradycardia improved by interruption of surgical stimulation was observed only in one patient, no bradycardia or asystole was observed in others. At the end of 3 months follow-up a 30-75% reduction in seizure frequency was identified. Postoperative Horner syndrome, peritracheal hematoma, vocal cord paralysis, aspiration were not observed, but in two cases pharynx pain was detected in early postoperative period. Conclusion: Implantation of VNS requires general anesthesia and endotracheal intubation. Large diameter iv catheter is safe because of the proximity of vagal nerve to internal carotid artery and jugular vein. Close hemodynamic monitoring and follow-up is essential because of possibility of arrhythmia, bradyarrhythmia, and asystole during VNS placement. © 2018 Anestezi Dergisi. All rights reserved.

PubMedID: 26474268 BACKGROUND: Anesthesia and surgery can lead to major distress for children. Sedative premedication and preoperative preparation techniques are available to reduce preoperative anxiety in children. We aimed to assess the effect of informational video based on role-play modelling on preoperative anxiety and postoperative behavior changes in children undergoing surgery. METHODS: Forty-two children aged 5-12 years, with American Society of Anesthesiologist physical status I-II, scheduled for elective outpatient surgery, were enrolled in this study. Patients were randomly allocated to one group with or without information video presentation. In group V, patients watched the information video (N.=21). Other children were verbally informed in a standard care (group C, N.=21). We recorded patient's demographics (age, birth order, surgery time, surgery type, history of previous surgery, parent's age, parental working status, parental education level), the preoperative anxiety level using Modified Yale Preoperative Anxiety Scale (MYPAS) and at 1 week after discharge, new developing postoperative maladaptive behaviors (POMB) using the Post Hospitalization Behavioral Questionnaire by telephone interview. RESULTS: Patient's demographics were similar in both groups. Total MYPAS scores were found to be lower in group V as compared to group C P=0.0001). Difficulty getting to sleep, nocturnal enuresis, fear of dark, to object to go to bed at night and decreased appetite of new developing POMB were found to be lower in group V than group C. We also found a correlation between anxiety scores and POMB. CONCLUSIONS: The presentation of an informational video based on model making reduces preoperative anxiety at the time of placement of the facemask and postoperative negative behavioral changes in children.

The streptozocin-induced diabetic rat is a model of chronic pain that shows signs of hyperalgesia and allodynia and may replicate signs in diabetic humans. Here we investigated the antinociceptive effects of A803467, a highly selective blocker of Nav1.8 channels, in diabetic rats with painful neuropathy. We systemically (intraperitoneal) or locally (intraplantar) administered A803467 (or lidocaine, a nonselective sodium channel blocker, as a control) to diabetic rats with hyperalgesia and allodynia and then measured thermal latencies and mechanical thresholds. With intraperitoneal administration, A803467 led to 6-fold greater reduction of hyperalgesia and 2-fold greater reduction of allodynia than did lidocaine. Whereas the antihyperalgesic effects of lidocaine and A803467 were similar after intraplantar administration, A803467 (1 mg) was at least 2 times more effective as an antiallodynic than was lidocaine (0.5 mg). These results suggest that compared with lidocaine, systemic or local blockade of Nav1.8 channels by A803467 may more effectively relieve hyperalgesia and allodynia in diabetic neuropathy.

PubMedID: 23312086 The streptozocin-induced diabetic rat is a model of chronic pain that shows signs of hyperalgesia and allodynia and may replicate signs in diabetic humans. Here we investigated the antinociceptive effects of A803467, a highly selective blocker of Nav1.8 channels, in diabetic rats with painful neuropathy. We systemically (intraperitoneal) or locally (intraplantar) administered A803467 (or lidocaine, a nonselective sodium channel blocker, as a control) to diabetic rats with hyperalgesia and allodynia and then measured thermal latencies and mechanical thresholds. With intraperitoneal administration, A803467 led to 6-fold greater reduction of hyperalgesia and 2-fold greater reduction of allodynia than did lidocaine. Whereas the antihyperalgesic effects of lidocaine and A803467 were similar after intraplantar administration, A803467 (1 mg) was at least 2 times more effective as an antiallodynic than was lidocaine (0.5 mg). These results suggest that compared with lidocaine, systemic or local blockade of Nav1.8 channels by A803467 may more effectively relieve hyperalgesia and allodynia in diabetic neuropathy. Copyright © 2012 by the American Association for Laboratory Animal Science.

