Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

Objective: We aimed to investigate the effects of hypotensive anesthesia on oxidative stress with serum thiol/disulfide balance in patients undergoing elective septoplasty procedures under general anesthesia. Methods: Seventy-two patients between the ages of 18-60, with a physical condition I –II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anesthesia, patients were divided into the groups as Hypotensive Anesthesia (n = 40) and Normotensive Anesthesia (n = 32). Serum thiol/disulfide levels were measured by the method developed by Erel & Neşelioğlu. Results: The native thiol and total thiol values of both groups measured at the 60th minute intraoperatively were significantly lower than the preoperative values (both p < 0.01). Intraoperatively, at the 60th minute, there was no significant difference in terms of post-native thiol and post-total thiol levels between hypotensive and normotensive anesthesia groups (p = 0.68, and p = 0.81, respectively). Age > 40 years and female gender were found to have a significant effect on dynamic oxidative stress (p = 0.002, and p = 0.001, respectively). Conclusion: This pilot study has found that hypotensive anesthesia had no adverse effect on dynamic thiol/disulfide balance in elective surgeries.

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A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

The American Surgeon ◽

10.1177/0003134820973384 ◽

2020 ◽

pp. 000313482097338

Author(s):

Elizabeth McCarthy ◽

Benjamin L. Gough ◽

Michael S. Johns ◽

Alexandra Hanlon ◽

Sachin Vaid ◽

...

Keyword(s):

Postoperative Recovery ◽

Logistic Regression Models ◽

Community Institution ◽

Physical Status Classification ◽

Estimated Blood Loss ◽

Comparative Review ◽

Significant Difference ◽

American Society ◽

The Individual ◽

American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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Electroacupuncture at St36 Accelerates the Recovery of Gastrointestinal Motility after Colorectal Surgery: A Randomised Controlled Trial

Acupuncture in Medicine ◽

10.1136/acupmed-2013-010490 ◽

2014 ◽

Vol 32 (3) ◽

pp. 223-226 ◽

Cited By ~ 25

Author(s):

Zhaodi Zhang ◽

Changsong Wang ◽

Quanyi Li ◽

Mingyue Zhang ◽

Haifang Zhao ◽

...

Keyword(s):

Colorectal Surgery ◽

Gastrointestinal Motility ◽

Controlled Trial ◽

Bowel Function ◽

Group 13 ◽

Group Data ◽

Significant Difference ◽

American Society ◽

Randomised Controlled ◽

American Society Of Anesthesiologists

Objectives To evaluate whether electroacupuncture (EA) at ST36 can accelerate the recovery of gastrointestinal motility after colorectal surgery. Methods Forty patients of American Society of Anesthesiologists physical status II and III undergoing elective open resection of malignant colorectal tumours were included in this study. Using a sealed envelope method, the patients were randomly divided into two groups either receiving EA (EA group) or sham EA (SEA group). Data regarding the recovery of bowel function (times to the first bowel sounds, passage of flatus and defaecation) were collected and analysed. Results In the EA group, the time intervals from surgery to the first bowel movement and passage of flatus were shorter than in the SEA group (13±10 h vs 19±13 h, p<0.05 and 23±14 h vs 32±18 h, p<0.05, respectively). There was no significant difference between the groups regarding the time to first defaecation (68±45 h vs 72±53 h, p>0.05). Conclusions EA at ST36 accelerates the recovery of gastrointestinal motility after colorectal surgery. Trial Registration JJ22011-15.

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Effects of menopause and tibolone on antioxidants in postmenopausal women

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563053857941 ◽

2005 ◽

Vol 42 (3) ◽

pp. 220-223 ◽

Cited By ~ 21

Author(s):

Perin Vural ◽

Cemil Akgül ◽

Mukaddes Canbaz

Keyword(s):

