Ertan Teksöz

Oronasopharyngeal Suction versus No Suction in Normal and Term Infants Delivered by Elective Cesarean Section: A Prospective Randomized Controlled Trial

Background/Aim: There are controversies about the routine use of oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. Methods: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. Results: The mean SaO2 values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO2 of ≧92% (6 vs. 11 min) and ≧86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower in the no suction group during the first 6 min except the second one. All neonates without suction had an Apgar score of 10 at the 5th min, while the mean ± SD for ONPS group was 9.34 ± 0.48 (p < 0.001). Conclusion: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section.

Oronasopharyngeal suction versus no suction in normal, term and vaginally born infants: a prospective randomised controlled trial.

This prospective randomised controlled trial aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). The no suction group showed lower mean heart rates through the 3rd and 6th minutes and higher SaO2 values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO2 of ≥ 92% (6 vs. 11 min) and ≥ 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001).

The Comparison of the Effects of Different Doses of Levobupivacaine Infiltration on Wound Healing

Introduction-Aim: The easiest method in postoperative analgesia is the infiltration of the wound with local anesthetic drugs. Although many local anesthetic drugs have been used for this type of infiltration, studies on levobupivacaine are rare. The aim of this study was to investigate the effects of different concentrations of levobupivacaine infiltration on wound healing. Method: Forty female Wistar-Albino rats (280–300 g) were included in the study, which were randomly separated into four groups. Rats were infiltrated with 1.25 mg/mL levobupivacaine in group L1.25 (n = 10), with 2.50 mg/mL levobupivacaine in group L2.5 (n = 10), with 3.75 mg/mL levobupivacaine in group L3.75 (n = 10), and with normal saline in control group (n = 10). Breaking-strength measurements, levels of hydroxyproline, and fibrotic index were evaluated in the tissue samples taken from the rats. Results: When the breaking-strength measurements were evaluated, we have found a significant difference between the control and the study groups (p < 0.05). In the intergroup comparison the difference between groups L1.25 and L3.75 was statistically significant (p < 0.05). In all of the levobupivacaine groups the levels of hydroxyproline were higher compared to the control group. Also significant differences were observed between groups L1.25 and L2.5 and groups L1.25 and L3.75 (p < 0.05). The levels of tissue fibrotic index were higher in all of the levobupivacaine groups compared to the control group (p < 0.05) and also a difference was observed between groups L1.25 and L3.75 in terms of tissue fibrotic index (p < 0.05). Conclusion: We have concluded that levobupivacaine used in clinical doses have a significant effect on the fastening of wound healing and this effect increases with an increase in the concentration of the levobupivacaine. We believe that levobupivacaine will be more widely preferred in the near future in the postoperative analgesia.

Anesthesia in a child with massive thyroid enlargement

SIR—‘Cretinism’ is a congenital deficiency of thyroid hormones, retarding mental and physical growth. The tongue is large and the neck is short and thick. Intubation can be difficult. Tracheomalacia and hematoma formation can complicate the postoperative course, but can be minimized by an experienced surgical team. A 19-year-old, mentally and growth retarded girl who was 1.27 m high and weighed 31 kg was scheduled for elective thyroidectomy for giant diffuse goiter (Figure 1). The right thyroid lobe was 16 · 15 · 8 cm and the left lobe was 20 · 15 · 8 cm. In her preoperative examination, difficulty in breathing, tachycardia (120–130 bÆmin), minimal mitral regurgitation and minimal tricuspid insufficiency was determined. Because the patient could not cooperate, respiratory function tests, indirect and fiberoptic laryngoscopic examination could not be performed and Mallampati scoring could not be determined. The neck was short and thick. Sternomental distance could not be measured because of the thyroid gland. Thyromental distance was measured as 4.0 cm, and the trachea could not be palpated. Under these conditions, it was decided that the case carried a high risk of difficult airway. Anesthesia induction was provided with 1 mg midazolam, 1 lgÆkg fentanyl, 1.5 mgÆkg lidocaine and incremental doses of 10 mg propofol (total 70 mg) until eyelash reflex was lost. During induction of anesthesia manually assisted spontaneous mask ventilation was maintained for 3 min with 100% oxygen. Direct laryngoscopy was performed. Direct view of the glottic area and vocal cords was obtained and a size 5.5 cuffed tracheal tube was inserted orally. After the endotracheal intubation 0.1 mgÆkg vecuronium was given for muscle relaxation. After the successful operation, the patient was transferred to our intensive care unit for mechanical ventilation and further monitoring. She was extubated and observed closely especially for the complications of tracheamalacia and bleeding for 24 h. The postoperative course was uneventful then she was discharged to the ward without any complications. When the masses that were dissected during the operation were weighed and measured right thyroid and left thyroid lobe was found 460 g in weight and 16 · 15 · 8 cm wide, 775 g in weight and 20 · 15 · 8 cm wide respectively weighing 1235 g in total. In the literature, one study claimed that the rate of difficult airway is 11.1% (2). However, another study found no association between goiter and difficult intubation in patients undergoing thyroidectomy, and the rate of difficult airway was 5.3% (3). Agarwal et al. (4) suggest that patients with longstanding goiter, even when benign, are more prone to develop tracheomalacia. On the basis of their experience they (a)