Ebru Biricik

The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy

BACKGROUND:Dexamethasone has been shown to cause inhibition of sugammadex reversal in functionally innervated human muscle cells. In this prospective, double-blind, randomized, controlled study, we evaluated the effect of dexamethasone on the reversal time of sugammadex in children undergoing tonsillectomy and/or adenoidectomy. METHODS:We recruited 60 patients with ASA physical status I to II, between the ages of 3 and 8 years, scheduled for elective tonsillectomy and/or adenoidectomy. After the induction of anesthesia, patients in group D received IV dexamethasone at a dose of 0.5 mg/kg within a total volume of 5 mL saline, whereas patients in group S received only 5 mL IV saline as the control group. At the end of surgery, all patients were given a single bolus dose (2 mg/kg) of sugammadex at reappearance of T2. Demographic data, hemodynamic variables, time to recovery (a train-of-four ratio of 0.9), time to tracheal extubation, and adverse effects were recorded. RESULTS:There was no statistical significance between 2 groups in time to recovery and time to extubation. Time to recovery was 97.7 ± 23.9 seconds in group D and 91.1 ± 39.5 seconds in group S (P = 0.436; 95% confidence interval, −10.3 to 23.5). Time to extubation was 127.9 ± 23.2 seconds and 123.8 ± 38.7 seconds in group D and in group S, respectively (P = 0.612; 95% confidence interval, −11.9 to 20.05). CONCLUSIONS:IV dexamethasone, given after induction of anesthesia, at a dose of 0.5 mg/kg, does not substantively affect the reversal time of sugammadex in pediatric patients undergoing adenoidectomy and/or tonsillectomy.

Effect of Ketamine, Thiopental and Ketamine-Thiopental Combination during Electroconvulsive Therapy for Depression.

OBJECTIVE We aimed to evaluate the effect of anaesthesia with thiopental (4 mg kg(-1)), ketamine (1 mg kg(-1)) and ketamine-thiopental (1 mg kg(-1) and 4 mg kg(-1), respectively) combination during electroconvulsive therapy (ECT) on the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patients with resistant major depression. METHODS Patients with HDRS scores above 17 were included. The patients were randomly divided into three groups according to the anaesthesia used. Group 1 was given thiopental (4 mg kg(-1)), Group 2 was given ketamine (1 mg kg(-1)) and Group 3 was given ketamine (1 mg kg(-1)) and thiopental (4 mg kg(-1)). Succinylcholine (1 mg kg(-1)) was administered in all patients for muscle relaxation. HDRS and HAM-A scores were evaluated before ECT, after 3, 6. ECT and after the final ECT. Systolic and diastolic blood pressures, heart rates and oxygen saturations were recorded before and after anaesthesia induction and after the ECT procedure. Seizure duration was recorded. RESULTS Fifty-eight patients were included in the study. Thirty (52%) patients were male and 28 (48%) were female. The mean age was 42.7±15.8 years in Group 1, 44.8±11 years in Group 2 and 38.6±6.8 years in Group 3. In all groups, HDRS scores were reduced compared with the baseline values. There was no statistical significant difference between the groups regarding HDRS scores. HAM-A scores were higher in Group 2 and Group 3. Systolic and diastolic blood pressures and heart rate values were lower in Group 1 and the difference was statistically significant. CONCLUSION In this study, anaesthesia induced with thiopental, ketamine and thiopental-ketamine combination was observed to not result in a difference in ECT for patients with treatment-resistant depression. Ketamine at a dose of 1 mg kg(-1) given just before ECT did not enhance the antidepressant effect of ECT; however, anxiety scores were increased with ketamine application.

Sugammadex in a Patient with Brugada Syndrome

Brugada Syndrome was first described in 1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhythmias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right precordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complications. Many anaesthetics have been administered during the operation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study.

