Alper Yosunkaya

Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation : perioperative haemodynamics and anaesthetic requirements.

AbstractBackground: Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 μ/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation, need for anaesthetic agent and perioperative haemodynamic stability. Methods: Fifty patients scheduled for elective minor surgery were randomised into two groups (dexmedetomidine group and placebo group, n = 25 in each group). During and after drug administration, the Ramsey sedation scale was applied every 5 minutes. Fentanyl 1 μ/kg was administered to all patients and thiopental was given until lash reflex disappeared. Anaesthesia continuation was maintained with 50% : 50%, oxygen : nitrous oxide. Sevoflurane concentration was adjusted to maintain systolic blood pressure within 20% of preoperative values. After extubation, the Steward awakening score was applied at 5 and 10 minutes. Haemodynamic parameters and adverse effects were recorded every 10 minutes for 1 hour after surgery. Results: During intubation the need for thiopental and sevoflurane concentration were decreased by 39% and 92%, respectively, in the dexmedetomidine group compared with the placebo group. In all groups, blood pressure and heart rate increased after tracheal intubation; both were significantly lower in the dexmedetomidine group than in the placebo group (p < 0.05). Fentanyl requirement during the operation was 74.20 ± 10.53μg in the dexmedetomidine group and 84.00 ± 27.04μg in the placebo group (p < 0.05). At 5 minutes, the Steward scores were >6 in 56% of the dexmedetomidine group and in 4% of the placebo group (p < 0.05). At 10 minutes, sedation scores were ≥4 in all patients in the dexmedetomidine group (p < 0.05). Arterial blood pressure and heart rate in the postoperative period were significantly lower in the dexmedetomidine group compared with the placebo group (p < 0.05). Conclusion: Preoperative administration of a single dose of dexmedetomidine resulted in progressive increases in sedation, blunted the haemodynamic responses during laryngoscopy, and reduced opioid and anaesthetic requirements. Furthermore, dexmedetomidine decreased blood pressure and heart rate as well as the recovery time after the operation.

Laparoscopic-assisted pneumatic reduction of intussusception

The nonoperative treatment of intussusception is done by fluoroscopy, however, false-positive and negative images may lead to unnecessary operations. The aim of this study was to evaluate the feasibility of laparoscopy in pneumatic reduction. Surgical ileoileocolic intussusception was performed in 27 dogs. Sixteen dogs were observed for 3 days (group A), and 11 were observed for 5 days (group B). Laparoscopy was performed in the intussuscepted dogs during pneumatic reduction. Under general anesthesia, a 10-mm trocar was inserted supraumblically in the midline, and the laparoscope was introduced. The intussuscepted bowel was observed on the video monitor. A 5-mm trocar was inserted in the right upper quadrant. The mesentery of the terminal ileum was manipulated using grasping forceps to assist reduction. CO2 was insufflated into the rectum using a Foley catheter, and the reduction was observed on the video monitor. The success rate was 94% (mean reduction time, 2.5 minutes +/- 1.0) for group A and 100% (mean reduction time, 3.7 minutes +/- 0.8) for group B. Bowel perforation was observed in one dog, and recurrence of intussusception in another. The authors claim that observing the bowel on the video monitor may help in the differential diagnosis and reduction of difficult cases such as ileoileocolic and delayed intussusceptions. Therefore, unnecessary open surgery may be prevented.

Ultrasound-Guided Nasogastric Feeding Tube Placement in Critical Care Patients

BACKGROUND Nasogastric feeding tube (NGT) placement is a common practice performed in intensive care units (ICUs). Complications due to the improper placement of NGT are well known. In this prospective descriptive study, the effectiveness of ultrasound (US)-guided NGT placement was investigated. MATERIALS AND METHODS Fifty-six mechanically ventilated patients monitored in the ICU were included. A linear US probe was transversely placed just cranial to the suprasternal notch, and the concentric layers of the esophagus were attempted to be viewed on the posterolateral side of the trachea (generally left) by shifting the probe. If the esophagus can be seen, an attempt was made to insert the NGT under real-time visualization of ultrasonography. Furthermore, gastric placement of the NGT tip was confirmed with abdominal radiograph. RESULTS A total of 56 patients were included in the study. For 52 (92.8%), the NGT image was obtained during placement within the esophagus. For 3 (5.3%), the esophagus could not be seen by US, and NGT was placed blindly. For 1 patient, we could not detect passing of the NGT into the stomach despite the successful visualization of esophagus. In this patient, NGT was radiographically detected in the trachea after the procedure. CONCLUSION This study revealed that passing of the NGT through the esophagus could be visualized at a high rate in real-time US among ICU patients. These data suggest that ultrasonographic visualization of the upper esophagus during NGT insertion can be used as an adjuvant method for confirmation of correct placement.

