The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.

The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30) or 2 mg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

Wound infiltration with combined levobupivacaine and tramadol resulted in elimination of postoperative analgesic demand and reduction in the incidence of side effects. We conclude that infiltration of the wound site with combined levobupivacaine and tramadol provides significantly better analgesia compared with levobupivacaine or tramadol alone.

ÖZETAmaç: Çalışmamızın amacı, akut karbonmonoksit (CO) zehirlenmesi olan hastalarda atriyal ileti ve ventriküler repolarizasyon homojenlik bozukluklarını P dalga dispersiyonu (PDD), ve QT dispersiyonu (QTd) aracılığı ile araştırılmasıdır. Yöntemler: Retrospektif ve vaka-kontrollü olarak planlanan çalışmamıza, 30 akut CO zehirlenmesi olgusu ile (Grup ACOP), 30 sağlıklı olgu (Grup C) dâhil edildi. Grup ACOP' da acil servise başvuru anında çekilmiş standart 12 derivasyonlu elektrokardiyografi (EKG) kayıtları değerlendirildi. EKG kayıtlarından PDD, QT aralığı, QTd süreleri belirlendi. Düzeltilmiş QT aralığı (QTc) ve QTc dispersiyonu (QTcd) süreleri Bazett formülü kullanılarak belirlendi. Grup ACOP' da ve Grup C' de EKG kaydı ile eş zamanlı olarak alınmış kan örneklerinden serum elektrolit değeri ile Grup ACOP' da COHb değerleri belirlendi. İstatistik analiz için bağımsız örneklerde t ve Ki-kare testleri kullanıldı. Bulgular: Gruplar arasında yaş, cinsiyet dağılımları, antropometrik ölçümleri, serum elektrolit düzeyleri PR ve QT süreleri açısından anlamlı farklılık yoktu. Grup ACOP'da PDD (56.33±17.11 msn'ye karşın 28.33±11.16 msn, p<0.001), ve QTd (63.33±26.69 msn'ye karşın 42.16±7.84 msn, p<0.001) süreleri Grup C'den anlamlı olarak daha uzundu. Ek olarak, QTc ve QTcd süreleri de Grup ACOP'da Grup C' den anlamlı olarak daha uzun saptandı (p<0.001). Sonuç: Akut CO zehirlenmesi olgularında uzamış PDD, QTc ve QTcd süreleri nedeniyle atriyal ve ventriküler aritmi riski yüksektir. Bu olguların yoğun bakım ünitelerindeki takibi sırasında, oluşabilecek atriyal ve ventriküler aritmilere karşı dikkatli olunmalıdır.(Anadolu Kardiyol Derg 2011 1: 48-52) Anahtar kelimeler: Akut karbonmonoksit zehirlenmesi, P dalga dispersiyonu, düzeltilmiş QT süresi, düzeltilmiş QT dispersiyonu ABSTRACT Objective: The aim of our study was to investigate atrial conduction and ventricular repolarization inhomogeneities using P-wave dispersion (Pwd) and QT dispersion (QTd) analyses in acute carbon monoxide (CO) poisoning. Methods: Sixty patients were retrospectively included in this case-controlled study. Thirty acute CO poisoning patients were assigned to the Group with acute CO poisoning (ACOP). Patients who did not have acute CO poisoning were assigned to the control group (Group C, n=30). Anthropometric measurement, body mass index, electrocardiogram (ECG) and serum electrolyte levels were recorded in all patients. Also, carboxyhemoglobin (COHb) levels were recorded in Group ACOP. Pwd, QT interval and QTd durations were measured. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett formula. Independent samples t and Chi-square tests were used for statistical analysis. Results: No statistically significant difference was found between the age, gender distribution, anthropometric measurement, serum electrolytes, PR and QT durations between the groups. The Pwd (56.33±17.11 msec vs 28.33±11.16 msec, p<0.001) and QTd (63.33±26.69 msec vs 42.16±7.84 msec, p<0.001) were significantly longer in Group ACOP than in Grou...

Ischemia reperfusion injury causes the release of free oxygen radicals. Free oxygen radicals initiate the production of toxic metabolites, such as malondialdehyde (MDA), through the lipid peroxidation of cellular membranes. Following lipid peroxidation, the antioxidant enzyme system is activated against reactive oxygen species (ROS) and attempts to protect cells from oxidative damage. There is a balance between the scavenging capacity of antioxidant enzymes and ROS. Because of this balance, the total antioxidant capacity (TAC) measurement is a sensitive indicator of the overall protective effects of the antioxidants. Alpha(2) receptor agonists are effective in preventing hemodynamic reactions during extremity surgeries by preventing the release of catecholamines secondary to tourniquet application. They have also been shown to possess preventive effects in various ischemia-reperfusion injury models. In our study, we examined the effects of dexmedetomidine on tourniquet-induced ischemia-reperfusion injury in lower extremity surgeries performed under general anesthesia. The effects of dexmedetomidine were measured with serum MDA and TAC levels. We studied 60 adult American Society of Anesthesiologists (ASA) physical status I or II patients undergoing one-sided lower extremity surgery with tourniquet. The patients were randomly divided into two groups. Group D was administered a dexmedetomidine infusion at a rate of 0.1μg/kg/minute(-1) for 10 minutes prior to induction and then at 0.7μg/kg/hour(-1) until 10 minutes before the end of the operation. The control group (Group C) received a saline infusion of the same amount and for the same period of time. General anesthesia was induced with thiopental, fentanyl, and rocuronium and maintained with nitrous oxide and sevoflurane in both groups. Venous blood samples were obtained before the administration of the study drugs (basal) at 1 minute before tourniquet release and at 5 and 20 minutes after tourniquet release (ATR). In both groups, MDA levels decreased at 5 and 20 minutes ATR when compared with the basal values (p<0.05). TAC levels decreased at 1 and 5 minutes ATR and then returned to basal values at 20 minutes ATR (p<0.05). In reference to the prevention of lipid peroxidation in tourniquet-induced ischemia-reperfusion injury, the results from the two groups in our study showed that dexmedetomidine did not have an additional protective role during routine general anesthesia.