Ersel Güleç

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.

Coadministration of Intravenous Remifentanil and Morphine for Post-thoracotomy Pain: Comparison With Intravenous Morphine Alone

OBJECTIVES In this double-blind, randomized study, the authors compared the effects of a patient-controlled remifentanil and morphine combination with morphine alone on post-thoracotomy pain, analgesic consumption, and side effects. DESIGN A prospective, randomized, double-blind clinical study. SETTING University hospital. PARTICIPANTS Volunteer patients at a university hospital undergoing elective thoracotomy surgery. INTERVENTIONS Patients were allocated randomly into 2 groups to receive patient-controlled analgesia: the morphine (M) group or the morphine plus remifentanil (MR) group. Pain, discomfort, sedation scores, cumulative patient-controlled morphine consumption, rescue analgesic (meperidine) requirement and side effects were recorded for 24 hours. MEASUREMENTS AND MAIN RESULTS Sixty patients were allocated randomly to receive intravenous patient-controlled analgesia with morphine alone (M) or morphine plus remifentanil (MR) in a double-blind manner. Patients were allowed to use bolus doses of morphine (0.02 mg/kg) or the same dose of a morphine plus remifentanil (0.2 µg/kg) mixture every 10 minutes without a background infusion. VAS scores were lower in the MR group than in the M group at 30 minutes (p = 0.04), 1 hour (p = 0.03), and 2 hours (p = 0.04). Mean cumulative doses of morphine were not significantly different at 27.8±15 mg for the M group and 21.9±10.5 mg for the MR group. Significantly more patients needed meperidine in the M group (p = 0.039); these also experienced more nausea (p = 0.01). CONCLUSIONS Coadministration of PCA remifentanil with morphine for the treatment of post-thoracotomy pain did not reduce morphine consumption but provided superior analgesia, less use of rescue analgesics, and fewer side effects compared to morphine alone.

Rectus sheath block for postoperative pain relief in children undergoing major abdominal surgery

Abstract Background: Regional anaesthetic techniques in children has become increasingly popular and used to provide analgesia for umbilical and epigastric hernia repair, laparoscopic surgery, pyloromyotomy and other

Major Histocompatibility Complex Class I-related Chain A and B Gene Expression in Sepsis Patient

ABSTRACT Major histocompatibility complex class I-related chain A and B (MICA/B) function in the regulation of protective responses due to stress induced expression. One of the major causes of the morbidity is sepsis. The objective of this study was to measure the mRNA levels of these genes in the control and sepsis patient groups. Data showed increases in mRNA concentrations of MICA and MICB in the Patient Group in contrast to the Control Group. However this level was found higher than MICA mRNA concentration in the patient group. The current study is the first report according to the researchers’ knowledge representing the significant increases in the MICA and MICB expressions in the sepsis. This might provide a useful data for emphasizing these molecules as sensitive biomarkers. Further research is needed to enlighten the detail mechanisms of the MICA/B roles and to develop new treatment approaches.

Association between preoperative maternal anxiety and neonatal outcomes: a prospective observational study.

STUDY OBJECTIVE Preoperative anxiety can be associated with poor postoperative clinical outcomes. We aimed to assess whether preoperative maternal anxiety level of obstetric patients scheduled for elective cesarean surgery has an effect on clinical outcome of the newborn. DESIGN A prospective observational study. SETTING Operating room. PATIENTS Sixty pregnant women with American Society of Anesthesiologists physical status 1 and 2 scheduled for elective cesarean surgery were enrolled. INTERVENTIONS All patients received spinal anesthesia with hyperbaric bupivacaine 12.5mg. MEASUREMENTS We performed a State-Trait Anxiety Inventory questionnaire to evaluate preoperative maternal anxiety. We used the Apgar scoring system to assess the physical condition of the newborn. Hemodynamic measurements (heart rate, systolic and diastolic blood pressure) were recorded at baseline, skin incision, childbirth, and 10, 15, and 30minutes after skin incision. The use of ephedrine, nausea, and vomiting were recorded as well. MAIN RESULTS Average preoperative maternal state anxiety score was 41.1±4.6, and trait anxiety score was 50.9±5.7. Average Apgar scores of newborns were 7.6±0.8 and 9.2±0.6, at first minute and fifth minute, respectively. We found no significant relationship between the anxiety scores and Apgar scores at first and fifth minute. Forty-two patients required ephedrine, 5 patients had nausea, and 5 patients had vomiting. CONCLUSIONS We concluded that there was no relationship between preoperative maternal anxiety scores and Apgar scores at the first and fifth minute.

