Gaye Kaya

Comparison of the laryngeal mask (LMA ™ ) and laryngeal tube (LT ® ) with the new perilaryngeal airway (CobraPLA ® ) in short surgical procedures

Background and objective: We compared the laryngeal mask airway (LMA™) and the laryngeal tube (LT®) with the newly introduced perilaryngeal airway (CobraPLA®, PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. Methods: After premedication, 90 ASA I–II patients awaiting short surgical procedures were randomized to receive, LMA, LT or PLA. Anaesthesia was induced with intravenous propofol (2.5 mg kg−1) and mivacurium (0.2 mg kg−1). Number of attempts, time of insertion of the device, any other unwanted effect, mean aterial pressure, heart rate, oxygen saturation and end‐tidal carbon dioxide were recorded. At the end of surgery, the cuff of the device was immediately deflated and the airway device was removed. The device was examined and noted for the presence of visible blood. Patients were asked to rate their throat soreness, dysphonia and dysphagia 1 and 24 h postoperatively. Results: There were no differences in haemodynamic variables. Insertion times for the devices were similar (LMA: 20 ± 11 s, LT: 19 ± 14 s and PLA: 21 ± 12 s.) The success rates at first insertion were lower in the (LMA group (57%) when compared with the PLA (97%, P < 0.05). The number and type of airway interventions for achieving an effective airway were similar. When the airways were removed 50% of the PLA devices had positive blood traces, while only 17% of the LMA and LT devices had positive blood traces (P < 0.01). Fifty percent of the patients suffered from a sore throat in the PLA group, which was significantly higher than in the LMA and LT groups (P < 0.05). Conclusion: We conclude that haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with, LMA, LT and PLA, but LT and PLA were easier to insert; LMA and LT caused less mucosal trauma.

The prevention of propofol injection pain by tramadol or ondansetron.

BACKGROUND AND OBJECTIVE To compare the efficacy of tramadol and ondansetron in minimizing the pain due to injection of propofol in 100 patients. METHODS An intravenous cannula was inserted in the dorsum of the hand. After tourniquet application to the forearm, tramadol 50 mg (Group 1, n = 50) or ondansetron 4 mg (Group 2, n = 50) was injected. The tourniquet was released after 20 s, and propofol 5 mL was administered over 5 s. The patients were observed and asked if they had pain in the arm and the response was assessed. Nausea and vomiting and degree of sedation were recorded for the first postoperative 24 h. RESULTS Twenty-one patients in Group 1 and 14 patients in Group 2 reported no pain. Slight pain was seen in 15 patients in Group 1 and in 18 patients in Group 2. Moderate pain was seen in 10 patients in Group 1 and 15 patients in Group 2. Severe pain was seen in four of the patients in Group 1 and three patients in Group 2. There was no significant difference of pain between Groups 1 and 2, but we found a significant reduction of nausea and vomiting in the ondansetron group compared with the tramadol group (P = 0.033). CONCLUSIONS Tramadol or ondansetron are equally effective in preventing pain from propofol injection. The added benefit of a reduction in nausea and vomiting after operation in the ondansetron group may be a reason to prefer this drug.

Caudal neostigmine for postoperative analgesia in paediatric surgery

Background: This study was conducted to evaluate analgesia and side‐effects of caudal neostigmine coadministered with bupivacaine in paediatric surgery.

Infiltration with ropivacaine plus lornoxicam reduces postoperative pain and opioid consumption

PurposeTo compare efficacy and patient outcome of wound infiltration with ropivacaine, lornoxicam, or their combination for control of pain following thyroid surgery.MethodsEighty patients underwent thyroid surgery were randomly assigned to one of four groups. Before skin closure, local tissues were infiltrated with 12 mL saline in Group S, with 10 mL of ropivacaine 0.75% plus 2 mL saline in Group R, with 2 mL of lornoxicam (8 mg) plus 10 mL saline in Group L, and with 10 mL ropivacaine 0.75% plus 2 mL lornoxicam (8 mg) in Group RL. Pain scores, total and incremental meperidine consumption were recorded at 30 min, one, two, three, four, six, eight, 12, 18, and 24 hr postoperatively. Time to first analgesic requirement, patient satisfaction, and duration of hospital stay were also compared after surgery.ResultsThe pain scores in Group RL were significantly lower in the first 12 hr than in Group S, and in the first four hours than in Groups R and L (P < 0.01). The time to first analgesic requirement was significantly longer (14.8 ± 8.4 hr vs 5.9 ± 5.2 hr;P < 0.01), the total pethidine consumption was significantly less than Group S (34.0 ± 33.0 mg vs 78.0 ± 29.8 mg; P<0.001), return of gastrointestinal function, ambulation time, length of hospital stay (P < 0.05) were significantly shorter, and patient satisfaction (P < 0.01) was significantly better in Group RL than in Group S (P < 0.05).ConclusionWound infiltration with ropivacaine 0.75% plus lornoxicam 8 mg combination improved postoperative pain control and patient comfort, and decreased the need for opioids than the use of either drug alone.AbstractObjectifComparer ľefficacité ďune infiltration avec de la ropivacaïne, du lornoxicam ou leur combinaison après une opération de la thyroïde et comparer ľévolution des patients.MéthodeDes patients devant être opérés à la thyroïde (80) ont été répartis en quatre groupes. Avant la fermeture cutanée, les tissus locaux ont été infiltrés avec 12 mL de solution saline dans le groupe S, 10 mL de ropivacaïne à 0,75 % plus 2 mL de solution saline dans le groupe R, 2 mL de lornoxicam (8 mg) plus 10 mL de solution saline dans le groupe L et 10 mL de ropivacaïne à 0,75 % plus 2 mL de lornoxicam (8 mg) dans le groupe RL. Les scores de douleur et la consommation totale et incrémentielle de mépéridine ont été notés à 30 min, puis à une, deux, trois, quatre, six huit, 12, 18 et 24 h après ľopération. Le moment de la première demande ďanalgésique, la satisfaction du patient et la longueur du séjour ont été comparés.RésultatsLes scores de douleurs ont été significativement plus bas chez les patients du groupe RL que chez ceux du groupe S pendant les 12 premières heures et que chez ceux des groupes R et L pendant les quatre premières heures (P < 0,01). Le moment de la première demande ďanalgésique a été plus tardif (14,8 ± 8,4 h vs 5,9 ± 5,2 h ; P < 0,01), la consommation totale de péthidine a été plus basse que dans le groupe S (34,0 ± 33,0 mg vs 78,0 ± 29,8 mg ; P < 0,001), le retour de la fonction gastro-intestinale et de la marche a été plus précoce, la longueur du séjour hospitalier (P < 0,05) plus courte et la satisfaction des patients (P < 0,01) meilleure dans le groupe RL que dans le groupe S (P < 0,05).ConclusionĽinfiltration dans le site ďincision avec une combinaison de ropivacaïne à 0,75 % et de 8 mg de lornoxicam a amélioré le contrôle postopératoire de la douleur et le confort des patients et a diminué les besoins ďopioïdes par rapport à ľusage ďun seul médicament.