Vitamin D and Anaesthesia

Vitamin D is a vitamin not only associated with calcium-phosphorus metabolism but also affects many organ systems. Because of its effect on the immune system in recent years, it has attracted much attention. Vitamin D deficiency is a clinical condition that can be widely observed in the society. Thus, patients with vitamin D deficiency are often seen in anaesthesia practice. In the absence of vitamin D, prolongation of intensive care unit stay, increase in mortality and morbidity and also association of chronic diseases further increase the importance of vitamin D deficiency. The results obtained from studies have led to the question of whether poor surgical outcome is associated with vitamin D deficiency. We assessed the vitamin D deficiency and its negative consequences for the anaesthesiologist.

Amyloidosis and difficult airway: a case report -

Öz Amyloidosis is a disease which can affect any tissue in the body with extracellular deposition of low molecular weight protein fibrils. Amyloid deposition can appear in many organs and tissues. Amyloidosis of tongue occurs most commonly in systemic form as rubbery macroglossia due to extra-deposition of amyloid within the suprahyoid muscle. Anesthesiologist can experience the negative consequences of amyloidosis in many conditions. Difficult airway due to amyloid deposition in tongue is an unexpected condition. We aimed to report a case that had respiratory distress with extremely big tongue due to amyloidosis. We performed a fiberoptic intubation for emergent tracheostomy without any complication. Amiloidozis, düşük molekül ağırlıklı amiloid moleküllerinin ekstrasellüler birikimi ile karakterize bir hastalıktır. Amiloid birikimi kalp, karaciğer, böbrek, cilt, barsak, otonom sinir sistemi, dil ve karpal tünelde görülebilir. Dilde amiloidozis, amiloidin suprahyoid kaslarda ekstrasellüler depozisyonuna bağlı makroglossi çoğunlukla amiloidin sistemik formuna bağlı görülmektedir.Anestezistler amiloidozisle pek çok farklı durumda karşılaşabilirler. Dilde amiloid birikimine bağlı zor hava yolu beklenmedik bir durumdur. Fiberoptik bronkoskopi ile acil trakeostomi açılmasını sağladık ve herhangi bir komplikasyon gözlenmedi. Burada amiloidozise bağlı aşırı büyük dilden kaynaklanan solunum sıkıntısını sunulması amaçlanmıştır.

Alt ekstremite cerrahisi geçiren yaşlı hastalarda genel ve rejyonel anestezi sonrası görülen deliryum sıklığı ve risk faktörlerinin karşılaştırılması

Amac: Bu calismada; ortopedik cerrahi geciren yasli hastalarda genel anestezi veya rejyonel anestezi sonrasi gorulen deliryum insidanslarinin ve risk faktorlerinin karsilastirilmasi amaclanmistir. Gerec ve Yontem: Total kalca protezi, total diz protezi, femur kirigi cerrahisi geciren, 65 yas uzeri toplam 120 hastada gerceklestirildi. Genel anestezi (n: 70) veya rejyonel anestezi (n:50) uygulanmasina gore iki gruba ayrildi. Tum hastalarin, hemodinamik ve kan parametreleri, yas, cinsiyet, ameliyat suresi, anestezi tipi, eslik eden hastaliklar, sigara ve kullanilan ilac miktari gibi deliryumun potansiyel risk faktorleri, deliryum testleri (Confusion Assessment Method, Delirium Rating Scale-Revised-98), hastanede kalis sureleri ve maliyetleri kaydedildi. Bulgular: demografik veriler, operasyon zamani, preoperatif ve postoperatif hemodinamik ve laboratuar degerleri her iki grupta ayniydi. Tum hastalar icin deliryum insidansi %12.5 idi. Grup G’de 6 hastada (%8.6), grup R’de 9 hastada (%18) deliryum goruldu. En onemli risk faktorlerinin ileri yas ve polifarmasi oldugu saptandi. Agir deliryum gorulen hastalarda hastanede yatis suresi ve maliyet yuksekti. Sonuc: bu calisma total kalca- diz artroplastisi, femur kirigi cerrahisi geciren yasli hastalarin %12.5’unda deliryum gelistigini gostermistir. Deliryum insidansi rejyonel veya genel anestezi ile degisiklik gostermedi. Ileri yas ve polifarmasi deliryum icin risk faktorleridir. Deliryum hastane maliyeti ve hastanede yatis suresini artirir.