Abdurrahim Derbent

The efficacy of caudal morphine or bupivacaine combined with general anesthesia on postoperative pain and neuroendocrine stress response in children.

Background : The aim of this study was to compare the effectiveness of caudal morphine and bupivacaine usage on surgical stress response in children undergoing abdominal and genitourinary surgery while keeping anesthesia depth constant utilizing the bispectral index analysis (BIS).

Hemodynamic and electrolyte changes in patients undergoing neuroendoscopic procedures

ObjectsIntraoperative hemodynamic alterations and postoperative electrolyte disturbances related to endoscopic third ventriculostomy (E3V) have been reported. We aimed to evaluate prospectively those changes in patients undergoing neuroendoscopic procedures.MethodsThis study was carried out in 24 patients who underwent neuroendoscopic intervention. Sevoflurane was used for the induction and maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation, end-tidal CO2, and body temperature values were recorded according to the stages of the operation. Blood gas and blood chemistry analyses were performed before and after endoscopic procedure and were repeated on the third postoperative day.ConclusionsThere were no significant differences in intraoperative HR and MAP. Bradycardia occurred only in 1 of the 24 patients during the dilatation. In conclusion, we suggest the use of 0.9% NaCl for intravenous fluid replacement and a warm lactated ringer solution for ventricular irrigation during E3V to prevent intraoperative hemodynamic changes and postoperative electrolyte disturbances.

Pre-emptive Effects of Ibuprofen Syrup and Lidocaine Infiltration on Postoperative Analgesia in Children Undergoing Adenotonsillectomy

We aimed to compare the effects of lidocaine and adrenaline with ibuprofen syrup (administered before adenotonsillectomy) on post-operative analgesia and initiation of oral feeding. One group of 20 children received 100 g/5 ml ibuprofen suspension (10 mg/kg) 1 h before anaesthesia; bleeding control was provided by pre-incisional administration of 1:200000 adrenaline solution (10 ml). The same amount of 0.5% lidocaine solution plus 1:200000 adrenaline was applied pre-incisionally in a similar manner in a second group of 20 children. No significant differences were observed between the two groups in terms of the duration of operation and anaesthesia, post-operative pain scores, paracetamol requirements, times to initiation of liquid and solid food intake, or adverse side-effects. We conclude that ibuprofen syrup applied pre-incisionally and local infiltration with lidocaine are equally effective for post-operative analgesia.

Can antiemetics really relieve pain

The analgesic properties of 2 antiemetic agents—metoclopramide and ondansetron—were investigated in studies which showed that metoclopramide may decrease postoperative opioid requirements, but the analgesic effect of ondansetron is controversial. The postoperative effects of metoclopramide and ondansetron on pain in patients undergoing laminectomy were evaluated. Forty six patients were randomized into 3 groups: group M, which consisted of 15 patients who received intravenous (IV) metoclopramide 0.5 mg 30 minutes before surgery; group O, which consisted of 16 patients who received ondansetron IV 0.1 mg 30 minutes before surgery; and group C, which consisted of 15 patients who received the same volume of saline IV 30 minutes before surgery. The efficacy and duration of analgesia were assessed using a visual analogue scale (VAS) at 0, 0.5, 1, 3, 6, and 24 hours after surgery. Hemodynamic parameters, additional analgesic requirements, and adverse effects were recorded for the study groups. Diclofenac 75 mg was administered intramuscularly as a rescue analgesic during the postoperative period. VAS scores were lower in the metoclopramide group than in the ondansetron and control groups (P < .05, each). The patients in the ondansetron and control groups required much more diclofenac than the patients in the metoclopramide group (P < .05). Metoclopramide administered preoperatively provided postoperative analgesia in patients undergoing elective laminectomy

Old method, new drugs: comparison of the efficacy of sevoflurane, isoflurane, and desflurane in achieving controlled hypotension in spinal surgery.

This study compared the efficacy of isoflurane, sevoflurane, and desflurane in achieving hemodynamic stability in spinal procedures using moderate levels of controlled hypotension. After obtaining ethics committee approval and written informed consent, 32 American Surgical Association I-II patients were randomly allocated to receive isoflurane (n=12), sevoflurane (n=10), or desflurane (n=10) in O2-N2O (1:1) for maintenance of anesthesia. The induction of anesthesia, fentanyl dosage, and initial and maintenance volume replacements were standardized. Blood pressure was invasively monitored and maintained within a target systolic blood pressure (SBP) range of 80 to 90 mm Hg during the study. SBP outside this range was recorded. Volatile anesthetic concentration was adjusted according to the same protocol for all 3 agents. SPB control was maintained better with sevoflurane and isoflurane than desflurane; median SBP was outside the target range during 32% (range, 15%-55%) of study time with isoflurane, 26% (12%-42%) with sevoflurane, and 44% (20%-80%) with desflurane. Total blood loss did not differ among the groups. Sevoflurane and isoflurane administered in 2 L/min fresh gas flow were more effective than desflurane in achieving controlled hypotension in spinal surgery.

Erythropoietin diminishes isoflurane-induced apoptosis in rat frontal cortex.

During the brain growth spurt, anesthetic drugs can cause cellular and behavioral changes in the developing brain. The aim of this study was to determine the neuroprotective effect of erythropoietin after isoflurane anesthesia in rat pups.

Chronic pain following spine surgery

There has been an increasing trends in the procedures of spine surgery in recent years. Postoperative chronic pain in spine surgery can be caused by damage or instability of spinal column; pressure on nerves or segment of spinal cord; or can be due to long lasting nociception caused by inflammation, infection or tumour. Pain that lasts longer than 3-6 months after surgery can be define as postoperative chronic pain. The incidence of postoperative chronic pain after surgical procedures, was between 10-50%. Coping with any type of chronic pain is quite difficult. Chronic postoperative pain can be treated with: NSAIDs, paracetamol, opioids, anticonvulsants and invasive technics such as nerve blocs, central blocs.

Postoperative Visual Impairment after Spinal Fusion Surgery

Objective: The aim of this prospective study was to detect risk factors for visual impairment or changes in vision following spinal fusion surgery. Methods: A total of 68 patients aged 18 - 65 years, scheduled for posterior spinal fusion surgery, were included. Ophthalmic examinations were performed by an ophthalmologist on the day before surgery and repeated after the second postoperative day, within the first postoperative week. Patient characteristics were compared according to two clinical outcomes following surgery: worsening of vision during the pre- and postoperative interval (group 1) and no change in pre- and postoperative examinations (group 2). Results: The mean age of patients with postoperative visual changes was significantly higher than that for patients without postoperative visual changes. Total number of female patients and use of intraoperative ephedrine to treat hypotensive episodes were significantly higher in group 1 than in group 2 patients. Conclusion: Older age, female gender and intraoperative hypotensive episodes are potential risk factors for postoperative visual impairment in patients who have undergone spinal fusion surgery.

Pre-treatment of anaphylaxis, does it really work?

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Lowest doses of propofol or midazolam used in combination with low dose fentanyl infusion for the sedation of critically ill patients

ConclusionThe sedation and analgesia of the critically ill mechanically ventilated patients provided by low dose infusion following again a low dose bolus of midazolam and fentanyl maintained equally adequate, but more optimal levels of sedation and similar attenuation of hemodynamic response to aspiration when compared with propofol, but midazolam prolongs recovery and makes the patient prone to a mild CO2 retantion because of a slightly more pronounced reduction of respiratory rate.