In this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus. This study was performed based on anesthesia records. Depending on the drugs that would be given before the induction of anesthesia with etomidate, the patients were separated into 4 groups: no pretreatment (Group NP), fentanyl 1 µg·kg-1 (Group F), midazolam 0.03 mg·kg-1 (Group M), and midazolam 0.015 mg·kg-1 + fentanyl 0.5 µg·kg-1 (Group FM). Patients who received the same anesthetic procedure were selected: 2 minutes after intravenous injections of the pretreatment drugs, anesthesia is induced with 0.3 mg·kg-1 etomidate injected intravenously over a period of 20-30 seconds. Myoclonic movements are evaluated, which were observed and graded according to clinical severity during the 2 minutes after etomidate injection. The severity of pain due to etomidate injection, mean arterial pressure, heart rate, and adverse effects were also evaluated. Study results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM. We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.

Donmez T, et al. Ann Surg Treat Res. 2017 Mar;92(3):136-142. https://doi.org/10.4174/astr.2017.92.3.136

Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (P < 0.001 and P = 0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (P < 0.001). Platelet levels did not reach statistical significance between the groups (P = 0.709). However, patients with AMI had significantly higher PLR levels than the control group (P = 0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (r = 0.548, P < 0.001), and between PLR and CRP (r = 0.528, P < 0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681-0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486-0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

Uzman S, et al. Ann Surg Treat Res. 2017 Apr;92(4):208-213. https://doi.org/10.4174/astr.2017.92.4.208

Background: Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia.Material and Methods: Fifty American Society of Anesthesiologist (ASA) I–III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n= 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups.Results: PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24.Conclusion: Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.

Donmez T, et al. Ann Surg Treat Res. 2016 Aug;91(2):59-65. http://dx.doi.org/10.4174/astr.2016.91.2.59