Effects of sevoflurane, isoflurane and propofol infusions on post-operative recovery criteria in geriatric patients.

We compared the effects of sevoflurane, isoflurane and propofol infusions on postoperative recovery criteria in geriatric patients. Sixty patients aged > 65 years, classified as American Society of Anesthesiologists (ASA) group 1 or 2 and undergoing gynaecological or urological procedures were randomized equally into three groups. Group 1 received 1 minimum alveolar concentration (MAC) sevoflurane in a 50% O2/N2O mixture and group 2 received 1 MAC isoflurane in a 50% O2/N2O mixture. Group 3 received a 50% O2/N2O mixture plus propofol total intravenous anaesthesia (8 mg/kg for the first 30 min, followed by 6 mg/kg for maintenance). Recovery criteria comprising the times to spontaneous eye opening, extubation, response to verbal stimuli and orientation were recorded following the discontinuation of anaesthesia. Recovery times were significantly shorter in groups 1 and 3 compared with group 2. We conclude that sevoflurane and propofol had similar effects on recovery criteria and were associated with a faster recovery than isoflurane.

Efficacy of levobupivacaine wound infiltration with and without intravenous lornoxicam for post-varicocoele analgesia: a randomized, double-blind study.

AbstractBackground and objective: The oxicam NSAID lornoxicam is a potent analgesic with excellent anti-inflammatory properties in a range of painful and/or inflammatory conditions, including postoperative pain. Levobupivacaine, the S-(−)-isomer of bupivacaine, is a long-acting local anaesthetic that can be infiltrated into wounds for management of postoperative pain. We assessed the analgesic efficacy of lornoxicam when administered as an adjuvant to levobupivacaine wound infiltration after varicocoele operation. Methodsp: Sixty patients who underwent varicocoele surgery were randomly assigned to three different treatment groups. Before skin closure, patients received the following treatments: group I (n = 20) patients received normal saline 20 mL wound infiltration and intravenous lornoxicam (Xefo®, Nycomed Pharma AS, Roskilde, Denmark) 2 mL (8 mg); group II (n = 20) patients received 0.25% levobupivacaine (Chirocaine®, Abbott Scandinavia AB, Solna, Sweden) 10mL with normal saline 10 mL wound infiltration and intravenous normal saline 2 mL; group III (n = 20) patients received 0.25% levobupivacaine 10 mL with normal saline 10 mL wound infiltration and intravenous lornoxicam 2 mL (8 mg). Pain scores and total pethidine (meperidine) consumption were measured at 1, 2, 4, 6, 12 and 24 hours postoperatively. Time to first analgesic requirement and patient satisfaction were also compared post-surgery. Results: Pain scores during the first 6 hours postoperatively were significantly lower in group III than in group I and group II (p < 0.01). Total pethidine consumption was significantly lower in group III (34.0 ± 28.0 mg) than in group I (74.0 ± 25 mg) and group II (76.0 ± 29 mg) [p < 0.01]. Time to first analgesic was also significantly longer in group III (14.8 ± 8.4 hours) than in group I (6.2 ± 5.2 hours) and group II (5.8 ± 7.1 hours) [p < 0.01]. The incidence of postoperative nausea and vomiting was significantly lower in group III than in group I and group II (p < 0.05). More patients in group III described their analgesia as good or excellent than in group I or group II (p < 0.01). Conclusion: In this study, levobupivacaine wound infiltration with adjuvant intravenous lornoxicam administration was associated with better postoperative analgesia during the early postoperative hours after varicocoele surgery than that induced by lornoxicam alone or levobupivacaine wound infiltration alone.