Oxidative Stress ◽

Ascorbic Acid ◽

Postmenopausal Women ◽

Plasma Concentrations ◽

Lipid Peroxide ◽

Lipid Peroxides ◽

Thiol Groups ◽

Plasma Ascorbic Acid ◽

Total Thiol ◽

Significant Difference

Background: Oxidative stress has been implicated in the pathogenesis of ageing and menopause, and can arise through the increased production of lipid peroxides and/or a deficiency of antioxidant defence. Aim: To investigate the effects of the menopause and tibolone treatment (2.5 mg/day for six months) on plasma antioxidants and lipid peroxidation. Methods: Plasma concentrations of ascorbic acid, α-tocopherol, total thiol groups, caeruloplasmin, erythrocyte glutathione (GSH) and malondialdehyde (MDA) were measured in 24 postmenopausal and 24 premenopausal healthy women. Results: Data analysis indicates a significant decrease in plasma ascorbic acid, α-tocopherol, total thiol groups, caeruloplasmin, erythrocyte GSH and a significant increase in lipid peroxides (expressed as MDA concentrations) in postmenopausal women. There was no significant difference between control and study groups in the mean plasma caeruloplasmin concentrations. It was found that there is a significant increase in α-tocopherol and significant decrease in lipid peroxide concentrations in postmenopausal after tibolone treatment. Conclusions: The menopause is associated with an increase in oxidative stress and a decrease of some antioxidants, such as ascorbic acid, α-tocopherol, total thiols and erythrocyte GSH. Tibolone treatment leads to a decrease in concentrations of plasma lipid peroxide, probably by stimulating direct and indirect mechanisms of tocopherol regeneration and increasing plasma concentrations of vitamin E. However, due to the relatively small numbers involved this study can be regarded as a pilot. Further studies performed on a larger scale are necessary to establish the exact mechanisms of tibolone in inhibiting oxidative stress in postmenopausal women.

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A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20205450 ◽

2020 ◽

Author(s):

Pushpal Gandhi ◽

Mahendra Agrawal ◽

Bhavika Agrawal ◽

Simarn Behl

Keyword(s):

Epidural Analgesia ◽

Comparative Evaluation ◽

Hemodynamic Parameters ◽

Regional Technique ◽

Significant Difference ◽

Group 2 ◽

Reversible Loss ◽

American Society ◽

The One ◽

American Society Of Anesthesiologists

Background: Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.Methods: Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).Results: There is no significant difference in age, weight, sex, and ASA grade in all three groups.Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group. Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.Conclusions: Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.

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Assessing the completeness of perioperative anesthetic record documentation in a tertiary hospital

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i6.1401 ◽

2020 ◽

Vol 24 (6) ◽

Author(s):

Hayatul Akma Bolhan ◽

Nurlia Yahya ◽

Azarinah Izaham ◽

Wan Rahiza Wan Mat ◽

Raha Abdul Rahman ◽

...

Keyword(s):

Prospective Observational Study ◽

Tertiary Care ◽

Tertiary Hospital ◽

Policy Statement ◽

Anesthetic Record ◽

Standard Guideline ◽

Tertiary Care Institution ◽

American Society ◽

American Society Of Anesthesiologists

Background and Objective: Many previous studies assessing the completeness of perioperative documentation of surgical patients were reported to be inadequate and unsatisfactory. The aim of this study was to compare the perioperative anesthetic record (PAR) at our tertiary care institution to a standard guideline and have an audit of its completeness. Methodology: It was a prospective, observational study, done in the general operating theater of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). We compared our PAR to the American Society of Anesthesiologists (ASA) policy statement on documentation of anesthesia care. We audited the completeness of PAR documentation of 358 patients by using a self-generated checklist which was created in accordance to the PAR parameters. A total of 44 parameters were studied covering three phases; preoperative, peroperative and post-operative phases. Results: Although the UKMMC PAR varied from the ASA guidelines, various salient parameters were identical in both. None of the perioperative forms were completely filled throughout the three perioperative phases. Out of 44 parameters studied, only 2 parameters were completely filled, which were medications administered and fluid therapy. Conclusion: Parameters given in the UKMMC PAR varied with the ASA guidelines and the documentation was found to be only partially complete. Hence, necessary modification of the current PAR in our institution, and the stress on filling it completely is needed to improve the quality of perioperative anesthetic documentation. Keywords: Audit; Completeness; Perioperative; Anesthetic record; Documentation Citation: Bolhan HA, Yahya N, Izaham A, Mat WRW, Rahman RA, Musthafa QA. Anaesth. pain intensive care 2020;24(6):--- Received: 23 April 2020, Reviewed: 17 August 2020, Revised: 18 October 2020, Accepted: 27 October 2020

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An Evaluation of Oxidative Stress With Thiol/Disulfide Homeostasis in Patients With Persistent Allergic Rhinitis

Ear Nose & Throat Journal ◽

10.1177/0145561320926336 ◽

2020 ◽

pp. 014556132092633

Author(s):

Ayse E. Göker ◽

Maide H. Alagöz ◽

Tolgar L. Kumral ◽

Semih Karaketir ◽

Ayça B. Yilmazer ◽

...