Nothing is known about actions of levobupivacaine, a long-acting local anaesthetic belonging to the amino amide group, in diabetes-induced neuropathic pain conditions. In this study, we therefore investigated the possible antihyperalgesic and antiallodynic effects of levobupivacaine in diabetic animal model. Actions of systemically (intraperitoneal) or locally (intraplantar) administrated levobupivacaine on streptozotocin-induced diabetic rats with painful neuropathy were examined using a thermal plantar test and a dynamic plantar aesthesiometer. Effects of levobupivacaine were compared with those of a well-known amide local anaesthetic lidocaine. Levobupivacaine was more potent than lidocaine in all tests employed on diabetic rats. After intraperitoneal injections to diabetic rats, levobupivacaine, but not lidocaine, produced pronounced antihyperalgesic and antiallodynic effects. However, intraplantar administration of both levobupivacaine and lidocaine produced antihyperalgesic and antiallodynic action in diabetic rats. In contrast to the transient effects of lidocaine (30 min), antihyperalgesic and antiallodynic actions of levobupivacaine gradually disappeared within 120 min after intraplantar injections. Intraperitoneal or intraplantar administrations of levobupivacaine or lidocaine at the effective dose had no effect on any parameters in intact rats. Findings revealed that antiallodynic and antihyperalgesic potency of levobupivacaine was higher in comparison with that of lidocaine after their intraperitoneal or intraplantar administration to diabetic animals. Furthermore, locally administrated levobupivacaine has the greatest antihyperalgesic and antiallodynic actions in diabetic rats. 2011 The Authors. © 2011 The Authors Fundamental and Clinical Pharmacology.

European Anaesthesiology Congress (Euroanaesthesia) -- JUN 12-15, 2010 -- Helsinki, FINLAND WOS: 000209824000643 … European Soc Anaesthesiol

European Anaesthesiology Congress (Euroanaesthesia) -- JUN 12-15, 2010 -- Helsinki, FINLAND WOS: 000209824000503 … European Soc Anaesthesiol

Background: Etomidate may cause injection pain and myoclonus during the anaesthesia induction. Both benzodiazepines and opioids reduce myoclonus, however so far dexmedetomidine has not been studied for the same. We designed a study to investigate the effects of pretreatment with IV midazolam or dexmedetomidine on the incidence and severity of myoclonus and injection pain during induction of anaesthesia with etomidate. Patients & Methods: 152 patients were pre-treated before the etomidate injection, either with saline (Group P, n= 51) or midazolam 0.5 mg/kg (Group M, n=51) or dexmedetomidine 1 microg/kg (Group D, n=50). Results: Both Groups M and D showed a significantly lower incidence of myoclonus compared with Group P. Within 60 s after induction with etomidate, 19 (37%) of 51 patients in the midazolam group, 15 (30%) of 50 patients in the dexmedetomidine group and 46 (90%) of 51 patients in the placebo group developed myoclonic movements. Also, within 60 s after induction with etomidate, 1 (2%) of 51 patients in the midazolam group, 3 (6%) of 50 patients in the dexmedetomidine group and 43(6%) of 51 patients (85%) in the placebo group developed injection pain after the etomidate induction. Conclusion: We conclude that either dexmedetomidine or midazolam administered before etomidate induction reduces myoclonic muscle movements and injection pain during anaesthesia induction without any haemodynamic side effects.

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PubMedID: 12856822 Divalent cations, such as calcium and magnesium, are constantly present in extracellular compartment of most organisms. Modification of extracellular concentrations of divalent ions causes changes in physiologic functions, such as excitability and conduction of the nerves. The present study was designed to investigate and compare the effects of calcium and magnesium on nerve conduction and lidocaine-induced nerve conduction block. The aim of our study was to contribute to better understanding of physiological and pharmacological roles of divalent cations. Experiments were conducted on the sciatic nerves by using the sucrosegap recording technique. We evaluated the effects of test solutions containing different calcium or magnesium concentrations, prepared with or without lidocaine, on compound action potentials to determine physiological and pharmacological roles of these cations. After the control recordings, the nerve was exposed to Ringer's solution containing 0, 1.9, 3.8 mM Ca2+ and 1.9 and 3.8 mM Mg2+ with or without 1 mM lidocaine. Decreasing the Ca2+ concentrations in Ringer's solution with or without lidocaine enhanced both tonic and phasic blocks. However, increased Mg2+ concentration did not change the tonic blocks but increased the phasic blocks. In conclusion, the results suggested but not prove that Ca2+ and Mg2+ may have different mechanisms of action on peripheral nerves. While Ca2+ directly affects the gating of Na+ channels, action of Mg2+ can be explained by surface charge theory.

Eighty adult patient accepted to study undergoing elective orthopedic, laparascopic or plastic surgery following informed patient consent and approval by our ethical committee. Patients were monitored at the theatre with ECG, systemic BP, SpO2 and T without any premedication. Anaesthesia induction was obtained with thiopenthone (5 mg/kg) and maintained with 2% sevoflurane or 1% isoflurane + 66% N2O in oxygen. Peripheric nerve stimulator was set on following anaesthesia induction. Approximately 5 minutes was awaited for stable neuromuscular calibration. The patients were then assigned randomly four groups equally. To group I 2% sevoflurane + atracurium (0.5 mg/kg), to group II 2% sevoflurane + cisatracurium (0.1 mg/kg), to group III 1% isoflurane + atracurium (0.5 mg/kg), and to group IV 1% isoflurane + cisatracurium (0.1 mg/kg) were applied. The onset time (T95) clinical duration(T25), recovery index (T75-25), spontaneous recovery time (T4/T1 70%) and endotracheal intubation conditions were assessed in four groups. All patients were intubated when 95% neuromuscular block obtained. Goldberg scale was used for determination of intubation condition. Haemodynamic and demographic data did not show any difference among the groups. Intubation condition were statistically significant better in group II and IV than group I and III (p

