Füsun Bozkirli

A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy.

Aim:  This study was conducted to compare the efficacy and safety of tramadol with those of fentanyl and to evaluate the impact of age in pediatric patients undergoing upper gastrointestinal endoscopy (UGIE).

Effect of high-dose lidocaine treatment on superoxide dismutase and malon dialdehyde levels in seven diabetic patients

Background and Objectives: We report on the use of intravenous (IV) high‐dose lidocaine to relieve diabetic neuropathic pain, and the techniques effects on clinical measures of lipid peroxidation. Methods: Under continuous electrocardiogram monitoring, IV lidocaine (5 mg kg−1 in 100 mL saline) was administered over 30 minutes to 7 non‐insulin‐dependent diabetic patients suffering from neuropathic pain who reported increased pain within the preceding 6 months. This treatment was performed once a week for 1 month. Blood samples were collected from the contralateral limb to determine plasma superoxide dismutase (SOD) and malondialdehyde (MDA) levels on admission and following the final lidocaine administration. Results: Plasma MDA concentrations significantly decreased after the final IV lidocaine treatment (P < .05, paired t‐test), whereas SOD levels did not show a statistically significant difference compared with baseline levels. Conclusions: High‐dose lidocaine treatment lessens MDA levels, a marker of free‐radical‐mediated cell damage. This suggests that one of lidocaines mechanism of action may be its effect on oxygen free radicals, which in turn impacts lipid peroxidation.

Anesthetic management of a child with Rubinstein-Taybi syndrome for cervical dermoid cyst excision

which are characteristics of this syndrome (Fig. 1). Thyroid ultrasonography showed a multilocular cystic 33 3 20mm mass anterior to the thyroid gland. There was no mass activity on thyroid scintigraphy. The total blood count and other laboratory test results were within normal ranges. No gastroesophageal reflux was observed on esophagogastrography. The right testis had not descended, and the left testis was retractile. The results of cranial computerized tomography and chromosomal analysis were normal. He had no cardiac defects. He was diagnosed as having the autosomal dominant mutagenic form of RTS. There was an uneventful history of operation and anesthesia for a midline neck mass diagnosed as a thyroglossal cyst that was performed at another center 1 year previously. On this occasion, the midline neck mass was above the previous one and was thought to be a recurrent thyroglossal cyst preoperatively. The patient’s height was 90cm (,3 percentile), and his weight was 14kg (3–10 percentiles). He fasted for 8h and was not premedicated before induction of anesthesia. His heart rate was 130 beats·min21 and his SpO2 was 99%. After preoxygenation, anesthesia was induced by 50% N2O/O2 mixture in sevoflurane via a face mask. After intravenous access had been obtained, 0.5mg kg21 of atracurium was injected, and endotracheal intubation was performed without difficulty with an uncuffed tube that had an internal diameter of 4.5mm. Anesthesia was maintained with 50% N2O/O2 mixture in sevoflurane. The neck mass was excised. At the end of anesthesia, spontaneous ventilation was promptly reestablished. After reversal of residual muscle paralysis with 0.5mg of neostigmine and 0.25mg of atropine, the endotracheal tube was removed. Rectal paracetamol was administered for postoperative pain. No significant problem was encountered during induction, maintenance, and extubation. The pathologic diagnosis of the mass was dermoid cyst.

The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy

ABSTRACT Background: The aim of this study was to assess the early postoperative pulmonary function and arterial blood gases in patients who have undergone open versus laparoscopic nephrectomy. Materials and Methods: Forty patients were randomly assigned to undergo laparoscopic (LN, n=20) or open nephrectomy (ON, n=20). Pulmonary function tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume at 25% (FEF25), forced expiratory volume at 50% (FEF50), forced expiratory volume at 25% to 75% (FEF25–75), forced expiratory volume in 1 second (FIV1) and peak expiratory flow (PEF) were performed one day before the operation and on the postoperative day 1. The arterial blood gas analysis (pH, pCO2, pO2, SaO2) was made at breathing room preoperatively, in the recovery phase and on postoperative day 1. Results: All spirometric variables decreased after both open and laparoscopic nephrectomy on postoperative day 1. FEV1, FVC, FEF25 and FEF25–75 values decreased on postoperative day 1 (39.7%, 37.4%, 27.7%, 51.8% respectively) in the open surgery group and they were significantly lower in laparoscopic group (29.9%, 32.5%, 23.2%, 44.5% respectively). There were no significant differences in FEF50, PEF and FIV1 between the groups. The SaO2 and pO2 values also decreased in both groups. During early recovery, pH decreased while pCO2 increased significantly but they returned to preoperative values on postoperative day 1 in both groups. Conclusion: Laparoscopic nephrectomy is better than open nephrectomy considering pulmonary functions.

