Fevzi Yılmaz Göğüş

The effect of propofol and alfentanil on the increase in intraocular pressure due to succinylcholine and intubation.

Purpose The aim of this study was to evaluate the effects of propofol and alfentanil on the increase in intraocular pressure (IOP) due to succinylcholine and intubation, in comparison with thiopental sodium and vecuronium bromide. Methods Forty patients aged 20–50 years, scheduled for elective surgery requiring endotracheal intubation, were assigned to four groups of ten. General anesthesia was induced with 2.5 mg/kg propofol in Group I, 2.5 mg/kg propofol and 10 μg/kg alfentanil in Group II and 5 mg/kg thiopental in Groups III and IV; muscle relaxation was obtained with either 1.5 mg/kg succinylcholine (Group I, II and III) or 0.1 mg/kg vecuronium bromide (Group IV). In all patients mean arterial pressure, heart rate, oxygen saturation and IOP were recorded before (baseline) and after induction, after the muscle relaxant and after endotracheal intubation. Results Compared with their baseline values in Group I IOP decreased significantly after propofol (p<0.01) and increased significantly after intubation (p<0.01). In Group II IOP decreased significantly after propofol and alfentanyl (p<0.001), remained low after succinylcholine (p<0.01) and did not change after intubation. In Group III IOP decreased significantly after thiopental (p<0.001) and increased significantly after intubation (p<0.001). In Group IV it decreased significantly after thiopental (p<0.001), remained low after vecuronium (p<0.001) and increased significantly after intubation (p<0.05). Conclusions In all Groups, IOP did not increase significantly after succinylcholine, but only anesthesia induced with propofol and alfentanil prevented the increase in IOP due to intubation.

Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery

STUDY OBJECTIVE The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. DESIGN Prospective randomized study. SETTING In the operating room. PATIENTS Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. INTERVENTIONS Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. MEASUREMENTS Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. MAIN RESULTS There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P < .05). Heart rate and systolic blood pressure increased in neostigmine group 3 minutes after the medication and during postoperative measurements (P < .05). Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P < .05). CONCLUSIONS We suggest that sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery.

The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy.

For the treatment of postoperative pain, multimodal analgesia can reduce the side effects and required dose of opioids by combining drugs and methods with different modes of action. This study evaluated the efficacy of preoperative oral pregabalin and perioperative intravenous lidocaine in patients undergoing laparotomy.

The Preventive Effect of Dopamine Infusion in Rats with Abdominal Compartment Syndrome

ABSTRACT Background: The most significant perfusion disorder of the intra-abdominal viscera occurs in the abdominal compartment syndrome (ACS). Free oxygen radicals diffuse into the body during the reperfusion phase of ACS. Our aim was to determine the effects of dopamine infusion (3 μg/kg/min) on renal perfusion, cytokine levels, free oxygen radicals, and renal histopathological changes in the presence of ACS in a prospective randomized manner. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6). Group 1 was used as control. In group 2, air was inflated until the intra-abdominal pressure (IAP) reached 20 mmHg. In group 3, dopamine was infused for 60 min meanwhile IAP was kept at 20 mmHg. In group 4, dopamine was infused for 60 min before IAP rise. After this phase, renal artery (RA) perfusion was measured continuously. Myeloperoxidase activity (MPO), glutathione (GSH), and lipid peroxidation (MDA) levels were measured in tissue samples and histopathological scoring was performed. Results: Dopamine treatment before and during ACS significantly decreased MPO and MDA levels and also increased renal blood flow and GSH levels. However, histopathological damage was improved simultaneously. Conclusion: Dopamine infusion before and during ACS, increases renal perfusion and decreases free oxygen radicals. According to our findings, dopamine infusion may be proposed for the treatment of ACS and perfusion disorders in critically ill patients.

Co-existence of Pott's disease and alkaptonuria in a 21-month-old child.

reported in a case with PDA 30 h after the procedure (4). The migrated devices are usually removed surgically, whereas in the presented case the device was removed by endovascular techniques. Two patients had late complications: peripheral embolization in the left leg 1 year after implantation of an Amplatzer device and sudden death 1.5 year later (2). In such procedures, regardless of the occluder type, the migration of device can happen in 1.1% of the cases and surgical removal is required in 0.2% of all the cases (3). Early and easy migration of the device can be caused by the technical reasons like inappropriate choice of the device (insufficient length of the rim). Device-defect ratio also had a significant effect on delivery success and composite success. Defect stretch diameter had the largest influence on outcome, and implantation was possible in only 67% if the stretched diameter of the defect was >20 mm (5). The other possible causes of migration of the device are either because of choice of the occluder or less experience in application of the device. The migration of the device in percutaneous transcatheter occlusion procedures may cause life-threatening complications and we suggest that all patients should go to intensive care unit postoperatively. The anesthesiologists should be careful to the developing techniques and complications of such procedures. Yusuf Unal M D* Serdar Kula M D† Gokcen Emmez M D* Rana Olgunturk M D† Sahin Yardim M D* *Department of Anesthesiology and Reanimation and †Department of Pediatric Cardiology, Gazi University School of Medicine, Ankara, Turkey (email: yunal71@yahoo.com, yunal@gazi.edu.tr) References

Perioperative Effects of Different Narcotic Analgesics Used to Improve Effectiveness of Total Intravenous Anaesthesia.

