Background:This study was conducted to compare the efficacy and effects of dexmedetomidine and midazolam in preoperative sedation.Materials and Methods:A total of 125 patients in American Society of Anaesthesiologists (ASA) I-II were divided into three groups: Group I (n = 40) for controls, Group II (n = 40) for Dexmedetomidine (1 μg/kg), and group III was the midazolam group (n = 45). Group III was further divided into three subgroups according to the doses of midazolam: Group IIIA (n = 15) received 0.02 mg/kg, group IIIB (n = 15) received 0.04 mg/kg, and group IIIC (n = 15) received 0.06 mg/kg of midazolam. Drugs were infused over a 10-minute period with appropriate monitoring. Ramsay and visual analog scores, for sedation and anxiety, respectively, and mean arterial pressure, heart rate, and SpO2 measurement, including respiratory rates were recorded, every 5 minutes for 30 minutes following infusion.Results:There was marked sedation and a decrease in anxiety in groups II and IIIC (P < 0.01). Mean arterial pressure (MAP) and heart rate (HR) decreased significantly in group II (P < 0.01 and P < 0.05, respectively), but there was no associated hypotension (MAP <60 mm Hg) or bradycardia (HR <50 bpm) (P < 0.05). Respiratory rates and SpO2 values decreased in groups II, IIIA, IIIB, and IIIC. The differences in respiratory rates were not significant (P > 0.05); however, decrease in SpO2 was significant in group IIIC (P < 0.01).Conclusions:Dexmedetomidine was as effective as higher doses of midazolam in sedation. The hemodynamic and respiratory effects were minimal. Although dexmedetomidine caused significant decrease in the blood pressure and heart rate, it probably just normalized increased levels caused by preoperative stress.

Background: Diabetes mellitus (DM) causes debilitating complications and, as a result, diabetics frequently require intensive care. Although lungs are not thought to be affected primarily by DM, an increasing number of studies indicate physiological and structural abnormalities in diabetic lungs. Objectives: Pyrrolidine dithiocarbamate (PDTC) is a metal chelator and a potent inhibitor of NF-ĸB. Keeping in mind that NF-ĸB activation may be crucial in end-organ injury due to DM, we studied the role of PDTC on the inhibition of NF-ĸB activation and its effects on possible lung injury in rats with streptozotocin-induced DM. Methods: 36 Sprague-Dawley rats were allocated into 4 groups: diabetes, diabetes + PDTC, control and control + PDTC. At the end of 10 weeks, rats were sacrificed and their lungs were taken for histopathological and immunohistochemical evaluation [for NF-ĸB (p65) and endothelial nitric oxide (eNOS) immunoreactivities]. Protein carbonyl content (PCC), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured. Results: Histopathologically, basal membranes were thickened and there was intense inflammatory reaction in diabetic lungs. However, the PDTC group, in which there were poor positive expressions of eNOS and p65 activity compared to diabetes group, revealed fewer inflammatory changes. PCC levels in diabetic lungs were higher, but SOD and GSH activities were lower. However, measurements of these parameters in the PDTC group and controls gave similar results. Conclusion: Lungs are exposed to changes induced by oxidative stress in diabetes through NF-ĸB activation and PDTC seems to be useful to prevent diabetic lung injury.

BACKGROUNDTransesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE.DESIGN AND SETTINGSA prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey.METHODSA total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented.RESULTSAnxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P<.05 and P<.001, respectively).CONCLUSIONHypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

Evaluation of the data obtained in the study demonstrated that post-spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, this downward change did not result in deterioration of cognitive functioning.

