Intelligent Generating Controller a Desflurane Concentration Value Which Helps to Decrease Blood Pressure

Pawel Ratajczyk,1 Bartosz Dominikowski,2 Agnieszka Czylkowska,3 Bartlomiej Rogalewicz,3 Cezary Kulak,4 Tomasz Gaszynski1 1Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 2Institute of Electrical Engineering Systems, Lodz University of Technology, Lodz, Poland; 3Institute of General and Ecological Chemistry, Lodz University of Technology, Lodz, Poland; 4Medical Simulation Center, Medical University of Lodz, Lodz, PolandCorrespondence: Tomasz Gaszynski, Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Kopcinskiego Str 22, Lodz, 90-153, Poland, Email [email protected]: The aim of the article is to determine the appropriate concentration of desflurane to effectively counteract the increase in blood pressure resulting from surgical stress. In medical practice, this increase is often limited by using additional doses of opioid drugs. Additional medications or higher doses of those already used may adversely affect your health. During anesthesia, physician must note the use of drugs and remember them, especially those that he has recently administered, which affect his concentration. For this purpose, the authors decided to propose support for the selection of desflurane concentration so that frequent use of opioid drugs is not necessary. The authors used a system based on AI issues to accomplish this task. The learned system supports the anesthesiologist’s work by imitating him.Patients and Methods: The proposed method for selecting the desflurane concentration is based on a fuzzy controller. This system includes a learning mechanism that allows for minimizing the operating error. The main advantage of this system is the ability to build a function allowing the selection of anesthesia parameters without knowledge of the mathematical description of the process. To accomplish this task, you need an expert who will provide information in the construction of logical if-then sentences (points in space). The fuzzy controller connects the points in the consideration space appropriately, generating a hypersurface. The algorithm test was performed only by computer without the participation of patients.Results: The operation of the proposed algorithm was verified by computer simulation. The authors of the article analyzed the compliance of the obtained results with the table provided by the expert. The desflurane concentration values obtained by computer simulation are similar to those given in the table Minimal driver error does not affect the patient’s clinical response. This error results from the functions used in the fuzzy system and its settings. The results of the performance test of the proposed algorithm are presented in a time course, and it has the shape of a step function. The work proposes a function that allows you to enter the time needed for the body’s reaction to reach the desired Etdes level.Conclusion: In this study, a controller was created to support the selection of the concentration of desflurane allowing for a reduction in blood pressure (resulting from surgical stress). The results obtained by computer simulation provide valuable insights for optimizing anesthesia. This system can also be used as an important simulation program for teaching purposes.Keywords: fuzzy logic, anesthetic support, desflurane, mathematical models of desfluran

Investigation of the Protective Effects of Dexmedetomidine, Midazolam, Propofol, and Intralipid on Oxidative Stress and Inflammation in Rats with Lidocaine-Induced Toxicity

Mustafa Kemal Kucun,1 Eray Metin Guler,2,3 Ayten Saracoglu,4 Mehmet Yildirim,5 Cumaali Demirtas,5 Ferda Serdogan,6 Hakan Beyaztas,2,7 Selman Aktas,8 Merve Kacan,9 Tomasz Gaszynski,10 Pawel Ratajczyk,10 Kemal Tolga Saracoglu11 1Department of Anesthesiology and Intensive Care, Bartin State Hospital, Bartin, Turkey; 2Department of Medical Biochemistry, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Istanbul, Türkiye; 3Department of Medical Biochemistry, Hamidiye Institute of Health Sciences, University of Health Sciences Turkey, Istanbul, Türkiye; 4Department of Anesthesiology, ICU & Perioperative Medicine Aisha Bint Hamad Al Attiyah Hospital HMC, Doha, Qatar; 5Department of Physiology, Hamidiye Faculty of Medicine, University of Health Sciences, Istanbul, Turkey; 6Department of Anesthesiology and Intensive Care, Turhal State Hospital, Tokat, Turkey; 7Department of Medical Biochemistry, HaydarpasaNumune Health Application and Research Center, University of Health Sciences Turkey, Istanbul, Türkiye; 8University of Health Sciences, Hamidiye Faculty of Medicine, Department of Biostatistics and Medical Informatics, Istanbul, Turkey; 9Department of Anesthesiology and Intensive Care, Kocaeli City Hospital, Kocaeli, Turkey; 10Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 11Department of Anesthesiology, ICU & Perioperative Medicine Hazm Mebaireek General Hospital HMC, Industrial Area Ar-Rayyan, Doha, QatarCorrespondence: Mustafa Kemal Kucun, Department of Anesthesiology and Intensive Care, Bart&inodot;n State Hospital, Bart&inodot;n, Turkey, Email [email protected]: The aim of this study was to compare the effects of dexmedetomidine, midazolam, propofol, and intralipid on lidocaine-induced cardiotoxicity and neurotoxicity.Methods: Forty-eight male Sprague-Dawley rats were randomly divided into six groups (n = 8 per group): control (C), lidocaine (L), lidocaine + dexmedetomidine (LD), lidocaine + midazolam (LM), lidocaine + propofol (LP), and lidocaine + intralipid (LI). Dexmedetomidine (100 μg/kg), midazolam (4 mg/kg), propofol (40 mg/kg), and intralipid (10 mg/kg) were administered intraperitoneally as pretreatment. Lidocaine (90 mg/kg) was administered intraperitoneally to induce oxidative stress in all groups except the control. After 60 minutes of electrocardiography (ECG) recording, the rats were sacrificed, and heart and brain tissue samples were collected. Comparative measurements of total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and inflammatory parameters were conducted.Results: In heart tissue samples, TAS was significantly higher in LI and LD groups (p < 0.05). Additionally, oxidative stress was significantly higher in the LM group (p < 0.05). Despite an increase in oxidative stress in brain tissue samples across all groups, it was found that all groups exhibited antioxidant protective effects (p < 0.05). Inflammatory parameters in heart and brain tissues significantly decreased in all groups, especially in the LI group (p < 0.05).Conclusion: It was observed that pretreatment with midazolam increased oxidative stress induced by lidocaine, while dexmedetomidine and intralipid exhibited greater antioxidant effects. Dexmedetomidine and intralipid used as pretreatment were shown to be more effective in protecting against oxidative stress and inflammation.Keywords: oxidative stress, inflammation, dexmedetomidine, midazolam, propofol, intralipi

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

TotalTrack video intubating laryngeal mask in super-obese patients &ndash; series of cases

Tomasz Gaszynski Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland Background: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods: Twenty-four super-obese patients (body mass index &gt;50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. Keywords: super-obese, intubation, ventilation, laryngeal mask, standard laryngoscope, video laryngoscope&nbsp