Ahmet Cemil İsbir

Thoracic paravertebral block for postoperative pain management in percutaneous nephrolithotomy patients: a randomized controlled clinical trial.

Objective: To investigate the effect of thoracic paravertebral block (PVB) on pain control and morphine consumption in percutaneous nephrolithotomy operations. Subjects and Methods: This randomized controlled clinical study was performed on 60 American Society of Anesthesiologists (ASA) I-II patients between the ages of 18 and 60 years who underwent percutaneous nephrolithotomy with approval of the ethical committee and written consent of the patients. Patients were randomly allocated into two groups: group P had 4 ml of 0.5% levobupivacaine injected at each of the T10, T11, and T12 paravertebral spaces and a standard PVB, and group C received 4 ml of 0.9% NaCl solution. All patients were given standard general anesthesia. The follow-up of saturation, heart rate, peripheral oxygen, and blood pressure values was recorded before induction, intraoperatively, and postoperatively. At postoperative 1, 2, 6, 12, and 24 h, the visual analog scale (VAS), Ramsey sedation score, respiratory rate, and 24-hour total morphine consumption were recorded. In addition, side effects and satisfaction of patients were recorded. Results: VAS scores and total morphine consumption were lower in group P than in group C: 2.3 vs. 4.3 and 22.3 vs. 43.2 mg, respectively (p < 0.05). The level of satisfaction was higher in group P than group C. Differences between groups in other parameters were not significant. Conclusions: Thoracic PVB with levobupivacaine provided a good postoperative analgesia and increased patient satisfaction for those who underwent percutaneous nephrolithotomy.

The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study

Objective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. Methods: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. Results: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. Conclusion: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.

Comparison of the Effects of Desflurane and Sevoflurane on Middle Ear Pressure: A Randomized Controlled Clinical Trial

Objective: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. Methods: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. Results: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. Conclusion: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.

Effect of Chronic Knee Pain on Cognitive Function: Clinical Study

Abstract Objectives: Chronic knee pain is a clinical problem that causes inconvenience in social, familial, and business environments. In clinic, while etiologies of chronic knee pain are generally known, its effects on cognitive functions are not fully understood. This study aims to measure and evaluate the relationship between cognitive function and chronic knee pain. Methods: Ninety-eight patients between 18 and 70 years of age having knee pain for at least 6 months were included in the study. Two groups were divided between A1 and A2, both patients of chronic knee pain. Cognitive functions were evaluated in the A1 group before treatment and in the A2 group after taking treatment. Both groups had the same number of patients [N = 98]. The Montreal Cognitive Assessment [MOCA] was applied to the patients before and after treatment. The patients with a MOCA score 26 and over were accepted as normal in terms of cognitive functions. Results: The MOCA score of the A2 group was significantly higher than that of A1 group. Visual analog scale values in group A2 were significantly decreased compared to A1. Although orientation scores were decreased, patients in group A2 showed a statistically significant increase in cognitive functional indicators like visual functions, language, abstract thinking, and delayed recall compared with group A1. Conclusions: The chronic knee pains might lead to cognitive function disorders in the long term. This can be prevented with the effective treatment of pain so that quality of life of patients can be increased. Moreover, the use of costly diagnosis and treatment methods can be prevented.

Investigation of the efficacy of PVI (Pleth Variability İndeks) monitorization on intraoperative fluid and blood transfusion, intraoperative hemodynamics in total hip surgeries.

