Hasan Hepağuşlar

Preemptive diclofenac reduces morphine use after remifentanil-based anaesthesia for tonsillectomy

Summary Background: We investigated the effect of preincisional rectal diclofenac on pain scores and postoperative morphine requirements of children undergoing tonsillectomy after remifentanil‐propofol anaesthesia in a randomized clinical trial.

Low doses of rocuronium during remifentanil-propofol-based anesthesia in children: comparison of intubating conditions.

Background : In this prospective double‐blind study, intubation conditions were compared at 90 s following two different low doses of rocuronium during remifentanil and propofol anesthesia in children undergoing ambulatory procedures.

Comparison of the effect of sevoflurane and propofol on oxygenation during gradual transition to one-lung ventilation

BACKGROUND It is known that hypoxic pulmonary vasoconstriction increases as a result of intermittent regional hypoxic challenges. The aim of this study was to compare the effects of sevoflurane and propofol on oxygenation and shunt fraction during one-lung ventilation in a novel model of hypoxic preconditioning before one-lung ventilation. METHODS Sixteen Wistar-albino rats were anesthetized intra-peritoneally before venous and arterial cannulations and tracheotomized. The animals were randomly allocated to receive either sevoflurane 2% or 10mg/kg/h propofol infusion and ventilated with 100% oxygen at an inspiratory rate of 80 breaths/min for 30min. Three cycles of one-lung ventilation and two-lung ventilation were performed and one-lung ventilation was continued for 15min. Arterial blood gas samples were obtained as follows: after cannulation and tracheotomy, following 30min of treatment with sevoflurane or propofol, and at the 5th and 15th min of one-lung ventilation. RESULTS The PaO2 levels were higher and shunt fractions were lower in rats receiving propofol compared to rats treated with sevoflurane but the difference was not significant; the two groups were comparable in terms of PaCO2. CONCLUSIONS The similar effects of sevoflurane and propofol on PaO2 during one-lung ventilation following hypoxic preconditioning may be due to other causes beside the inhibition of hypoxic pulmonary vasoconstriction. Gradual transition to one-lung ventilation is a novel technique for preconditioning experiments for one-lung ventilation.

The Effect of Midazolam Pre-Medication on Rocuronium-Induced Neuromuscular Blockade

We investigated the effect of midazolam pre-medication on rocuronium-induced neuromuscular blockade during sevoflurane anaesthesia. Twenty-two patients scheduled for elective surgery were randomly divided to receive either no pre-medication (control group) or pre-medication with 0.1 mg/kg midazolam intramuscularly (midazolam group). Anaesthesia was induced with fentanyl and propofol, and maintained with sevoflurane and nitrous oxide in oxygen. Neuromuscular responses were monitored using acceleromyography. The onset and clinical duration of action, time to recovery of first twitch of train-of-four (TOF) response to 75% of control, recovery index and time for TOF recovery to 25% and 50% were recorded. Patient-related data were similar in both groups. The parameters recorded were not significantly different between the groups. Midazolam pre-medication does not influence the time-course of action of rocuronium during sevoflurane anaesthesia.

Hybrid coronary revascularization in beating heart coronary artery bypass; the results and review of the literature

Background: The aim of this study is to evaluate demographic, clinical and laboratory features and outcomes of the hybrid cases undergoing beating heart coronary artery bypass grafting. Methods: January 2011 2015 in the isolated beating heart coronary bypass performed (n = 54). The cases were retrospectively analyzed with demographic characteristics and used hybrid approaches. After off-pump coronary artery bypass surgery (OPCAB), the cases were followed for following hybrid coronary revascularization (HCR) with multivessel coronary artery disease (MVCAD). Results: Fifty-four consecutive patients underwent elective HCR (n = 7) or OPCAB (n = 47). The cases consisting of 12 female (22.2%), 42 male (77.7%) were found. 54 cases with an average age of 62.51 years (min: 41, max: 86) (13.279 SD) have been observed. There was no any complication in HCR group. Stroke in 2 case (3.7%), hypoxic ischemic encephalopathy (right internal lacunar infarct) and transient ischemic attack (TIA) in two cases (3.7%) were detected. Inpatients mortality ratio was 7.4% with multiple organ failure. Conclusion: HCR is associated with successful results. We believe that OPCAB should be preferred in selected cases with potential high risk morbidity.

Severe calcific constrictive pericardiectomy operation: ‘Hearts of stone’

Background: Dense constrictive pericarditis, ‘Hearts of stone’ is a rare condition characterized by limitation of myocardium due to a massive fibrosis and calcification of the pericardium. The aim of this study was to research the literature to discuss the surgical intervention and management of densely calcified constrictive pericarditis. Methods: Over a seven-year period, 19 consecutive patients who underwent pericardiectomy operation for severe constrictive pericarditis reviewed to determine reasons, surgical techniques, mortality and morbidity rates, and improvement of functional capacity. We freed the anterior pericardium from phrenic nerve to phrenic nerve. In two cases, we used a rongeur to break down the dense calcification. The indications for pericardiectomy were tuberculous in 4 cases (21%), idiopathic-fibrous in 11(57.8%), rheumatic in 2(10.5%), uremic in 1(5.2%), and neoplastic in 1(5.2%). Results: Inpatients mortality ratio was 5.2% in case of isolated severe calcified pericardiectomy. Ascites in 3 patients (15.7%), hepatomegaly in 4 (21%) and peripheral edema in 15 (78.9%) were found on their physical examination. In the 1st postoperative month follow up, dramatically improvement of preoperatively functional capacity were the number of cases in New York Heart Association class IV (worse general condition) moved from 14 to II; in class III from 4 to II; in class II from to I in one case. In our all series, idiopathic-fibrous was the most frequent cause of chronic severe constrictive pericarditis, but the second most common tuberculous pericarditis was increasing overall. Postoperative and neoplastic pericarditis were rare. Conclusion: The preoperative clinical conditions and functional status at follow-up was improved in all cases. We recommended that the orthopedic surgical instrument, ‘rongeur’, is very useful to cut that totally calcified tissue. Keywords: Constrictive pericarditis, pericardiectomy, heart failure, calcification

Cost-Effectiveness of Minimally Invasive Intervention in Aortofemoral Revascularization

Minimally invasive surgical procedures have become popular recently because they offer several advantages over conventional operative techniques. A person undergoing a minimally invasive procedure usually experiences less pain, is discharged earlier from hospital, returns to work sooner and has a less obtrusive postoperative scar. Excluding highly technical techniques (e.g. laparoscopic surgery), operations performed using mini-laparotomy are usually more cost-effective than conventional procedures, largely because they are less expensive to perform. Our paper investigates cost-effectiveness and other parameters relating to minimally invasive aortofemoral revascularization procedures performed at our clinic. We compared 20 similar cases, half where revascularization was undertaken using mini-laparotomy and half where conventional laparotomy was selected. From our findings we conclude that mini-laparotomy is safe and reliable for aortobifemoral bypass procedures and has several advantages over traditional techniques; namely, shorter operating time, earlier resumption of intestinal function, shorter duration of in-patient stay and reduced costs.