Akcan Akkaya

Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy.

The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients.

Does the kidney injury molecule-1 predict cisplatin-induced kidney injury in early stage?

Background It is not possible to diagnose acute kidney injury (AKI) in early stages with traditional biomarkers. Kidney injury molecule-1 (KIM-1) is a novel biomarker promising the diagnosis of AKI in early stages. We studied whether urinary and serum KIM-1 (KIM-1 U and KIM-1 S ) concentrations were useful in predicting cisplatin-induced AKI in early stages. Methods We prospectively analysed 22 patients on cisplatin treatment. KIM-1 S and KIM-1 U concentrations were assessed in the samples of the patients on four different time periods (before treatment [BT], first [AT1], third [AT3] and fifth [AT5] day after treatment). Results KIM-1 U concentrations on the first day after cisplatin treatment in patients with AKI were significantly increased compared to both KIM-1 U concentrations of the same patients BT (P = 0.009) and to AT1-KIM-1 U concentrations of the patients without AKI (P = 0.008). A receiver operating characteristic analysis revealed that AT1-KIM-1 U concentrations may predict AKI with an 87.5% sensitivity and 93.3% specificity (area under the curve = 0.94). KIM-1 S concentrations were not significantly changed between BT and AT periods. Conclusions KIM-1 U concentrations may predict cisplatin-induced AKI in early stages with high sensitivity and specificity.

Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty.

Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P ≤ 0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P < 0.001 and P < 0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (P = 0.002 and P < 0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients.

A New Diagnostic Marker For Acute Pulmonary Embolism In Emergency Department: Mean Platelet Volume

OBJECTIVE To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

Ultrasound-guided femoral and sciatic nerve blocks combined with sedoanalgesia versus spinal anesthesia in total knee arthroplasty.

Background Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. Methods We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. Results A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). Conclusions Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.

A case of anesthesia mumps after general anesthesia

To the Editor: We report a 57-year-old female patient who underwent a correction of surgical scar and sagging of the abdominal skin by plastic surgeons. She was 155 cm and 95 kg, with body mass index 37.5 kg/m. She had a history of arterial hypertension for 5 years. General anesthesia was induced by propofol 3 mg/kg and fentanyl 1 lg/kg. Endotracheal intubation was performed with muscle relaxation using rocuronium bromide 0.6 mg/kg after assisted ventilation and induction. Maintenance of anaesthesia was achieved with sevoflurane (2–3 vol%) in 50% O2 and 50% air. The patient was extubated without any problems at the end of the surgery. In the recovery room, a painless swelling on the left pre-auricular and post-auricular areas extending up to the angle of the mandible was detected (Fig. 1). In addition, there was crepitation on palpation. There was no evidence of inflammation. The left parotid gland swelling was decreased in the next 24 h and resolved completely in 2 days. Pneumoparotitis is a postoperative complication of general anesthesia characterized by acute transient swelling of the parotid gland that is defined as ‘‘anesthesia mumps.’’ Anesthesia mumps is a rare and interesting clinical entity. However, the phenomenon is a clinical condition well known to experienced anesthesiologists. This clinical entity results from air refluxing into the parotid ductal system via an incompetent Stensen duct orifice [1]. These swellings usually resolve spontaneously over a period of a few hours to a few days without any known sequelae [2]. The exact mechanism of the development of pneumoparotitis in not fully understood. Stensen’s duct leaves the lateral surface of the parotid gland, passes lateral to the masseter muscle, and enters the oral cavity through the buccal tissues adjacent to the maxillary first and second molars [3]. Possible explanations include positive pressure ventilation during general anesthesia and increased pressure in the oral cavity. Pneumoparotitis has been reported in the following situations or maneuvers in the literature: wind instrumentalists, balloon and glass blowers, bicycle tire inflation by mouth, dental procedures using air-powered equipment, cough in chronic obstructive pulmonary disease and cystic fibrosis, nose blowing, whistling, valsalva maneuver to clear ears, and spirometry [4]. We thought that the clinical picture in the present case may have resulted from intra-oral pressure increase via mask ventilation during general anesthesia. Medical history and physical examination are important in the differential diagnosis of the disease. Obstructive, inflammatory, metabolic, and neoplastic causes of parotid gland enlargement should be ruled out. Crepitation on palpation is diagnostic for pneumoparotitis, but it can be mistaken in up to 50% of the patients [4]. Gland swelling, erythema, and tenderness on palpation may be detected in pneumoparotitis as a consequence of inflammation and infection [5]. In our case; the clinical examination showed swelling of the gland and crepitation on palpation, but erythema and pain were not observed. In conclusion, parotid gland enlargement with air after general anesthesia is a rare condition. Medical history, physical examination, and radiologic studies may play an important role in the differential diagnosis and management of the condition. U. Y. Tekelioglu (&) A. Akkaya A. Demirhan H. Bayır H. Kocoglu Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey e-mail: drtekelioglu@yahoo.com

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

BACKGROUND Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. OBJECTIVE To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. METHODS A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. RESULTS A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups (p>0.05). CONCLUSION Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

BACKGROUND AND OBJECTIVES Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. METHOD 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre-induction loading dose of 50mgkg(-1) over 10min and maintained at 15mgkg(-1)h(-1); in Group D, dexmedetomidine was given at 1mcgkg(-1) 10min before induction and maintained at 0.6mcgkg(-1)h(-1). Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. RESULTS Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. CONCLUSIONS Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

Technology and Information Tool Preferences of Academics in the Field of Anaesthesiology

OBJECTIVE Researchers use a large number of information technology tools from the beginning until the publication of a scientific study. The aim of the study is to investigate the technology and data processing tool usage preferences of academics who produce scientific publications in the field of anaesthesiology. METHODS A multiple-choice survey, including 18 questions regarding the use of technology to assess the preferences of academicians, was performed. RESULTS PubMed has been the most preferred article search portal, and the second is Google Academic. Medscape has become the most preferred medical innovation tracking website. Only 12% of academicians obtain a clinical trial registration number for their randomized clinical research. In total, 28% of respondents used the Consolidated Standards of Reporting Trials checklist in their clinical trials. Of all participants, 21% was using Dropbox and 9% was using Google-Drive for sharing files. Google Chrome was the most preferred internet browser (32.25%) for academic purposes. English language editing service was obtained from the Scribendi (21%) and Textcheck (12%) websites. Half of the academics were getting help from their specialist with a personal relationship, 27% was doing it themselves, and 24% was obtaining professional assistance for statistical requirements. Sixty percent of the participants were not using a reference editing program, and 21% was using EndNote. Nine percent of the academics were spending money for article writing, and the mean cost was 1287 Turkish Liras/year. CONCLUSION Academics in the field of anaesthesiology significantly benefit from technology and informatics tools to produce scientific publications.

Submental Orotracheal Intubation in Maxillofacial Fracture Surgery: Report of Two Cases.

Two patients, aged 18 and 28 years, with maxillofacial trauma due to motor vehicle accident, were operated upon by a team of plastic surgeons. In this report we aimed to present our experience with submental intubation procedure in these cases, in which orotracheal or nasotracheal intubation was impossible due to panfacial fracture.