Preoperative Psychological Preparation of Children

Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed.

Effects of auditory and audiovisual presentations on anxiety and behavioral changes in children undergoing elective surgery

Background: Preoperative anxiety is a critical issue in children, and associated with postoperative behavioral changes. Aims: The purpose of the current study is to evaluate how audiovisual and auditory presentations about the perioperative period impact preoperative anxiety and postoperative behavioral disturbances of children undergoing elective ambulatory surgery. Materials and Methods: A total of 99 patients between the ages of 5–12, scheduled to undergo outpatient surgery, participated in this study. Participants were randomly assigned to one of three groups; audiovisual group (Group V, n = 33), auditory group (Group A, n = 33), and control group (Group C, n = 33). During the evaluation, the Modified Yale Preoperative Anxiety Scale (M-YPAS) and the posthospitalization behavioral questionnaire (PHBQ) were used. Results: There were no significant differences in demographic characteristics between the groups. M-YPAS scores were significantly lower in Group V than in Groups C and A (P < 0.001 and P < 0.001, respectively). PHBQ scores in Group C were statistically higher than in Groups A and V, but, no statistical difference was found between Groups A and V. Conclusion: Compared to auditory presentations, audiovisual presentations, in terms of being memorable and interesting, may be more effective in reducing childrens anxiety. In addition, we can suggest that both methods can be equally effective for postoperative behavioral changes.

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery

Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods: Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4).Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion: The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanil-sevoflurane in CABG surgery.

Çocuklarda ultrasonografi eşliğinde yapılan rektus kılıf bloğunda lokal anestezik volümünün anestezik ve analjezik ajan tüketimi üzerine etkisi

Amac: Bu calismada, cocuklarda yapilacak major abdominal cerrahilerde, ultrasonografi esliginde iki farkli volumle uygulanan rektus kilif blogunun peroperatif sevofluran ve postoperatif morfin tuketimi uzerine etkilerinin arastirilmasi amaclanmistir. Gerec ve Yontem: Amerikan Anestezistler Dernegi (ASA) I-II grubu, 1-16 yas arasi, major batin cerrahisi yapilacak 40 olgu calismaya dahil edildi. Genel anestezi uygulandiktan sonra rastgele iki gruba ayrilan olgulardan Grup I’e (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volum 0.1 ml/kg olacak sekilde serum fizyolojik ile seyreltilerek) ile Grup II’ye (n=20) 0.1 ml/kg % 0.25 levobupivakain (toplam volum 0.4 ml/kg olacak sekilde serum fizyolojik ile seyreltilerek) ile ultrasonografi esliginde rektus kilif blogu uygulandi. Operasyon boyunca hemodinamik veriler ve sevofluran tuketimi, operasyon sonunda agri duzeyleri, ek analjezik ihtiyaci ve sedasyon duzeyleri kaydedildi. Bulgular: Intraoperatif donemde inspire edilen ve tuketilen sevofluran miktarlari her iki grupta da benzer olup, toplam sevofluran tuketimi Grup I’de 106.85±28.6 ml, Grup II’de 91.50±36.6 ml olarak bulundu (p>0.05). Olgularin postoperatif agri ve sedasyon skorlari ve ek analjezik ihtiyaclari arasinda fark saptanmadi. Sonuc: Major abdominal cerrahi uygulanacak cocuklarda ultrasonografi esliginde yapilan rektus kilif blogunun etkin ve guvenilir bir analjezi sagladigi, uygulanan lokal anestezik volumunu arttirmanin intraoperatif sevofluran tuketimini ve postoperatif ek analjezik ihtiyacini azaltmadigi kanisina varildi.