Anesthesic Management for Escobar Syndrome: Case Report

Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

Effects of steep Trendelenburg position and pneumoperitoneum on middleear pressure in patients undergoing robotic radical prostatectomy

BACKGROUND/AIM The aim of this study was to quantify the changes in middle ear pressure (MEP) during robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS Thirty patients undergoing RARP were included in this study. MEP was obtained at the following time points: awake (T1), postintubation (T2), pneumoperitoneum + 1 h of Trendelenburg position (T3), pneumoperitoneum + 2 h of Trendelenburg position (T4), pneumoperitoneum + 3 h of Trendelenburg position (T5), desufflation + supine position (T6), and 1 h after extubation in the postanesthesia care unit (T7). Heart rate, mean arterial pressure (MAP), peak airway pressure (PAP), tidal volume, minute ventilation, EtCO2, and blood gas values were recorded. RESULTS MEP was significantly higher at T4, T5, T6, and T7 as compared to T1 values. PAP values were significantly increased at T3, T4, and T5 compared to T2. MAP values at T3, T4, and T5 were significantly higher compared to T1. PaCO2 increased significantly at T4, T5, and T6 and pH decreased significantly at T4 and T5 when compared to T2. CONCLUSION The combination of steep Trendelenburg position and pneumoperitoneum during RARP caused a significant increase in MEP, PaCO2, and EtCO2 levels. This propensity for increased MEP may cause problems in patients with preexisting ear disease.

Comparison of the effects of neuroleptanesthesia and enflurane or sevoflurane anesthesia on neuromuscular blockade by rocuronium.

Forty-five unpremedicated ASA class I or II patients scheduled to undergo either orthopedic or ear, nose, and throat surgery under general anesthesia with an anticipated duration of approximately 1.5–3 h were enrolled in this study after approval of the hospital ethics committee and written informed consent from the patients had been obtained. All patients were free from neuromuscular, endocrine, liver, or renal diseases and were not receiving drugs known to interact with neuromuscular blocking agents. They required muscle relaxation only for endotracheal intubation. An intravenous infusion of 0.9% sodium chloride solution was given initially via the basilic vein on one of the arms, while the other arm was kept for monitoring neuromuscular block. The heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) (Odam Physiogard SM 785, Wissenbourg, France), and end-tidal concentrations of CO2 and volatile anesthetics (Artema MM 256, Sundbyberg, Sweden) were monitored. Each patient was allocated to one of three groups: enflurane (group E, n 15), sevoflurane (group S, n 15), and neuroleptanesthesia (group NA, n 15). The induction of anesthesia was performed with i.v. fentanyl 2μg · kg 1 and thiopentone 5–7 mg·kg 1, followed by a volatile anesthetic, either enflurane or sevoflurane, with assisted ventilation by mask in groups E and S, respectively. The volatile anesthetics (enflurane or sevoflurane) were administered in 66%/33% : nitrous oxide/oxygen at the endtidal concentration corresponding to 1 minimum alveolar concentration (MAC) in the present study. One MAC of enflurane and sevoflurane was assumed to be 0.57% and 0.66% in approximately 66% nitrous oxide, respectively [13]. In group NA, anesthesia was induced with i.v. droperidol 0.2mg · kg 1, fentanyl 5μg · kg 1, and thiopentone 1–2mg · kg 1 during inhalation of 66%/33% : N2O/O2. Stable end-tidal anesthetic concen