Emin Silay

Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion

Objective — The effects of desflurane and sevoflurane on QT interval and QT dispersion have been investigated in a prospective, double-blind, randomized study of patients undergoing noncardiac surgery. Interventions — Sixty American Society of Anaesthesiologists physical status I-II adult patients were randomly assigned to two groups.Anaesthesia was induced with inhalation of desflurane (desflurane group) or sevoflurane (sevoflurane group) in increasing concentrations to 3 minimal alveolar concentration level. The maintenance of anaesthesia was provided with 2 minimal alveolar concentration agents in both groups until the end of the study. Electrocardiogram, heart rate and blood pressure were recorded as follows: before premedication, before induction, 1 and 3 min after the induction of anaesthesia, after the administration of vecuronium and after the tracheal intubation. The induction times and the complications were recorded. Measurements and results — The QTc interval was significantly more prolonged with desflurane than with sevoflurane at the first and third minute after the induction, and at the third minute after the administration of vecuronium.There were no significant differences in the QT dispersion between the two groups. Heart rate and blood pressure were found to be significantly higher in the desflurane group. Conclusion — The QTc interval was more prolonged with desflurane than sevoflurane, and QT dispersion was normal with both agents.

Does Benzydamine Hydrochloride Applied Preemptively Reduce Sore Throat Due to Laryngeal Mask Airway

Sore throat is a common postoperative complaint. We investigated whether preemptive benzydamine hydrochloride (BH) treatment could prevent sore throat due to a laryngeal mask airway (LMA) cuff inflated with air. One-hundred ASA status I–II patients who underwent general anesthesia were randomly divided into two groups. In the first group, four puffs of BH were applied to the pharynx 30 min before the operation and 5 min before the induction of anesthesia. Distilled water with a similar bottle was applied with the same protocol in the second group. Anesthetic induction was provided with propofol and fentanyl. The pressure of the LMA cuff inflated with room air was measured after the first adjustment and after 30, 60, and 90 min of inflation in both groups. At the end of operation, the LMA was removed after the recovery of spontaneous breathing. After the operation, patients were asked about sore throat symptoms at the first, second, and fourth hours. There were no significant differences between groups for cuff pressures, cuff volumes, analgesic doses, or operation times. However, sore throat symptoms were significantly less severe for the BH group during both resting and swallowing. In conclusion, preemptive topical BH may decrease the incidence of sore throat due to LMA use.

An unusual complication of total intravenous anesthesia: mutism.

IMPLICATIONS We report a case of mutism secondary to total IV anesthesia with propofol, as an unusual complication that we have not found in the literature.

Anaesthetic Management of a Neonate with Giant Cystic Hygroma.

Cystic hygroma, which originates from embryonic lymphoid tissue, is a benign tumour without any potential for malignancy. It is commonly located in the neck area. Anaesthetic management of a large neck mass may be challenging due to difficulty in intubation and the severe haemodynamic effects of surgical removal of a giant tumour. Serious consequences such as sudden airway occlusion resulting in hypoventilation and hypoxemia may arise. We present the anaesthetic management of a 15-day-old infant who underwent surgical removal of a cystic hygroma located on the left side of the neck. Anaesthesia was induced by mask ventilation with sevoflurane in 100% oxygen and intubation was carried out while maintaining spontaneous ventilation. The endotracheal tube was sutured to the tip of the right lip to avoid movement or extubation. In addition to arterial cannulation for invasive blood pressure monitoring, central venous catheterization for perioperative fluid management was put in place. After 6 hours of surgery, the infant was transported to the neonatal intensive care unit and was extubated without difficulty the next day. Facial nerve injury was observed to be temporary.