During liver surgery and transplantation, periods of partial or total vascular occlusion are inevitable and result in ischemia-reperfusion (IR) injury. Nanomedicine uses the latest technological advancement, which has emerged from interdisciplinary efforts involving biomedical sciences, physics and engineering to protect and improve human health. Antioxidant nanoparticles are potential therapeutic agents. The present study investigated the effects of cerium oxide (Co) administration and sevoflurane anesthesia on liver tissue with IR injury. A total of 36 rats were randomly divided into control, Co, IR, IR-Sevoflurane (IRS), Co + IR and Co + IRS groups. In the IR, IRS and Co + IRS groups, hepatic IR was induced. Intraperitoneal Co was administered to the Co groups 30 min before ischemia. Sevoflurane was administered to the IRS and Co + IRS groups during IR injury. Liver tissue samples were examined under the light microscope by staining with hematoxylin and eosin. Thiobarbituric acid (TBARS) levels as well as catalase (CAT) and glutathione-S-transferase (GST) enzyme activity were evaluated in liver tissue samples. The IR group had considerably more hydropic degeneration, sinusoidal dilatation and parenchymal neutrophil infiltration than the Co, IRS, Co + IR and Co + IRS groups. CAT and GST enzyme activity were significantly higher in Co and Co + IR groups compared with the IR group. TBARS levels were significantly lower in Co, IRS, Co + IR and Co + IRS groups compared whit those in the IR group. Intraperitoneal injection of Co with sevoflurane decreased oxidative stress and damage to the liver.
We aimed to present perioperative management of bleeding due to uterine atony and/ or rupture and postoperative intensive care unit (ICU) follow-up of a parturient after spontaneous vaginal delivery. A 36-year-old parturient at 41 weeks of gestation with a history of epilepsy was admitted for induction of labor. During pushing, she had a grand mal seizure treated with diazepam. After delivery of the placenta, emergency hysterectomy under general anesthesia was required to control bleeding despite treatment with uterotonics (carbetocine, methylergonovine, and misoprostol) and tranexamic acid followed by Bakri balloon placement. Crystalloids (2 L), colloids (1.5 L), blood products (3 ES, 4 FFP) and 2 grams (g) of IV fibrinogen concentrate were administered throughout the operation. After extubation, the patient was transferred to ICU and 1 g of IV fibrinogen was administered. During her ICU follow-up, hemoglobin decreased to 7.3 g/dL and a bleeding from uterine artery was diagnosed, and embolization was performed by interventional radiology. Patient was transferred to ward and discharged on the postoperative 7th day. Consequently, perioperative management of PPH with use of fibrinogen along with uterotonics, blood/blood products and fibrinogen demonstrated to be life saving in an epileptic parturient who underwent emergency hysterectomy because of atony and/or rupture after spontaneous vaginal delivery. Keywords: Obstetric hemorrhage, fibrinogen, intensive care unit follow up ÖZ Spontan vajinal doğum sonrası uterin atoni ve/veya rüptür nedeniyle kanaması olan bir gebede peroperatif kanama yönetimi ve postoperatif yoğun bakım ünitesi (YBÜ) takibini sunmayı amaçladık. Epilepsi öyküsü olan 36 yaşında travay-doğum için kabul edilen 41 haftalık gebeye doğum indüksiyonu başlandı. Ikınma sırasında diazepam ile sonlandırılan grand mal nöbeti oldu. Plasentanın çıkışından sonra, uterotonikler (karbetozin, metil ergonovin ve misoprostol) ve traneksamik asit verilmesine ve Bakri balonunu yerleştirilmesine rağmen kanamayı kontrol etmek için genel anestezi altında acil histerektomi gerekti. Operasyon boyunca kristaloid (2 L), kolloid (1,5 L), kan ürünleri (3 ES, 4 FFP) ve İV 2 gram (g) fibrinojen konsantresi uygulandı. Ekstübasyondan sonra vaka YBÜ'ye alındı ve 1 g fibrinojen daha uygulandı. YBÜ takibinde Hb'si 7.3 g/dL olan olguda, girişimsel radyoloji tarafından tespit edilen uterin arter kanaması için embolizasyon yapıldı. Postoperatif 3. günde servise çıkarılan olgu 7. günde taburcu edildi. Sonuç olarak spontan vajinal doğum sonrası atoni ve/veya rüptür nedeniyle acil histerektomi yapılan epileptik gebede uterotonik, kan/kan ürünleri ve fibrinojen kullanılmasının PPH'nin perioperatif yönetiminde hayat kurtarıcı olduğu gösterildi.
The patient's position including standard traditional sitting position (TSP) or lateral position during insertion of the epidural catheter plays a major role in the success of labour epidural analgesia. Recently, crossed-legged sitting position (CLSP) has been recommended as an alternative for the administration of regional analgesia for labour. The authors compared the cross-legged sitting position (CLSP) with traditional sitting position (TSP) in performing epidural analgesia for labor to elucidate which is an easier option for placing an epidural catheter. The rate of successful epidural insertion at the first attempt was higher in CLSP group than that of TSP group. The landmark, needle-bone contact and comfort during positioning were comparable between the groups. In an earlier study, maternal and neonatal effects of either TSP or lateral decubitus position to perform combined spinal epidural (CSE) anaesthesia in otherwise healthy parturients underwent elective caesarean section (CS) were investigated. Rate of performing CSE at the 1st attempt was higher in the TSP than that of lateral decubitus position. Incidence of paresthesia due to Whitacre spinal needle used for CSE was less in the TSP than that of lateral decubitus. Thus, choice of CLSP over TSP for epidural block during labor analgesia and TSP over lateral decubitus for CSE for CS seem to be better in terms of ease of insertion. In a study including 60 pregnant women with lumbopelvic pain practicing yoga in CLSP had lower pain compared to standard posture exercise. Yet to our knowledge, there is no study that primarily compares the three positions (TSP, CLSP or lateral decubitus) altogether to demonstrate the ease of insertion of epidural catheter for vaginal and caesarean delivery to provide analgesia and/or anesthesia. If CLSP could have been one of the competitors of the two studies, we would be able to suggest one position over another without any hesitation.
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