Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 9 Articles
Background: Selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are reported to have potent\nantiemetic effects for postoperative nausea and vomiting (PONV). The purpose of this study was to prospectively\nevaluate the efficacy of palonosetron, granisetron, and ramosetron for the prevention of PONV in patients\nundergoing laparoscopic gynecologic surgery.\nMethods: In this prospective, randomized observational study, 105 healthy female patients who were undergoing\nlaparocopic hystectomy under general anaesthesia were enrolled (clinical trial number: NCT01752374,\nwww.clinicaltrials.gov). Patients were divided into three groups: the palonostron (0.075 mg i.v.; n = 35), the\ngranisetron group (3 mg i.v.; n = 35), and the ramosetron group (0.3 mg i.v.; n = 35). The treatments were given\nbefore the end of surgery. The incidence of PONV, severity of nausea/vomiting, and the use of rescue antiemetic\nrequirements during the first 48 h after surgery were evaluated.\nResults: The overall incidence of PONV was 33.3 % for this series. The number of complete responders at 48 h after\nthe surgery was 21 (60.0 %) for palonosetron, 24 (68.6 %) for granisetron, and 26 (71.4 %) for ramosetron,\nrepresenting no statistical difference (P = 0.086).\nConclusions: There were no significant differences in the overall incidence of postoperative nausea and vomiting\nand complete responders for palonosetron, granisetron and ramosetron group....
Background: Intact orthostatic blood pressure regulation is essential for early mobilization after surgery. However,\npostoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of\npostoperative OI include impaired vasopressor responses relating to postoperative autonomic dysfunction. Thus,\nbased on a previous study on haemodynamic responses during mobilization before and after elective total hip\narthroplasty (THA), we performed secondary analyses of heart rate variability (HRV) and aimed to identify possible\nabnormal postoperative autonomic responses in relation to postural change.\nMethods: A standardized mobilization protocol before, 6 and 24 h after surgery was performed in 23 patients\nscheduled for elective THA. Beat-to-beat arterial blood pressure was measured by photoplethysmography and HRV\nwas derived from pulse wave interbeat intervals and analysed in the time and frequency domain as well as by\nnon-linear analysis using sample entropy\nResults: Before surgery, arterial pressures and HR increased upon standing, while HRV low (LF) and high frequency\n(HF) components remained unchanged. At 6 and 24 h after surgery, resting total HRV power, sample entropy and\npostural responses in arterial pressures decreased compared to preoperative conditions. During standing HF\nvariation increased by 16.7 (95 % CI 8.0ââ?¬â??25.0) normalized units (nu) at 6 h and 10.7 (2.0ââ?¬â??19.4) nu at 24 h compared\nto the preoperative evaluation. At 24 h the LF/HF ratio decreased from 1.8 (1.2ââ?¬â??2.6) nu when supine to 1.2 (0.8ââ?¬â??1.8)\nnu when standing.\nConclusions: This study observed postoperative autonomic cardiovascular dysregulation that may contribute to\nlimited HRV responses during early postoperative mobilization...
Background: Dexamethasone is an antiemetic alternative to ondansetron. We aimed to compare the effects of\ndexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing\nlaparoscopic surgery.\nMethods: We searched PubMed, Embase, Medline and Cochrane Library (from inception to July 2014) for eligible\nstudies. The primary outcome was the incidence of PONV during the first 24 h after surgery. The secondary\noutcomes included PONV in the early postoperative stage (0ââ?¬â??6 h), PONV in the late postoperative stage (6ââ?¬â??24 h),\nand the postoperative anti-emetics used at both stages. We calculated pooled risk ratios (RR) and 95 % CIs using\nrandom- and fixed-effects models.\nResults: Seven trials involving 608 patients were included in this meta-analysis, which found that dexamethasone\nhad a comparable effectiveness in preventing PONV (RR, 0.91; 95 % CI, 0.73-1.13; P = 0.39) with that of ondansetron\nwithin 24 h of laparoscopic surgery, with no evidence of heterogeneity among the studies (I2 = 0 %; P = 0.71). In\nthe early postoperative stage (0ââ?¬â??6 h), ondansetron was better at decreasing PONV than dexamethasone (RR, 1.71;\n95 % CI, 1.05-2.77; P = 0.03), while in the late postoperative stage (6ââ?¬â??24 h), dexamethasone was more effective in\npreventing PONV than ondansetron (RR, 0.51; 95 % CI, 0.27-0.93; P = 0.03). There was no significant difference in\nthe postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).\nConclusions: Dexamethasone was as effective and as safe as ondansetron in preventing PONV. Dexamethasone\nshould be encouraged as an alternative to ondansetron for preventing PONV in patients undergoing laparoscopic\nsurgery....