Eighty adult patients were accepted to study undergoing elective orthopedic, laparascopic or plastic surgery following informed consent and approval by our ethical committee. Anaesthesia induction was obtained with thiopentone (5 mg/kg) and maintained with 2 % sevoflurane or 1 % isoflurane + 66 % N2O in oxygen. Peripheric nerve stimulator was set on following anaesthesia induction. The patients were assigned randomly four groups equally. To group I 2 % sevoflurane + vecuronium, to group II 2 % sevoflurane + rocuronium, to group III 1 % isoflurane + vecuronium, to group IV 1 % isoflurane + rocuronium were applied. All patients were intubated when 95 % neuromuscular block obtained. The onset time (T95), clinical duration(T25), recovery index (T75-25) and spontaneous recovery time (T90) and endotracheal intubation conditions were assessed in four groups of patients. Haemodynamic and demographic data did not show any difference among groups (p>0.05). Intubation condition were statistically significant in group I than group II and in group III than group IV (p0.05). T75-25 values were found longer in group I than group II. In conclusion the onset of action of rocuronium was faster than vecuronium whereas vecuronium induced intubation conditions were better than rocuronium. T75-25 and T90 is similar in all groups and 2 % sevoflurane or 1 % isoflurane did not change rocuronium and vecuronium induced neuromuscular block.

This study was designed to compare the neuromuscular effects of mivacurium and rocuronium in elderly and young patients. Forty-two young and 42 elderly patients were included in the study. Anaesthesia was induced with thiopentone in patients without premedication. The patients were divided into four groups, each containing 21 patients. In group I (young) and in group II (elderly) rocuronium (0.6 mg/kg) in group III (young) and in group IV (elderly) mivacurium (0.15 mg/kg) was used. Tracheal intubation was performed upon completion of maximum depression in single twitch. The quality of intubation was evaluated by Goldberg's Scale. Anaesthesia was maintained with isoflurane, N2O and O2. Clinical duration due to neuromuscular block, 50 %, 75 % and 90 % recovery time, clinical recovery time and recovery index were measured and recorded with Train-of-four stimulation. The onset time was found to be shorter in the groups where rocuronium was used in comparison to mivacurium groups (p>

This study aims to demonstrate the effect of propofol on isolated rat aorta strips in relation with vascular contraction-relaxation and Na+/K+- Ca++/Mg++ ATP'ase activity. The protocol was approved by ethic committee of Cukurova University. Fifteen wistar rats (200-300 g) were killed by a blow to the head. Thoracic aorta were isolated carefully and were cut with the shape of helical strips and placed in organ baths. Before investigation of the effects of propofol, strips were tested by using acetylcholine followed maximally contraction with phenylephrine (with and without endothelium) propofol was than added to organ baths fluid. Fifteen intact and denuded aorta strips were used to investigate Na+/K+ and Ca++/Mg++ ATP'ase activity. Student's-t test was used for statistical analysis. While approximately 33 % relaxation was occurred on endothelium intact thoracic aorta strips by acetylcholine, acetylcholine-induced relaxation was not observed on endothelium denuded strips. Propofol (3x10-4 M and 3x10-5 M) attenuated the relaxation 16-44 % induced by acetylcholine in endothelium intact thoracic aorta (p

In our study, we aimed to compare the effect of sevoflurane and isoflurane on postoperative recovery time, mental and psychomotor functions and pain relief in fourty adult patients (ASA I-II) undergoing for ambulatory (out-patient) surgery. The patients were divided into two groups, randomly. All patients were premedicated by diazem (10 mg IM) and atropin (0.5 mg IM). Anaesthesia induction was obtained with thiopentone (5 mg/kg) and vecuronium (0.1 mg/kg) administrated in patient who needed endotracheal entubation or muscle relaxation. Anaesthesia was maintained with sevoflurane (1.0-2.5%) and N2O (66%) in oxygen in group I and with isoflurane (0.5-1.5%) and N2O (66%) in oxygen in group II. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), peripheral O2 saturation (SpO2) and ECG were observed before induction, after induction and intubation, before, after extubation and at postoperative 5., 10., 15., 20., 25., 30. minutes. However, PAR scala was recorded following extubation and postoperative 5., 10., 15., 20., 25., 30., 40., 50., 60., 75. and 90. minutes. SCS (Short Cognitive Scale) and VAS (Visual Analog Scale) were recorded at postoperative 5., 10., 15., 20., 25., 30., 40., 50., 60., 75. and 90. minutes. Eight and up values was accepted reliable for PAR. There were not found statistically significance between groups in SAP, DAP, HR, and SpO2 values (p>0.05). PAR value was statistically significance higher in group I than group II at 10. minutes (p0.05). Eight and up values for PAR were much lower in group I (p0.05). Finally sevoflurane has shorter postanaesthetic recovery time than isoflurane. However sevoflurane and isoflurane can be used easily for ambulatory (out-patient) surgery and does not show any difference on recovery regarding mental and psychomotor function.