F. Yılmaz Göğüş

The in vitro effects of isoflurane, sevoflurane, and propofol on platelet aggregation

UNLABELLED We studied the in vitro effects of sevoflurane, isoflurane, and propofol anesthesia on platelet function. Thirty patients undergoing minor surgical procedures were divided into three groups (n = 10 each). Induction of anesthesia was achieved by using 5 mg/kg thiopental i.v., and 0.1 mg/kg vecuronium i.v. was used for muscle relaxation. Anesthesia maintenance was provided by sevoflurane in the first, isoflurane in the second, and propofol infusion in the third group with 70% N2O in O2. Hemoglobin, hematocrit, thrombocyte count, prothrombin time, activated partial thromboplastin time, international normalized ratio, arterial pH, von Willebrand factor, viscosity, platelet aggregation, and bleeding time were measured 1 h pre-, intra-, and postanesthesia. There was no difference among the platelet aggregation ratios of the pre-, intra-, and postoperative periods in the isoflurane group. The aggregation ratios in the sevoflurane and propofol groups were significantly reduced at intraoperative periods compared with preoperative values. Diminished aggregation values were also found 1 h postoperatively compared with the control values in the sevoflurane and propofol groups. We conclude that, in patients with a bleeding tendency during the intra- and early postoperative period, isoflurane may be preferred as a general anesthetic. IMPLICATIONS In our study, using vacuum-operated tubes, we demonstrated that sevoflurane and propofol had a significant inhibitory effect on intraoperative and early postoperative platelet aggregation, whereas isoflurane had no effect. Therefore, isoflurane may be preferred as a general anesthetic in patients with a clinically relevant bleeding tendency.

Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol.

Background : Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children.

Does bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery

In this randomized, double-blind and controlled study we evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery. Forty-five patients were assigned to 3 groups. After general anesthesia induction, bilateral superficial cervical plexus block with 0.25% bupivacaine 15 mL in each side was performed in Group I, and local anesthetic wound infiltration with 0.25% bupivacaine 20 mL was performed in Group II. In Group III (control) no regional block was administered. Intravenous patient-controlled analgesia was used to evaluate postoperative analgesic requirement. Neither visual analog scale scores nor total patient-controlled analgesia doses were different among groups. We concluded that bilateral superficial cervical plexus block or local anesthetic wound infiltration with 0.25% bupivacaine did not decrease analgesic requirement after thyroid surgery.

Perioperative Anesthetic and Surgical Complications of the Nuss Procedure

OBJECTIVE The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN A retrospective analysis. SETTING An academic hospital. PARTICIPANTS Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.

A reliable method for preventing pain on injection of propofol

criteria were a history of chronic pain syndromes, thrombophlebitis, and analgesic administration. No premedication was administered. In all patients, 0.9% NaCl infusion was started from an antecubital or a large forearm vein with an 18-gauge teflon cannula before induction. The infusion rate was 100 cc·h21 in the first group and 900 cc·h21 in the second group. Anesthesia was induced with propofol i.v. at a rate of 10 mg in 5 s until loss of consciousness. Propofol was injected from a three-way stopcock connected to the cannula while keeping the infusion of the 0.9% NaCl solution running. In all patients, systolic, diastolic, and mean arterial pressure and heart rate were recorded before and after propofol injection. The patients were asked to grade pain according to a four-point verbal rating scale (0, no pain; 1, mild pain; 2, moderate pain; 3, severe pain). The propofol dose required for induction was also recorded. The results were analyzed statistically with ANOVA, Student’s t, Fisher’s exact (incidence of pain), and Mann–Whitney (severity of pain) tests, and P , 0.05 was accepted as significant.