Background: Many researchers have suggested that the glutamatergic system may be involved in the effects of\nantidepressant therapies. We investigated the effects of doxepin, imipramine, and fluoxetine on the excitatory\namino acid transporter type 3 (EAAT3).\nMethods: EAAT3 was expressed in Xenopus oocytes by injection of EAAT3 mRNA. Membrane currents were recorded\nafter application of L-glutamate (30 Ã?¼M) in the presence or absence of various concentrations of doxepin, imipramine,\nand fluoxetine. To study the effects of protein kinase C (PKC) activation on EAAT3 activity, oocytes were pre-incubated\nwith phorbol 12-myristate-13-acetate (PMA) before application of imipramine and doxepin.\nResults: Doxepin at 0.063ââ?¬â??1.58 Ã?¼M significantly decreased EAAT3 activity. Imipramine reduced EAAT3 activity in\na concentration-dependent manner at 0.16ââ?¬â??0.95 Ã?¼M. However, fluoxetine did not affect EAAT3 activity, and PMA\nincreased EAAT3 activity. At 0.32 Ã?¼M, imipramine caused an equivalent decrease in EAAT3 activity in the presence\nor absence of PMA. However, 0.79 Ã?¼M doxepin did not abolish the enhancement of EAAT3 activity by PMA.\nConclusions: We showed that doxepin and imipramine, but not fluoxetine, inhibited EAAT3 activity at clinically\nrelevant concentrations. This reveals a novel mechanism of action for doxepin and imipramine; that they increase\nglutamatergic neurotransmission. PKC may be involved in the effects of doxepin on EAAT3, but is not involved in\nthe effects of imipramine at the concentrations studied....
Background: Both hydrogen sulphide (H2S) and mild hypothermia have been reported to prevent brain damage\ncaused by reperfusion assault through regulating the N-methyl-D-aspartate receptor (NMDAR). However, the relationship\nbetween the two treatments and how they exert neuro-protective effects through NMDARs remain to be elucidated.\nMethods: Transient cerebral ischemia was induced using the Pulsinelli four-vessel occlusion method. We used sodium\nhydrosulphide (NaHS) as the H2S donor. We randomly divided 100 Spragueââ?¬â??Dawley rats into five groups of 20: Sham\noperation group (Sh), normothermic (36-37 Ã?°C) ischemia group (NT), mild hypothermic (32-33 Ã?°C) ischemia group (mHT),\nnormothermic ischemia combined with NaHS treatment group (NT + NaHS), and mild hypothermic ischemia combined\nwith NaHS treatment group (mHT + NaHS). After 6 hrs of reperfusion, rats were decapitated and hippocampus samples\nwere immediately collected. We measured NR2A (GluN1), NR2B (GluN2) and p-CREB protein levels using western blotting.\nWe further analyzed BDNF mRNA expression by real-time PCR. Hematoxylin and eosin (HE) staining was used to examine\npyramidal cell histology at the CA1 region. All statistical analyses were carried out by ANOVA and LSD t-test as\nimplemented by the SPSS 13.0 software.\nResults: In the four test groups with ischemia-reperfusion, hippocampal H2S concentration increased following treatment,\nand administration of NaHS further increased H2S levels. Moreover, administration of both NaHS and mild hypothermia\nresulted in up-regulation of NR2A and NR2B protein expressions, as well as p-CREB protein and BDNF mRNA levels. At the\ncellular level, NaHS and mild hypothermia groups exhibited lower damage caused by ischemia-reperfusion in the CA1\nregion of the hippocampus. The strongest protective effect was observed in rats treated with combined NaHS and mild\nhypothermia, suggesting their effects were additive.\nConclusion: Our results support previous findings that hydrogen sulphide and mild hypothermia can prevent\nischemia-reperfusion injury. Both treatments caused an up-regulation of NMDA receptors, as well as an elevation in\np-CREB protein and BDNF mRNA levels. Thus, hydrogen sulphide and mild hypothermia may provide neuro-protective\neffect through activating the pro-survival CREB signaling pathway....
