Deniz Karakaya

Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia.

Perioperative hypothermia is a common problem in anesthesia practice. Regional anesthesia, like general anesthesia, influences the thermoregulatory process. The aim of our study was to compare the efficacy of ondansetron and meperidine in the prevention of shivering during and after spinal anesthesia. Methods: In this double-blind study, 75 patients were randomized into 3 groups. Group O and Group M were given ondansetron 8 mg and meperidine 0.4 mg/kg intravenously immediately before spinal anesthesia, respectively. Group C received saline at identical times. The core temperatures and the incidence of shivering were recorded. Association between maximum block height and mean rectal temperatures of the patients were also evaluated. Results: The core temperature was preserved in both ondansetron and meperidine groups with respect to the control group. Shivering was observed in 8% of patients in groups O and M and 36% in group C. The correlation between maximum block height and mean rectal temperatures was lost in the ondansetron and meperidine groups. Conclusion: Ondansetron and meperidine have similar antishivering effects. In addition, both ondansetron and meperidine altered the correlation between the core temperature and block level during spinal anesthesia.

Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block.

Background and Objectives To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 μg/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 μg/mL for axillary brachial plexus block. Methods Sixty patients were randomly allocated to 3 groups and received axillary brachial plexus block with 40 mL bupivacaine 0.25% (group B), 40 mL bupivacaine 0.25% with fentanyl 2.5 μg/mL (group BF), or 40 mL bupivacaine 0.125% with fentanyl 2.5 μg/mL (group DBF). The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events were noted. Results The mean duration of sensory block and analgesia were longer in group BF (10.1 hours and 20.9 hours) than group B (6.9 hours and 11.6 hours) and DBF (5.9 hours and 12.0 hours) (P < .01, P < .001, respectively). The mean duration of motor block was also longer in group BF (10.7 hours) than group B (4.9 hours) (P < .01). Only 2 patients experienced motor block in group DBF. The frequency of successful block was 35% in group DBF (P < .01). Hemodynamic parameters were similar in all groups. In group B, only 1 patient experienced dizziness. Nausea was observed in 1 patient in each fentanyl group. Conclusion The addition of 100 μg/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone.

Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia

Background : The factors affecting the thermal status in neonates and infants undergoing general anesthesia are not yet investigated in detail. We evaluated the factors leading to intraoperative hypothermia in 60 neonates and infants.

Comparison of Neonatal Effects of Epidural and General Anesthesia for Cesarean Section

We assessed the influence of anesthetic technique for cesarean section on neonatal outcome. Thirty parturient women (ASA I/II) were randomly allocated into two groups. In Group GA general anesthesia was induced with 4 mg·kg–1 thiopental and 1.5 mg·kg–1 succinylcholine. In group EA epidural anesthesia was performed with 20 ml 0.375% bupivacaine through L3–4 inter-space. 1-min Apgar scores were significantly higher in group EA (p < 0.001). Neurologic and Adaptive Capacity scores at 2 and 24 h were higher in group EA (p < 0.001). In terms of blood gas values, umbilical arterial pH and pO2 values were higher in group EA (p < 0.05 and p < 0.001, respectively). The first breast-feeding intervals were found to be shorter in group EA (p < 0.001). We conclude that in terms of better Apgar and NAC scores, acid-base status and earlier initiation of breast-feeding, the epidural anesthesia may be preferred to general anesthesia in cesarean section.

Is tissue coring a real problem after caudal injection in children

Background : The aim of this study was to determine whether tissue coring occurs with 22‐G hollow needle and 22‐G caudal block needle during caudal injection in children, as well as evaluating the nature of the coring material if it did occur.

Brachial plexus injury during subclavian vein catheterization for hemodialysis

Although the subclavian vein is often used for placement of double-lumen hemodialysis catheters, the risk factors for complications for the patients with chronic renal failure are underestimated. We report a case of a patient with chronic renal failure in whom brachial plexus injury was caused by both a compressive hematoma and direct insertion of a needle resulting from a subclavian vein catheterization attempt for hemodialysis. This case emphasizes the need for determining the coagulation status of the patient especially with chronic renal failure before performing invasive procedures.

Comparison of fentanyl–bupivacaine or midazolam–bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

Summary Background: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml·kg−1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy.

Acute normovolemic hemodilution and nitroglycerin-induced hypotension: comparative effects on tissue oxygenation and allogeneic blood transfusion requirement in total hip arthroplasty.

