Hanife Karakaya Kabukcu

Background: This study aimed to evaluate the effects of obstructive sleep apnea syndrome (OSAS) surgery on oxidative stress, antioxidant capacity, and oxidative protein modifications. Changes in Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Advanced Oxidation Protein Products (AOPP), Ischemia-Modified Albumin (IMA), and Total Thiol (TT) levels were analyzed in the preoperative and postoperative periods. Methods: Sixty-seven patients aged 18–65 years with an Apnea–Hypopnea Index (AHI) > 5 who underwent OSAS surgery were included. Demographic characteristics were recorded. Venous blood samples were collected at four time points: before anesthesia induction (T1), at the end of surgery (T2), on postoperative day 3 (T3), and at postoperative month 3 (T4). TOS, TAS, AOPP, IMA, and TT levels were measured and statistically evaluated. Results: Of the patients, 13.4% (n = 9) were female and 86.6% (n = 58) were male. No significant changes were observed in TOS, TAS, AOPP, or IMA levels between time points. However, TT levels at postoperative month 3 were significantly higher than those at earlier measurements (p < 0.05). Positive correlations were found between AHI and TOS, AOPP, and IMA levels, while TAS and TT showed no significant correlation with AHI. Conclusions: Surgery for OSAS did not produce significant postoperative improvements in oxidative stress parameters except for TT elevation. These results indicate that surgical intervention alone may be insufficient for biochemical recovery in OSAS and should be complemented by lifestyle and supportive therapies.

Introduction: Oxidative stress and airway inflammation are important in the pathophysiology of obstructive sleep apnea syndrome (OSAS). We examined the levels of inflammation and oxidative stress parameters in patients without OSAS and grouped as mild, moderate, and severe OSAS according to the apnea-hypopnea index (AHI). In addition, we investigated the changes in these parameters in patients whose airway obstruction was resolved by surgical treatment. Materials and method: The groups included 18 patients with an AHI below 5 (group 1), 28 patients with an AHI between 5 and 15 (group 2), 25 patients with an AHI between 15 and 30 (group 3), and 30 patients with an AHI of over 30 (group 4). Blood samples were collected from patients following the induction of anesthesia (1st measurement), after the operation (2nd measurement), on the postoperative 3rd day (3rd measurement), and at the postoperative 2nd month (4th measurement). Arylesterase (ARE), paraoxonase (PON), nitrotyrosine (NT), leukocyte, CRP, and HDL were measured. Results: The inter-group comparisons revealed differences in the 3rd measurement of leukocyte count and CRP value, in the 3rd and 4th measurements of HDL (p < 0.05). No significant difference was observed in the inter-group or intra-group comparisons for ARE, PON, and NT values (p > 0.05). Conclusion: We observed that CRP, HDL PON, ARE, NT levels, and the leukocyte count were not related to the severity of OSAS in patients with OSAS. The difference observed in CRP and leukocyte count may be due to the continuous effect of the inflammatory effect of surgery in the early post-operative period. We thought that the increase in HDL in all groups after the 5th postoperative day was due to the surgical correction of airway obstruction. As a result, we concluded that CRP, HDL, PON, ARE, NT, and leukocyte levels are not markers for OSAS.

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. 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. 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. The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.

To investigate the contribution of Bispectralindex monitoring on the amount of used anaesthetic substance and the quality of anaesthesia in patients with persistent atrial fibrillation who would undergo cardioversion. The prospective, randomised, controlled clinical study was conducted at Akdeniz University, Antalya, Turkey from October 2010 to November 2011 Sedation was performed on 50 adult patients using midazolam and fentanyl. Patients were randomised to group 1 and 2. In group 1 cardioversion was performed when the BispectralIndex value was seen to have decreased to 0.05). No statistically significant difference was detected between the groups in terms of induction time, anaesthetic need and Bispectral Index values (p>0.05). In both groups, 2(8%) patients perceived pain and 2(8%) perceived the procedure. In the presence of anaesthetist in the team, Bispectral Index monitoring did not contribute to the determining of anaesthetic drug dosage and the depth and quality of anaesthesia in patients with persistent atrial fibrillation during cardioversion.