Demet Sergin

Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children

Objective To investigate the effects of sociodemographic factors and maternal anxiety levels on behaviour in children undergoing surgery. Methods This study included children aged 3–12 years who were scheduled for surgery, and their respective mothers. Each mother completed a questionnaire concerning sociodemographic and economic characteristics. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) form Tx-1, following transfer of the child to the operating room. An anaesthesiologist rated preoperative anxiety in each child using the Frankl Behaviour Rating Scale (FBRS) and Venham Picture Test (VPT). Results One hundred children (mean ± SD age 7 ± 2.7 years) who received dental (47%), plastic (39%) or urological (14%) surgery, and 100 mothers (mean ± SD age 34 ± 6.6 years) were included. A statistically significant difference between maternal STAI Tx-1 scores and children’s VPT scores was revealed. There was no significant difference between maternal STAI Tx-1 scores and children’s FBRS scores. Maternal education level and socioeconomic status had no effect on FBRS, VPT and STAI Tx-1 scores. Conclusion Maternal knowledge and experience of anaesthesia, and high levels of maternal anxiety, may be related to increased anxiety in children undergoing surgery.

Neuromuscular Functions on Experimental Acute Methanol Intoxication.

OBJECTIVE The incidence of accidental or suicidal ingestion of methyl alcohol is high and methyl alcohol intoxication has high mortality. Methyl alcohol intoxication causes severe neurological sequelae and appears to be a significant problem. Methyl alcohol causes acute metabolic acidosis, optic neuropathy leading to permanent blindness, respiratory failure, circulatory failure and death. It is metabolised in the liver, and its metabolite formic acid has direct toxic effects, causing oxidative stress, mitochondrial damage and increased lipid peroxidation associated with the mechanism of neurotoxicity. Methanol is known to cause acute toxicity of the central nervous system; however, the effects on peripheral neuromuscular transmission are unknown. In our study, we aimed to investigate the electrophysiological effects of experimentally induced acute methanol intoxication on neuromuscular transmission in the early period (first 24 h). METHODS After approval by the Animal Experiment Ethics Committee of Ege University, the study was carried out on 10 Wistar rats, each weighing about 200 g. During electrophysiological recordings and orogastric tube insertion, the rats were anaesthetised using intra-peritoneal (IP) injection of ketamine 100 mg kg(-1) and IP injection of xylazine 10 mg kg(-1). The rats were given 3 g kg(-1) methyl alcohol by the orogastric tube. Electrophysiological measurements from the gastrocnemius muscle were compared with baseline. RESULTS Latency measurements before and 24 h after methanol injection were 0.81±0.11 ms and 0.76±0.12 ms, respectively. CMAP amplitude measurements before and 24 h after methanol injection were 9.85±0.98 mV and 9.99±0.40 mV, respectively. CMAP duration measurements before and 24 h after methanol injection were 9.86±0.03 ms and 9.86±0.045 ms, respectively. CONCLUSION It was concluded that experimental methanol intoxication in the acute phase (first 24 h) did not affect neuromuscular function.

Evaluation of a Multimodal Approach to Postoperative Pain in Patients Undergoing Flank Incision in the Urology Operating Room

OBJECTIVE In this study, we evaluated subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. METHODS Forty-nine patients under The American Society of Anesthesiologists Physical Status classification (ASA) I-III aged 18-85 years undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomised study. The patients were divided into two groups (Group O [n=25] and Group M [n=24]) and received standard general anaesthesia. Tramadol (100 mg) and paracetamol (100 mg) were given intravenously before fascia closure and 20 mL of 0.25% levobupivacaine was injected locally at surgical incisions in all patients. Patients in Group M also received 0.1 mg kg(-1) morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively, and patient satisfaction were recorded. RESULTS Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects, or vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60, and 120 minutes compared to Group O (p<0.05). CONCLUSION In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.

The Effects of Preoperative Anxiety on Anesthetic Recovery and Postoperative Pain in Donor Nephrectomy

Introduction Kidney transplant is the most effective choice of treatment for patients with end-stage kidney failure. About 20-25% of all the kidney transplants performed come from living donors. No prospective study is readily available regarding the effects of preoperative anxiety on anesthetic recovery and postoperative pain in donor nephrectomy. We aimed to investigate the effects of preoperative anxiety on anesthetic recovery and postoperative pain in patients who will undergo donor nephrectomy in this prospective study. Methods 48 volunteers who were scheduled for donor nephrectomy, aged between 18‐60 years, with an ASA physical status score of I or II were included in the study. The anxiety levels of the patients were measured using STAI (State Trait Anxiety Inventory) scale during preoperative period. All of the patients were administered general anesthesia following routine monitoring in operating rooms. Morphine PCA was used to provide postoperative analgesia. Correlation of preoperative STAI scores of the patients with demographic data, post anesthesia recovery data and postoperative pain scores were investigated. Results STAI scores of the patients showed no statistically significant correlations with demographics, ASA scores, history of prior surgery, chronic pain, degree of kinship with recipient, educational status, monthly income and smoking status of the patients. STAI I score was found to be significantly correlated with spontaneous respiration time, adequate respiration time, extubation time and the MAS ≥9 time(p<0,01). STAI scores were found to be significantly correlated with the VAS scores of the 30th minute,1st hour,2nd hour,4th hour,8th hour, 12th hour and 24th hour(p<0,05). A significant correlation was established between the STAI I and STAI II scores and the total amount of analgesic administered in 24hours(p<0,05). Conclusion It is suggested that 38-45% of the patients scheduled for surgery under anesthesia experience anxiety in preoperative period. Effect of anxiety levels on postanesthetic recovery and postoperative pain intensity is still a matter of discussion. Our study showed that patients with high preoperative anxiety levels had a late recovery from anesthesia and high postoperative pain scores. Thus, we suggest that postoperative anxiety levels should be measured preoperatively as adequate planning towards amelioration of excessive anxiety may contribute to anesthetic recovery and postoperative pain intensity. Figure. No caption available. Figure. No caption available. References 1. Kälble T, Lucan M, Nicita G, Sells R, Burgos Revilla FJ, Wiesel M. European Association of Urology. EAU guidelines on renal transplantation. Eur Urol. 2005 Feb;47(2):156–66. 2. Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth. 2014 Apr;28(2):222–7. 3. Kehlet H, Jensen ST, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet: 2006; 371618–125.