Bayazit Dikmen

Acupuncture on Yintang Point Decreases Preoperative Anxiety

OBJECTIVES The aim of this study was to investigate the effect of ear-press needle acupuncture on Yintang point for preoperative anxiety. DESIGN This was a prospective, randomized, single-blind, controlled study. SETTINGS/LOCATION The study setting was the Department of Anesthesiology in Ankara Training and Research Hospital of Ministry of Health, Ankara, Turkey. SUBJECTS The study comprised 52 adult surgical patients. INTERVENTIONS A single, 20-minute session of single-point acupuncture was applied on Yintang (acupuncture group) or sham point (sham acupuncture group). OUTCOME MEASURES The efficacy of acupuncture was evaluated by means of the changes in bispectral index (BIS) and STAI (State-Trait Anxiety Index). RESULTS BIS values in the acupuncture group were significantly lower than in the sham group in all time intervals (p<0.0042). BIS values were lower than baseline in the study group during the entire study period (p<0.0004) while no such effect has been observed in the sham group (p>0.0004). Mean values of state anxiety (STAI-S) decreased after acupuncture in the study group (p=0,018), while no change was observed in trait anxiety (STAI-T) (p=0.156). Patients of the sham group showed no change in both parameters (p=0.387 and p=0,116). CONCLUSIONS Ear-press needle acupuncture on Yintang point reduces preoperative anxiety in adult surgical patients.

Bilateral Extraoral, Infraorbital Nerve Block for Postoperative Pain Relief After Cleft Lip Repair in Pediatric Patients: A Randomized, Double-Blind Controlled Study

The objective of this study was to evaluate the effectiveness of bilateral extraoral infraorbital nerve block with 0.25% bupivacaine administered at the end of surgery in postoperative pain relief after cleft lip repair. Forty ASA I-II children were randomly divided into 2 groups. Group I received 1.5 mL 0.25% bupivacaine and group II received 1.5 mL saline. FLACC scores of the patients in the recovery room in group I were 4 times less than in group II (P = 0.001) and in the first 4 hours postoperatively were apparently less in group I (P = 0.001). Mean time to first paracetamol requirement was longer in group I (P = 0.001). Total paracetamol consumption was lower in group I (P = 0.001). None of the patients required rescue tramadol in group I, whereas all patients in group II needed. In group I, parent satisfaction scores were higher (P = 0.001). Vomiting incidence was higher in group II (P = 0.028). Bilateral extraoral, infraorbital nerve block administered at the end of surgery provides satisfactory analgesia with high parental satisfaction and lower complication rates and reduces rescue analgesic consumption in patients undergoing repair of cleft lip.

Postoperative analgesic efficacy of intravenous dexketoprofen in lumbar disc surgery.

BackgroundWe investigated the postoperative analgesic efficacy and effect on total tramadol consumption of intravenous dexketoprofen trometamol, a new nonsteroidal anti-inflammatory drug, in patients that had undergone lumbar disc surgery. MethodsSixty patients were included in this placebo-controlled, randomized, double-blind study. General anesthesia was applied to both groups. Group D (n=30) received dexketoprofen (50 mg) intravenously 30 minutes before the end of surgery and at the postoperative 12th hour, whereas group C (n=30) received 2 mL of 0.9% NaCL intravenously at the same time points. All patients received a patient controlled analgesia device with a tramadol, 25 mg bolus, 15 minutes lockout protocol, and were followed with visual analog scale, verbal rating scale, modified Aldrete recovery scoring system, and Ramsay sedation scale in the postoperative period. ResultsThere was no significant difference between the groups for demographic data, duration of surgery, mean arterial pressure, and heart rate. The time to first postoperative analgesic requirement was significantly longer in group D (151.33±81.98 min) than group C (19±5.78 min) (P<0.001). Total tramadol consumption was significantly lower in group D (117.50±48.31 mg) than group C (311.67±59.35 mg) (P<0.05). Visual analog scale and verbal rating scale values in group D were significantly lower than group C at all follow-up periods (P<0.001). There was a significant difference between the groups for the modified Aldrete recovery scoring system (P<0.05) but not for Ramsay sedation scale. The instances of nausea and vomiting among the side effects were significantly lower in group D (P<0.05). ConclusionWe found that dexketoprofen was an effective analgesic for postdiscectomy pain when used alone or in addition to opioids. It is easy to administer and decreases tramadol consumption and opioid-related side effects.

