Alkin Colak

Preoperative oral celecoxib versus preoperative oral rofecoxib for pain relief after thyroid surgery.

Background and objective: The study compared the analgesic efficacy and safety of two preoperatively administered cyclo‐oxygenase‐2 inhibitors, celecoxib and rofecoxib. Methods: Ninety adult patients undergoing thyroid surgery were divided into three groups (each n = 30). They were given a single oral dose of placebo, celecoxib 200 mg or rofecoxib 50 mg 1 h before induction of anaesthesia. All patients received a standard anaesthetic. Intraoperative blood loss was measured. Pain scores, sedation scores, heart rate, mean arterial pressure and respiratory rate were noted at 0, 1, 2, 4, 6, 12 and 24 h postoperatively. Analgesic (meperidine) requirements and adverse effects were recorded during the first postoperative 24 h. Results: Compared with placebo, pain scores were significantly lower with rofecoxib at all time points (P < 0.05) and were significantly lower with celecoxib (P < 0.05) during the first 4h. Pain scores were significantly lower with rofecoxib compared with celecoxib at 6, 12 and 24h (P < 0.05). The average cumulative 24h meperidine dose was significantly lower with both celecoxib (54.9 ± 34.4mg) and rofecoxib (42.8 ± 40.9 mg) compared with placebo (76.8 ± 6.2 mg) (P < 0.01 and P < 0.001, respectively). There were no differences in the intraoperative blood loss, heart rate, mean arterial pressure, respiratory rate, sedation scores and incidence of adverse effects among groups. Conclusions: The preoperative administration of rofecoxib 50mg and less so of celecoxib 200 mg provide a significant analgesic benefit with regard to postoperative pain relief and decrease in additional opioid requirements after thyroid surgery.

The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting

Background and Objective: The haemodynamic responses during extubation can cause complications after open‐heart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses. Methods: Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg−1 (group I, n = 40), magnesium 30 mg kg−1 (Group II, n = 40) or normal saline (Group III, n = 40). Study medication was administered as a 20‐min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and 1 min after extubation. Results: Heart rate was lower in Group I than in Groups II (P < 0.05) and III (P < 0.001) and lower in Group II than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and II during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation, lower in Group II than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation. Conclusion: We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.

Comparison of temporal artery, nasopharyngeal, and axillary temperature measurement during anesthesia in children

STUDY OBJECTIVE To evaluate the accuracy and precision of a new, noninvasive infrared thermometer applied to the temporal artery. DESIGN Prospective randomized study. SETTING Trakya University Hospital. PATIENTS 60 ASA physical status 1 and 2 children undergoing surgery. INTERVENTIONS During anesthesia, temperature measurements were recorded with three different techniques: temporal artery, nasopharynx, and axillary temperature. MEASUREMENTS Temperatures measured from the nasopharynx, temporal artery, and the axilla were recorded at 15-minute intervals for the first hour, then at 30-minute intervals until the completion of surgery. During each measurement, heart rate and midarterial pressure were recorded. MAIN RESULTS There were no statistically significant differences between temperatures recorded at the temporal artery and nasopharynx at 15, 30, 45, 60, 90, and 120 minutes, and the completion of surgery. Axillary temperatures were statistically lower than those recorded at the nasopharynx and the temporal artery (P < 0.001). Bland-Altman plots showed a correlation of temperature measurements between the temporal artery and nasopharyngeal methods. The axillary method had a lower correlation with the temporal artery and the nasopharyngeal methods. CONCLUSIONS The temporal artery thermometer is a substitute for the nasopharyngeal thermometer for core temperature measurement during anesthesia in children.