Influence of Dexamethasone on Nausea and Vomiting during Patient-Controlled Analgesia with Tramadol

AbstractObjective: The aim of this study was to evaluate the prophylactic effect of dexamethasone on postoperative nausea and vomiting (PONV) during patient-controlled analgesia (PCA) with tramadol. Methods: 50 patients [American Society of Anesthesiologists (ASA) I–II] were enrolled in this randomised, placebo-controlled study. In group I, saline was administered as a control. In group II, 150 μg/kg dexamethasone was administered as an intravenous bolus and then tramadol added in the PCA device. We assessed PONV and the need for rescue antiemetics in the 24 hours postoperatively. Results: 17 of 25 dexamethasone-treated patients (68%) had no nausea, four patients (16%) experienced nausea, two patients (8%) retched, two patients (8%) vomited once, no patients vomited repeatedly and seven patients (28%) required rescue antiemetics. In the placebo-treated group, three of 25 patients (12%) had no nausea, 12 (48%) had nausea, three (12%) retched, three patients (12%) vomited once, four patients (16%) vomited repeatedly and 17 patients (68%) required a rescue antiemetic. The incidence of nausea, vomiting and administration of a rescue antiemetic were significantly less in dexamethasone recipients compared with the saline-treated group (p < 0.05). There were no significant differences between the groups in the pain score results or in the consumption of tramadol. Conclusion: Our results demonstrate that a single dose of dexamethasone reduced the incidence of PONV during PCA with tramadol.

The role of intravenous immunoglobulin in the treatment of cerebral vasospasm induced by subarachnoid haemorrhage: An experimental study

Objectives: The aim of this study was to determine whether intravenous immunoglobulin (IVIG) prevents cerebral vasospasm in rabbits with induced subarachnoid haemorrhage (SAH). The effect of IVIG on apoptosis in the endothelial cells of the basilar artery was also evaluated. Methods: Eighteen New Zealand white rabbits were allocated randomly into three groups. SAH was induced by injecting autologous blood into the cisterna magna. Group 1, the control group, was subjected to sham surgery (no induction of SAH). Group 2 had SAH alone and Group 3 had SAH plus IVIG. Three days after treatment, the animals were sacrificed. The basilar artery tissues were analysed histologically and the malondialdehyde levels in the brain stem tissues were evaluated biochemically. Results: Differences in the histopathological luminal areas and full wall thicknesses in the SAH plus IVIG group and the SAH group were statically insignificant (p > 0.005). The malondialdehyde level was also found to be lower in the IVIG group than in the SAH group, although this difference was not significant (p > 0.005). Conclusion: Although the IVIG treatment was revealed to have no vasodilator effect on the SAH-induced spastic basilar artery, it was shown to have a beneficial effect on the apoptosis of endothelial cells, probably via anti-inflammatory mechanisms.

Clinical Outcome Following the Use of Inadequate Solutions for Continuous Veno-Venous Hemodiofiltration

Backgrounds. A short time ago, commercially available diafiltration and replacement fluids could be found o n the hospital in Turkey. Instead, peritoneal dialysis solution (PDS) for continue veno-venous hemodiafiltration (CVVHDF) therapy and normal saline as replacement fluid are used. In this retrospective study, we investigated the effects of PDS and bicarbonate-buffered hemofiltration solution (Bic-HFS). Methods. We did a retrospective chart review of 24 patients treated with continue renal replacement therapy (CRRT) between January 2004 and February 2008. Peritoneal dialysis solution (PDS) was used in 14 patients, and bicarbonate-buffered hemodialysis solution (bic-HFS) was used in 10 patients. Results. Demographic data, laboratory findings, and mortality rate were similar both groups. Blood glucose and lactate levels were higher in the PD group than the bic-HFS group (p < 0.05). Hyperglycemia occurred more frequent in the PDS group than in the bic-HFS group (64% versus 30%, respectively; p < 0.05). Metabolic acidosis occurred in eight patients (57%) in the PDS group and three patients (30%) in the bic-HFS group (p < 0.05). Hypotension was higher in the PDS group (10, 71%) than in the bic-HFS group (3, 30%; p < 0.05). Conclusion. Using PDS fluid as dialysate for CVVHDF therapy is not a preferable solution because of the metabolic disturbances that it can cause.