Background: Weaning from mechanical ventilation is associated with the presence of asynchronies between the\npatient and the ventilator. The main objective of the present study was to demonstrate a decrease in the total\nnumber of patient-ventilator asynchronies in invasively ventilated patients for whom difficulty in weaning is\nexpected by comparing neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) ventilatory\nmodes.\nMethods: We performed a prospective, non-randomized, non-interventional, single-center study. Thirty patients\nwere included in the study. Each patient included in the study benefited in an unpredictable way from both modes\nof ventilation, NAVA or PSV. Patients were successively ventilated for 23 h in NAVA or in PSV, and then they were\nventilated for another 23 h in the other mode. Demographic, biological and ventilatory data were collected during\nthis period. The two modes of ventilatory support were compared using the non-parametric Wilcoxon test after checking\nfor normal distribution by the Kolmogorovââ?¬â??Smirnov test. The groups were compared using the chi-square test.\nResults: The median level of support was 12.5 cmH2O (4ââ?¬â??20 cmH2O) in PSV and 0.8 cmH2O/Ã?¼volts (0.2ââ?¬â??3 cmH2O/Ã?¼volts)\nin NAVA. The total number of asynchronies per minute in NAVA was lower than that in PSV (0.46 vs 1,\np < 0.001). The asynchrony index was also reduced in NAVA compared with PSV (1.73 vs 3.36, p < 0.001). In\nNAVA, the percentage of ineffective efforts (0.77 vs 0.94, p = 0.036) and the percentage of auto-triggering\nwere lower compared with PSV (0.19 vs 0.71, p = 0.038). However, there was a higher percentage of double\ntriggering in NAVA compared with PSV (0.76 vs 0.71, p = 0.046).\nConclusion: The total number of asynchronies in NAVA is lower than that in PSV. This finding reflects\nimproved patient-ventilator interaction in NAVA compared with the PSV mode, which is consistent with\nprevious studies. Our study is the first to analyze patient-ventilator asynchronies in NAVA and PSV on such\nan important duration. The decrease in the number of asynchronies in NAVA is due to reduced ineffective\nefforts and auto-triggering....
Background: Carriers of plasminogen activator inhibitor -1 (PAI-1) -675 genotype 5G/5G may be associated with\nlower preoperative PAI-1 plasma levels and higher blood loss after heart surgery using cardiopulmonary bypass\n(CPB). We speculate if polymorphisms of PAI-1 -844 A/G and angiotensin converting enzyme (ACE) intron 16 I/D also\nmight promote fibrinolysis and increase postoperative bleeding.\nMethods: We assessed PAI-1 -844 A/G, and ACE intron 16 I/D polymorphisms by polymerase chain reaction\ntechnique and direct sequencing of genomic DNA from 83 open heart surgery patients that we have presented\nearlier. As primary outcome, accumulated chest tube drainage (CTD) at 4 and 24 h were analyzed for association\nwith genetic polymorphisms. As secondary outcome, differences in plasma levels of PAI-1, t-PA/PAI-1 complex and\nD-dimer were determined for each polymorphism. SPSS�® was used for statistical evaluation.\nResults: The lowest preoperative PAI-1 plasma levels were associated with PAI-1 -844 genotype G/G, and\nhigher CTD, as compared with genotype A/A at 4 and 24 h after surgery. Correspondingly, 4 h after the\nsurgery CTD was higher in carriers of ACE intron 16 genotype I/I, as compared with genotype D/D. PAI-1\nplasma levels and t-PA/PAI-1 complex reached nadir in carriers of ACE intron 16 genotype I/I, in whom we\nalso noticed the highest D-dimer levels immediately after surgery. Notably, carriers of PAI-1 -844 genotype\nG/G displayed higher D-dimer levels at 24 h after surgery as compared with those of genotype A/G.\nConclusions: Increased postoperative blood loss secondary to enhanced fibrinolysis was associated with\ncarriers of PAI-1 -844 G/G and ACE Intron 16 I/I, suggesting that these genotypes might predict increased\npostoperative blood loss after cardiac surgery using CPB....
