Hasan Husnu Yuce

Surgical management of 58 patients with placenta praevia percreta

SummaryObjectiveThe aim of this study is to present our experience with surgical management of placenta praevia percreta.MethodsThis study was conducted from January 2009 through March 2014 at Harran University Hospital and was a chart review of all patients who underwent caesarean hysterectomy with the placenta left in situ for placenta praevia percreta.ResultsThe study group comprised 58 patients. All of the patients underwent ultrasound mapping of the placental area before surgery. Emergent caesarean hysterectomy was only performed in 9 patients; 49 patients underwent planned caesarean hysterectomy. Bilateral internal iliac artery ligation was performed in all cases. Four patients (6.9 %) had bladder damage, one patient (1.7 %) required cystotomy, and one patient (1.7 %) required re-operation because of postoperative hemorrhage. The mean operative time was 141.6 (range: 95–355) minutes. Only 17 (29.3 %) patients were administered more than four units of red blood cells. There was no ureteral damage or maternal death. Furthermore, there were no complications in 42 (72.4 %) patients.ConclusionsCaesarean hysterectomy for placenta praevia percreta is associated with increased maternal morbidity. However, preoperative diagnosis of placenta praevia percreta, ultrasound mapping of the placenta, and the presence of a multidisciplinary experienced team may decrease maternal morbidity and mortality. Moreover, the urinary system may be protected in the patients with placenta praevia percreta without serious morbidity.

Effects of sevoflurane and desflurane on oxidative stress during general anesthesia for elective cesarean section

SummaryBackgroundAnesthetic agents might considerably influence maternal-fetal oxidative stress and antioxidants during cesarean section (CS). The aim of this study was to investigate the effects of desflurane and sevoflurane on oxidative stress parameters both in mothers and newborns undergoing elective CS.Materials and methodsEighty ASA physical status I–II, term parturients undergoing elective CS under general anesthesia were randomized to desflurane (Group D) and sevoflurane (Group S) groups. Blood samples were collected from mothers before operation and postoperatively and umbilical artery samples were obtained at delivery. Total oxidant status (TOS), total antioxidant capacity (TAC) status, lipid hydroperoxide (LOOH), and free sulfhydryl (–SH) levels were measured and oxidative stress index was calculated. Secondary outcomes included maternal hemodynamics.ResultsPreoperative LOOH, TOS, OSI, TAC, and –SH levels were similar among groups. Postoperative maternal serum LOOH, TOS, and OSI levels were significantly increased in Group D compared to Group S (p = 0.003, p = 0.005, p = 0.04; respectively). Postoperative umbilical artery LOOH, TOS, OSI levels were also significantly increased in Group D compared to Group S (p = 0.04, p = 0.02, p = 0.01; respectively). Postoperative TOS (p = 0.001, < 0.001 respectively) and OSI (p = 0.003, < 0.001 respectively) levels in both Group D and Group S were statistically significantly decreased compared to preoperative levels. Postoperative LOOH and –SH levels in Group S (p = 0.04, 0.029 respectively) were statistically significantly decreased compared to preoperative levels. There were no significant differences in TAC and –SH levels among groups (p = nonsignificant [n.s.]). Maternal perioperative mean blood pressure and heart rate were similar among groups (p = n.s.).ConclusionOxidative stress indices might be modified with preferred anesthetic agent and sevoflurane showed more favorable effects than desflurane in view of oxidative stress.ZusammenfassungHintergrundAnästhetika könnten den materno-fötalen oxidativen Stress und Antioxidantien während einer Sectio Caesarea (CS) erheblich beeinflussen. Ziel der vorliegenden Studie war es, die Wirkungen von Desfluran und Sevofluran auf Parameter des oxidativen Stresses sowohl bei Müttern, die sich einer elektiven CS unterziehen, als auch bei deren Neugeborenen zu untersuchen.Material und MethodenAchtzig zum Termin mittels elektiver CS unter Allgemeinnarkose Gebärende im ASA physikalischen Status I–II wurden randomisiert entweder Desfluran (Gruppe D) oder Sevofluran (Gruppe S) zugeteilt. Blutproben wurden von den Müttern prä- und postoperativ abgenommen, Nabelschnurblut bei der Geburt. Der Gesamt-Oxidations-Status (TOS), die totale antioxidative Kapazität (TAC), Lipid Hydroperoxid (LOOH) sowie die freien Sulfhydrylgruppen (–SH) wurden bestimmt. Der oxidative Stress Index (OSI) wurde berechnet. Die Hämodynamik der Mutter war ein sekundäres Outcome.ErgebnisseDie präoperativen LOOH, TOS, OSI, TAC und –SH Konzentrationen waren bei beiden Gruppen ähnlich. Die postoperativen mütterlichen LOOH, TOS, OSI Serum Konzentrationen waren in Gruppe D im Vergleich zur Gruppe S signifikant erhöht (p = 0,003, p = 0,005, p = 0,04; respektive). Postoperative Nabelschnur-Arterien Werte von LOOH, TOS, OSI waren in Gruppe D im Vergleich zur Gruppe S auch signifikant erhöht (p = 0,04, p = 0,02, p = 0,01; respektive). Postoperative TOS (p = 0,001, < 0,001 respektive) und OSI (p = 0,003,< 0,001 respektive) Werte waren sowohl in Gruppe D als auch Gruppe S statistisch signifikant im Vergleich zu den präoperativen Werten erniedrigt. Postoperative LOOH und –SH Konzentrationen waren in Gruppe S (p = 0,04, 0,029 respektive) im Vergleich zu präoperativen Werten statistisch signifikant erniedrigt. Auch die postoperative LOOH und –SH Werte der Gruppe S (p = 0,04, 0,029 respektive) waren im Vergleich zu den präoperativen Werten statistisch signifikant erniedrigt. Es bestand kein signifikanter Unterschied der TAC und –SH Werte zwischen den Gruppen (p = nicht signifikant [n.s.]). Auch der mittlere perioperative Blutdruck und die Herzfrequenz waren bei beiden Gruppen ähnlich (p = n.s).SchlussfolgerungenOxidative Stress Indikatoren können durch das bevorzugte Anästhetikum beeinflusst werden. Sevofluran zeigte bezüglich oxidativen Stress günstigere Wirkungen als Desfluran.