Keyword(s):

Oxidative Stress ◽

Allergic Rhinitis ◽

Prospective Observational Study ◽

Allergen Exposure ◽

The Other ◽

Prick Test ◽

Total Thiol ◽

Persistent Allergic Rhinitis ◽

The Mean ◽

Sinonasal Symptoms

Background: We evaluated the efficacy of medical treatment on thiol–disulfide balance despite ongoing allergic stimulation. Methods: The research design was a prospective observational study that included 35 persistent allergic rhinitis (AR) patients. All patients who were diagnosed with persistent AR were included. A skin prick test was applied to all patients, and the Sino-nasal Outcome Test-22 was used to evaluate sinonasal symptoms. Thiol/disulfide homeostasis balance parameters were measured using a novel automatic and spectrophotometric method and compared statistically. Serum total thiol (TT), native thiol (SH), disulphide (SS), disulphide/native thiol (SS/SH), disulphide/total thiol (SS/TT), and native thiol/total thiol (SH/TT) ratios were measured after the second month of the treatment. Results: The 35 patients included 20 (58%) females and 15 (42%) males. The mean age of the patients was 33.17 ± 9.9 years. Disulphide, SS/SH, and SS/TT ratios decreased significantly after the treatment ( P < .05), while SH and SH/TT increased significantly ( P < .05). The mean SH measurement increased significantly in the second month ( P = .001), but TT mean measurements showed no difference after the treatment ( P = .058). The mean SS measurements, on the other hand, decreased significantly in the second month ( P = .003). Conclusion: Thiol/disulfide homeostasis may be used as a marker to evaluate the efficacy of persistent AR treatments. After the treatment, the increase in SH levels suggested the decrease in oxidative stress, even though allergen exposure continued.

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Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

The American Surgeon ◽

10.1177/000313480707300801 ◽

2007 ◽

Vol 73 (8) ◽

pp. 737-742 ◽

Cited By ~ 22

Author(s):

Naveen Pokala ◽

S. Sadhasivam ◽

R.P. Kiran ◽

V. Parithivel

Keyword(s):

Blood Loss ◽

Operative Time ◽

Laparoscopic Approach ◽

Complicated Appendicitis ◽

Complication Rates ◽

Intraabdominal Abscess ◽

Estimated Blood Loss ◽

Significant Difference ◽

American Society ◽

American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

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Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

Anesthesiology ◽

10.1097/aln.0b013e318210f9e3 ◽

2011 ◽

Vol 114 (4) ◽

pp. 856-861 ◽

Cited By ~ 126

Author(s):

Christophe Dadure ◽

Magali Sauter ◽

Sophie Bringuier ◽

Michelle Bigorre ◽

Olivier Raux ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Surgical Correction ◽

Intraoperative Bleeding ◽

Significant Difference ◽

Surgical Data ◽

American Society ◽

American Society Of Anesthesiologists ◽

To Receive

Background Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Tranexamic acid (TXA) decreases intraoperative blood loss during cardiac or orthopedic surgery in children. We hypothesized that intraoperative TXA would reduce blood transfusion relative to placebo in patients pretreated with erythropoietin. Methods Forty consecutive children, American Society of Anesthesiologists status 1 or 2, scheduled to undergo surgical correction of craniosynostosis were randomly assigned to receive either intravenous TXA or saline, 0.9%, intraoperatively. All children received preoperative erythropoietin (600 U/kg once a week for 3 weeks before surgery). Perioperative blood loss, number and volume of transfusions, percentage of children who underwent transfusion, and side effects were noted after surgery and at the end of the study. Surgeon satisfaction and cost of treatment were also recorded. Results There was no significant difference between groups in demographic or surgical data. In the TXA group, the volume of packed erythrocytes transfused was significantly reduced by 85% (from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2 ml/kg) throughout the study period (P < 0.05). Compared with the placebo group, the percentage of children requiring blood transfusion was lower in the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P < 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of 19; P < 0.05). Preoperative and postoperative hematologic parameters were comparable in both groups. There were no adverse events. Conclusion In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement.