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : It is known that diabetes leads to depletion of the cellular antioxidant defense system and this causes the organ injuries related to the diabetic complications. Antioxidants have been shown to reduce indices of oxidative stress measures in experimental disease models and in humans. The present study was designed to evaluate the oxidative stress in lungs as well as the therapeutic effect of pomegranate juice (PJ), as an antioxidant, in rats with streptozotocin-induced diabetes. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Twenty seven rats were enrolled in the study where diabetes was induced by streptozotocin injection. Rats were treated with either PJ or saline for 10 weeks, and their lungs were harvested for histologic and immunohistochemical evaluation at the end. Protein carbonyl content (PCC), sialic acid (SA), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured in the pulmonary tissue as well as the presence of endothelial nitric oxide synthase (eNOS), through immunohistochemistry. R Re es su ul lt ts s: : The pulmonary tissue in diabetic rats showed oxidative alterations related to the streptozotocin treatment. There was increased eNOS expressions in diabetic lungs, but PJ treatment diminished both eNOS expressions and inflammatory changes in pulmonary tissue. PCC and SA levels were higher in diabetic lungs (p<0.01) whereas SOD was lower (p=0.021) and GSH did not change significantly in comparison to PJ-treated diabetic group (p=0.374). C Co on nc cl lu us si io on n: : The PJ treatment effectively reduced the oxidative stress and contributed to tissue recovery in experimental diabetic lungs. These findings would be of clinical relevance.K Ke ey y W Wo or rd ds s: : Oxidative stress; diabetes complications; lung; models, animal; punicaceae Ö ÖZ ZE ET T A Am ma aç ç: : Diyabetin hücresel antioksidan savunma sisteminde azalmaya yol açtığı bilinmektedir ve bu da diabetik komplikasyonlara bağlı organ hasarına neden olur. Antioksidanların oksidatif stres ölçütleri göstergelerini azalttığı deneysel hastalık modellerinde ve insanlarda gösterilmiştir. Bu çalışma akciğerlerdeki oksidatif stresi ve streptozotosinle indüklenmiş diyabeti olan sıçanlarda, bir antioksidan olan nar suyunun tedavi edici etkisini değerlendirmek için tasarlandı. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Streptozotosin enjeksiyonu ile diyabetin indüklendiği 27 sıçan çalışmaya alındı. Sıçanlar 10 hafta boyunca nar suyu veya serum fizyoojikle tedavi edildi ve bitiminde histolojik ve immünohistokimyasal değerlendirmeler için akciğerleri toplandı. Akciğer dokusunda protein karbonil içeriği (PCC), sialik asit (SA), süperoksit dizmutaz (SOD) ve redükte glutatyon (GSH) aktiviteleri ve endotelyal nitrik oksit sentaz (eNOS) varlığı immünohistokimyasal olarak ölçüldü. B Bu ul lg gu ul la ar r: : Diyabetik sıçanlarda akciğer dokusu streptozotosin uygulamasına bağlı oksidatif değişiklikler gösterdi. Diyabetik akciğerlerde artmış eNOS ekspre...

The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70% of conventionally used doses seems possible with US guidance. This article is published in English.

Öz Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normal hastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yan etkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acil serviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olan hastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı 50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyeti ile başvurdu. Hastada metformin ilişkili laktik asidoz (pH<7.35, laktat düzeyi>5 mmol/L ve bikarbonat<22 mmol/L) tanımlandı. Erken tanı ve hemodiyaliz veya hemofiltrasyon yöntemleri ile metabolik asidozun hızlı düzeltilmesi, destek tedavisi ve kan glikoz düzeyinin ayarlanması pozitif sonuçlara neden olacaktır.

Introduction: Coffin-Siris Syndrome (CSS) is a rare congenital malformation syndrome characterized with mild to severe developmental and cognitive delay, coarse facial features, fifth digit aplasia or hypoplasia associated with ectodermal, constitutional and organ-related (cardiac/neurolo gical/gastrointestinal/genitourinary. . .) anomalies. Here, we have reported a successful anesthetic and airway management in a case of 5-year old boy with CSS who underwent congenital heart surgery. Case report: A 5-year old male child weighing 14 kg, who was diagnosed as CSS underwent operation for the repair of partial atrioventricular septal defect and secundum atrial septal defect. This case report pertains to the successful anesthetic and airway management in the background of difficult airway and presence of various cardiac abnormalities. Although patient was anticipated to be difficult for intubation due to laryngomalacia, micrognathia, macroglossia, tracheal intubation was performed without any difficulty using fiber-optic laryngoscopy. At the end of the operation, the patient was transferred to the cardiovascular intensive care unit and was extubated when his spontaneous breathing was satisfactory 4 h later after the operation without any complication. Results and discussion: CSS often requires surgery and anesthetic intervention. The abnormal facial and airway as well as mental related features may lead intubation difficult, potentially due to short neck, large tongue and lips, poor dentition and poor communication. Thinking that the practicing anesthetist needs to have appropriate knowledge for this entity and the equipment for managing difficult airway should readily be available. One of these patients which successfully managed without any complication was described in this brief report.