Capsicum plasters on acupoints decrease the incidence of emergence agitation in pediatric patients

Aim:  To detect the effect of capsicum plasters on bilateral HT 7 acupoints for decreasing Emergence agitation (EA) in pediatric patients undergoing tonsillectomy and/or adenoidectomy.

Effects of repeated desflurane and sevoflurane anesthesia on enzymatic free radical scavanger system

Background: To investigate the possible effects of repeated sevoflurane and desflurane anesthesia on hepatocellular system by evaluating the free radical metabolism, hepatocellular enzymes and histopatholgical changes in rats. Methods: Four groups of animals were studied. Sevoflurane 2% (v/v) and desflurane 6% (v/v) in air/O2 were administered to animals in group II (n = 9) and III (n = 9) respectively. 100% (v/v) O2 was administered in group IV (n = 9). Administration was done for 60 minutes over 3 days. Nine animals were allocated to control group (group I), superoxide dismutase (SOD), catalase (CAT), glutathion peroxidase (GSH-Px), glutathione-s-transferase (GST) and thiobarbituric acid reactive substances (TBARS) were studied. Also electron microscopy was performed. Results: Catalase, SOD, GSH-Px, GST activities and TBARS levels were significantly higher in groups II and III than in group I (p < 0.05). All parameters were significantly higher in groups II versus group IV (p < 0.05). On the other hand, SOD, GSH-Px and GST activities were significantly elevated in group III than IV, but CAT activity and TBARS levels were not significantly. Catalase, SOD, GSH-Px, GST but not TBARS levels were significantly higher in groups II and III than in group IV (p < 0.05). TBARS levels were higher in group III than in group IV, but this elevation was not statistically significant. CAT, SOD and GSH-Px activities were significantly higher in groups II than in group III (p < 0.05). Conclusion: Although electron microscopy findings were similar for group II and III, we can conclude that sevoflurane might cause more cellular damage than desflurane by causing higher activation of free radical metabolising enzymes.

Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists

BACKGROUND AND OBJECTIVES residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution. METHODS This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation <90% and 90-93% despite receiving 3 L/min nasal O2, respiratory rate > 20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study. RESULTS The incidence of PORC was 43% (n = 179) for TOFR < 0.9, and 15% (n = 61) for TOFR < 0.7. The incidence of TOFR < 0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR < 0.9 was found in 46% (n = 126) of the patients receiving neostigmine. CONCLUSIONS When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

Epileptic Seizure Following IV Tramadol in a Patient with Mental Retardation and Cerebellar Ataxia

OBJECTIVE To present a case of an epileptic seizure related to intravenous (IV) tramadol for pain control following a total abdominal hysterectomy operation on a patient with mental retardation and cerebellar ataxia. BACKGROUND Tramadol is an analgesic with a dual mechanism of action and has several side effects, one of which is epileptic seizure. CASE REPORT A 42-year-old female with mental retardation and cerebellar ataxia presented with an epileptic seizure after administration of IV tramadol for postoperative pain. Magnetic resonance imaging scans were normal, but laboratory tests showed hypocalcemia. Next, calcium replacement was administered. Postoperative pain treatment with tramadol was discontinued because tramadol was felt to be a possible cause of the seizure observed in this patient. In order to treat the epileptic seizure, IV phenytoin sodium infusion was started. On the second postoperative day, calcium levels were found to be normal, and the IV antiepileptic medication was changed to an oral form. The patient had no subsequent seizures during the clinical follow-up. She was discharged on the fourth postoperative day without any other complications. CONCLUSION Even in recommended doses, IV tramadol may cause epileptic seizures on predisposed patients.

A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery.

OBJECTIVES The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

Ropivacaine for unilateral spinal anesthesia; hyperbaric or hypobaric?

BACKGROUND AND OBJECTIVES The aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine. METHODS The prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I-III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL of distilled water (density at room temperature was 0.997) and group Hyper (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL (5mg.mL(-1)) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15° Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15° Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L(3-4) lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed. RESULTS Time to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00±163.29s) than in group Hypo (763.63±208.35s) (p<0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper. CONCLUSION Both hyperbaric and hypobaric ropivacaine (11.25mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings.

Regional intravenous anesthesia in knee arthroscopy

OBJECTIVE: The goal of the study was to investigate the regıonal ıntravenous anesthesıa procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain. MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted.The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters. RESULTS: The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer. CONCLUSION: Regıonal ıntravenous anesthesıa using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.