Valproic acid intoxication with suicide attempt in a pediatric patient

room. There have been very few reports on tipepidine hibenzate intoxication. We found a total of five reports, only two of which were detailed case reports (Table 1). The first was a report by Baggio et al. from 1980, in which a 5-year-old girl had been given double the usual daily dose of tipepidine hibenzate for 2 weeks and became irritable and anxious. In another one from Mitsubishi Tanabe Pharma Corporation, a boy who had been given mixed syrup with thick precipitate became transiently confused. Tipepidine hibenzate acts on the cough center in the medulla, but the cause of the neurological side-effects including delirium is unknown. The US Food and Drug Administration recommended withdrawal of cough and cold medicines for children under 6 years old, because serious adverse drug event may occur. Most of the symptoms of minor respiratory illness are self-limiting, and it is important to reduce non-essential medications for children. According to the drug package insert, syrup is a suspended solution and it thus easily forms sediment when mixed with other drugs. Pharmacists must instruct patients or their parents that the medicine must be thoroughly shaken prior to administration. This is a point of great importance because a variety of drugs for acute respiratory tract infection in children are often used in the mixture. In the present case, the patient’s mother had not been instructed to shake the medication prior to administration. A 6-day dosage period was also longer than normal and allowed plenty of time for sedimentation to occur. Figure 1 shows the appearance of each syrup. The mequitazine was clear and colorless, the tipepidine hibenzate was cloudy and white, and the carbocysteine was clear and yellow. The mixture of the three drugs, however, was milky white and exhibited sedimentation. If this syrup mixture is administered without shaking, drug intoxication due to the intake of sedimented tipepidine hibenzate could easily occur. If multiple drugs are required, syrup medicines should be prescribed separately. Parents tend to prefer syrup medicines over powder medicines, but this means that we leave the final decision on drug dosage to the parents, leaving room for error. In addition, syrup medicines are often put in a plastic bottle with an easy-open cap. This increases the possibility of accidental ingestion by children. Drug bottles with safety caps designed to prevent accidental ingestion are commonly used in the USA, but they are not popular in Japan because of their expense. In the present case there was no prescribing error: the overdose occurred accidentally. This is a very important point compared with previous reports of drug overdose. To avoid ingesting medication sediments, the directions should be stipulated inthe prescription clearly, and communicated to the parents and their children. Scrupulous attention is always required when prescribing drugs for children.

The effect of methylene blue treatment on aspiration pneumonia

BACKGROUND The study aimed to examine whether methylene blue (MB) prevents different pulmonary aspiration materials-induced lung injury in rats. METHODS The experiments were designed in 60 Sprague-Dawley rats, ranging in weight from 250-300 g, randomly allotted into one of six groups (n = 10): saline control, Biosorb Energy Plus (BIO), hydrochloric acid (HCl), saline + MB treated, BIO + MB treated, and HCl + MB treated. Saline, BIO, and HCl were injected into the lungs in a volume of 2 mL/kg. After surgical procedure, MB was administered intraperitoneally for 7 days at a daily dose of 2 mg/kg per day. Seven days later, rats were killed, and both lungs in all groups were examined biochemically and histopathologically. RESULTS Our findings show that MB inhibits the inflammatory response reducing significantly (P < 0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue hydroxyproline content, malondialdehyde levels, and decreased (P < 0.05) the antioxidant enzyme (superoxide dismutase and glutathione peroxidase) activities. MB treatment significantly (P < 0.05) decreased the elevated tissue hydroxyproline content and malondialdehyde levels and prevented the inhibition of superoxide dismutase and glutathione peroxidase (P < 0.05) enzymes in the tissues. Furthermore, there is a significant reduction in the activity of inducible nitric oxide synthase (iNOS), terminal deoxynucleotidyl transferase dUTP nick end labeling, and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with MB therapy. CONCLUSIONS MB treatment might be beneficial in lung injury and therefore shows potential for clinical use.

Endotrakeal tüp kafının doğru basınçta şişirilmesinde anestezistin deneyimi önemli mi

Objectives: Cuff pressure in endotracheal tubes should be in the range of 26–30 cm H 2 O. In this study we aimed to examine whether anesthesiologist’s experience is important while inflating the endotracheal tube correctly af ter the intubation. Materials and methods: The patients who were included to the study were intubated after the induction of general anesthesia. The patients were divided into 4 groups according to the training year of the anesthesia research assistant resident inflating the endotracheal tube (ET) cuff. Group I (n=64) the cuff pressure which were inflated by the first year residents; Group II (n=92) the cuff pressure which were inflated by the 2 nd year residents; Group III (n=144) the cuff pressure which were inflated by the 3 rd year residents; Group IV (n=93) the cuff pressure which were inflated by the 4 th year residents were measured by manometer. Results: When we compared the cases in which the cuff pressure were between 26-30cm H 2 O we found that the best results were in Group II and respectively in Group III and IV and the worst results were in Group I. The difference between Group II and Group I were statistically significant (p<0.05).

A Comparison of the Effects of Different Types of Laryngoscope on the Cervical Motions: Randomized Clinical Trial

BACKGROUND The rate of cervical injury among all trauma patients is 3.1%. The most important point during intubation of those patients is not to increase the cervical injury. AIMS In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. STUDY DESIGN Prospective, randomized clinical trial. METHODS One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly assigned the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2(®) type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying general anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. RESULTS One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). CONCLUSION A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904).

Post-Operative Malignant Hyperthermia in a Child after Colon Interposition.