Oxigênio Suplementar em Cesariana Eletiva sob Raquianestesia: Manejar um Punhal com Cuidado

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model

Abstract Curcumin and dexmedetomidine have been shown to have protective effects in ischemia–reperfusion injury on various organs. However, their protective effects on kidney tissue against ischemia–reperfusion injury remain unclear. We aimed to determine whether curcumin or dexmedetomidine prevents renal tissue from injury that was induced by hind limb ischemia–reperfusion in rats. Fifty rats were divided into five groups: sham, control, curcumin (CUR) group (200 mg/kg curcumin, n = 10), dexmedetomidine (DEX) group (25 μg/kg dexmedetomidine, n = 10), and curcumin–dexmedetomidine (CUR–DEX) group (200 mg/kg curcumin and 25 μg/kg dexmedetomidine). Curcumin and dexmedetomidine were administered intraperitoneally immediately after the end of 4 h ischemia, just 5 min before reperfusion. The extremity re-perfused for 2 h and then blood samples were taken and total antioxidant capacity (TAC), total oxidative status (TOS) levels, and oxidative stress index (OSI) were measured, and renal tissue samples were histopathologically examined. The TAC activity levels in blood samples were significantly lower in the control than the other groups (p < 0.01 for all comparisons). The TOS activity levels in blood samples were significantly higher in Control group and than the other groups (p <  0.01 for all comparison). The OSI were found to be significantly increased in the control group compared to others groups (p < 0.001 for all comparisons). Histopathological examination revealed less severe lesions in the sham, CUR, DEX, and CUR–DEX groups, compared with the control group (p < 0.01). Rat hind limb ischemia–reperfusion causes histopathological changes in the kidneys. Curcumin and dexmedetomidine administered intraperitoneally was effective in reducing oxidative stress and renal histopathologic injury in an acute hind limb I/R rat model.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Airway management in newborn with Klippel-Feil syndrome

Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3.5mm ID non-cuffed endotracheal tube in first attempt. Operation lasted for 45min. Following uneventful surgery, she was not extubated and was transferred to the newborn reanimation unit. On the postoperative third day, the patient died due to hyperdynamic heart failure. This case is the youngest child with Klippel-Feil syndrome in literature and on whom oral intubation was performed. We also think that positioning of this younger age group might be easier than older age groups due to incomplete ossification process.

Adição de 75 mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea

BACKGROUND AND OBJECTIVES Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS 60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour. RESULTS Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027). CONCLUSIONS Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects.

Caudal anesthesia in Hurler's syndrome.

agement should be based on individual and thorough preanesthesia airway assessment for each patient; it should be noted that not all children and adolescents with alpha-mannosidosis would be able to perform a lung function test and this introduces a bias in our observations. All patients should be carefully observed postoperatively, e.g., for airway edema (which in comparable disorders poses a high risk). Premedication with an anxiolytic drug (e.g., midazolam) and prophylaxis for postoperative nausea and vomiting should be considered. We recommend that anesthesia for patients with alpha-mannosidosis should be performed in centers experienced in anesthesia for patients with rare metabolic disorders.

Anesthetic management of pediatric patient with spinal muscular atrophy

Spinal muscular atrophies are a group of mostly inherited neuromuscular disorders selectively affecting the lower motor neuron resulting in progressive proximal manifestation of muscle weakness. The clinical features ranged from weakness of proximal muscles of the lower limb to dysphagia and respiratory dysfunction. Anesthetic management is often difficult in these patients as a result of muscle weakness, respiratory dysfunction, difficult airway management and hypersensitivity to neuromuscular blocking agents. In this case report we describe a child patient with type II Spinal muscular atrophies for left inguinal hernia repair. We decided to use a caudal technique and propofol infusion. We review the available literature and discuss the potential anaesthetic problems in the management of pediatric patients with this degenerative neuromuscular disorder. Pam Med J 2016;9(1):57-61

The Anaesthetic Management of a Patient with Maple Syrup Urine Disease

Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder caused by a deficit of oxidative decarboxylation of branched-chain aminoacids. It leads to a build-up of leucine, isoleucine, valine, and toxic metabolites in blood and urine, progressing to acute and chronic brain dysfunction. The first symptoms appear in early childhood and are characterized by sweet-smelling urine, with an odor similar to that of maple syrup. At birth, infants seem healthy, but if untreated, they may suffer from neurological deterioration, seizures, hypertonia, or ataxia. During stressful situations, such as infection or surgery, patients may experience severe ketoacidosis, rapid neurological deterioration, and hypoglycemia. We report the anaesthetic management in a child patient with MSUD, admitted for peritonal dialysis catheter insertion with general anaesthesia.