Systemic effects of epidural betamethasone injection

AbstractA single epidural injection of a steroid may produce a suppression of the adrenocortical secretion. We aimed to evaluate systemic effects of a single epidural injection of betamethasone in this study. The study included 33 patients with low back pain. None of the patients had received local or systemic steroid therapy within 2 months before the injection. The epidural injection consisted of 10 mg of betamethasone diluted in 8 ml 0.25% bupivacaine. Injections were performed between 8:00 and 9:00 a. m. Before the injection in the same day (D0) cortisol, ACTH, fasting levels of glucose, triglycerides, cholesterol, sodium, and potassium were checked in the blood. The same assays were done again by the same laboratory at 15, 30, 45 min, and 7 (D7) and 21 (D21) days after the steroid injections. In all patients, cortisol and ACTH were normal at D0. ACTH and cortisol significantly decreased 45 min and at D7 after steroid injection, but returned to normal on D21. There were no significant changes in mean ...

The effects of adding diphenhydramine hydrochloride to lidocaine in intravenous regional anaesthesia

AbstractThis study aimed to evaluate whether diphenhydramine hydrochloride (DPH) could be used to reduce the dose of lidocaine for intravenous regional anaesthesia (IVRA). Sixty patients undergoing upper limb operations were divided into three groups (20 each). All patients received IVRA as follows: group 1 received 3 mg/kg lidocaine, group 2 received 40 mg DPH and 1.5 mg/kg lidocaine, and group 3 received 1.5 mg/kg lidocaine diluted to 40 ml with 0.9% saline solution. The onset of sensory block was tested by a pinprick. The duration of anaesthesia time was also recorded. Intraoperative pain was assessed using a five point pain score system. Side effects during surgery and after release of the tourniquet were recorded. Only 4 patients in group 3 had sufficient analgesia. Therefore, the patients in group 3 were excluded from the study. Data from 40 patients (group 1 and 2) were analysed. The onset time of sensory block was significantly shorter in group 1 than group 2 (2.4 ± 1.54 min and 6.85 ± 1.46 min, r...

Closure versus nonclosure of peritoneum at cesarean section: evaluation of postoperative pain

AbstractOur purpose was to evaluate postoperative opioid requirements in the closure or nonclosure of peritoneum at cesarean section. Eighty patients who were to undergo cesarean delivery were randomly assigned to two groups. The operative technique was randomized to include either nonclosure of both visceral and parietal peritoneum (study group) or closure of both layers (control group). Operating time and duration of general anesthesia was recorded. The pain was evaluated at rest in the first 12, 24 and 36 h after operation. The amount of morphine used was recorded at the same hours. The mean operating and anesthesia time were significantly longer in the control group than in the study group. Visual analogue scale (VAS) showed no difference in postoperative pain comparing closure to nonclosure of the peritoneum but patients of the control group required significantly more postoperative opioids. In conclusion, nonclosure of the visceral and parietal peritoneum reduces operating time and postoperative opi...

Effects of isoflurane and sevoflurane on the survival of skin flaps in rats

The effects of inhalational anaesthetic agents on survival of flaps are not well known. We investigated the effect of isoflurane and sevoflurane anaesthesia on survival of flaps using a caudally-based McFarlane skin flap in 20 male Wistar rats. Sevoflurane 1 minimum alveolar concentration (MAC) and isoflurane (1 MAC) in oxygen mixture was given to the animals. A 4×10 cm caudally-based standard McFarlane flap was raised. There were no differences in any haemodynamic values or blood gases between the sevoflurane group and the isoflurane group. Skin flaps were assessed on the seventh day. The isoflurane group had a significantly smaller area of skin flap necrosis and an increased area of flap surviving than the sevoflurane group. We conclude that survival is significantly improved when isoflurane is used as the inhalational anaesthetic rather than sevoflurane.