Amaç: Genel anestezi altında yapılan total kalça artroplastisi operasyonlarında, invaziv standart monitörizasyon ile non invaziv PVI monitörizasyon tekniklerinin hemodinamik parametrelerdeki farklılıklar, sıvı ve kan transfüzyonu üzerine etkilerini kıyaslamayı amaçladık. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra ASA I-II grubu, 30-85 yaş arası, 82 hasta üzerinde PVI ölçümleri ile standart monitörizasyon ölçümlerinin, hastaların hemodinamik parametreleri, sıvı ve kan transfüzyonuna etkinlikleri prospektif olarak karşılaştırıldı. I. grup hastalar, peroperatif dönemde, noninvaziv PVI monitörizasyonu yanında anestezi monitorü ile II. grup hastalar ise; sadece anestezi monitorü ile standart monitorize edildi. Hastalara mayi replasmanı, standart monitorizasyon grubundaki hastalara 8ml/kg/saatten kristaloid ile, PVI monitorizasyonu yapılan gruba ise PVI değerlerine göre, hedef PVI<% 13 olacak şekilde kristaloid replasmanı yapıldı. PVI grubuna kan kaybı da gözönünde bulundurularak hedef PVI<% 13 olacak şekilde kristaloid+kolloid+kan transfüzyonu yapıldı. Standart monitorizasyon grubuna da; kan transfüzyonu için kriter olarak %15-30 arası kayıplarda kristaloid+kolloid infüzyonu, kan kaybı oranı >%30, >1500 ml üzeri kayıplarda kan transfüzyonu uygulanmıştır. Bulgular: Ölçülen pulse oksimetri değerleri karşılaştırıldığında gruplar arası farklılık önemli bulundu. PVI ölçümleri zaman içerisinde bir düşüş gösterdi. Her iki gruptaki bireylerin giriş Hgb değerleri karşılaştırıldığında farklılık önemli bulunurken, çıkış Hgb değerleri karşılaştırıldığında farklılık önemsiz bulundu. Verilen toplam mayi açısından karşılaştırıldığında gruplar arası farklılık önemli bulunup, PVI monitörizasyon grubuna daha az mayi replasmanı yapıldı. Sonuç: Non-invaziv PVI monitorizasyonun, standart monitorizasyonla kıyaslandığında hastanın hemodinamik stabilitesinin sağlanmasında ve mayi rejiminin takibinde daha pratik, komplikasyonsuz ve kullanımının kolay olduğu kanaatindeyiz. Ancak PVI monitorizasyonun, daha fazla araştırılarak sıvı yönetimi dışındaki parametreler üzerindeki etkinliğinin aydınlatılmasına ihtiyaç olduğunu düşünmekteyiz.

Evaluation of Low and High Flow Anesthesia Methods' Effects on Perioperative Hemodynamics, Depth of Anesthesia and Postoperative Recovery in Patients Undergoing Abdominal Surgery

page no: 27/33 www.ommegaonline.org Vol:5 Issue: 1 Abstract: Objective: The safe implementation of low-flow anesthesia has greatly facilitated, because of the anesthesia machines monitors that analyze the anesthetic gas composition detailed way, increase the knowledge of anesthetics. In this research; we aimed to compare the effects of high and low-flow general anesthesia methods on the peroperative hemodynamics, anesthesia depth and postoperative recovery time in patients with abdominal surgery in the presence of bispectral index monitoring. Methods: ASA I-II, 40 patients; 18 75 ages, who will have abdominal surgery were randomly divided into two groups, after the approval of the ethics committee (2016 06/02) and the patients. Anesthesia induction was performed with 6 mg/kg thiopental sodyum, 1 μg/kg remifentanil and 0.5 20 μg/kg/min remifentanil infusion, 4 6% desflurane after routine ECG, blood pressure, SpO2 and BIS monitorization to all patients. In the low-flow group after the first 10 min 4 lt/min fresh flow, the flow was reduced to 1 lt/min. Values of the heart rate, MBP, SpO2, FiO2, BIS, tympanic temperature at before induction and after intubation and the minutes of 15th, 30th, 45th, 60th, 90th,120th are recorded. Lactate and COHb values were measured in blood gas analyzes performed at 30th and 90th minutes. Results: When SpO2 and FiO2 values measured in different time periods of the individuals in both two groups were compared, differences between the minutes of 30th, 45th, 60th, 90th, 120th were significant. Conclusion: In this research; it is revealed that low-flow anesthesia which has advantages in many aspects can be used safely like high flow anesthesia when applied with adequate information equipment, appropriate anesthesia devices and necessary monitorizations.