Betül Başaran

Analgesia and Respiratory Function after Laparoscopic Cholecystectomy in Patients receiving Ultrasound-Guided Bilateral Oblique Subcostal Transversus Abdominis Plane Block: A Randomized Double-Blind Study

Background Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours. Material/Methods In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h. Results VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0–2 h and 2–24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables. Conclusions After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement.

Controversial clinical practices for patients with preeclampsia or HELLP syndrome: a survey

Abstract Background: Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices. Materials and methods: An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009–2012) and HELLP syndrome (2005–2012). Online surveys were sent to all authors using the email addresses found in their publications. Results: Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques. Conclusions: A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.

Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

OBJECTIVE Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. MATERIAL AND METHODS Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. RESULTS Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. CONCLUSION A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.

Anaesthetic Management of Laparoscopic Morgagni Hernia Repair in a Patient with Coexisting Down Syndrome, Patent Foramen Ovale and Pectus Carinatum.

Laparoscopic repair has several advantages with a minimally invasive surgical option for children with Morgagni hernias; however, a number of physiological sequelae results from pneumoperitoneum and insufflation. These physiological changes may be more significant in patients with a congenital heart disease. Perioperative detailed evaluation, meticulous monitorization and cooperation with a surgical team are important in cases with patent foramen ovale for the possible risk of the paradoxical gas embolism. We present the anaesthetic management of a patient with patent foramen ovale, Down syndrome and pectus carinatus who successfully underwent laparoscopic Morgagni hernia repair. Under a well-managed anaesthesia that prevented complications because of pneumoperitoneum, laparoscopic surgery would be safe enough for patients with Morgagni hernia having an associated congenital heart disease.

The Impact of Nurse's Experience on Operation Time in Laparoscopic Cholecystectomy

DOI: 10.4328/JCAM.2276 Received: 05.01.2014 Accepted: 20.01.2014 Printed: 01.09.2015 J Clin Anal Med 2015;6(5): 562-4 Corresponding Author: Betül Kozanhan, Konya Education and Research Hospital, Clinic of Anesthesiology and Intensive Care, Konya, Turkey. T.: +90 3322232251 F.: +90 3322236182 E-Mail: betulkozanhan@gmail.com Özet Amaç: Çalışmamızda hemşire tecrübesinin laparoskopik kolesistektomi ameliyatının süresi üzerine etkisini belirlemeyi amaçladık. Gereç ve Yöntem: Konya Eğitim ve Araştırma Hastanesi genel cerrahi ameliyathanesinde, on yıldan daha fazla laparoskopik ameliyat tecrübesi olan, bir genel cerrahi uzmanının, Ocak 2010-2013 tarihleri arasında yaptığı laparoskopik kolesistektomi vakalarının dosyaları geriye dönük olarak tarandı. Ultrasonografide safra kesesinde taş ve/veya polipi olduğu için ameliyat edilen hastalar çalışmaya alındı. Hastaların yaş, cins, safra kesesi patolojisi, ASA skoru, ameliyatı asiste eden hemşire ve ameliyat süresine ait bilgiler elde edildi. Ameliyatı asiste eden hemşireler, laparoskopik ameliyat tecrübesi 10 yıldan fazla olan tecrübeli dört hemşire (grup 1), 5 yıldan az tecrübesi olan dört hemşire (grup 2) olarak iki gruba ayrıldı. Veriler Excel ortamında kaydedildi, istatistiki hesaplama için SPSS 18.0 programı kullanıldı. P<0.05 anlamlı kabul edildi. Bulgular: Çalışmamıza dahil edilen 197 hastanın 38(%19) i erkek, 159(%81) u kadın, 17(%9) si 65 yaş üstünde, 180(%91) i altında olup, yaş ortalaması 46,7±13,8 idi. Tecrübeli hemşireler 104(%53) ameliyatı, az tecrübeli hemşireler 93(%47) ameliyatı asiste etmişlerdi. Tüm ameliyatlar için ortalama ameliyat süresi 63,2±20,1 dakika idi. Bu süre tecrübeli hemşire grubunda 51,5±9,0 dakika, az tecrübeli hemşire grubunda 73,0±5,6 dakika olarak tespit edildi. Aradaki fark anlamlı (P<0.05) idi. ASA kriterleri ve hasta yaşının ameliyat süresi üzerine etkisi olmakla birlikte aradaki fark (P>0.05) anlamlı değildi. Tartışma: Laparoskopik kolesistektomide ameliyat hemşiresinin tecrübeli olması ameliyat süresini kısaltmaktadır.

Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia

The combination of propofol and ketamine is commonly used for total intravenous anesthesia. These drugs can be delivered in different syringes or in the same syringe. We hypothesized that the drugs might separate and different concentrations of each drug could be found in different parts of the syringe during the procedure period when they were mixed in 1 syringe.

Simple handling of venous air embolism during abdominal myomectomy

We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment.

Paravertebral Block Combined with Sedation for a Myasthenic Patient Undergoing Breast Augmentation

Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period.