Emilija Atanasovska, Krume Jakovski, Elena Kostova, Aleksandar Petlichkovski, Chedo Dimitrovski, Iskra Bitovska, Igor Kikerkov, Ognen Petrovski and Nikola Labachevski
Effects of Rosiglitazone on Metabolic Parameters and Adiponectin Levels in Fructose-Fed Rats
Aim. To investigate the effect of the peroxisome proliferators-activator receptor gamma agonist, rosiglitazone, on metabolic parameters and adiponectin levels in an animal model of the metabolic syndrome.
Material and methods. Metabolic syndrome was induced in 32 male Wistar rats by adding a fructose in drinking water for 12 weeks. During the last 4 weeks, 16 rats were treated with rosiglitazone (5 mg/kg/day), while the remaining 16 did not receive any medication (fructose group). Another control group consumed standard rat chow and water for 12 weeks.
Results. Chronic fructose administration induced a significant increase in systolic blood pressure (SBP), body weight, serum triglycerides (TG), free fatty acids (FFA), insulin, glucose AUC0-120 (during oral glucose tolerance test) and decreased serum high density lipoprotein (HDL) cholesterol and adiponectin concentrations compared with the control group. Treatment with rosiglitazone over the final 4 weeks reversed these effects and significantly reduced SBP, TG, FFA, insulin concentrations and glucose AUC0-120 compared with the fructose group. In addition, rosiglitazone increased serum levels of adiponectin twofold from 3.44 ± 0.46 to 7.03 ± 1.30 μg/ml.
Conclusion. This study indicates that rosiglitazone treatment improves the components of the metabolic syndrome, which is accompanied with an increase in adiponectin concentrations.
Marija Toleska, Biljana Kuzmanovska, Andrijan Kartalov, Mirjana Shosholcheva, Jasminka Nancheva, Aleksandar Dimitrovski and Natasha Toleska
Opioid free anesthesia (OFA) is deffined as anaesthesiological technique where opioids are not used in the intraoperative period (systemic, neuroaxial or intracavitary). Anaphylaxis caused by opioids (fentanyl) is very rare, and the reaction is presented with hypotension and urticaria. When we have proven allergy to fentanyl, patients’ refusal of placing epidural catheter and refusal of receiving bilateral ultrasound guided transversus abdominis plane block (USG TAPB), we must think of using multimodal nonopioide analgesia. The concept of multimodal balanced analgesia is consisted of giving different analgesic drugs in purpose to change the pathophysiological process which is included in nociception, in way to receive more effective intraoperative analgesia with less adverse effects. This is a case report of a 60-year-old male patient scheduled for laparotomic hemicolectomy, who previously had proven allergy to fentanyl. We have decided to give him an opioid free anaesthesia. Before the induction to anaesthesia, the patient would receive dexamethasone (dexasone) 0.1 mg/kg and paracetamol 1 gr intravenously. The patient was induced into general endotracheal anesthesia according to a standardized protocol, with midazolam 0.04 mg/kg, lidocaine hydrochloride 1 mg/kg, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg. Anaesthesia was maintained by using sevoflurane MAC 1 in order to maintain mean arterial pressure (MAP) with a value of +/- 20% of the original value. After tracheal intubation, the patient had received ketamine hydrochloride 0.5 mg/kg (or 50 mg ketamine) in bolus intravenously and a continuous intravenous infusion with lidocaine hydrochloride (lidocaine) 2 mg/kg/hr and magnesium sulfate (MgSO4) 1,5 gr/hr. At the end of surgery the continuous intravenous infusion with lidocaine and magnesium sulfate was stopped while the abdominal wall was closed and 2.5 g of metamizole (novalgetol) was given intravenously. VAS score 2 hours after surgery was 6/10 and 1 gr of paracetamol was given and the patient was transferred to the Department. Over the next 3 days, the patient had a VAS score of 4-6/10 and only received paracetamol 3x1g and novalgetol 3x1 gr daily, every four hours.
Marija Toleska, Andrijan Kartalov, Biljana Kuzmanovska, Milcho Panovski, Mirjana Shosholcheva, Aleksandar Dimitrovski, Risto Cholanchevski, Natasha Toleska and Milka Zdravkovska
Introduction: Patients undergoing laparoscopic cholecystectomy do experience postoperative pain, especially in the abdomen. Postoperative pain management remains a major challenge after laparoscopic procedures. Administration of intraperitoneal local anesthetic (IPLA) after surgery is used as a method of reducing postoperative pain. In this study, we evaluated the effect of intraperitoneal infiltration of local anesthetic (bupivacaine) for pain relief after laparoscopic cholecystectomy.
Material and methods: In this prospective, controlled, and randomized study were included 50 patients aged 25-60 years (35 female and 15 male), scheduled to laparoscopic cholecystectomy with ASA classification 1 and 2. Patients were classified randomly into two groups: group A, which included 25 patients who received intraperitoneal instillation of bupivacaine 0.5% 20 ml; and group B, which included 25 patients who didn’t receive any intraperitoneal instillation. Postoperative pain was recorded using the visual analogue scale (VAS) for 24 hours after laparoscopic cholecystectomy.
Results: There was no significant difference with respect to age, weight, and sex; duration of surgery; and anesthesia time. VAS scores at different time intervals were statistically significantly lower at all times in group A compared to group B. There were statistically significant differences in VAS scores between group A and group B at all postoperative time points - 1hr,4 hr,8 hr,12hr and 24hr (p < 0.00001).
Conclusion: Intraperitoneal instillation of bupivacaine provides good analgesia in the postoperative period after laparoscopic cholecystectomy.