Background: Hypoxemia caused high altitude leads to an increase and variability in CSF volume. The purpose of\nthis prospective study was to detect the differences, if any, between moderately highlanders and lowlanders in\nterms of anaesthetic parameters under neuroaxial anaesthesia.\nMethods: Consecutive patients living at moderately high altitude (Erzurum, 1890 m above the sea level) and sea\nlevel (Sakarya, 31 m above the sea level) scheduled for elective lower extremity surgery with spinal anaesthesia\nwere enrolled in this study (n = 70, for each group). Same anaesthesia protocol was applied for all patients. Spinal\nanaesthesia was provided with hyperbaric bupivacaine 0.5 %, 9 mg (1.8 mL) in all patients. Anaesthetic\ncharacteristics and hemodynamic parameters of patients were recorded. The findings obtained in two different\naltitudes were compared using appropriate statistical tests. If data was not normally distributed, comparisons were\ndetermined using the Mannââ?¬â??Whitney U-test. Comparisons were determined using the Independent T test when\ndata was normally distributed and Fisherââ?¬â?¢s exact test was used to compare the percentage values.\nResults: Duration of the block procedure (minutes) was significantly shorter at the sea level (14.34 Ã?± 0.88) than at\nmoderate altitude (20.38 Ã?± 1.46) (P < 0.001). Motor block duration (minutes) was higher at the sea level compared to\nthe moderate altitude (310.2 Ã?± 104.2, 200.4 Ã?± 103.2; respectively; P < 0.05). Also, the sensory block time (minutes) was\nhigher at the sea level compared to moderate altitude (200.2 Ã?± 50. minutes vs. 155.2 Ã?± 60.7 min; respectively;\nP < 0.05). Moderate altitude group had significantly higher MABP values at baseline, during surgery and at\npostoperative 1st and 2nd hours than in the sea level group (P < 0.05, for all). Moderately high altitude group had\nlower heart rate values at baseline, during surgery and postoperative 1st and 2nd hours compared with the sea level\ngroup (P < 0.05). PDPH was seen more frequently (7.14 vs. 2.85 %; P < 0.05) at moderate altitude.\nConclusions: Hemodynamic variations and more anaesthetic requirements following the spinal anaesthesia may be\nobserved at moderately high altitudes compared to the sea level....
Background: Early utilisation of neuraxial anaesthesia has been recommended to reduce the need for general\nanaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not\nstraight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for\nemergency caesarean section, in pregnant women with a body mass index (BMI) ââ?°Â¥ 40 kg/m2, to those with a\nBMI < 30 kg/m2. The results will be used to calculate the sample size of a planned prospective study.\nMethods: In this retrospective, (1:1) caseââ?¬â??control pilot study, obese subjects and control subjects were selected\nfrom the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural\nanalgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was\nextracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions.\nChi-square or Fisherââ?¬â?¢s exact tests were used to detect differences between groups. Multiple logistic regression was\nused to examine variables predictive of extension failure.\nResults: There were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m2 and 23.9\n(3.0) kg/m2 in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal\ndefinition) was 2.48 (95 % CI:1.02 ââ?¬â?? 6.03) for the obese group compared with the control group (adjusted for age,\nparity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 %\nCI:1.43 ââ?¬â?? 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted\nextension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese\ngroup.\nConclusions: In this small retrospective cohort, patients with a BMI ââ?°Â¥ 40 kg/m2 were significantly more likely to fail\nepidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were\nsignificant predictors of extension failure; their clinical relevance requires further evaluation....
Loading....