Ayten Bilir

Comparison of the effects of sevoflurane and isoflurane on myocardial protection in coronary bypass surgery.

OBJECTIVE The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. METHODS After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2% . Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. RESULTS Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10th minute and 20th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. CONCLUSION Sevoflurane provides a better myocardial protection than isoflurane, as may be inferred by the lower levels of the myocardial injury markers troponin-T and CK-MB observed with sevoflurane.

The Evaluation of Hydroxyethyl Starch (6% HES 130/0.4) Solution's Potential Preventive Effects on Coagulation Status in Women with Gynecologic Malignancies Using Rotation Thromboelastography.

Objective: The aim of this study was to determine the effects of in vitro hemodilution with 6% hydroxyethyl starch (HES) 130/0.4 solution on the coagulation status of women with gynecologic malignancies by using rotation thromboelastogram (ROTEM®). Materials and Methods: Twenty-two patients with gynecological tumors scheduled for anesthesia were enrolled. Blood samples were diluted by 20% with 6% HES (130/0.4) solution. Results: In the INTEM assay, clotting time (CT) (p<0.01) and clot formation time (CFT) (p<0.001) were significantly increased and maximum maximum clot formation (MCF) (p< 0.001) was significantly decreased in HES hemodilution compared with the undiluted control samples. In the EXTEM assay, there was a similar significant increase in increase in CFT (p<0.01) and a decrease in maximum a decrease in MCF (p<0.01) in HES hemodilution when compared with control samples. Conclusion: HES 130/0.4 solution causes significant hypocoagulable changes in the thromboelastographic profile of gynecologic cancer patients in vitro.

Does tramadol affect coagulation status of patients with malignancy

Aim: The study investigated the direct effects of tramadol on the coagulation status of women with gynecologic malignancies in vitro. Materials and Methods: Citrated whole-blood samples from 21 patients with gynecologic tumors were spiked ex vivo with 2 or 6 μl/ml tramadol. Thrombelastography (TEG) analysis was performed using ROTEM® to assess clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF). Results: In the INTEM assay, CT (P < 0.05) and CFT (P < 0.01) were significantly prolonged with tramadol at a 6 μl/ml concentration compared with baseline. There were no significant differences in MCF values between the baseline and the tramadol-treated samples (P > 0.05). Blood medicated with tramadol (6 μl/ml) clotted slowly (increased CT and CFT). Conclusion: The changes observed by TEG demonstrated that tramadol impairs hemostasis in a concentration-dependent manner in the whole blood of women with gynecologic malignancies in vitro.

Evaluation of the Analgesic Efficacy of Dexketoprofen Added to Paracetamol

OBJECTIVE Multimodal analgesic methods are preferred for the treatment of postoperative pain; as a result, the additive effects of analgesics are provided while probable side effects are avoided. The current study aimed to compare the effects of the combination of dexketoprofen and paracetamol with regard to postoperative pain therapy. METHODS Ninety-six patients who underwent non-malignant gynaecological laparotomy operations were included in this study. Patients were randomized into 3 groups. Group D received 50 mg intravenous dexketoprofen 15 minutes before the end of the operation and 8 and 16 hours after the operation. Group P received 1 g intravenous paracetamol and Group DP received the combination of 500 mg paracetamol and 25 mg dexketoprofen at the same time intervals. All patients received morphine infusion after operation. Total morphine consumption at 24 hours, visual analog scale, patient satisfaction and side effects were investigated. RESULTS Comparison of the visual analog scale scores revealed that the Group DP presented lower scores at 24th hours compared to the other groups; and the difference between Group DP and Group D was statistically significant. Total morphine consumption was not significantly different between the three groups. The minimum number of side effects was observed in the Group DP. CONCLUSION Co-administration of paracetamol, dexketoprofen and morphine provided good analgesia and fewer side effects in gynaecological abdominal surgery.

Emergency surgery in a newborn patient with severe congenital hypothyrodism

We aimed to discuss anaesthesia management in a newborn with severe hypothyroidism forwhomwe could not provide hypothyroidism treatment due to tracheoesophageal fistula and anal atresia. The baby girl was planned for the correction of tracheoesophageal fistula due to rapidly increasing abdominal distension and rapid deterioration in her general condition of tracheoesophageal fistula and to be operated considering that abdominal distensionwas developed secondary to anal atresia. Before the operation her thyroid hormoneswere very low with sT3: 1.56 pq ml (N:2-4,4 pq ml), sT4: 0.135 ng ml (N:0,9-1,6 ng ml) and very high with TSH N500 U ml (N:0.274,2 U ml). Although it was planned to initiate oral L-thyroxine treatment with pre-diagnosis of primary congenital hypothyroidism, oral or rectal treatment could not be used due to tracheoesophageal fistula and anal atresia. Intravenous treatment could not also be provided. The patient was transferred for urgent surgery since the patient could not be fed orally, and could not be provided necessary treatment and due to potential intestinal perforation. The patient was transferred to the OR without premedication, and then monitorized. Anaesthesia was induced using sevoflurane and intravenous remifentanil 0.5mcg kg. Tomaintain anaesthesia, 50% oxygen 50% air, sevoflurane and remifentanil (0.05–0.2 μg kg min) infusion was initiated. The operation was started after the patient was accurately positioned. The patient was hemodynamically stable and did not have any problems during operation and monitoring in the recovery room, therefore the patient was sent to the neonatal intensive care unit. Thyroid hormones are the hormones affecting the functions of almost all organ systems in the body and have critical importance especially for brain and somatic development in babies [1]. In our case, oral treatment could not be administered due to existing tracheoesophageal fistula and anal atresia. Furthermore, the patient was operated due to her emergency status since we could not provide available L-thyroxine treatment intravenously. In patients with untreated severe hypothyroidism or myxedema coma, elective surgery should be performed and if possible, patient

The effect of flunarizine pretreatment on postoperative morphine consumption

OBJECTIVES This study was designed to document the effects 10 mg flunarizine, administrated in the preoperative period, on postoperative morphine requirement and analgesic quality, in abdominal surgery. METHODS Thirty patients, aged 18 to 55 years, were studied. Patients were randomly allocated to one of two equally sized groups, and received either 2 capsules of 5 mg flunarizine (Group I) or 2 placebo capsules (Group II) 2 hours before the operation, immediately after the extubation and at the 15th minute, Aldrete postanesthesia recovery scores were assessed. In the postoperative period, patients were connected to a patient-controlled analgesia device for intravenous morphine, and the first analgesic requirement time was recorded. Ramsay sedation scale, visual analogue pain scale and morphine consumption were assessed after the extubation. RESULTS Systolic arterial pressures at the 5th minute of the preoperative period were significantly lower in the flunarizine group than placebo group. Heart rates in the 45th minute were also lower in the flunarizine group. Flunarizine patients reported statistically lower visual analogue pain scale values in the postoperative 12th hour. There was no significant difference in postoperative sedation scores between the groups. Flunarizine did not lengthen the first analgesic requirement time and similarly did not lessen the morphine requirement. CONCLUSION We conclude that 10 mg flunarizine administered in the preoperative period had no significant effects on clinical parameters, had no analgesic effect and did not augment the analgesic effects of morphine at this dose.