Malignant hyperthermia (MH) is a rare and potentially life threatening fatal complication of anaesthesia. We present a 2-year-old boy with late onset MH after colon interposition to replace the oesophagus under sevoflurane anaesthesia. The patient was treated with intravenous dantrolene sodium as well as cooling and controlled ventilation. Despite treatment, the patient developed cardiopulmonary arrest at 21 hours after the operation and died. It should be kept in mind that post-operative MH may develop during these types of operations with ischaemia-reperfusion injuries.

Anaesthesia Management of a Child with West Syndrome

West syndrome (WS) is an epileptic encephalopathy usually occurring during the first year of life and is characterized by severe electroencephalography (EEG) derangement. Most of these patients may develop cerebral palsy, facial malformations, and skeletal deformities. The anaesthesiologist should make the preoperative assessment carefully due to epileptic seizures and should consider the possibility of difficult intubation because of coexisting anatomic malformations during the anaesthesia management of patients with WS. This report presents a case of general anaesthesia management in a left femoral fixation operation in an 11-year-old, 18 kg male patient.

What can Anthropometric Measurements Tell us About Mallampati Classification

Objective: Mallampati scoring is the most common examination method for predicting possible intubation problems. The purpose of this study is to investigate the relationship of facial anthropometric measurements with the modified Mallampati score (MMS). Material and Methods: The study population consisted of 153 male and 170 female volunteers (mean ages, 48,9p16,9 and 44,1p15,4 years, respectively). All participants were subjected to Mallampati scoring and facial anthropometric measurements during pre-operative visit. Anthropometric measurements included inter-incisor gap, lower face height, thyrogonial length, thyromental distance and bigonial distance. The relationship of anthropometric measurements with the MMS was investigated by statistical analysis. Results: Bigonial distance showed a positive correlation with the MMS (r=0.857; pl0.001), whereas inter-incisor gap, lower face height, and thyromental distance showed negative correlations (r=-0.809, r=-0.738, and r=-0.762 respectively pl0.001 for all). ROC and AUC analysis showed that the BGD level had the highest significant AUC (pl0.001). Optimal cut-off point for BGD was g113 mm, and at this cut-off point, the sensitivity rate was 94.8% and the specificity rate was 95.9%. BGD was the best predictor for discriminating MMS 3-4. Conclusion: We suggest that facial measurements such as bigonial distance may be used as alternatives for Mallampati evaluation when the patients condition is not suitable for Mallampati scoring. Turkish Baslik: Antropometrik Olcumler Mallampati Siniflamasi Hakkinda Ne Soyleyebilir? Anahtar Kelimeler: Antropometri, Bigonial mesafe, kesici disler arasi mesafe, Modifiye Mallampati skoru, Tiromental mesafe Giris: Mallampati skoru entubasyon ile ilgili olasi sorunlari tahmin etmek icin en yaygin kullanilan yontemidir. Bu calismanin amaci, modifiye Mallampati skoru (MMS) ile yuz antropometrik olcumler arasindaki iliskiyi arastirmaktir. Metod: Calisma 153 erkek ve 170 kadin gonullu ile (ortalama yas, 48,9 p 16,9 ve 44,1 p 15,4 yil, sirasiyla) yapildi. Tum katilimcilar pre-operatif ziyareti sirasinda Mallampati skoru degerlendirmesi ve yuz antropometrik olcumleri yapildi. Antropometrik olcumler arasinda kesici disler arasi mesafe, alt yuz yuksekligi, tirogonial uzunluk, tiromental mesafe ve bigonial mesafe vardi. MMS ile antropometrik olcumler arasindaki iliski istatistiksel analizi ile arastirildi. Sonuc: Bigonial mesafe MMS ile pozitif korelasyon oldugu gozlendi kesici disler arasi mesafe, alt yuz yuksekligi ve tiromental mesafe negatif korelasyon gostermekteydi (r = 0.857 p l0.001) (r = -0,809, r = -0,738, r = - 0.762 p l0.001). ROC ve AUC analizi bigonial mesafede yuksek duzeyde anlamli AUC (p l0.001) oldugu saptandi. Bigonial mesafe icin optimal cut-off noktasig 113 mm idi ve bunun duyarlilik orani % 94.8 ve ozgulluk orani % 95.9 idi. Bigonial mesafe MMS 3-4 icin en iyi tanimlayici oldugu saptandi. Tartisma: Bu calisma, hastanin genel durumunun Mallampati skorunun degerlendirmesi icin uygun olmadigi zamanlarda bigonial mesafe gibi antropometrik yuz olcumleri Mallampati degerlendirmesi icin alternatif olarak kullanilabilecegini gostermektedir.