Background. The aim of this study is to compare the effects of sevoflurane and propofol on one lung ventilation (OLV) induced ischemia-reperfusion injury (IRI) by determining the blood gas, ischemia-modified albumin (IMA), and malonyldialdehyde (MDA). Material and Methods. Forty-four patients undergoing thoracic surgery with OLV were randomized in two groups (sevoflurane Group S, propofol Group P). Anesthesia was inducted with thiopental and was maintained with 1–2.5% of sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil. Hemodynamic records and blood samples were obtained before anesthesia induction (t 1), 1 min before two lung ventilation (t 2), 30 min after two lung ventilation (t 3), and postoperative sixth hours (t 4). Results. Heart rate at t 2 and t 3 in Group P was significantly lower than that in Group S. While there were no significant differences in terms of pH and pCO2, pO2 at t 2 and t 3 in Group S was significantly lower than that in Group P. IMA levels at t 4 in Group S were significantly lower than those in Group P. Conclusion. Sevoflurane may offer protection against IRI after OLV in thoracic surgery.
Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2–t 9 and t 2–t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2–t 8 and t 2–t 9. IMA levels in Group T were significantly lower than those in Group S at t 2–t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.
Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy.
Chylothorax is rare as a sequela to cardiac surgery. Its prevalence in cardiothoracic procedures is 0.3% to 1.5%; after median sternotomy, it is still more unusual.1,2 It is more frequent in pediatric than in adult cardiothoracic surgery. 3-5Postoperative chylothorax is associated with high rates of morbidity and mortality. 6 It can cause metabolic disturbances, nutritional deficiencies, respiratory disorders, immunodeficiency and infections, prolonged hospitalization, and high treatment costs. 7,8 Chylothorax after coronary artery bypass grafting (CABG) is rare, but it occurs most often if the left internal mammary artery (LIMA) has been used as a graft. We describe 2 cases of chylothorax that developed in adults after CABG, both of which were treated successfully with medical therapy alone. Case Reports Patient 1A 60-year-old man was admitted to our institution after a sudden onset of chest pain that radiated to his left arm. Coronary angiographic results led our heart team to perform CABG.After a median sternotomy, the LIMA was harvested as a peduncle, the pleura was incised, and the saphenous vein was harvested. First, the reversed saphenous vein graft was anastomosed to the 2nd diagonal branch (D2). Then the LIMA was anastomosed to the left anterior descending coronary artery (LAD). After the proximal anastomosis, the patient was weaned from cardiopulmonary bypass.The operative and first postoperative days were eventless. On the 2nd postoperative day, pale pink discoloration of the pleural drainage fluid was noticed. Chylothorax was diagnosed when biochemical analysis of the pleural fluid revealed total cholesterol, 43 mg/dL; triglycerides, 398 mg/dL; glucose, 67 mg/dL; and total protein, 2.7 g/dL. Pleural drainage was 100 to 250 mL/d.From the outset, the patient was given nothing by mouth but received, via total parenteral nutrition (TPN), a low-fat diet rich in medium-chain fatty acids (MCFA) (total calorie intake, 1,800 kcal/d. In addition, intravenous somatostatin was started (infusion rate of 3.5 µg/kg/hr for the first 48 hr, increased to 5 µg/kg/hr for the next 48 hr, and then to 7 µg/kg/hr for the 3rd 48 hr). No side effects-such as hypersensitivity, hypotension, or hypoglycemia-were noted.On the 7th postoperative day, the patient's oral intake of a low-fat diet was started. The pleural drainage fluid decreased during the course of this conservative therapy. The chest tube was removed on postoperative day 13, after the drainage of fluid had ceased. Follow-up chest radiography yielded normal results. The patient was dis-
Background. This retrospective study was designed to investigate the efficacy and safety of intermittent portal triad clamping (PTC) with low central venous pressure (CVP) in liver resections. Methods. Between January 2007 and August 2013, 115 patients underwent liver resection with intermittent PTC. The patients' data were retrospectively analyzed. Results. There were 58 males and 57 females with a mean age of 55 years (±13.7). Cirrhosis was found in 23 patients. Resections were performed for malignant disease in 62.6% (n = 72) and for benign disease in 37.4% (n = 43). Major hepatectomy was performed in 26 patients (22.4%). Mean liver ischemia period was 27.1 min (±13.9). The mortality rate was 1.7% and the morbidity rate was 22.6%. Cumulative clamping time (t = 3.61, P < 0.001) and operation time (t = 2.38, P < 0.019) were significantly correlated with AST alterations (D-AST). Cumulative clamping time (t = 5.16, P < 0.001) was significantly correlated with D-ALT. Operation time (t = 5.81, P < 0.001) was significantly correlated with D-LDH. Conclusions. Intermittent PTC under low CVP was performed with low morbidity and mortality. Intermittent PTC can be safely applied up to 60 minutes in both normal and impaired livers.
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