OBJECTIVE We aimed to evaluate the depth of anaesthesia, perioperative haemodynamics, postoperative pain scores, analgesic consumption in patients receiving remifentanil- or alfentanil-based total intravenous anaesthesia for single-level lumbar discectomy. METHODS Seventy patients undergoing discectomy were enrolled in the study. Patients were intravenously administered an initial bolus dose of 2 mg kg(-1) propofol and 10 mcg kg(-1) alfentanil or 1 mcg kg(-1) remifentanil, followed by 6 mg kg(-1) h(-1) propofol and either 1 mcg kg(-1) min(-1) alfentanil or 0.25 mcg kg(-1) min(-1) remifentanil infusion. Bispectral index (BIS) values, mean arterial pressure, heart rate, end-tidal carbon dioxide and oxygen saturation were recorded. Postoperative pain scores at 0, 30 and 60 min were measured and recorded with additional opioid requirements. RESULTS Postoperative pain scores at 0 and 30 min, total analgesic consumption and requirement for additional analgesics were significantly high in the remifentanil group. After the first hour, the pain scores were not significantly different. Mean arterial blood pressure was significantly low at 45 and 60 min preoperatively in the remifentanil group. In the remifentanil group, heart rate at 15, 30, 45, 60 min were significantly lower than those in the alfentanil group. BIS values of the two groups were not significantly different at any measurement time point. BIS values of remifentanil group at 30, 45, 60, 90 and 180 min significantly increased compared with those at 15 min. CONCLUSION Alfentanil provided more stable BIS and haemodynamic values preoperatively and less opioid consumption, along with lower pain scores, during the early postoperative period compared with remifentanil in patients undergoing single-level discectomy.

Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study.

OBJECTIVE Training students on simulators before allowing their direct contact with patients is well accepted. There is no clinical or manikin-based simulation study in the literature comparing tracheal intubation with Airtraq, laryngeal mask airway (LMA) CTrach and Macintosh laryngoscopes performed by medical students having no prior intubation experience. METHODS After obtaining written informed consents, 123 participants were included in the study. The participants were asked to intubate the manikin five times with each device randomly. After all the participants had completed their fifth intubations, the measurements were performed. The primary outcome variables were the first-attempt success rate and the time for a successful intubation, while the secondary outcome variables were to determine the scores of dental trauma, the difficulty visual analogue scale and the optimization manoeuvres. RESULTS The LMA CTrach group revealed a significantly higher number of intubation attempts. The mean time for a successful intubation was the longest in the LMA CTrach group (17.66±8.22 s, p<0.05). Students defined the Airtraq as the easiest to use and the Macintosh laryngoscope as the most difficult device to use and learn. Dental trauma severity was significantly lower in the Airtraq group than in the other groups (p<0.05), and it was found to be 0 in 81.1% in the Airtraq group. The head extension optimization manoeuvre rate was significantly higher with the Macintosh laryngoscope than with the Airtraq laryngoscope (p<0.05). CONCLUSION This study, in which different types of laryngoscopes were compared, revealed that the Airtraq laryngoscope has advantages, such as shorter intubation duration, less additional optimization manoeuvres, less dental trauma intensity and is easier to learn compared with the LMA CTrach and Macintosh laryngoscopes.

The Effects of Desflurane and Propofol on the Release of Thyroid Hormones in Euthyroid Patients Undergoing Elective Lumbar Discectomy

OBJECTIVE In this study, we aimed to compare the effects of desflurane and propofol on the release of thyroid hormones in euthyroid patients undergoing single-level lumbar discectomy. METHODS The study group included 21-65-year-old American Society of Anesthesiology (ASA) I-II euthyroid 40 patients undergoing elective single-level lumbar discectomy. They were randomly divided into 2 groups (n=20). In the maintenance of anaesthesia, Group D received desflurane inhalational anaesthesia and remifentanil infusion, and Group P received propofol and remifentanil IV infusions. Four blood samples for the determination of plasma levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) were collected 5 min before and 60 min after the induction of anaesthesia and 60 min and 24 h after the surgery. RESULTS Plasma TSH levels in both groups reached the highest levels at the first postoperative hour and returned to the preoperative levels 24 hours after the surgery. Regarding plasma FT3 levels, there were no significant differences within and between groups. There were no significant differences in plasma FT4 levels within the patients of Group P, but in Group D, FT4 levels reached its peak in the first hour of anaesthesia induction and returned back to preoperative levels 24 hours postoperatively (p<0.05). CONCLUSION Further studies are needed to confirm our findings and evaluate patients with thyroid gland pathologies.

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery

OBJECTIVE Single intravenous bolus administration and postoperative or perioperative infusions are the most preferred methods of ketamine. Nevertheless, there is no clear explanation on the ideal ketamine administration method. In this study, we aimed to compare the effects of the most common ketamine administration methods and administration time on postoperative opioid consumption. METHODS Fifty-two patients undergoing colectomy for colon cancer were randomly assigned into four groups. Group 1 was the control group. Group 2 received only a single intravenous bolus dose of 0.5 mg kg(-1) ketamine at induction. Group 3 received 0.5 mg kg(-1) intravenous ketamine bolus at induction and perioperative ketamine infusion at a rate of 0.25 mg kg(-1) h(-1). Group 4 received a bolus of 0.5 mg kg(-1) intravenous ketamine at induction and perioperative and postoperative ketamine infusion at a rate of 0.25 mg kg(-1) h(-1). Postoperatively, visual analogue scale pain scores, side effects, and morphine consumption were recorded. RESULTS There was no statistically significant difference in postoperative pain scores. Total morphine consumption was found to be significantly lower in Group 4 compared to the other groups (p=0.03, p=0.004, p=0.03, respectively). During the 1(st), 2(nd), and 4(th) hours in the postoperative period, patient-controlled analgesia morphine consumption was significantly lower in Group 4 compared to the control group (p<0.01). CONCLUSION Preoperative single-bolus dose or intraoperative low-dose ketamine infusion does not decrease postoperative morphine consumption; however, per- and postoperative 48-hour ketamine infusion has a significant effect in decreasing morphine consumption without decreasing the incidence of side effects in patients undergoing major abdominal surgery.