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BACKGROUND: Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis. OBJECTIVE: In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery. METHODS: Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour. RESULTS: We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group. CONCLUSION: ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.

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Abstract Objective: To provide a new interpretation of the effect of intraoperative hemodynamic data on postoperative acute kidney injury (AKI) development and to determine the accuracy of some biomarkers which are thought to be the early markers of renal injury. Methods: One hundred adult patients who were connected to the heart-lung pump during open-heart surgery were included in this study. Hemodynamic data, oxygen delivery, and transfusions were recorded intraoperatively, and the preoperative and 3. postoperative hour cystatin C, interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) parameters were measured for early detection of kidney damage. In the analysis, 95% significance level was used to determine the difference. Results: According to the Kidney Disease Improving Global Outcomes criterion, AKI developed in 24 patients, 18 of whom were stage 1, two were stage 2, and four were stage 3. AKI (+) patients had more transfusions in the intraoperative period and AKI development was a risk factor for postoperative complications. NGAL and IL-18 levels were found to be approximately two-fold in the postoperative period in AKI (+) patients, whereas cystatin C was not sensitive in AKI detection. Conclusion: AKI development increases the risk of postoperative complications. NGAL and IL-18 were successful in detecting AKI in the early postoperative period.

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INTRODUCTION: To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. METHODS: The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. RESULTS: BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. CONCLUSION: The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.

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Abstract Introduction: To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. Methods: The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. Results: BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. Conclusion: The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.

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BACKGROUND: The purpose of this study was to compare the analgesic quality and duration of ropivacaine 0.2% with the addition of clonidine (1 microg.kg(-1)) with that of ropivacaine 0.2% and the addition of ketamine (0.5 mg.kg(-1)) to that of ropivacaine 0.2% and also compare the postoperative cortisol, insulin and glucose concentrations, sampled after induction and 1 h later following caudal administration in children. METHODS: According to the randomization, patients in the ropivacaine group (R; n = 25) received ropivacaine 0.2%, 0.75 ml.kg(-1); those in the clonidine group (RC; n = 25) received ropivacaine 0.2% 0.75 ml.kg(-1) plus clonidine 1 microg.kg(-1) and those in the ketamine/ropivacaine group (RK; n = 25) ropivacaine 0.2% 0.75 ml.kg(-1) plus ketamine 0.5 mg.kg(-1) (10 mg.ml(-1) concentration). Drugs were diluted in 0.9% saline (0.75 ml.kg(-1)) and prepared by a staff anesthesiologist not otherwise involved in the study. In all groups, the duration of analgesia, analgesic requirements, sedation and insulin, glucose, cortisol concentrations were recorded and statistically compared. RESULTS: There were no significant differences among the three study groups with respect to age, weight or duration of surgery. Caudal administration of clonidine 1 microg.kg(-1) or ketamine 0.5 mg.kg(-1) induced a longer duration of analgesia (P < 0.05) compared with ropivacaine alone. Insulin levels were increased and cortisol reduced in all groups. Glucose concentration was increased in all groups and statistically significant (P < 0.05). CONCLUSIONS: Addition of ketamine and clonidine to ropivacaine 0.2% 0.75 ml.kg(-1), when administered caudally in children, prolongs the duration of postoperative analgesia. The need for subsequent postoperative analgesic is also reduced. Caudal analgesia attenuates or allows partial changes to postoperative cortisol, insulin or blood glucose responses to surgery.

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