STUDY OBJECTIVES To study the comparative effects of acute normovolemic hemodilution and nitroglycerin-induced hypotension on tissue oxygenation and blood transfusion requirement. DESIGN Prospective, randomized study. PATIENTS 30 ASA physical status I and II patients scheduled for primary total hip arthroplasty. INTERVENTIONS Patients were randomized to one of three groups of 10 patients each, to receive acute normovolemic hemodilutin (Group 1) or nitroglycerin-based hypotension (Group 2); Group 3 served as the control group. In Group 1, 2 U of blood was collected and replaced with an equal volume of hydroxyethyl starch (200/0.56%) immediately after anesthesia induction. In Group 2, nitroglycerin was infused at a rate sufficient to reduce mean arterial pressures to 60 to 65 mmHg before initiation of surgery. When hematocrit was reduced to 25%, at first autologous blood and then, if necessary, allogeneic blood was transfused to Group 1, and allogeneic blood was transfused to the other two groups, until hematocrit reached 30% for 5 days postoperatively. MEASUREMENTS AND MAIN RESULTS Total transfused allogeneic units of blood were determined by the fifth postoperative day. Arterial oxygen content (CaO2), venous oxygen content (CvO2), and oxygen extraction ratios (EO2) were calculated by standard formulas. The mean allogeneic transfusion requirement was significantly lower in Group 1 (1.3 +/- 0.8 U) than in Group 2 (2.3 +/- 0.8 U) or Group 3 (2.7 +/- 1.1 U) (p < 0.05). In Group 1, CaO2 and CvO2 were decreased at all times, but EO2 was significantly increased from 15 +/- 3.9% to 33.3 +/- 5.3% (p < 0.001). As for the other two groups, although CaO2 and CvO2 were decreased, EO2 was not significantly increased. CONCLUSIONS Acute normovolemic hemodilution is more effective than nitroglycerin-induced hypotension in reducing allogeneic blood transfusion requirement in total hip replacement surgery, without significant metabolic changes.

Fatal fever of unknown origin in acute cervical spinal cord injury: five cases.

Abstract Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.

Behavioural effects of chronic exposure to sub-anesthetic concentrations of halothane, sevoflurane and desflurane in rats

BackgroundA double-blind, randomized trial was conducted to determine the behavioural effects of chronic exposure to subanesthetic concentrations of halothane, sevoflurane and desflurane in rats.MethodsHalothane, sevoflurane and desflurane group rats received 0.1%, 0.3%, and 0.6% concentrations in a flow rate of 3 L·min-1 O2, respectively. Control animals also received 3 L·min-1 O2 in another investigation room, which had the same properties as the study group rooms. Rats breathed inhaled agents or oxygen between 09:00-13:00 hr every day for 30 days. After 30 days of inhalation of subanesthetic doses of inhaled agents or oxygen, behavioural tests were applied.ResultsTests of exploratory activity and curiosity (hole-board test), anxiety (elevated plus maze test) and learning and memory functions (multiple T maze test), demonstrated that chronic exposure to subanesthetic concentrations of all three anesthetics alters behavioural functions in rats. However, impairment of learning (P<0.05) and memory function (P<0.05) were greater in association with desflurane, in comparison to halothane and sevoflurane-treated rats.ConclusionChronic exposure to subanesthetic concentrations of halothane, sevoflurane and desflurane is associated with behavioural change in rats. Of the three drugs, desflurane was associated with the lowest learning and memory function test scores.RésuméObjectifDéterminer, par une étude randomisée à double insu, les effets comportementaux de l’exposition chronique à des concentrations sous-anesthésiques d’halothane, de sévoflurane et de desflurane chez les rats.MéthodeĽhalothane, le sévoflurane et le desflurane ont été administrés à des groupes de rats selon des concentrations respectives de 0,1 %, 0,3 % et 0,6% à un débit 3 L·min-1 d’O2. Les animaux témoins ont aussi reçu 3 L·min-1 d’O2 dans un local d’expérimentation qui avait les même propriétés que le local du groupe à l’étude. Les rats ont respiré les anesthésiques d’inhalation ou de l’oxygène entre 9 h et 13 h tous les jours, pendant 30 jours. Après quoi, des tests de comportement ont été appliqués. Résultats : Les tests d’activité exploratrice et de curiosité (planche trouée), d’anxiété (test de labyrinthe «elevated plus maze test») et des fonctions cognitive et mnésique («multiple T maze test») ont démontré qu’une exposition chronique à des concentrations sous-anesthésiques des trois agents altèrent les comportements des rats. Ľatteinte cognitive (P < 0,05) et mnésique (P < 0,05) a été plus importante avec le desflurane, comparé à l’halothane et au sévoflurane.ConclusionĽexposition chronique à des concentrations sousanesthésiques d’halothane, de sévoflurane et de desflurane est associée à un changement de comportement chez les rats. Le desflurane a produit les scores les plus bas aux épreuves cognitives et mnésiques.