Cagla Ozbakis Akkurt

Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial

STUDY OBJECTIVE To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine. DESIGN Prospective, randomized, double-blinded study. SETTING University-affiliated hospital. PATIENTS One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery. INTERVENTIONS Patients were randomly assigned to neostigmine (70 μg/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade. MEASUREMENTS We recorded PONV, recovery parameters, antiemetic consumption, and side effects. MAIN RESULTS Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P < .05), but thereafter low and comparable. Postoperative antiemetic and analgesic consumption were similar in each group. Extubation (median [interquartile range], 3 [1-3.25] vs 4 [1-3.25]; P < .001) first eye opening (4 [3-7.25] vs 7 [5-11]; P < .001), and head lift (4 [2-7.25] vs 8 [11-25]; P < .001) in minutes were shorter in patients given sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine. CONCLUSIONS Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine.

Comparison between ultrasound-guided sciatic–femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy

Objective To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic–femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). Methods Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2 ml (10 mg) of 0.5% levobupivacaine and the USFB group received a 25 ml mixture consisting of 10 ml of 2.0% lidocaine, 10 ml of 0.5% levobupivacaine and 5 ml of saline (15 ml for the femoral and 10 ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. Results A total of 40 patients were enrolled in the study (n = 20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. Conclusions USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.

The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

OBJECTIVES To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. DESIGN Randomized, double-blinded study. PATIENTS 120 patients ASA I-II who underwent abdominal hysterectomy. INTERVENTIONS All the patients were given 1g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCl (8mg, 2ml IV) (Group I, N=60) and saline (2ml IV) (Group II, N=60) at the skin closure. MEASUREMENT Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. MAIN RESULTS Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1h [by 1.3 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [Q1, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P=0.95. CONCLUSIONS Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: Propofol-based versus desflurane-based anesthesia

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.

Induction with Propofol Decreases Emergence Agitation in Pediatric Patients

Background and objectives: Emergence agitation (EA) is a common complication seen after inhalational anesthesia especially with sevoflurane, with an incidence of 20-80%. The hypothesis of the study was that induction with propofol reduces the incidence and severity of emergence agitation when compared with sevoflurane in children undergoing inguinal hernia surgery. Methods: 116 Children undergoing inguinal hernia were randomly assigned to two groups: Sevoflurane group received sevoflurane increasing concentrations up to 8% and propofol group received 3 mg kg propofol in induction. Postoperative agitation treatment and analgesia was standardized, and postoperative assessments included Cole Agitation Scale and narcotic consumption for agitation, Wong-Baker Faces Pain Rating Scale for pain, first spontaneous eye opening time, first verbal command follow time, post-anesthesia care unit (PACU) staying time, first analgesic requirement time and parents satisfaction. Results: The incidence of EA at arrival in PACU and the cumulative incidences at the end of the postoperative two hours were significantly lower in the propofol group. EA scores were lower in propofol group in all measurement times during postoperative 30 minutes. Fentanyl consumption at arrival in PACU and the sum of the two hours were significantly lower in propofol group. Pain scores were lower in propofol group in the postoperative 24 hours. First analgesic requirement time and parents satisfaction were higher in propofol group. Conclusion: Propofol in accurate dose is effective in reducing the incidence and intense of EA in children undergoing inguinal hernia and maybe preferred in children with high risk of EA.