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The study of oropharyngeal pack soaked in lignocaine with dexamethasone in patients undergoing nasal surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205455 ◽

2020 ◽

Vol 8 (1) ◽

pp. 22

Author(s):

Mahendra Agrawal ◽

Pushpal Gandhi ◽

Bhavika Agrawal ◽

Simarn Behl

Keyword(s):

Blood Pressure ◽

Retrospective Study ◽

Systolic Blood Pressure ◽

Sore Throat ◽

Pressure Pulse ◽

Postoperative Sore Throat ◽

Significant Difference ◽

Group A ◽

American Society ◽

American Society Of Anesthesiologists

Background: The aim of this study determines the efficacy of lignocaine lignocaine with dexamethasone used topically in form of oropharyngeal pack in reducing postoperative sore throat (POST), hoarseness and throat irritation. Methods: This retrospective study total of 70 adult patients included in the lignocaine and dexamethasone (LD) group. LD group patients received combination of 5 ml lignocaine 2% and 2 ml (8 mg) dexamethasone in oropharyngeal packing.Results: There is no significant difference in age, gender, and American society of anesthesiologists (ASA) grade I and II. There was no significant difference the studied group in term of measured hemodynamic indices Systolic blood pressure, diastolic blood pressure, pulse rate, and respiratory rate. Post extubation incidence of mild sore throat was occurred in patients 11 (31.4%) at 30 min, 13 (37.1%) at 2 hours, 6 (17.1%) at 6 hours, and 5 (14.2%) at 5 (14.2%). Moderate sore throat and severe sore throat was not present. Hoarseness of voice was present only 4 (11.4%) at 30 min. There was significant deference in throat irritation. A decrease in incidence of hoarseness was also seen in group LD. Conclusions: In LD group a positive beneﬁt is seen in form of reduction of POST, hoarseness and throat irritation helping in better recovery of patients.

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The Effect of COVID-19 Pandemic on the Hip Fractures in Advanced Age

Forbes Journal of Medicine ◽

10.5222/forbes.2021.94830 ◽

2021 ◽

Author(s):

Ahmet Metin Özsezen ◽

Ahmet Burak Bilekli ◽

Anıl Özgür ◽

Onur Denizhan Sivri ◽

Çağrı Neyişçi ◽

...

Keyword(s):

Primary Care ◽

Hip Fractures ◽

The Elderly ◽

Mortality Rates ◽

Demographic Characteristics ◽

Low Energy ◽

Primary Care Unit ◽

Significant Difference ◽

American Society ◽

American Society Of Anesthesiologists

Objective: Hip fractures due to domestic low-energy traumas are common problems that can cause significant morbidity and mortality in the elderly population. Since the Covid-19 outbreak, although the lock-down of older people could decrease contagion,the incidence of domestic traumas did not decrease, and led to development of various comorbidities. In this study, we aimed to compare the epidemiology of hip fractures in 6 months of the pandemic in 2020, with the equivalent 6-month period in the previous year to determine the relationship between lock-down and hip fractures due to domestic falls. Method: In this retrospective study, patients over 65 years old who were hospitalized due to hip fractures between May 1st, 2020 - November 30th, 2020 were compared with the similar cohort hospitalized between May 1st, 2019 - November 30th, 2019. The patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) scores, type of anesthesia, time until surgery, comorbidities, surgical treatment modality, need for postoperative primary care unit, postoperative complications, and mortality. Results: Overall, 210 patients were included in our study. There was no significant difference between the groups regarding demographic characteristics and ASA scores. In the 2020 group, there were eight patients (8.6%) who were Covid-19 PCR- positive. There was no death proven by PCR that was related to COVID-19 disease. Time to surgery, fracture type, anesthesia type did not differ between the two groups. The need for a postoperative primary care unit was higher in the 2020 group. Ninety-day mortality rates were not significantly different between the two groups. Conclusions: In conclusion, despite higher mortality rates described in the literature, there was no Covid -19 associated mortality in our study. Hip fractures in the elderly did not alter with social mobilization; hence they usually occur due to domestic low- energy traumas. Reporting of the information in this patient group by all centers will provide important data in the management of hip fractures in this special process.

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